Join the Toilet Revolution

By Eric Bond | November 19, 2013

People with HIV can live better and healthier lives through improved access to water, sanitation, and hygiene.

Jon Hrusa/Swaziland

Clean water and sanitation. If you have them, you probably rarely think about them. But if you don’t, your everyday life is much more complicated and your health is at much greater risk—especially if you are living with HIV.


Since 1990, almost 2 billion people have gained access to improved sanitation, according to UNICEF. This is good news, especially for children younger than age 5. The World Health Organization (WHO) reports that infant mortality is decreasing worldwide — and better access to clean water and sanitation is a prime reason, along with better access to nutritious food.


Still, sub-Saharan Africa lags behind the rest of the world. According to a resource guide published through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), only half of the people in sub-Saharan Africa have access to sanitary water sources and only slightly more than one third have access to sanitary waste disposal.


Children Living with HIV Need Clean Water

According to PEPFAR, people with HIV can live better and healthier lives through improved access to water, sanitation, and hygiene. (WASH). The main components of WASH are safe water (water that can be consumed without risk), sanitation (safe disposal of human waste), and hygiene (a personal environment that is relatively germ-free).

Unsanitary water is the leading cause of diarrhea, which endures without access to sanitary waste disposal and clean water. Diarrhea starves the body of nutrition and water, both of which are necessary to young bodies fighting HIV.

Fifty percent of the people living with HIV suffer from chronic diarrhea caused by infectious agents, weakening their immunity and contributing to disease progression. Children living with HIV cannot get complete benefits of antiretroviral medications (ARV’s) if they suffer from diarrhea because the drugs cannot be fully absorbed before leaving the digestive tract.

Clean water, however, can reduce diarrhea among people living with HIV by as much as 65 percent.

Children Living with HIV Need Toilets

People don’t like to talk about it, but as the popular children’s book proclaims, “Everybody Poops.”


Chief Macha of Choma, head of the 114 villages in southern Zambia has not shied away from this important public health issue. He has led a movement to improve sanitation. He calls it “the Toilet Revolution.” According to Chief Macha, efforts to treat epidemics like HIV, tuberculosis, or malaria are hobbled if patients live in unsanitary conditions.


Although HIV is not transmitted through waste or water, people living with HIV are susceptible to many of the opportunistic infections that are transmitted through germ-infested living conditions.


Highlighting the enormity of the problem in some communities, Chief Macha told an Al Jazeera reporter, "I am the chief of this place, and I have no running water and my toilet is outside my house…. imagine the rest of the people, if it is so for me." 


Though he still lacks indoor plumbing, Chief Macha has succeeded in creating sanitary waste disposal for his family—and for everyone in his chiefdom. After two years of working with his constituents to build latrines, sanitation coverage improved from 50 percent to 100 percent.


By outlawing open defecation in Choma, Chief Macha has succeeded in dramatically decreasing the number of diarrhea cases among his constituents, according to a case study by the United Nations Children’s Fund (UNICEF).


The results in Chief Macha’s chiefdom highlight the progress that can be made through a focused effort.


Join the Toilet Revolution by raising awareness about World Toilet Day on Nov. 19. The World Toilet Day website includes a petition to world leaders to follow through on promises to improve sanitation as well as ideas for talking about a basic human topic that most people tend to avoid.


Our friends at WASH Advocates are looking for support for the Water for the World Act 2013, which will improve the efficacy of U.S. foreign aid for clean water, sanitation and hygiene programs. Water for the World will make sure that WASH is a priority for the U.S. Agency for International Development (USAID). It will prioritize funds to communities that most need WASH services. And it will institute “best practices for effective aid,” making sure that funds are spent wisely.


Eric Bond is EGPAF’s Senior Writer, based in Washington, D.C.