Facing two water crises: Having enough water and ensuring it's safe to drink

A market vendor in Bamako, Mali buys Aquatabs water purification tablets for her shop from a Palladium sales promoter. The tablets are one of several solutions for ensuring safe water at point of use. Photo: David J. Olson

This was originally published on Global Health TV on March 29, 2018.

We talk about a world water crisis like there’s only one but there are really two. The first crisis we see playing out in Cape Town – the growing number of places that do not have enough water of any kind. The second crisis is ensuring that the water people do have is safe to drink.

The city of Cape Town has just dodged a bullet – at least for 2018. Day Zero -- the day when dams levels reach 13.5% of capacity and the taps are turned off – was originally expected to take place in April, then pushed back to July. Now it has been postponed to 2019. This video shows how Capetonians are dealing with the crisis.

The three-year long drought hasn’t ended but severe water rationing has helped postpone disaster. The combined levels of dams supplying Cape Town is down to 22.7%, according to the city’s water dashboard. Capetonians have been asked to limit their water use to 50 liters (13 gallons) per person per day, and many have risen to the occasion (as a point of comparison, the average U.S. resident uses 367 liters per day, or 100 gallons).

Unfortunately, Cape Town is not an anomaly: Fourteen of the world’s megacities now experience water scarcity or drought conditions, according to Ecolab’s Water Risk Monetizer. 

New test to detect HIV in babies boosts hope of meeting UN targets

This was originally published on Global Health TV on October 25, 2016.

When Saquina, a 38-year-old single mother living in Nacala Porto, Mozambique, learned she was HIV positive while pregnant, she thought her life was over. Instead, she decided to accept her HIV status and follow the advice of the nurse who counseled her.

She did not miss any visits to the health center. She took the pills that helped prevent transmission of the virus to her unborn child. She participated in support groups with other HIV-positive mothers. When her son Frenchou was born, she gave him medication every day and breastfed him exclusively for six months.

When he was two years old, Frenchou was tested for HIV and found negative — another of many recent successes in the prevention of mother-to-child transmission (PMTCT), according to the Elizabeth Glaser Pediatric AIDS Foundation.

Between 2009 and 2015, there was a 60% decline in new HIV infections in children in the 21 priority countries, according to a UNAIDS report released in June. Seven of those countries reduced infections by more than 70%. A total of 1.2 million new infections among children were averted in these countries.

But if you thought thought that all is now well with PMTCT, and that we can move on to other HIV challenges, you would be mistaken. While a 60% drop is certainly encouraging, it is significantly below the 90% target set by the World Health Organization (WHO). UNAIDS has set a goal of eliminating all new HIV infections among children by 2020 while ensuring that 1.6 million children have access to HIV treatment by 2018.

In South Africa, an HIV campaign with a personal touch struggles to show its relevance

A Banake field worker talks to a family in Khayelitsha. Photo by Nicole Safker.

NOTE: This was originally published on the Knowledge4Health Blog on March 5, 2013.

Residents of Khayelitsha worry about a neighbour’s daughter who is only 13 but does not go to school because she cannot afford transport. She was raped by an old man. Her mother does not care and drinks a lot, swears at her about the rape and hits her. The child wants to go to school, so she went to stay in a neighbour’s home. The neighbour is also struggling and cannot afford the transport and school fees. – Banake Initiative Field Worker Diary

This is only one of many heart-breaking stories from the notes of field workers involved in an effort to improve communication among families affected by HIV/AIDS and encourage them to use HIV prevention services in Khayelitsha, the largest township of Cape Town, South Africa. The notes reveal shocking callousness and indifference on the part of township residents, but also compassion, like the neighbor who gave shelter to the 13-year-old girl.

The Banake Initiative was started in 2009 by DKT South Africa, an affiliate of DKT International, whose normal approach is focused on getting affordable health products and services to low-income people through the private sector. However, DKT decided that a different approach was required in South Africa, where HIV prevalence of people 15-49 has been stuck at around 17% since 2003 (the fourth highest rate in the world) despite years of work by many well-financed programs and the excellent availability of condoms (In November 2012, UNAIDS announced that the rate of new infections in South Africa had been reduced by 41% between 2001 and 2011).

AIDS prevention must be more of a priority

Everyone working in HIV/AIDS -- as I have been for 17 years since I founded Society for Family Health, the leading HIV prevention organization in Zambia in 1992 -- has heard the aphorism "We can't treat our way out of this epidemic" and everyone knows that for every person that goes on treatment, there are several more new infections.

Both Randall Tobias and Mark Dybul, the first two PEPFAR coordinators, always said that HIV prevention was a priority. But in reality, prevention was never a priority with PEPFAR and could never be a priority since the law that created PEPFAR hamstrung prevention efforts by limiting them to 20% of the budget. And the bitter political battles swirling around HIV prevention during the eight Bush years prevented an evidence-based formula for measuring the number of HIV infections from being implemented. Instead, PEPFAR was reduced to measuring prevention with process indicators such as messages transmitted and campaigns conducted.

I thought of all of this today when reading the press accounts of the visit of Secretary of State Hilary Clinton to HIV/AIDS programs supported by the U.S. government in South Africa. Treatment dominated Secretary Clinton's visit and understandably so, given the fact that South Africa has more HIV-positive people than any other country in the world. But where is prevention in all of this? After all, even South Africa, with its vastly greater resources as compared to any other sub-Saharan African country, cannot treat its way out of its epidemic.

That is why I was so pleased to see, hidden at the end of today's Washington Post account of Secretary Clinton's visit to South Africa, the following paragraph:

"U.S. Rep. Nita M. Lowey (D-NY), the head of the House Appropriations subcommittee that funds foreign aid programs, said at the ceremony that she hopes to see more assistance going toward prevention, rather than just treatment."

Bless the heart of Rep. Lowey for reminding us of this simple fact: We will never get ahead of the AIDS pandemic until we focus more on prevention, which continues to be grossly neglected. It is so much easier -- although much, much less cost-effective -- to treat people after they have been infected than to prevent the infection in the first place.

And it is awfully messy -- not to mention politically perilous -- to protect injecting drug users, sex workers and the men who patronize them, and even more controversial when we direct efforts at adolescents who most adults would prefer to pretend will be celibate until marriage.

Thanks to Rep. Lowey for reminding us of the importance of prevention, and let's hope Eric Goosby, the incoming PEPFAR coordinator, hears her plea, and directs more PEPFAR resources into prevention, finally. The future of the pandemic depends on it.