From Brijmohan Kandpal, SIMAR, Uttaranchal
Posted 9 August 2007

I work for SIMAR, an NGO working in Chamoli and Bageshwar districts of Uttaranchal on natural resources, sanitation, and health issues. The state has a high proportion of incoming migrant labour mainly from Eastern India, as well as outgoing labour of Uttaranchalis working in other states who return home for short periods. Both these migrant populations are prone to HIV, with the non-mountainous districts like Dehradun and Nainital being the potential hotspots. Additionally, we are concerned about some of the complex and multi-dimensional effect that Water, Sanitation, and Hygiene (WASH) and HIV have on each other. These are:

• People Living with HIV (PLHIV) have lower immunity, making them highly susceptible to opportunistic infections (OI), most of which are related to WASH.
• Adequate safe water is essential for domestic and medical purpose. Lack of access to safe water for PLHIV will enhance their vulnerability and morbidity.
• Water borne diseases like typhoid and gastroenteritis further compromise the immunity of PLHIV, increasing the mortality. In addition, OI increase the need for Anti Retroviral Treatment.
• Decreased supply or quality of water requires extra work from caregivers to fetch water usually from distant sources. This in turn may increase the economic burden, as PLHIV may need to buy water.
• PLHIV carry the triple burden of stigma, poverty, and unemployment. Hence, they have minimal say in WASH services or decisions at community level.

Due to the reasons listed I request the members to share their expertise with regard to the following:

• Experiences of special care and precautions regarding safe water, sanitation, and hygiene undertaken for PLHIV.
• Examples and References of research studies, papers, articles, and the like on linkages between HIV and safe water, sanitation and hygiene.
• Measures to sensitize PLHIV, Health Care services and the broader community regarding the special water requirements for PLHIV.

Your inputs will help us in understanding and designing water and sanitation interventions to be sensitive to needs of PLHIV, and will be deeply appreciated.

Please see attachment below for the responses.