AIDS and Behavior

, Volume 17, Issue 5, pp 1675–1682 | Cite as

HIV and H2O: Tracing the Connections Between Gender, Water and HIV

  • Brooke S. West
  • Jennifer S. Hirsch
  • Wafaa El-Sadr
Substantive Review


The health consequences for HIV-affected families of insufficient access to safe water and sanitation are particularly dire: inadequate access complicates medication adherence and increases vulnerability to opportunistic infections for persons living with HIV. The gendered nature of water collection and HIV care—with women disproportionately bearing the burden in both areas—presents an unrealized opportunity to improve HIV outcomes through investments in water/sanitation. We synthesize the literature on HIV and water/sanitation to develop a conceptual model that maps the connections between women’s double burden of resource collection and HIV care. Drawing on theories of gender and systems science, we posit that there are multiple paths through which improved water/sanitation could improve HIV-related outcomes. Our findings suggest that the positive synergies of investing in water/sanitation in high HIV prevalence communities that are also expanding access to ART would be significant, with health multiplying effects that impact women and entire communities.


Water and sanitation Gender HIV Antiretroviral therapy Sub-Saharan Africa 



This study was funded by a Seed Grant from the Department of Sociomedical Sciences at the Mailman School of Public Health, Columbia University, New York, NY. We would like to thank Les Roberts for his feedback on an early draft of this manuscript. We would also like to thank Daniel M. Sheehan, the Institute for Social and Economic Research and Policy (ISERP) and the Columbia Population Research Center (CPRC) at Columbia University for assistance with GIS mapping and imaging.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Brooke S. West
    • 1
  • Jennifer S. Hirsch
    • 1
  • Wafaa El-Sadr
    • 2
  1. 1.Department of Sociomedical Sciences, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  2. 2.Mailman School of Public HealthICAP-Columbia UniversityNew YorkUSA

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