4. Impacts on the demand for and delivery of WSH services

People living with HIV/AIDS, including the families and caregivers of those infected, have special needs over and above those of unaffected consumers of WSH services. As responsibility for household activities passes to the young, the old and outside carers with busy lives, the need for convenient and reliable water and sanitation facilities and for appropriate hygiene education becomes a priority. The TOP quotes a woman interviewed in a South African village who estimated that it takes 24 buckets of water a day, fetched by hand to care for a family member who was dying of AIDS – water to wash clothes, the sheets and the patient after regular bouts of diarrhoea. Affordability and subsidies for those whose incomes have been hit by sickness and frailty grow in importance, as does the need to provide clean, safe water and sanitation facilities in schools, to minimise the huge pressures on girls to drop out of education because of home burdens.

For many years, the WSH sector has been a leader in adopting community management of services, backed by demand-responsive support from government agencies. The spread of HIV/AIDS reinforces the need for community action and especially the gender-responsive perspectives that have featured in the WSH approach. At the same time, the epidemic hits at the very people whose motivation and training have equipped them to keep local WSH facilities running. It requires technologies and support systems that enable the new caretakers to operate and maintain the systems.

At the community level, there are evident and vital links between sustaining appropriate WSH services and coping with HIV/AIDS. It is not just the specific health benefits from safe water and hygienic sanitation – though those are critical too. It is the social awareness, shared commitment and combined competence of motivated communities that now must go beyond a capacity to keep facilities working and extend to caring for HIV/AIDS victims and preventing new infections.

It is important too that both HIV/AIDS and WSH provision need to be linked to poverty reduction strategies and to all eight Millennium Development Goals. The poor suffer most from HIV/AIDS, which at the same time increases their poverty. The vicious cycle extends to the ability to pay for WSH services. The success of demand-responsive approaches to WSH services in achieving sustainability is under threat, and needs to be modified to take account of reduced ability of HIV/AIDS-infected families to contribute to the cost of services. The same is true of private sector participation, where commercial returns are needed to sustain services and those without the means to contribute are increasingly marginalised. That inevitably means government and external support being required as part of anti-poverty and HIV/AIDS reduction strategies. Provision of safe water and sanitation is a core element in the International Framework for Action for the Protection of Orphans and Vulnerable Children developed by UN agencies, bilateral donors and international child-focused NGOs.

The TOP commends a Sustainable Livelihoods Approach (SLA) as a way of analysing the true value of WSH services in HIV/AIDS coping strategies. It also emphasises the links between HIV/AIDS and WSH services from the human-rights perspective. Water and sanitation have gained ground in recent years in becoming accepted as both a basic need and a human right. The need now is to focus those basic needs on the changing context of HIV/AIDS, where parallel rights are being established. Restoring basic human dignity has always been a prime aim of the WSH sector. In an HIV/AIDS environment, the right to dignity and the influence of women as decision makers take on an added importance.