205601 Integration of water, sanitation and hygiene into HIV programs: Lessons from Malawi

Monday, November 9, 2009: 4:50 PM

Shannon Senefeld , Catholic Relief Services; Argosy University, Baltimore, MD
Antonia Powell , Catholic Relief Services, Baltimore, MD
Alisha Myers , Catholic Relief Services, Baltimore, MD
Robin Ngalande , Dedza Catholic Health Commission, Baltimore, MD

Research demonstrates that improvement of water, sanitation, and hygiene (WSH) for people living with HIV in resource-poor settings may significantly improve health outcomes. However, few programs have explored how to effectively integrate WSH into home-based care (HBC) and other HIV services. The current research aims to identify feasible strategies for integration via a pilot study in rural Malawi.


The research design collected pre-/post-test data on WSH knowledge, attitudes and practices (KAP) of HBC clients. A barrier analysis was also conducted. Data was collected from HBC and non-HBC households. Based on baseline data, WSH interventions were implemented within the communities over a one-year period. The post-test examines changes over time in KAP within HBC households.


Baseline results demonstrated significant WSH differences between HIV-affected and non-affected households. In households without latrines, a higher percentage of HBC household (55.6%) than non-HBC household (44.4%) reported indiscriminate defecation. Prevalence of diarrhea among non-HBC households was 2.5% and 7.1% among HIV-affected households. However, HBC households had better access to water sources than non-HBC households. The post-intervention data collection begins March 2009, consisting of a cross-sectional household survey of HBC households.


Based on findings, the presenter will comment on the impact of community-based WSH activities, including borehole construction; community training on sanitary platform construction; construction of demonstration latrines; and alternative latrine-designs for HBC clients. The presenter will also discuss utilization including the negotiation of do-able actions for HBC households and highlight successful strategies.

Learning Objectives:
By the end of the presentation, the participants will be able to: 1) Identify the special vulnerability of PLHIV with regard to WASH programming in resource-constrained settings; 2) Discuss examples of piloted strategies to integrate traditional WASH programming into existing HIV programs; and 3) Differentiate between proven and non-proven methods to respond to WASH needs of PLHIV

Keywords: HIV/AIDS, HIV Interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked in HIV programming for more than 10 years. I led the initial research on health outcomes and behaviors on this in Malawi several years ago. I am conducting the final evaluation of the project as lead evaluator next month. I have a MA degree in International Development and am working on my doctorate. I have worked overseas in development for years. I have published and presented in many other settings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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