Water, sanitation and hygiene in community and home-based care for people living with HIV/AIDS/TB in Durban, South Africa.

Abstract

The majority of HIV/AIDS patients in South Africa receive health care services at home. However, few studies have examined water; sanitation and hygiene (WASH) in home and community-based care. The main objective of this study was to explore community health workers’ (CHWs) perceptions of WASH in home-based care and the implications for people living with HIV/AIDS/TB, their family members and the health workers themselves. The participants in this qualitative study were drawn from four community home-based care organizations that provide care to HIV/AIDS/TB clients. These organizations are located in four marginalized communities in Durban. Data was collected using participant observation of care-giving activities; semi-structured interviews with five home-based care project managers from the organizations and five focus group discussions with a total of 49 CHWs. Some AIDS patients are incontinent. It is typical for CHWs to find patients in closed areas with bedding soiled by urine and feces. It was found that CHWs had limited access to protective materials such as gloves and aprons and therefore tended to avoid carrying out activities that could help maintain proper hygiene in the home for fear of infection. Furthermore, limited access to water and an unreliable water supply meant that CHWs had to fetch water from immediate neighbors or surrounding areas and this limited the time spent with their patients. The unavailability of water had ramifications for the number of times patients could bath. Insufficient water also presented a challenge to CHWS and families in maintaining proper sanitation. There is a great need for adequate water, proper sanitation and hygiene in community-based care. Inadequate access to water influences sanitation and hygiene, and this affects the work of CHWs. The government needs to respond promptly to the water and sanitation needs of marginalized communities with limited resources. The study’s findings have implications for policy on WASH and community-based care in low-income communities.