Throughout the world, lack of access to nearby safe water and HIV/AIDS are two crucial public health issues. Lack of access to quality water continues to be a daily concern for the majority of the world’s population. According to the World Health Organization, approximately 780 million people in the world continue to lack access to quality water. To reduce the health burden, several water interventions are being implemented worldwide. HIV/AIDS is also a persistent and critical public health concern. To date, there are approximately 35.3 million people living with HIV and nearly 1 out of every 20 affected adults are living in Sub-Saharan Africa. Kenya is one country that faces both of these issues; about 6% of Kenyans are believed to be HIV positive while 46% have limited access to safe water.
" 6% of Kenyans are believed to be HIV positive while 46% have limited access to safe water. "
For immune compromised people, such as HIV-infected individuals, access to water is essential for maintaining a healthy nutritional status to reduce disease progression.Water contributes significantly to nutritional well-being. One source for nutrients is available in potable water; minerals in water may include calcium, sodium, magnesium, lead, chloride, selenium, potassium, chromium, bromide, iodide, fluoride, and manganese. Adequate nutrition contributes to proper immune function within the body and decreases the potential for opportunistic infections.
Additionally, nutrition provides calories used for energy throughout the day. According to the World Health Organization, HIV-infected adults should consume an additional 20% to 30% of their normal caloric intake during periods of symptomatic disease or opportunistic infections in order to maintain immune health. Moreover, it is recommended to reduce physical activity while a person is experiencing a low CD4 count or high viral load. Aside from antiretroviral (ARVs) treatment, maintaining proper health, nutrition, and hygiene contribute to an active lifestyle for individuals infected with HIV.
Problems can arise in physically active, HIV-affected populations living in hot climates with limited access to water. The person may not have available water for consumption or to prepare food; people may experience physical demands gathering water at far distances and increased sweating and fluid loss in hot environments. Ultimately, access to water is essential in order to avoid adverse health effects. Moderating physical activity and improving nutritional status is beneficial for people living with HIV.
In addition to physical health outcomes, mental health problems are common among HIV-infected and HIV-affected families. Several studies have reported that improved family functioning and social support have been associated with better quality of life and fewer symptoms of depression among HIV-infected individuals. Additionally, it is recognized that emotional distress has a negative impact on immune system function; for example, Ironson et al. (1994) found that emotional distress was significantly related with an immune-compromised status and potential opportunistic infections.
Community members share time together and enhance their relationships.
Several outcomes may occur in an HIV-affected family experiencing an implemented water intervention. The purpose of this study was to explore consequences and outcomes of an HIV-affected family located in a dry, arid setting that recently experienced access to water. These experiences provided a better understanding of lifestyle changes, including physical, social, and mental aspects.
The study took place in Kitui, Kenya where several water interventions have been implemented from 2007 to 2013. Prior to the implementation of the water interventions, access to nearby water sources was poor. Primary water gatherers of the household could take up to 3 to 4 hours to collect water daily. There are many families living within this region that were positively affected by the recent water intervention; unfortunately, rates of HIV and families affected by HIV/AIDS in the region are currently unknown.
Because our research question represented a unique scenario, a qualitative case study was used. A larger qualitative study was conducted throughout this region and this case study was embedded within the larger context of information. The family lived in a dry, semi-arid region where rainfall averages has significantly decreased over the last eight years. Members included a mother (60 years of age) and father (65 years of age) who were HIV-positive and two HIV-negative children (34 and 15 years of age). The father was physically very thin, but he was sharp and excited about the interview. He was an active member of the water committee and was happy to share his story on how the water intervention changed his life. The mother was also thin, but more physically fit. She met us on the road because she was returning from working at a community garden. She was carrying vegetables in her hands. The children were also quite outspoken and excited to share their experiences about the water and how it positively contributed to the family. Each member recounted their individual story within a semi-structured interview. They were open, honest, and pleased to explain life before and after access to water.
Before the implementation of the water intervention, the family experienced a myriad of health, social, and economic hardships including poor nutrition, insufficient income, poor housing (semi-permanent), and lack of time for quality relationships within the immediate family and community. Gathering water before the intervention was very difficult for the family. The mother indicated, "Before the water intervention, I used to collect water from Athi. It was very far from here, it used to take 3 or 4 hours to get there and collect water.” But afterwards, additional time and energy was spent on various household chores. The daughter also mentioned, "The distance has been shortened and also, the time taken to fetch water. The time I have saved from getting water from this project is used to clean utensils, the compound, the clothes, going to the farm or any other duties at home.”
Community members help each other on farming and land preparation.
The family spent most of their daily time for water collection, lacking time to strengthen relationships with family and community members. Afterwards, additional time gained was also used on strengthening relationships. The father expressed, "It has brought us more together as a family because whoever is going for water will only take 30 minutes and he/she will be back. We are able now to discuss duties and responsibilities as a family in our home. That has enhanced and strengthened our relationship as a family. We have more time as a family and this is the result of the short time taken to go and collect water and this time, we are able to do other duties here in the home.My neighbors and friends are able to form groups to help each other, especially on brick making, farming, land preparation before the rainy season- and all this is possible because the water is nearby and nobody will refuse to come and help you- for the reason, ‘I am going to fetch water.’ So, our relationships are enhanced. Also, on our relationships, we are more together because we are sharing the same benefits from the water. As we discuss and meet, we can appreciate together that we are clean and happy and as a community, we think this is a positive change for having the project here.” Improved family functioning can contribute to positive mental and physical development in each member of the family. For HIV-infected individuals, maintaining both mental and physical health can contribute to better health outcomes.
After having access to nearby water, the family experienced improvements in nutrition and hygiene.The father explained, "I can bathe anytime. The kids can bathe also. And also, the clothes are very clean. Also with the cleanness, it’s quite important because in our counseling session, people with HIV/AIDS, it’s encouraged that we eat nutritious foods and also maintain hygiene to prevent infection and to build up our CD4 count.”
"I can now create awareness about people living with HIV/AIDS, it’s because water is nearby. "
Shortened distance and time gained also provided the opportunity to the HIV-affected family to spread awareness about living with HIV/AIDS, focusing on maintaining health-conscious practices to avoid opportunistic infections. The father indicated, "I can now create awareness about people living with HIV/AIDS, it’s because water is nearby. If my wife was going to Athi, maybe she would not be back, so I would not be able to go and create awareness. So, now, I can go with my friends, create awareness, and encourage them- those who are living positively on good practices. Also, the people who are not maintaining cleanness, personal hygiene, when we meet in our groups for awareness, we emphasis on these factors. We tell them they don’t have a reason for being dirty because water is nearby and they usually change. So, that is advising each other as a group to show that we are together- because if you see your neighbor is not cleaning the childrens clothes, they are dirty, you can tell them in a polite way. That shows we are together as a group and as a community."
Water improved the lifestyle of the HIV-affected family. Each family member’s experiences revealed health and social benefits from nearby access to water. Also, additional time was used to strengthen relationships within household family members and community, which contributes to improved physical and mental health outcomes. This study provides evidence for the need of nearby access to quality water in order to improve the quality of life of HIV-infected individuals and HIV-affected family members. These outcomes should be considered when evaluating the impact of an implemented water intervention.