WASHing Up: Making Health Care Facilities Safer for People Living with HIV

The Pump is proud to participate in Blog Action Day 2010. Blog Action Day is an annual event held every October 15 that unites the world’s bloggers in posting about the same issue on the same day with the aim of sparking a global discussion and driving collective action. Blog Action Day organizers chose water as 2010’s theme because  access to clean water is not just a human rights issue. It’s an environmental issue. An animal welfare issue. A sustainability issue. Water is a global issue, and it affects all of us.

We know the basics: People living with HIV (PLWH) have compromised immunity, which means that they are highly susceptible to waterborne infections. Unsafe water, inadequate sanitation, and poor hygiene can spread diseases that cause such life-threatening symptoms as diarrhea, which can be especially lethal to PLWH.

Now, a new training resource is available to address water, sanitation, and hygiene (WASH) practices at health facilities to improve the quality of life for PLWH and their families. WASH is an evidence-based disease prevention intervention that implements small, doable actions to reduce the risk of unsafe water or hygiene practices to PLWH. Small, doable actions are simple, easy-to-adopt, low-cost, and evidence-based. One example of a small, doable action is using a Tippy Tap for handwashing when clean, running water is not available.

Why are interventions like WASH so important?

Diarrhea and the dehydration it causes may contribute to HIV disease progression by impairing immunity.[1] Diarrheal illness in HIV-positive patients can interfere with the absorption of ARV drugs and essential nutrients, further exacerbating HIV infection and illness.[2]

This is why access to clean water and proper sanitation is critically important for people living with HIV. This is especially true in health care settings, where up to 30 percent of patients develop infections during their stay, according to WHO estimates.[3] Yet in many resource-limited countries, where clean water is rare and can be an expensive commodity, awareness of the importance of good sanitation and hygiene does not always lead to practice. The good news is that, even in the most remote locations, individuals and health care facilities can take simple measures to prevent infections.

How well does it work?

Studies have found that WASH interventions reduce morbidity and mortality. For example, water treatment using chlorine products at the point-of-use can reduce diarrheal episodes by up to 39 percent, while improved sanitation reduces diarrhea by 32 percent, and promotion of hand washing can result in a decrease in diarrhea cases by as much as 45 percent.[4]

The WASH intervention is unique because it takes into account potential shortages in supplies and provides alternate solutions. One such solution is to use wood ash in a plastic container for handwashing after defecation or assisting someone with diarrhea when soap is not available. Additionally, all of the measures the intervention covers can easily be adopted by health workers in health facilities, but can also be taught to PLWH and their caregivers, so WASHing becomes routine.

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AIDSTAR-One Facebook RibbonThe WASH curriculum was developed by AIDSTAR-One, USAID’s global HIV/AIDS project providing support and technical assistance to teams working around the world. WASH is draft-to-be-piloted, and is available for download.AIDSTAR-One welcomes feedback about the curriculum on this blog, on Facebook, via Twitter, or at info@aidstar-one.com


[1] Good, R.A. et al. 1979. Nutritional Deficiency, Immunologic Function, and Disease. American Journal of Pathology 84: 599–614.

[2] Bushen, O.Y. et al. 2004. Diarrhea and Reduced Levels of Antiretroviral Drug: Impairment with Glutamine or Alanyl Glutamine in Randomized Controlled Trial in Northeast Brazil.” Clinical Infectious Diseases 38(12): 1764-1770.

[3] WHO. 2005. Health Through Safe Health Care: Safe Water, Basic Sanitation and Waste Management in Health Care Settings. Geneva: WHO. Available at www.healthcarewaste.org.

[4] WHO. 2004. Water Sanitation and Hygiene Links to Health, Facts and Figures. Geneva: WHO. Available at www.who.int/bulletin/volumes/86/1/07-049619/en/index.html.

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