1. The HIV/AIDS Pandemic :
Fundamental Cause for Urgent
Scale-up in Water Sector
Rouzeh Eghtessadi
Public Health Specialist- Gender & Human Rights
Southern Africa HIV/AIDS Information Dissemination Service
(SAfAIDS)
17 Beveridge Rd, Avondale, Harare, Zimbabwe
Tel: +263 33 61 93/4
Fax: +263 33 61 95
Website: http://www.safaids.org.zw

2. Building the Case…..
 Themain objective of the water supply
sector has always been to improve people's
health by providing access to safe water
supply and sanitation.
 Withadvent of HIV/AIDS, this becomes
even more urgent

3. Critical Links: Water,
Sanitation & HIV/AIDS
Perspectives categorizing these linkages:
 Consumer
 Health
 Human Rights
 Gender
 Community-driven development
 Poverty Alleviation

4. Critical Consumer Links with
HIV/AIDS
 Public health systems can no longer cope with
demand for water
 HIV/AIDS affected households impoverished
unable to pay user fees forfeit right to
quality water & sanitation
 Shift in “care-economy” from institution to
home-base care (also influenced by cultural
preferences)

5. “Having no proper sanitation means that there is a vicious
cycle of poverty, diseases and bad hygiene……
The cycle of epidemic is at a stage where many people are
falling sick. Through home based and palliative care,
people are looked and cared for. One of the important
ingredients of care is water…”
Nkululko Nxesi (director of the South African National Association of
People living with AIDS (NAPWA), , South Africa, 2002

6. Critical Health Links with
HIV/AIDS (1)
 Water (quality and Quantity, Availability,
affordability and Accessibility) is imperative for
– Successful adherence to antiretroviral treatment regimens
– Consumption of powdered formula in infant feeding as well
as nutrition boosting for ill adults (ENSURE)
 Thedesign of water systems often don’t take into
account those fetching water may be children or older
people (pump handles not too high, pumping not too
heavy, the walls of the well not too high etc)

7. Critical Health Links with
HIV/AIDS (2)
 Poor water handling and sanitation practices
– personal hygiene & domestic hygiene,
– food hygiene and
– safe waste water disposal and drainage
…….increase water and sanitation related diseases-
opportunistic infections
 Poor access to sanitation:
– Long distances for fetching water by care-givers or those
who are weak
– Unfriendly toilet facility for access by ill user
– Risk of rape while fetching water or relieving oneself in
remote places, and thus increasing vulnerability to infection
with HIV

8. Critical Health Links with
HIV/AIDS (3)
 Burial issue and safety of transmission myths need to
be addressed
 Erroneous beliefs contribute to HIV/AIDS related
stigma and discrimination eg:
– People can become infected with HIV/AIDS due to
groundwater pollution near burial sites (Engelbrecht 1998;
Ashton and Ramasar 2001);
– People (playing children) can become HIV infected through
poor waste disposal practices: condoms and sanitary
napkins (Molefe and Appleton 2001).

9. Critical Gender Links with
HIV/AIDS
 School enrolment rates for girls decrease in
communities with high prevalence rates, as girls are
required to take on a wider range of household and
domestic responsibilities, including fetching water and
using it domestic/agriculture/home based care
 Water collection and other reproductive tasks is
increasingly burdensome:women’s health deteriorate as
less time for self-care, and gender practical needs

10. Critical Community-driven
Development Links with
HIV/AIDS
 What is water is known as “Community management”
can be compared to “community HIV/AIDS
competence” environmental sustainability
 This approach puts communities in the driver's seat and
requires government & civil society to
– Be demand-responsive,
– Build capacities (especially problem solving skills) and
– Create an enabling environment by providing technical
support, formation of partnerships and supportive policy
frameworks

11. Critical Human Rights
Links with HIV/AIDS (1)
 Access to safe water and sanitation is considered not
only a basic need but also a human right
At the Johannesburg
World Summit for Sustainable Development, delegates of the
"The Civil Society Action Programme on Water" launched a
statement saying that secure access to sufficient safe water
and sanitation to meet basic human needs, including water
for small-scale productive use to support livelihoods
strategies, must be considered a human right

12. Critical Human Rights
Links with HIV/AIDS (2)
 Stigma & discrimination of HIV/AIDS of
affected/infected families becomes exclusion
factor for participation in community-based
water decision- making.
 MIPA necessary to ensure that the voices of
people living with HIV/AIDS are heard, either
directly or indirectly by representation

13. Critical Human Rights Links
with HIV/AIDS (3)
 Actively involving people affected by HIV/AIDS has
proven
– to be also an effective strategy to tackle S&D and create
more openness.
– that people living with HIV/AIDS can also be employed
very effectively in water and sanitation improvement
programmes, particularly as peer educators - with the added
benefits of breaking down prejudices
– to support positive living through providing income
generation opportunities

14. Critical Poverty Alleviation
Links with HIV/AIDS (1)
 Poor access to basic services such as education, health
care and water and sanitation, that are indicators for
poverty,increase vulnerability to HIV infection
 Conditions related to poverty such as
– unemployment,
– low sense of self-worth and
– a sense of fatalism
….have been demonstrated empirically as being enormously
significant in vulnerability to HIV infection

15. Critical Poverty Alleviation
Links with HIV/AIDS (2)
 Increasing financial constraints will affect the
provision of water and sanitation
 Adequate water supply
– saves labour and energy
– contributes to diversification of income
– generates nutritional value
– reduces expenditure on health
….….. thus implicating sustainable livelihoods

16. Now to IWRM…….