title: The impact of flooding on people living with HIV: a case study from the Ohangwena Region, Namibia.
abstract: BACKGROUND
  Floods are a disaster situation for all affected populations and especially for vulnerable groups within communities such as children, orphans, women, and people with chronic diseases such as HIV and AIDS. They need functioning health care, sanitation and hygiene, safe water, and healthy food supply, and are critically dependent on their social care and support networks. A study carried out in the Ohangwena region, Namibia, where HIV prevalence is high and extensive flooding frequently occurs, aims to provide a deeper understanding of the impact that flooding has on people living with HIV (PLWHIV) as well as on HIV service providers in the region.
  
  
  METHODS
  The qualitative research applying grounded theory included semi-structured interviews with PLWHIV, focus group discussions with HIV service providers, and a national feedback meeting. The findings were interpreted using the sustainable livelihoods framework, the natural hazard research approach, and health behaviour theories.
  
  
  RESULTS
  The study reveals that flooding poses major problems to PLWHIV in terms of their everyday lives, affecting livelihoods, work, income, and living conditions. The factors threatening them under normal conditions - poverty, malnutrition, unsafe water, sanitation and hygiene, limited access to health facilities, a weak health status, and stigma - are intensified by flood-related breakdown of infrastructure, insecurity, malnutrition, and diseases evolving over the course of a flood. A potential dual risk exists for their health: the increased risk both of infection and disease due to the inaccessibility of health services and antiretroviral treatment. A HIV and Flooding Framework was developed to display the results.
  
  
  CONCLUSIONS
  This study demonstrates that vulnerabilities and health risks of PLWHIV will increase in a disaster situation like flooding if access to HIV prevention, treatment, care and support are not addressed and ensured. The findings and the HIV and Flooding Framework are not specific to Ohangwena and can be transferred to any flood-affected region that has a high HIV prevalence and relies mainly on subsistence agriculture. They serve as a model case for analysing vulnerabilities related to health and health service provision under disaster conditions. The impact will vary according to the physical, geographical, climatological, social, and behavioural characteristics of the region and the people affected. In the Ohangwena region, a disaster risk management mechanism is already in place which addresses people with HIV during flooding. However, preparedness could be improved further by applying the HIV and Flooding Framework.
authors: Institute for Hygiene and Public Health, WHO CC for Health Promoting Water Management and Risk Communication, University of Bonn, Bonn, Germany; carmen.anthonj@ukb.uni-bonn.de.
authors: Carmen
authors: C
authors: Anthonj
authors: Directorate of Special Programmes, Ministry of Health and Social Services (Ohangwena Region), Eenhana, Namibia.
authors: Odon T
authors: OT
authors: Nkongolo
authors: Institute for Hygiene and Public Health, WHO CC for Health Promoting Water Management and Risk Communication, University of Bonn, Bonn, Germany.
authors: Peter
authors: P
authors: Schmitz
authors: Directorate of Special Programmes, Ministry of Health and Social Services (Ohangwena Region), Eenhana, Namibia.
authors: Johannes N
authors: JN
authors: Hango
authors: Institute for Hygiene and Public Health, WHO CC for Health Promoting Water Management and Risk Communication, University of Bonn, Bonn, Germany.
authors: Thomas
authors: T
authors: Kistemann
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000628:therapy; D000328:Adult; D003695:Delivery of Health Care / Q000458:organization & administration*; D004190:Disasters; D005260:Female; D055868:Floods; D066296:Grounded Theory; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D006920:Hygiene; D008297:Male; D008875:Middle Aged; D009276:Namibia / Q000453:epidemiology; D011203:Poverty; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012499:Sanitation; D011795:Surveys and Questionnaires
keywords: HIV and AIDS; Namibia; disaster preparedness; flooding; food security; vulnerability