The ill-provision of water and sanitation services poses the greatest risk to people living with HIV and AIDS in South Africa – a majority of whom reside in slum settlements. People living with HIV and AIDS (PLWHA) die after succumbing to opportunistic infections, especially water-borne diseases (e.g., diarrhoea, cholera). This study was based on 485 individuals with HIV and AIDs drawn from three types of settlements (rural, peri-urban and urban slums) and sampled from three selected provincial districts of Khayelitsha (Western Cape), Ukhahlamba (Eastern Cape) and Groblersdal (Limpopo). The results show PLWHA having higher willingness-to-pay (WTP) for sanitation at ZAR448.40/month compared to water (ZAR428.60). Those living in urban slum settlements show the highest WTP for sanitation (ZAR552.70), followed by the ones in rural areas (ZAR500.24). The results underscore important implications: PLWHA face greater sanitation challenges relative to water; those in slum settlements endure the worst sanitation insecurity compared to counterparts living in other settlement types; higher WTP for sanitation implies that PLWHA will derive greater benefits from improvements in sanitation services relative to water. To conclude, it is imperative for municipal authorities to prioritize the provision of sanitation facilities to PLWHA especially in urban slums as part of the ‘pro-poor service delivery’ campaigns.

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