How does toilet access influence pregnant and breastfeeding women’s adherence to HIV medication?

Access to adequate sanitation, including access to toilet facilities, increases human dignity and promotes health. Pregnant and breastfeeding women have an increased need for access to toilet facilities and potable water. This is especially true for women receiving antiretroviral therapy (ART) to manage HIV, who have an increased demand for toilet facilities due to side effects such as diarrhea, nausea, and vomiting. This treatment is crucial in eliminating transmission of HIV from pregnant and breastfeeding mothers to their children. 

Anti-retroviral drugs

Anti-retroviral drugs

Women living without access to toilet facilities may intentionally skip their medication to avoid having to find a place to use the toilet more frequently due to the treatment’s side effects. Newly published research from Bixby member Dr. Jerry Nutor sought to understand how access to different types of toilet facilities could influence a woman’s intent to adhere to ART. This study also looked at how this intention was influenced by demographics and knowledge about HIV transmission.

Researchers surveyed 150 pregnant and breastfeeding women receiving antiretroviral drugs in effort to prevent HIV transmission to their infant in rural and urban parts of Zambia. Researchers found that significantly more participants from the rural district reported low intention to stick with the treatment than from the urban district. They also found that rural women with less knowledge about transmission were more likely to reported low intention to adhere to ART.

After adjusting for demographic factors, researchers found that urban women were more likely to report higher adherence if they had access to a pit latrine or no toilet access rather than access to a flush toilet. Rural women were significantly more likely to report lower adherence with the same facilities. The majority of urban dwellers have access to flush toilets, though they may face challenges using them if there is no running water. Previous research has found that when there is a lack of access to water, urban dwellers have to use unhygienic pit latrines or nearby drains; women who may not feel comfortable doing so may have lower ART adherence intention during that time. Overall, the study indicates that just having a sense of a comfortable toilet may be sufficient motivation for higher ART adherence intention.

These findings speak to the need for communities to consider sanitation conditions and housing as important determinants of health outcomes. However, more research is needed to examine the relationship between toilet access and health/wellbeing for women living with HIV in low resource countries. Future research should expand on understanding why and how toilet access can influence ART adherence intention.