Viorica Peta Biology 1615; 4pm class Fall Semester Lata Moses March 20,2014

Effect of home-based water chlorination and safe storage on diarrhea among persons with human immunodeficiency virus in Uganda
Introduction
Human Immunodeficiency Virus (HIV) infection weakens peoples immune system, making them highly susceptible to all sorts of infections and certain types of cancers. Bad water and pathogens affect HIV/non HIV people differently; people infected with HIV are more vulnerable to death and illness than those that are not infected. Based on the article, it was found that worldwide, more than 34 million people are infected with HIV and 3.3 millions are under the age of 15.Due to the indigent living conditions 5-30% of sub-Saharan African population is infected with HIV, which leads to a high risk of diarrhea. HIV itself is also a potential cause of diarrhea and poor living conditions and limited access to drinking safe water have the chances to affect peoples social life. For a great majority of people with HIV that live in regions where access to wash is the most

important; the risk of different infections is very high, including diarrhea; which presents profound challenges for healthcare providers and policy makers. The lack of wash is also leading cause to morbidity and mortality among HIV people.

Materials and Methods

In order to reduce the risk of diarrhea disease, scientists added Safe Water System (SWS) locally produced a sodium hypochlorite solution among persons with HIV in Uganda and in addition, it has been shown that cotrimoxazole prophylaxis decreases the incidence of diarrhea among people with HIV. During testing, it was performed a randomized controlled trial of a home-based, safe water intervention on the frequency and severity of diarrhea among persons with HIV. Between April 2001-November 2001,509 HIV persons and 1,521 negative HIV received a closed-mouth plastic container, a dilute chlorine solution, and hygiene education. During the experiment people with HIV received one 500ml bottle of 0.5% sodium hypochlorite solution, a cloth and basic hygiene education. After 5 months, in order to reduce the incidence of diarrhea it was evaluated two interventions, SWS and cotrimoxazole; participants being people from Uganda who have had bad water. Weekly visits and questionnaire were taken place. During testing it was provided samples throughout study to test for viral content. In the samples was determined which pathogens were resistant to treatment and samples were stored in sterile and on ice containers.

Results
No significant difference between intervention comparison groups in a baseline demographic characteristics, HIV status, and CD4 cell count was found. It was collected the water samples from the Uganda population (more than 90%), and it was detected Escherichia coli (E. coli). During water testing E. coli contamination were found. In result, the water was boiled-not treated and persons with HIV+ had more episodes on diarrhea than people with HIV-.The median E.coli counts of the contaminated water samples evaluated in October 2002 did not differ by arm and the use of water sources for hand washing increased in intervention from 74.9% to 90.4%. When compared, persons with HIV+ versus persons HIV-, had more diarrhea and more days of work or school lost due to diarrhea and cotrimaxozole prophylaxis among persons with HIV+ was associated with fewer diarrhea episodes. In result together, cotrimaxozole and SWS reduced diarrhea episodes by 67%.

Discussion/Conclusion
Overall, it was concluded that people with HIV+ had 25% fewer episodes of diarrhea;33% fewer days on diarrhea and 24% fewer episodes on diarrhea with blood or mucous in stool. The effects of SWS and cotrimoxazole on diarrhea were complementary. Benefit people from SWS were kids 3-12 years old, and the elder >59 years old. The sicker with HIV+ you are the more diarrheas you have, to treat HIV you dont have to have dirty water. In conclusion people with HIV+ should live

in clean areas and drink clean water. Safe water system SWS have been shown to reduce diarrhea and death. It is important to determine the cause of diarrhea so that the best treatment can be offered. Diarrhea remains a common problem in people with HIV+. HIV itself is also a potential cause of diarrhea. Based on our studies a home based SWS reduced diarrhea frequency and severity among people with HIV+ living in Africa and large scale of accomplishments should be considered. In addition to that intervention such as SWS that prevents diarrhea could potentially slow down the advancement of HIV disease. The results of this study support the statement by Lee Songbook, the Director-General of the World Health Organization, that successful treatment of HIV depends on safe

water.Antiretroviral treatment prolongs lives, but winning the war against the pandemic demands a combination of medicine, food, and clean water. Simple, inexpensive interventions such as the SWS and cotrimoxazole prophylaxis should be considered as components of a basic care package provided to all persons with HIV.