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The HIV/AIDS Pandemic : Fundamental Cause for Urgent Scale-up in Water SectorRouzeh EghtessadiPublic Health Specialist- Gender & Human RightsSouthern Africa HIV/AIDS Information Dissemination Service(SAfAIDS)17 Beveridge Rd, Avondale, Harare, ZimbabweTel: +263 33 61 93/4Fax: +263 33 61 95Website: http://www.safaids.org.zw
Building the Case….. Themain objective of the water supply sector has always been to improve peoples health by providing access to safe water supply and sanitation. Withadvent of HIV/AIDS, this becomes even more urgent
Critical Links: Water, Sanitation & HIV/AIDSPerspectives categorizing these linkages: Consumer Health Human Rights Gender Community-driven development Poverty Alleviation
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)
“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
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)
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
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).
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
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 drivers 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
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
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
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
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
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