In 2008 WaterAid India entered into a partnership with Uttar Pradesh State AIDS Control Society for a project titled Programme on Arresting Opportunistic Infections for People Living with HIV/AIDS (PLHA) to help improve the quality of their lives through water and sanitation. The project is being implemented through CREATE in 14 districts and involves anti-retro-viral therapy cells, located in the Medical Colleges and working with District Level Networks (DLNs) of HIV positives, Drop in Centres (DICs) and Community Care Centres (CCCs), which are care and support centres during opportunistic infection.

These have also become WASH information centres where people living with HIV/AIDS are able to learn about key hygiene practices. The centres share information through posters and pamphlets, display different toilet models, and offer a range of audio, video and other materials as well as group and individual counselling.

PLHAs are also able to use good quality facilities at the centres, such as water filters, washbasins, urinals and latrines. Staff are trained on WASH issues and are able to tell PLHA about the importance of good WASH practices in their lives.

Rapid Deterioration in Health

Mr. S. Singh is a driver in Chandauli district of Uttar Pradesh state. He was known, and perhaps envied, for his fearlessness and his well built physique. Over the years, Singh witnessed a rapid deterioration in health, with several episodes of diarrhoea. His frequent visits to doctors led to more expenses and when he was tested for HIV in 2005, he was shocked to find that he was positive.

By the time he came to know of his HIV status, his wife and three children were also found to be HIV +. He was unable to recover from this shock for several months. Slowly he was able to accept reality due to consistent counselling from District Level Networks (DLNs) of HIV positives, a group of NGOs running Drop in Centres (DICs), and interaction with and solidarity from similarly affected persons.

Since 2007 he and his wife had been taking antiretroviral therapy (ART), but their health was not improving, due to opportunistic infections like TB and diarrhoea. Being sick most of the time, he was unable to report to work and as a result, while his medical expenses increased, his income decreased. In October 2009 his wife died as a result of HIV leaving behind three children and her husband.

Information Centres in 14 Districts

In 2008 WaterAid India entered into a partnership with Uttar Pradesh State AIDS Control Society for a project titled Programme on Arresting Opportunistic Infections for People Living with HIV/AIDS (PLHA) to help improve the quality of their life through water and sanitation.

The project is being implemented through CREATE in 14 districts and involves antiretroviral therapy cells, located in the Medical Colleges and working with DLNs, DICs and Community Care Centres (CCCs), which are care and support centres during opportunistic infection.

These have also become WASH information centres where people living with HIV/AIDS are able to learn about key hygiene practices. The centres share information through posters and pamphlets, display different toilet models, and offer a range of audio, video and other materials as well as group and individual counselling.

PLHAs are also able to use good quality facilities at the centres, such as water filters, washbasins, urinals and latrines. Staff are trained on WASH issues and are able to tell PLHAs about the importance of good WASH practices in their lives.

Regular Counselling Sessions

Singh regularly visited the Chandauli DLN for counselling sessions and took notice of the messages on handwashing, diarrhoea management, safe water handling and use of toilet. He also received a hygiene kit, in 2009, which contained soap, ORS (oral rehydration solution) packets, SafeWat (chlorinating solution that purifies water), Dettol (an antiseptic), a towel and a pamphlet about the kit.

He adopted safer practices such as using a latrine, washing his hands, drinking safe water after chlorination and using ORS if he had diarrhoea. When the chlorine was finished, he started boiling water for consumption. Outreach workers from the DLN kept in touch and monitored these practices.

Steady Health Improvement

Over the months Singh witnessed a steady improvement in his health, with fewer episodes of diarrhoea. The ART treatment had a positive impact. During our recent visit he informed us, “I used to be really ill with frequent bouts of diarrhoea and TB and am on medical leave. But over the past eight months because of the adoption of hygienic practices like handwashing, use of boiled water and ORS during diarrhoea my health has improved considerably. I myself noticed an almost immediate reduction in diarrhoeal episodes after starting the use of SafeWat and now boiled water. Now I feel healthy enough to join back to my job.”

This was also confirmed by Manish, the DLN Coordinator in Chandauli. “When we first saw S. Singh, he was in bad shape. Due to resulting weakness he needed the support of others to walk. In 2009, when this project with CREATE started to focus on water, sanitation and hygiene, we understood this important link for PLHAs. At present he is healthy, episodes of diarrhoea have reduced and the improvement in his health will enable him to get back to his job.”

Survey on Practices and Coping Strategies

Like S. Singh, many PLHAs have seen and reported as to how WASH has created a positive impact in their lives. In a survey of practices and coping strategies among PLHA and with opportunistic infections done at the beginning of 2009, the following were the key findings:

  • 42% of respondents live in nuclear families and face discrimination
  • 48% of the respondents earn less than Rs. 2,000 as monthly income
  • 44% of respondents spent between Rs. 500 – Rs. 1000 per month on health
  • 26% of the respondents suffered from diarrhoea in last 15 days at time of interview
  • 49% of the respondents have no households latrines.

It also brought out that nearly 52% of them were unaware of opportunistic infections and its prevention and unaware of diarrhoea management and linkage of WASH to HIV/AIDS.

Minister: All People Living with HIV/AIDS in Uttar Pradesh State Will Be Given a Safe Water Source

Having established the linkages of WASH with HIV/AIDS and generated evidence of its impact, WaterAid India is moving towards integrating and mainstreaming WASH for PLHA into HIV/AIDS programming and also into WASH programming. The announcement by the Uttar Pradesh rural development minister, Mr. Daddu Prasad, who participated in a consultation on Mainstreaming WASH for PLHA in March 2010, that all PLHA in Uttar Pradesh state will be given a safe water source through a handpump is a step in the right direction.

Life Saving: Linkage of HIV/AIDS and WASH

PLHA are the most discriminated in society economically, socially and psychologically. The immuno-compromised status of PLHA renders them more susceptible to opportunistic infections like diarrhoea, which is experienced by over 90% of patients with AIDS. It becomes more frequent as immune deficiency progresses. Some of these diarrhoeal diseases are likely to be severe, recurrent and persistent, and associated with extra-intestinal disease. Diarrhoea and weight loss are independent predictors of mortality. Diarrhoea in HIV-infected individuals may be either acute (<7 days), or chronic (three or more liquid stools daily for >14 days). Easily accessible and sufficient water and sanitation are indispensable for people living with HIV and AIDS and also for the provision of home-based care to AIDS-affected persons. Water is needed for bathing patients and washing soiled clothing and linen. Safe drinking water is necessary for taking medicines; access to toilets is necessary for weak patients. Water is required to keep the environment (house and toilets) clean in order to reduce the risk of opportunistic infections. Home-based care requires more water than the 20 litres per capita per day that is considered ‘basic access’. In the context of HIV and AIDS,it is especially important that water supplypoints and toilets are easily accessibleand close to where they are needed. This reduces the burden of long distance water collection by caregivers or those who are weak.