Water Insecurity is Associated with Lack of Viral Suppression and Greater Odds of AIDS-Defining Illnesses Among Adults with HIV in Western Kenya

Abstract

Reliable access to safe and acceptable water in sufficient quantities (i.e., water security) is important for medication adherence and limiting pathogen exposure, yet prior studies have only considered the role of food security as a social determinant of HIV-related health. Therefore, the objective of this analysis was to assess the relationships between household water insecurity and HIV-related outcomes among adults living with HIV in western Kenya (N = 716). We conducted a cross-sectional analysis of baseline data from Shamba Maisha (NCT02815579), a cluster randomized controlled trial of a multisectoral agricultural and asset loan intervention. Baseline data were collected from June 2016 to December 2017. We assessed associations between water insecurity and HIV-related outcomes, adjusting for clinical and behavioral confounders, including food insecurity. Each five-unit higher household water insecurity score (range: 0–51) was associated with 1.21 higher odds of having a viral load ≥ 1000 copies/mL (95% CI 1.07, 1.36) and 1.26 higher odds of AIDS-defining illness (95% CI 1.11, 1.42). Household water insecurity was not associated with CD4 cell count (B: 0.27; 95% CI −3.59, 13.05). HIV treatment and support programs should consider assessing and addressing water insecurity in addition to food insecurity to optimize HIV outcomes.

HIV Sero-Status of Health Care Workers in Addis Ababa Public Hospitals After Post-Exposure Blood and Body Fluids: A Cross-Sectional Study, October 2022

“…This is comparable with the study that was reported from South Africa (4%), 20 Tanzania (3%), 21 and Nigeria (4.2%). 22 However, the result is much higher than the studies conducted in Iran (1.7%), 23 Australia (2.1%), 24 Kenya (1.5%), 25 and Tunisia (1.7%). 26 This discrepancy may be due to variation among the study participants, a lack of PPE, a higher patient load, and the infrequent use of PPE among participants in this study setting.…”

“…This is supported by many studies, such as those in Tunisia, 26 South Africa, 20 and Kenya. 25 The reason could be described as the availability of PPE in healthcare facilities influencing HCWs’ habits of using PPE during patient care and procedures, thereby reducing exposure to HIV and its impact on the outcome of exposure. Furthermore, the infrequent availability of PPE reduced HCWs’ compliance to wear PPE such as a glove, face mask, face shield, and apron, potentially amplifying their exposure to HIV infection; and finally, increasing the transmission of blood-borne pathogens.…”

HIV sero-status of healthcare workers in Addis Ababa public hospitals post exposure to infected blood and body fluids: A cross-sectional study, October 2022

“…HCWs who were midwives had four times higher odds of testing positive for HIV (AOR = 4.2, 95% CI: 3.17, 8.21). This is supported by many studies, such as those in Tunisia [27], South Africa [21], and Kenya [26]. The reason could be described as the availability of PPE in healthcare facilities, influencing HCWs' habits of using PPE during patient care and procedures, thereby reducing exposure to HIV and its impact on the outcome of exposure.…”

Water insecurity and gender‐based violence: A global review of the evidence

“…In this case, women who have experienced injuries or been subjected to violence are less physically able to collect water, creating further risk for scarcity in the household and related repercussions for nutrition and health. Water insecurity co‐occurs and exacerbates food insecurity (Brewis et al, 2020; Wutich & Brewis, 2014), HIV (Krumdieck et al, 2016; Nagata et al, 2021; Workman & Ureksoy, 2017), and COVID‐19 (Adams et al, 2021; Staddon et al, 2020; Stoler, Jepson, & Wutich, 2020). Water is also integral to sanitation and hygiene (Choudhary et al, 2020), increasing the potential for deleterious, syndemic interactions between water‐related infectious diseases, malnutrition, and dehydration.…”