Water, Sanitation and Hygiene (WASH) – A Mother-to-Child “Shield” for HIV-affected Families

In the past decades, HIV-affected families have largely benefited from effective medical interventions such as antiretroviral medications (AVRs) to sustain parents’ health and prevent mother-to-child transmission. But the lack in WASH programming – water, sanitation and hygiene can alter the effectiveness of such interventions. Water and sanitation has been found to decrease infections by helping HIV drugs get absorbed, rather than flushed out of the system due to chronic diarrhea.

Often in rural African villages the only water source for villagers is a basin with collected surface water which can be contaminated with bacteria and microorganisms. This untreated water is used for a wide range of daily activities from food preparation to treating people with health issues. Lack of sanitized public toilets and garbage removal exasperate the problem.

The unhealthy nature of the water exposes people to various water-borne diseases, including diarrhea and cholera. While diarrhea is a fairly ubiquitous symptom of HIV , the lack of water and sanitation perpetuates the cycle of illness.  Persistent diarrhea due to lack of adequate water and sanitation can inhibit the effectiveness of the ARVs taken to treat HIV, which can accelerate the progression of HIV/AIDS, thus further threatening HIV-infected mothers and their children.

It is widely acknowledged that adequate early medical interventions reduce the risk of mother-to-child transmission drastically, for women who are diagnosed with HIV before or during pregnancy. According to the Centers for Disease Control and Prevention, in the U.S., early intervention could alleviate the chance of transmission to less than 1%, while avoiding breastfeeding. Unfortunately, in rural regions, even if medical treatments are provided, the effect of such interventions will be dismissed due to the paucity of clean water. Among infants with HIV-infected mothers, those with unhealthy mothers bear eight times higher likelihood to get the virus than their counterparts with healthy mothers.

Although most mother-to-child transmissions occur during pregnancy, there is still 33% chance to transmit virus through breastfeeding. While recent research findings demonstrate that providing ARVs to HIV-exposed infants and their mothers prevents mother-to-child transmission, mothers in rural regions usually choose to replace breastfeeding with formula or choose softened food for their babies.  However, in an environment without clean water and sanitation, breastfeeding avoidance merely exposes infants to more diseases through water contamination.

For HIV-affected families without access to cheap formula in rural Africa, the only option is to feed infants with soften food mixed with untreated water. Moreover, even if the formula is obtainable, the lack of clean water and sanitation makes the safety of formula milk and bottles impossible. As a result, these bottle-fed infants suffer from six times higher chance to “die from diarrhea, respiratory or other infections compared to breast-fed child”.

Currently, ensuring WASH in developing regions is part of the Millennium Development Goals (MDGs). According to a report issued by WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, 89% of the world’s population has gained access to improved drinking water by 2010. This has resulted in the “target of halving the proportion of people without sustainable access to safe drinking water” to be  the first MDG  achieved. On the other hand, the report also shows there are still around 783 million people (11%) in the world without safe drinking water. And the target of sanitation is still far from reach.

Hence, a continuous and dedicated commitment is needed for WASH, whether it’s domestic– from a government to its own citizens or cross-border. Bilateral or multilateral means could be jointly used for building piped supplies and protected wells in the needy regions.

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