We’ve learned that safe drinking water is critical for people who have HIV/AIDS because they are prone to opportunistic infections from contaminated water that can make them persistently sick and can be fatal. When an adult is sick or dies from HIV/AIDS, it takes a horrible toll on the children who are more likely to not attend school, more likely to be sick, and even more likely to die.
We’ve also found that PUR is a unique tool to help people living with HIV/AIDS because it is so efficient in killing the bacteria and viruses as well as removing chlorine resistant parasites like Giardia and Cryptosporidium. This is why we’ve committed to providing a quarter of a billion liters of safe drinking water to people living with HIV/AIDS as part of our Children’s Safe Drinking Water Program. Today, we’ll visit two of these programs in Ethiopia.
PSI Ethiopia, funded by P&G and USAID, is providing kits to help keep people living with HIV/AIDS healthy. The kits include soap for hand washing, condoms to prevent transmission of the virus, deworming pills, a bucket for storing treated water and both PUR packets and a liquid chlorine disinfectant called Waterguard. Over a three year period, PSI will provide these kits to more 225,000 families and provide more than 5.5 million packets of PUR.
PSI is in the first stage of providing the kits and I’m visiting to learn how it can be improved. We visit a hospital in Metahara in the eastern part of Ethiopia. Sister Alamaz Ali Mohammed is a nurse in the hospital and tells us that this program is leveraging the existing infrastructure created to care for people living with AIDS. When people attend the hospital to receive their antiretroviral drugs for HIV/AIDS, they’ll be given the option to have one of the kits.
The Sister tells me that there is a high rate of diarrhea in the area and that the kits will be very useful. She tells a gathering of about a dozen people who have come for their therapy about the contents of the kit. In addition to working with the local nurses, in each of the hospital or clinic distribution points, PSI has trained two community health volunteers to assist with the education and provision of the kits.
At this hospital, one of the volunteers is Mamitu Fikre who we met in my blog just immediately prior to this. One of the things that I didn’t mention yesterday is that Mamitu has HIV/AIDS. She decided to be a volunteer so she can contribute to her community and help others who are suffering. She’s also learning important skills to ensure that she lives healthy.
Mamitu is a strong woman and I’m even more impressed about her efforts as a volunteer and PUR water vendor after learning about her struggles with HIV/AIDS. She credits her husband, who is HIV negative, for giving her support to be a volunteer and to be public with her status. There’s still a stigma against people with AIDS and indeed it’s a strong couple to take such a stand in this community.
Unlike Mamitu who is well versed in the benefits of safe drinking water for herself and her family, Abeba Mekuria has never heard about PUR before today. Even though she has HIV/AIDS, she didn’t understand the importance of safe drinking water to prevent opportunistic infections. She’s very glad to have learned about this today and is thankful to the hospital, PSI, USAID, and P&G for providing the kit.
After watching the efforts with PSI in Metahara and later in Addis, I suggest some improvements to the program. We’ll revise some of the educational materials and based on the results of a mid-term evaluation, we’ll improve the program as it scales-up to reach many more people in the next two years.
About a year ago, we agreed to also work with Family Health International (FHI) to provide PUR to people living with HIV/AIDS. I’ve known of FHI’s work for quite a while and admire their research capabilities. We agreed to a rigorous examination of the use of PUR to help people living with HIV/AIDS that will measure the impact on reported diarrhea, acceptance, and sustained usage. The study provides PUR to 3,400 families with at least one person who has HIV/AIDS.
FHI has a network of local non-governmental groups that work in the communities and provide home-based care. I’m particularly supportive of this approach since it is a great way to ensure proper use and encourage sustained usage through the regular visits of community volunteers. Each volunteer provides support to about 5 households and visits them at least once a week.
Typically, we focus provision of PUR to areas like Metahara where people drink from visually dirty water sources such as the irrigation ditches. The magic of the transformation of the water from dirty to clear with PUR makes it readily accepted in communities with these types of water sources. And, the liquid chlorine disinfectant, Waterguard, is a lower priced option for people with clear water. So, our working assumption has been that PUR will not be as well accepted in communities with clear water as Waterguard.
However, research is useful for challenging assumptions and the FHI research will specifically ask about preference and use of the various water treatment options. Imporantly, PUR provides a critical technical advantage over the chlorine disinfectants like Waterguard because PUR uniquely removes the chlorine-resistant parasites like Giardia and Cryptosporidium that can cause persistent diarrhea and be fatal among people living with AIDS. So, if the research shows that PUR is well-accepted among users of clear water, there is a rationale for providing it to people living with HIV/AIDS.
Compared to many parts of sub-Saharan Africa, Ethiopia has a relatively low percentage of people living with HIV/AIDS at 2.3%. However, when you consider the population size of 78 million, it has one of the highest numbers of total people living with AIDS in all of Africa at 1.8 million people. In Ethiopia, the highest concentration of people living with AIDS is in urban areas, so this research will be critical in helping shape strategy for helping these people.
Today, I’ll visit two of the homes that are part of the FHI study. Tadelech is a widow who has been using PUR for two months as part of the FHI study. Prior to using PUR, she used Waterguard to treat her water. Her water source is a tap outside her home and she believes that it’s usually safe. However, there was recently an outbreak of cholera in the area and one of her neighbors died. So, now she’s worried about the safety of the water. While she uses PUR correctly, is thankful for it, and will continue to use it during the study, she’ll switch back to Waterguard if she needs to purchase the product since Waterguard is cheaper.
We meet with Yeneayehu who has been using PUR for six weeks as part of the study. We’re sitting with Yeneayehu in her small mud-house that is about 10 feet by 10 feet. This small space serves as the sleeping space for her family of four as well as the living area and food preparation area when it’s raining. There’s a dirt floor and flies everywhere. Yeneayehu and her husband came to Addis from the north and settled in this slum with their family to try and find work.
Yeneayehu collects her water from a municipal tap that is shared by the people in this compound. She’d been given Waterguard in the past but didn’t continue to use it. She was also a recipient of the care kits provided by PSI so she has both Waterguard and PUR in her home, but likes PUR better. Even though Waterguard is simpler to use because you don’t have to stir and filter, she likes the taste of PUR-treated water better. She tells us that PUR is better because it removes things from the water and mentions parasites. Prior to using PUR, she got sick and had to go to the clinic. She tells us that her husband also has HIV/AIDS and prior to having PUR, he’d avoid drinking water. But, now everyone in the family is drinking the treated PUR water. Yeneayehu tells us that she hopes that she can continue to receive PUR from FHI but that if it’s not possible, she’ll try to buy from the local market.
It’s interesting that we’ve seen one person that prefers PUR and one that prefers Waterguard. Our assumption has been that most people will prefer Waterguard and so the FHI research will be very useful to take a systematic examination of people’s preference and acceptance. And, this research will help us refine our strategy going forward.
Regardless of the outcome of this specific research, it’s clear that there’s a great need for PUR in many parts of Ethiopia. PSI believes that they can grow the program within the next year to provide more than 100 million liters of safe drinking water each year by helping people living with AIDS, responding to cholera outbreaks, and continuing to provide PUR in areas where it’s needed the most. That’s all for my current trip. Much thanks for Henock Gezahegn for being my host this week.
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