Socioecological drivers and dimensions of household water insecurity among people with HIV in the Lake Victoria region, Kenya

Abstract

ABSTRACT Conceptual diagram showing socioecological drivers in the first column. They include environmental stressors, infrastructural inadequacies, and socioeconomic deprivations with corresponding images. One bold arrow points from these three drivers toward dimensions of water insecurity, which include availability, access, and quality. The arrow shows that socioecological drivers shape the manifestation of water insecurity. A final bold arrow from the three dimensions points to potential downstream links to HIV treatment interruptions, water-related illnesses, and psychosocial distress among people with HIV (PWH). Socioecological drivers shape the availability, access, and quality dimensions of household and communal water insecurity among PWH in the Lake Victoria region, Kenya. Downstream impacts on HIV and mental health are shown as conceptual pathways informed by existing literature and were not directly measured in this study. Despite progress in HIV management, resource insecurities continue to threaten the gains of antiretroviral therapy among people with HIV in resource-limited settings. Water insecurity, common in areas with high HIV burden, remains an underexplored barrier to optimal HIV care. This study assessed socioecological drivers and dimensions as determinants of water insecurity among 434 adults with HIV receiving care in public hospitals in a high HIV prevalence region of western Kenya. We used the 12-item Household Water Insecurity Experiences Scale and found a water insecurity prevalence of 64.3% among participants, with 22.4% having severe water insecurity (score ≥24). Drought (96.8%), poverty (90.3%), and poor infrastructure (90.1%) were frequently cited drivers, while affordability (82.4%), flooding (85.4%), and microbial contamination (75.7%) were common dimensions. Female participants had nearly four-fold higher odds of water insecurity (AOR = 3.65, 95% CI: 2.02–6.58), and temporary housing structures (AOR = 3.10, 95% CI: 1.75–5.51) and larger households (AOR = 1.23 per additional person, 95% CI: 1.09–1.39) further increased vulnerability. Water contamination and distant sources were also independent predictors. Water insecurity among PWH in Kisumu County is severe, multidimensional, and gendered, demanding integrated, multisectoral, and climate-resilient interventions within HIV care.