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Assessing the WASH Needs of People Living with HIV and AIDS in Papua

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Assessing the WASH Needs of People Living with HIV and AIDS in Papua ASSESSING THE WATER, SANITATION AND HYGIENE NEEDS OF PEOPLE LIVING WITH HIV AND AIDS IN PAPUA NEW GUINEA ACKNOWLEDGEMENTS This report was written by Vanessa Veronese, Research Assistant on the WaterAid Graduate Program. The author would like to extend thanks to all the Anglicare PNG staff who kindly participated in the design of the survey and data collection for the study. We send our warmest thanks to all the participants and their families; without them this research would not exist. Special thanks to James Wicken, Alana George, Rick Steele and Alison Macintyre for their feedback and guidance during the research. Anglicare PNG 2 Assessing the water, sanitation and hygiene needs of people living with HIV and AIDS in Papua New Guinea CONTENTS List of figures 4 4. RESEARCH AIM, OBJECTIVES List of tables 4 AND METHODOLOGY 11 Abbreviations 4 4.1 Aims and objectives 11 4.2 Methodology 11 EXECUTIVE SUMMARY 5 Phase 1 11 Methodology 5 Phase 2 12 Results 5 4.3 Limitations 13 HIV Status 5 Water access and use 6 5. RESULTS 14 Sanitation access and use 6 5.1 Demographic data 14 Hygiene practices 6 5.2 HIV and AIDS status 14 Health knowledge and health 5.3 Stigma and discrimination 15 seeking behaviours 6 5.4 Water use and access 15 Stigma and discrimination 6 5.5 Sanitation use and access 16 Vulnerability of HIV-exposed children 6 5.6 Hygiene, health knowledge Discussion 6 and health seeking behaviours 16 Recommendations 6 5.7 Hand washing 16 Conclusion 6 5.8 Health knowledge 17 5.9 Health seeking behaviours 17 1. INTRODUCTION 7 5.10 Vulnerability of children living with people living with HIV 17 2. LITERATURE REVIEW 8 2.1 The national context of HIV and 6. DISCUSSION 18 AIDS and WASH in Papua New Guinea 9 7. RECOMMENDATIONS 20 3. BACKGROUND AND RATIONALE 10 WASH actors 20 HIV service providers 20 REFERENCES 21 ANNEX 22 3 LIST OF FIGURES Figure 1 Map of study locations in PNG 12 Figure 2 Mode of reaching survey respondents 14 Figure 3 Main reasons for non-disclosure of HIV status 15 Figure 4 Uses of additional water among respondents PLHA (%) 16 Figure 5 Types of illness experienced by respondents in last two months 16 LIST OF TABLES Table 1 Selected Anglicare project sites 13 Table 2 Demographic factors of respondents by location (%) 14 Table 3 Relationship between stigma and discrimination and access to water facilities 15 Table 4 Treatment practices for diarrhoea in children (%) 17 Table 5 Comparison of diarrhoea in respondents and their children 17 ABBREVIATIONS ARV Antiretroviral treatment HBC Home-based care HWWS Hand washing with soap IEC Information, Education and Communication MDG Millennium Development Goal NGO Non-Government Organisation OD Open defecation OI Opportunistic infection PNG Papua New Guinea PPTCT Prevention of parent to child transmission WASH Water, sanitation and hygiene 4 Assessing the water, sanitation and hygiene needs of people living with HIV and AIDS in Papua New Guinea EXECUTIVE SUMMARY In 2010, 32,000 people were living with HIV in Papua New Guinea (PNG), a number that has been predicted to increase over the coming years (National AIDS Council Papua New Guinea, 2011) (UNAIDS, 2012). However, comprehensive care and support, treatment and in partnership to elucidate the specific WASH needs of people preventative services are improving across PNG, resulting in living with HIV in PNG to inform future Anglicare initiatives and people living with HIV leading longer and healthier lives. programming for people living with HIV. Owing to weakened immune systems, people living with HIV are The objectives of the research were: at risk of many life threatening opportunistic infections, many of – Gather baseline information on people living with HIV’s access which are caused by exposure to unsafe drinking water, inadequate to water and sanitation, and identify factors which may contribute sanitation and poor hygiene (World Health Organization, 2010). to vulnerability to accessing WASH facilities among people living Chief among them is diarrhoea which is experienced by more than with HIV 90% of people living with HIV in developing countries (Thom and – Investigate people living with HIV’s experiences with stigma and Forest, 2006). This increased prevalence may also increase the discrimination as they relate to accessing water and sanitation risk of diarrhoea among children living in the same household. facilities and services Diarrhoea can also interrupt the absorption of ARV medication and – cause deficiency in essential nutrients, leading to malnutrition and Investigate people living with HIV’s health knowledge and further exacerbating the consequences of HIV and AIDS (Bushen health seeking behaviours regarding the causes of WASH-related et al, 2004).Children born to mothers living with HIV (Keusch illnesses, particularly diarrhoea et al, 1992), children who are HIV positive themselves (Thea – Investigate the vulnerability of children living in HIV-affected et al, 1993) or children with a mother living with HIV who has households, and the specific WASH needs of mothers living experienced diarrhoea in the last seven days (Peletz et al, 2011) with HIV are all at increased risk of diarrhoea – which is the second largest – Identify opportunities and provide recommendations for killer of children under five globally (CHERG, 2012). Practices such integrating WASH messaging and programming into existing as replacement feeding with infant formula milk, complementary HIV support and care, treatment and preventative services. feeding and weaning require water for breast-milk substitute, food and drink preparation. Thus, these practices may increase the risk Methodology of exposure to unsafe water and consequent diarrhoea (Peletz et al, 2011; Arvelo et al, 2010). A survey with close-ended questions (see Annex) was developed to investigate the WASH knowledge, perceptions and practices of This risk of diarrhoeal disease can be mitigated by access to safe people living with HIV in PNG, and was administered by Anglicare water, adequate sanitation and hygiene (WASH). When behaviours staff in four sites in PNG between October-November 2012. such as treatment and safe storage of drinking water, safe disposal of excreta and hand washing are practised together, deaths from diarrhoeal diseases can be reduced by 65% (Bateman et al, 2002). Results However in PNG, access to safe water and adequate sanitation is Ninety three surveys were collected across four sites. The majority low: only 40% of the population has access to safe water and 45% of respondents were female (74%) and from urban areas (67%). to improved sanitation. As in many countries, these national figures Respondents typically lived in large households, with 36% living conceal a discrepancy between coverage of water and sanitation in with more than eight people. rural (33% and 13%, respectively) and urban areas (88% and 56% respectively) (JMP, 2014). 1. HIV Status Anglicare, one of the largest non-government organisations working On average, respondents had lived with HIV for 7.3 years and 90% on HIV and AIDS in PNG, and WaterAid, recognise the poor WASH were receiving ARV treatment for an average length of time of 5.2 coverage in PNG and the pressing need to introduce WASH practices years. Fifty seven percent of respondents had at least one family into HIV programming. Therefore, this research was designed member who was also HIV positive. Almost two-thirds (60%) of respondents described their current health as ‘healthy’ or ‘very healthy’. 5 2. Water access and use Discussion Over half of the respondents had access to an improved water Overall, respondents demonstrated a good knowledge of the source via a piped connection. Forty percent of respondents importance of WASH and the health benefits. However, this study accessed water through an unimproved source including 30% highlighted several WASH needs for people living with HIV that must from a lake, river or spring and 10% via an unprotected well be acknowledged and addressed for programming, as well as the or uncovered drum. Rural respondents were more likely to use particular WASH needs of parents living with HIV in regard to caring unimproved sources than urban respondents. Knowledge and for their children. practices regarding water treatment were low. The majority expressed a need for additional water since becoming HIV positive, mainly for drinking (90%) and bathing (76%). Recommendations Specific areas highlighted in this research that require addressing 3. Sanitation access and use include: Improved pit latrines were most commonly used (37%), followed – Provide comprehensive guidance on the self-treatment of by unimproved pit latrines (31%) and flush toilets (25%). Only 6.5% diarrhoea to people living with HIV, and their carers of respondents reported practising open defecation. Travel time – Prioritise latrine construction in communities where there is to a toilet varied from one minute to forty minutes and on average low sanitation facility coverage and a known high HIV prevalence people shared a toilet with at least ten people. (taking care not to disclose any member of the community’s 4. Hygiene practices HIV status) Almost all respondents (94%) acknowledged the increased – Develop education and guidelines regarding the safe treatment importance of hygiene for people living with HIV. Self-reported and storage of water, to be integrated within existing health rates of hand washing were high among the group, with over promotion activities for people living with HIV, in order to address 60% washing their hands after using the toilet, but with only 44% the needs people living with HIV expressed for additional water reported washing hands before eating. 27% washed their hands – Provide education around the transmission of HIV to overcome after changing their child’s nappy, and only 6% did not wash their stigma which may be preventing people living with HIV from hands at all. accessing WASH facilities – 5. Health knowledge and health seeking behaviours This education material should be tightly integrated into all programming designed for people living with HIV Diarrhoea was cited by 90% of respondents as the most common – opportunistic infection faced by people living with HIV.
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