Poor water, sanitation and hygiene practices exert a particularly heavy toll on people living with HIV/AIDS because of their vulnerability to opportunistic infections and loss of dignity. Diarrhea is one of the most common symptoms of HIV and AIDS, affecting 90 percent of people living with HIV/AIDS and resulting in significant morbidity and mortality (Katabira 1999; Monkemuller and Wilcox 2000). Research on co-infection of diarrhea and HIV and AIDS shows that morbidity and mortality due to diarrheal disease is many times more severe in children with HIV and AIDS. Controlling the spread of diarrhea and opportunistic infections experienced by HIV positive individuals is critical for their quality of life and the health of others in the household. The World Health Organization estimates that 85 to 90 percent of diarrheal illnesses in developing countries can be attributed to unsafe water and inadequate sanitation and hygiene practices (Pruess-Ustun et al. 2004).

To this end, in the last five years, The Hygiene Improvement Project (HIP), a USAID-funded initiative led by AED in partnership with The Manoff Group, ARD Inc., and IRC International Water and Sanitation Centre, has worked around the world, developing best practices, innovative tools and evidenced-based approaches for integrating water, sanitation and hygiene (WASH) into HIV/ AIDS programming. At the research, policy and planning, health facility, community, and household levels, we have explored the important overlap between WASH and HIV and have developed concrete ways for how to integrate improved WASH into HIV programs in order to attain positive health outcomes.  Our emphasis has been on the promotion of four key behaviors: including hand washing with soap; safe management of feces; safe treatment, handling and storage of water; and appropriate handling of menstrual blood. This work has resulted in numerous resources ranging from a literature review to policy guidance to communication and training tools.

We have assembled and organized the set of publications in this kit in order to provide a one-stop resource for anyone seeking guidance on HIV/AIDS-WASH integration. We foresee this resource kit being useful for program managers seeking information on expanding or creating an integrated program, for home-based care organizations seeking to integrate WASH into their household and community level interventions, for U.S. Government representatives seeking a strategy for planning and justifying supporting integration and for any other audience seeking to learn more about this critical intersection. Please note that the programmatic tools contained in this set of resources were developed by HIP in Uganda and Ethiopia but have since been expanded to other countries and are adaptable to any context.

Our resources are organized into the following folders:

• The Evidence Base
• PEPFAR as a Mechanism for Integration
• Integration in Policies and Guidelines
• General WASH & HIV Integration Guidance
   
• Integration into Programs: Training and Support Materials
• By Country
  • Kenya
  • Uganda
  • Ethiopia 
  • Tanzania
• By Behavior
  • Handwashing
  • Water Treatment and Storage
  • Feces
  • Menstrual Blood
• Assessment, Monitoring and Evaluation of Integration