Stories From the Field

Safe water and HIV: Evidence-based integration

Clean water can have significant impact on the quality of life for those living with HIV/AIDS

Jemima is a woman living with HIV in rural western Kenya, where rates of HIV are among the highest in the world. Nearly one in five adults is infected, and nearly 20% of children are orphaned. Jemima became a leader in her community by founding a group that provides emotional support and small loans to HIV-affected families in her home area. However, Jemima's own HIV disease continued to progress. She grew ill with diarrhea and wasted to a low of 77 lbs. A local volunteer found Jemima at home, bedridden, weak, and with oral thrush and skin infections.

The volunteer brought Jemima, her husband, and her sick grandchild to a USG-supported clinic, where staff provided the family a "Basic Care Package" to treat their symptoms and to prevent further illness. Developed in 2002, the 'Basic Care Package' is a bundle of evidence-based, high-impact, and low-cost health interventions developed by CDC Global AIDS Program public health researchers in Uganda (in partnership with other CDC scientists) to prevent the most debilitating opportunistic infections among people living with HIV. With suppressed immune systems, Jemima and others living with HIV are more vulnerable to opportunistic illnesses, such as those transmitted through contaminated water. These illnesses can be costly and difficult to treat in settings with limited resources.

The elements of the Basic Care Package are designed to be simple to implement, so they can be delivered at primary health care centers. The essential elements—delivered together or separately—include cotrimoxazole (a powerful antibiotic), insecticide- treated bed nets to prevent malaria, screening and management of STDs, Prevention of Mother to Child Transmission (PMTCT) services, and counseling (e.g., condom use and family planning), and point-of-use safe water systems. The safe water system of the Basic Care Package includes education as well as:

• Use of household-based water treatment methods and water storage in containers that limit hand contact (e.g., plastic containers with spigots and dilute chlorine tablets)
• Proper disposal of human or animal feces
• Promotion of hand washing with soap after handling human or animal feces, before food preparation, and before eating, along with the provision of soap

Each intervention has been shown to improve health outcomes while remaining cost effective. Alone, the Safe Water System has been documented to reduce diarrhea among persons with HIV by 25-35%, at a cost to $10 per family per year. Combining the safe water system with cotrimoxazole reduces diarrhea episodes among people living with HIV by 77% and days of work or school lost to diarrhea by 47%, at a cost of roughly $15 per family, per year. Because of these successes, the integrated Basic Care Package is now being scaled up under the U.S. President's Emergency Plan for AIDS Relief.

After receiving her Basic Care Package, Jemima's condition improved dramatically, and she regained a healthy weight of 132 lbs. She now promotes health interventions in her community and sells health products to help support the eight sick and orphaned children she has adopted. Jemima is a fervent advocate for the U.S. government-supported clinic and has referred more than 100 HIV-infected men, women, and children to receive care at the facility.

For the original story and more information, see CDC Global Health E-Brief [PDF - 5 pages].