People living with HIV / AIDS in a context of rural poverty : the importance of water and sanitation services and hygiene education : a case study from Bolobedu (Limpopo Province, South Africa)

In South Africa, HIV/AIDS is still approached primarily as a health issue, with interventions focussing mainly on prevention and treatment. The social implications and poverty dimensions of HIV / AIDS are recognised in policy, but have not yet been translated adequately into practice. Provision of affordable, accessible and reliable public services is essential in supporting health maintenance and reducing stress for people infected and affected with HIV/AIDS. Reliable delivery of good quality water and sound basic sanitation are critical in reducing exposure to pathogens to which HIV-positive people are particularly vulnerable. Where water services are inadequate or inaccessible, the time and monetary costs of accessing good quality water in sufficient quantities are high, particularly for HIV-infected people and their care-givers; similar points apply to sanitation. This case study, which focuses on three settlements in the Bolobodu area of South Africa’s Limpopo province, confirms these points.

The research found that discussion of HIV/AIDS issues remains taboo for the majority of people. In two of the three settlements, the breakdown of public water services has meant that residents have reverted to unprotected water services. This has significant time costs, and is particularly onerous for households directly affected by HIV/AIDS. It also impacts on the time available to care givers to provide support to needy households. Public health messages around ‘healthy living’ for People Living with HIV/AIDS (PLWA) focus on nutrition and exercise, with no reference to the role of good basic hygiene, water and sanitation in minimising exposure to pathogens and safe-guarding health. The importance of good nutrition, supported by food gardening, underlines the need to make water available for productive purposes to improve the livelihoods of impoverished households and maintain good immune functioning.

The study recommends that the water sector pays far closer attention to the specific impacts of inadequate services on those who are HIV positive, works to strengthen targeted multi-sectoral initiatives - notably with the health and agricultural sectors and in schools - and has a key role to play in promoting closer integration of support and training to care givers.