Extract from an article for the Water Wheel "The Links between AIDS, Water, Sanitation and Hygiene Experiences from Jeppe’s Reef, Mpumalanga" By Alana Potter and Virginia MoloseJeppe’s Reef is a peri-urban settlement in the west of the Nkomazi LM area in Mpumalanga. It is situated in the fertile Nkomazi valley, in close proximity to the Mozambique and Swaziland borders.
According to the 2001 Census, there are approximately 5200 households in Jeppe’s Reef, with an average of 6 members per household. The majority of the population is between 15 and 34 years.
Most of the population is unemployed and make their livelihoods from social grants, informal enterprises and limited livestock and food production. At least 15% of the local residents are immigrants or refugees from Swaziland and Mozambique and have difficulty accessing social support.
Jeppe’s Reef is serviced by a clinic and the Shongwe public hospital located about 3 km’s from the centre of the settlement.
HIV/AIDS in Jeppe’s Reef
While accurate HIV infection statistics are not available in the area, in a random sample of 15 households visited, seven households contained people who were actively ill, or taking TB or ARV medication.
Having worked in HIV/AIDS care in Jeppe’s Reef for more than 10 years, the co-founder of the iThemba Lethu Home Based Care (HBC) Group said “All I can say is that this area is dying and we are hardly scratching the surface – more than half the households we visit have someone who is sick, mostly young people.” (Bridgette Moyana).
The home-based caregivers interviewed indicated that it had taken years to encourage noticeably sick people to get tested and treated, and that denial was a big part of the problem. “Most people know about it but don’t believe people are sick until they see it. Some are locked away and their families refuse care – they say no one is sick here” (Rose Moyana).
Many people report stigma and discrimination on revealing their HIV status – “The young boys would find me collecting water from the tap and point fingers and say AIDS AIDS AIDS” (Esther Ngosi).
The Shongwe hospital is providing ARV treatment, mostly in the later stages of infection and after a long wait, and obviously only to people who are willing and able to be tested and know their status. The HBC Groups interviewed also reported that the municipality did not accept that HIV was a serious problem and claimed they were exaggerating in order to access donor funding.
Water and sanitation service provision
According to the Nkomazi IDP (2003), 41% of households receive water from communal standpipes at 200 meters, 36% receive water below RDP level, and 14% have yard connections. There are communal standpipes throughout Jeppe’s Reef. Water supply from these standpipes is controlled and only accessible between 6 and 10 in the morning.
Most households have pit latrines; some have VIP toilets implemented 5-10 years ago, and a limited number have VIPs recently implemented by the Nkomazi LM. The IDP states that 55% of households have VIPs, 20% have unimproved pits and 13% have no sanitation service at all.
What is Home Based Care doing?
Home-based caregivers undertake a range of activities, including fetching water, bathing patients, washing, laundry, digging pits for solid waste disposal, cleaning households and yards, assistance with access to social, health and other services, and providing counselling, information and support. The iThemba Lethu HBC Group also provides household food gardening training and support.
Water and sanitation needs of infected and affected households
Controlled water supply makes it difficult for home based caregivers to carry out their activities, and compromises the impact of health and hygiene education and promotion carried out by community health workers.
“When water is not in the yard and also comes out at particular times only, it makes it very difficult for us to wash clothes, clean houses and bath our patients when we visit them during our house call duties” (Christina Thwala).
Members of HBC groups indicated that they require 200 litres of water a day to care for their patients – 75-100 litres for laundry and the rest for cooking, bathing and drinking.
With regards to toilets, it was felt that “spiral toilets are not good for households with sick people, as often we need to carry or accompany a person to the toilet because they are too weak to walk. The spiral toilet does not make it easy for two people to fit in it, but we are very happy about the VIPs that are there” (Sarah Baloyi).
Many AIDS infected households interviewed had unauthorised connections to communal standpipes. “I was too weak to fetch water from down the road and the children would not help me, so I bought the pipes and connected up” (Mary Ndlovu). While there seemed to be a degree of tolerance of this on the part of other households, this will ultimately affect the flow rate and sustainability of scheme.
The home-based caregivers interviewed said their work would be more effective if AIDS-affected households could have taps in their yards. They felt this would enable them to nurse and care for greater numbers of sick people rather than waiting and collecting water from standpipes.
The also felt this would also enable household level food production, as good nutrition is crucial for the immunity of HIV+ people and for taking ARV medicine. Although trench gardening is used, there is not enough water to sustain food gardens in the dry season.
Experiences of people living with HIV/AIDS
“I have moved here to care for my son who is sick. We are just back from the doctor for stomach medicine. It cost me R50. We are not paying for water and there is plenty until 11 o clock in the morning. There is no food and we can’t grow food because the goats come and eat it”.
Thandi Mazibuzo
“I was too sick to get up and then I got the medicine. Now you see me I am well. Thandi has taught me food gardening and I eat spinach and beetroot with my mother and father. I need this food for the medicine. Now people are not so tired of me anymore because I am not so sick. The water for my garden comes from this pipe from the tap down there, but my toilet is full and we have a problem – how will I dig another one? So I use a bucket”.
Esther Ngosi
“My child is in grade 8 and must be tested but I am afraid the children will tease her. There are many people who are sick here but they cant get medicine and they are dying. Our toilets are old and we can’t get another one. There is also not enough water”.
Matetiwe Mhlanga
“If we had money we would buy a pipe and connect to the tap, but there is no money. The child fetches our water in this wheelbarrow in the morning before school but sometimes he doesn’t come and we have to wait till the next day”.
James Mhlabane, elderly man
