Skip to main content

Advertisement

SpringerLink
Log in

HIV and H2O: Tracing the Connections Between Gender, Water and HIV

  • Substantive Review
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

The health consequences for HIV-affected families of insufficient access to safe water and sanitation are particularly dire: inadequate access complicates medication adherence and increases vulnerability to opportunistic infections for persons living with HIV. The gendered nature of water collection and HIV care—with women disproportionately bearing the burden in both areas—presents an unrealized opportunity to improve HIV outcomes through investments in water/sanitation. We synthesize the literature on HIV and water/sanitation to develop a conceptual model that maps the connections between women’s double burden of resource collection and HIV care. Drawing on theories of gender and systems science, we posit that there are multiple paths through which improved water/sanitation could improve HIV-related outcomes. Our findings suggest that the positive synergies of investing in water/sanitation in high HIV prevalence communities that are also expanding access to ART would be significant, with health multiplying effects that impact women and entire communities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. PEPFAR. Celebrating life: fifth annual report to congress on PEPFAR. 2009.

  2. UNICEF and World Health Organization. Progress on drinking water and sanitation: 2012 update. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation; 2012.

  3. Pruss A, Kay D, Fewtrell L, Bartram J. Estimating the burden of disease from water, sanitation, and hygiene at a global level. Environ Health Perspect. 2002;110(5):537–42.

    Article  PubMed  Google Scholar 

  4. WHO. Guidelines for drinking water quality. 2nd ed. Geneva: WHO; 1997.

    Google Scholar 

  5. UNAIDS. Report on the global AIDS Epidemic. 2004.

  6. Kiongo J. The millenium development goal on poverty and the links with water supply, sanitation, hygiene and HIV/AIDS: a case study from Kenya. IRC International Water and Sanitation Center; 2005.

  7. WaterAid. Assessment of the adequacy of water, sanitation, and hygiene facilities in resource-poor areas of Nigeria in relation to the needs of vulnerable people. Abuja: WaterAid Nigeria; 2006.

    Google Scholar 

  8. Chimwaza AF, Watkins SC. Giving care to people with symptoms of AIDS in rural sub-Saharan Africa. AIDS Care. 2004;16(7):795–807.

    Article  PubMed  CAS  Google Scholar 

  9. Ngwenya BN, Kgathi DL. HIV/AIDS and access to water: a case study of home-based care in Ngamiland, Botswana. Phys Chem Earth. 2006;15–16:669–80.

    Google Scholar 

  10. Obi CL, Onabolu B, Momba MNB, et al. The interesting cross-paths of HIV/AIDS and water in Southern Africa with special reference to South Africa. Water SA. 2006;32(3):323–43.

    Google Scholar 

  11. Davies MA, Boulle A, Fakir T, Nuttall J, Eley B. Adherence to antiretroviral therapy in young children in Cape Town, South Africa, measured by medication return and caregiver self-report: a prospective cohort study. BMC Pediatr. 2008;8:12.

    Article  Google Scholar 

  12. Murphy DA, Roberts KJ, Martin DJ, Marelich W, Hoffman D. Barriers to antiretroviral adherence among HIV-infected adults. Aids Patient Care STDS. 2000;14(1):47–58.

    Article  PubMed  CAS  Google Scholar 

  13. Lule JR, Mermin J, Ekwaru JP, et al. Effect of home-based water chlorination and safe storage on diarrhea among persons with human immunodeficiency virus in Uganda. Am J Trop Med Hyg. 2005;73(5):926–33.

    PubMed  Google Scholar 

  14. Connell R. Gender and power: society, the person and sexual politics. Stanford: Stanford University Press; 1987.

    Google Scholar 

  15. Manji A, Pena R, Dubrow R. Sex, condoms, gender roles, and HIV transmission knowledge among adolescents in Leon, Nicaragua: implications for HIV prevention. AIDS Care. 2007;19(8):989–95.

    Article  PubMed  CAS  Google Scholar 

  16. O’Sullivan LF, Hoffman S, Harrison A, Dolezal C. Men, multiple sexual partners, and young adults’ sexual relationships: understanding the role of gender in the study of risk. J Urban Health. 2006;83(4):695–708.

    Article  PubMed  Google Scholar 

  17. Santana MC, Raj A, Decker MR, La Marche A, Silverman JG. Masculine gender roles associated with increased sexual risk and intimate partner violence perpetration among young adult men. J Urban Health. 2006;83(4):575–85.

    Article  PubMed  Google Scholar 

  18. Sarna A, Chersich M, Okal J, et al. Changes in sexual risk taking with antiretroviral treatment: influence of context and gender norms in Mombasa, Kenya. Cult Health Sex. 2009;11(8):783–97.

    Article  PubMed  Google Scholar 

  19. Hirsch J, Wardlow H, Smith D, Phinney H, Parikh S, Nathanson C. The secret: love, marriage and HIV. Nashville: Vanderbilt University Press; 2009.

    Google Scholar 

  20. Wingood GM, DiClemente RJ. Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Educ Behav. 2000;27(5):539–65.

    Article  PubMed  CAS  Google Scholar 

  21. Leischow SJ, Milstein B. Systems thinking and modeling for public health practice. Am J Public Health. 2006;96(3):403–5.

    Article  PubMed  Google Scholar 

  22. Ray I. Women, water and development. Annu Rev Environ Resour. 2007;32:421–49.

    Article  Google Scholar 

  23. Buor D. Water needs and women’s health in the Kumasi metropolitan area Ghana. Health Place. 2004;10(1):85–103.

    Article  PubMed  Google Scholar 

  24. Rathgeber E. Women, men, and water-resource management in Africa. In: Rached E, Rathgeber E, Brooks D, editors. Water management in Africa and the Middle East: challenges and opportunities. Ottawa: IDRC; 1996.

    Google Scholar 

  25. Upadhyay B. Gendered livelihoods and multiple water use in North Gujarat. Agric Human Values. 2005;22(4):411–20.

    Article  Google Scholar 

  26. Lewis N. Safe womanhood: a discussion paper. Toronto: International Federation of Institutes for Advanced Study; 1994.

    Google Scholar 

  27. Wegelin-Schuringa M, Kamminga E. HIV/AIDS and water, sanitation and hygiene, IRC International Thematic Overview Paper; 2003.

  28. Makoni FS, Manase G, Ndamba J. Patterns of domestic water use in rural areas of Zimbabwe, gender roles and realities. Phys Chem Earth. 2004;29:1291–4.

    Article  Google Scholar 

  29. Sijbesma C, Verhagen J, Nanavaty R, James AJ. Impacts of domestic water supply on gender and income: results from a participatory study in a drought-prone region in Gujarat, India. Water Policy. 2009;11(1):95–105.

    Article  Google Scholar 

  30. Devnarain B, Matthias C. Poor access to water and sanitation: consequences for girls at a rural school. Agenda. 2011;25(2):27–34.

    Google Scholar 

  31. Dworkin S, Ehrhardt A. Going beyond ABC to include GEM (gender relations, economic contexts, and migration movements): critical reflections on progress in the HIV/AIDS epidemic. Am J Public Health. 2007;97:13–6.

    Article  PubMed  Google Scholar 

  32. Higgins JA, Hoffman S, Dworkin SL. Rethinking gender, heterosexual men, and women’s vulnerability to HIV/AIDS. Am J Public Health. 2010;100(3):435–45.

    Article  PubMed  Google Scholar 

  33. Kipp W, Tindyebwa D, Rubaale T, Karamagi E, Bajenja E. Family caregivers in rural Uganda: the hidden reality. Health Care Women Int. 2007;28:856–71.

    Article  PubMed  Google Scholar 

  34. Taylor L, Seeley J, Kajura E. Informal care for illness in rural southwest Uganda: the central role that women play. Health Transit Rev. 1996;6:49–56.

    PubMed  CAS  Google Scholar 

  35. Akintola O. Unpaid HIV/AIDS care in Southern Africa: forms, context, and implications. Fem Econ. 2008;14(4):117–47.

    Article  Google Scholar 

  36. Akintola O. A gendered analysis of the burden of care on family and volunteer caregivers in Uganda and South Africa: health economics and HIV/AIDS research division (HEARD), University of KwaZuluNatal, Durban, South Africa; 2004.

  37. Peacock D, Weston M. Men and care in the context of HIV and AIDS: structure, political will and greater male involvement. Geneva: United Nations Division for the Advancement of Women; 2008.

  38. Peacock D, Stemple L, Sawires S, Coates TJ. Men, HIV/AIDS, and human rights. J Acquir Immune Defic Syndr. 2009;51(Suppl 3):S119–25.

    Article  PubMed  Google Scholar 

  39. Luker V. AIDS and the burden of care: mainstreaming gender or ‘main-themeing’ women? Dev Bull. 2004;64:78–81.

    Google Scholar 

  40. Akintola O. Gendered home-based care: more trouble for the troubled. Afr J AIDS Res. 2006;5(3):237–47.

    Article  Google Scholar 

  41. Tarimo EAM, Kohi TW, Outwater A, Blystad A. Gender roles and informal care for patients with AIDS a qualitative study from an urban area in Tanzania. J Transcult Nurs. 2009;20(1):61–8.

    Article  PubMed  Google Scholar 

  42. Kipp W, Nkosi TM. Factors associated with the self-reported health status of female caregivers of AIDS patients. West J Nurs Res. 2008;30(1):20–33.

    Article  PubMed  Google Scholar 

  43. Bachmann MO, Booysen FLR. Health and economic impact of HIV/AIDS on South African households: a cohort study. BMC Public Health. 2003;3:8.

    Article  Google Scholar 

  44. Bharat S, Aggleton P. Facing the challenge: household responses to HIV/AIDS in Mumbai, India. AIDS Care. 1999;11(1):31–44.

    Article  PubMed  CAS  Google Scholar 

  45. Feng MC, Feng JY, Chen TC, Lu PL, Ko NY, Chen YH. Stress, needs, and quality of life of family members caring for adults living with HIV/AIDS in Taiwan. AIDS Care. 2009;21(4):482–9.

    Article  PubMed  Google Scholar 

  46. Orner P. Psychosocial impacts on caregivers of people living with AIDS. AIDS Care. 2006;18(3):236–40.

    Article  PubMed  Google Scholar 

  47. Seeley J, Kajura E, Bachengana C, Okongo M, Wagner U, Mulder D. The extended family and support for people with AIDS in a rural-population in Southwest Uganda: a safety net with holes. AIDS Care. 1993;5(1):117–22.

    Article  PubMed  CAS  Google Scholar 

  48. Beard J, Feeley F, Rosen S. Economic and quality of life outcomes of antiretroviral therapy for HIV/AIDS in developing countries: a systematic literature review. AIDS Care. 2009;21(11):1343–56.

    Article  PubMed  Google Scholar 

  49. Braitstein P, Nash D, et al. Gender and the use of antiretroviral treatment in resource-constrained settings: findings from a multicenter collaboration. J Womens Health. 2008;17:47–55.

    Article  Google Scholar 

  50. Chen SC, Yu JK, Harries AD, Bong CN, Kolola-Dzimadzi R, Tok TS, King CC, Wang JD. Increased mortality of male adults with AIDS related to poor compliance to antiretroviral therapy in Malawi. Trop Med Int Health. 2008;13:513–9.

    Article  PubMed  CAS  Google Scholar 

  51. Cornell M, Myer L, Kaplan R, Bekker LG, Wood R. The impact of gender and income on survival and retention in a South African antiretroviral therapy programme. Trop Med Int Health. 2009;14:722–31.

    Article  PubMed  Google Scholar 

  52. ART-LINC Collaboration of the International Databases to Evaluate AIDS (IeDEA). Antiretroviral therapy in resource-limited settings to 2006: patient characteristics, treatment regimens and monitoring in sub-Saharan Africa, Asia and Latin America. Trop Med Int Health. 1996;2008(13):79–87.

    Google Scholar 

  53. Mills E, Ford N, Mugyenyi P. Expanding HIV care in Africa: making men matter. Lancet. 2009;374:275–6.

    Article  PubMed  Google Scholar 

  54. Homer J, Hirsch G. System dynamics for modeling public health: background and opportunities. Am J Public Health. 2006;96:452–8.

    Article  PubMed  Google Scholar 

  55. Blankenship K, Friedman S, Dworkin S, Mantell J. Structural interventions: concepts, challenges and opportunities for research. J Urban Health. 2006;83(1):59–72.

    Article  PubMed  CAS  Google Scholar 

  56. Carter RC, Tyrrel SF, Howsam P. The impact and sustainability of community water supply and sanitation programmes in developing countries. Water Environ J. 1999;13(4):292–6.

    Article  CAS  Google Scholar 

  57. Green L, Kreuter M. Health promotion as public health strategy for the 1990s. Annu Rev Public Health. 1990;11:319–34.

    Article  PubMed  CAS  Google Scholar 

  58. Roberts M. Public health and health psychology: two cats of Kilkenny? Prof Psychol Res Pract. 1987;18(2):145–9.

    Article  Google Scholar 

  59. UNHABITAT. HIV/AIDS checklist for water and sanitation projects. Nairobi: United Nations Human Settlements Programme; 2006.

    Google Scholar 

  60. UNAIDS. Global Report Fact Sheet: sub-Saharan Africa. 2010.

Download references

Acknowledgments

This study was funded by a Seed Grant from the Department of Sociomedical Sciences at the Mailman School of Public Health, Columbia University, New York, NY. We would like to thank Les Roberts for his feedback on an early draft of this manuscript. We would also like to thank Daniel M. Sheehan, the Institute for Social and Economic Research and Policy (ISERP) and the Columbia Population Research Center (CPRC) at Columbia University for assistance with GIS mapping and imaging.

Author information

Authors and Affiliations

  1. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA

    Brooke S. West & Jennifer S. Hirsch

  2. Mailman School of Public Health, ICAP-Columbia University, New York, NY, USA

    Wafaa El-Sadr

Authors
  1. Brooke S. West
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer S. Hirsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wafaa El-Sadr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brooke S. West.

Rights and permissions

Reprints and permissions

About this article

Cite this article

West, B.S., Hirsch, J.S. & El-Sadr, W. HIV and H2O: Tracing the Connections Between Gender, Water and HIV. AIDS Behav 17, 1675–1682 (2013). https://doi.org/10.1007/s10461-012-0219-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-012-0219-9

Keywords

Search

Navigation