However, water and sanitation facilities and services are grossly lacking
in both rural and urban areas of Africa and Asia. In sub-Saharan Africa about 44% of people lack an improved water supply and a shocking 63% have no access to basic sanitation . The Millennium Development Goals have set a target to halve by 2015 the proportion of people living without sustainable access to a safe drinking water supply and basic sanitation. But many working in the sector believe that the data underestimates the needs, and in addition have serious doubts about whether we shall approach the achievement of those targets. However, even if great progress is made in the next decade, hundreds of millions of people will remain without a safe water supply and well over a billion without a moderately decent sanitation system. These people will be those living in the poorest conditions, the most difficult to ‘reach’. Better targeting and prioritization of effort and resources is still needed. As described here, those affected by HIV/AIDS are amongst the most vulnerable and their particular needs must be given priority.

The points made clearly in this paper, based on detailed research, include many of the general issues that have been promoted as good practice in the water and sanitation sector for at least twenty years. These include better consultation with the users in planning both approaches and facilities, building on local knowledge and practices, and improving coordination with other sectors, such as health and education, and with other programmes, in this case home-based care services. Sadly, too many water, sanitation and hygiene projects still do not take sufficient consideration of these issues. However, people living with HIV/AIDS and their families, as well as carers, communities and others affected by the disease have particular needs, most of which, as described here, can be simply addressed if we only consider them in planning how to do our work.

This paper is a useful and striking addition to the limited literature on this important subject. But such research and writing is not enough. The messages put so clearly here must be taken to heart by the thousands involved in the HIV/AIDS and environmental health sectors. It is important that those working with international and local NGOs, as well as local government departments, should modify their attitudes, thinking and practices; equally, donors, who support such programmes, need to adapt their funding strategies to support those working in appropriate ways. Together, they can make a huge difference to the lives of those suffering from the HIV epidemic.

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