# Identifying the mechanisms of water insecurity on HIV treatment outcomes

> **NIH NIH R56** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2024 · $722,368

## Abstract

Project Summary / Abstract
Water insecurity (WI) is a major challenge in sub-Sharan Africa (SSA), where the number of people living with
HIV (PLWH) is disproportionately higher, and where populations are most likely to bear the impact of climate
change. The effects of water insecurity on health are well-documented in SSA: emotional distress is associated
with lack of safe water, including fear of contamination, worry over safety, and anxiety, increased migration and
thus HIV risk, as well as disruptions to health, care engagement, livelihoods, and relationships. Further, the
prevalence of WI among PLWH is high, and household WI and food insecurity (FI) lead to poor mental and
physical health. WI is also an important determinant of FI, suggesting multiple causal pathways to poor health
outcomes. While SSA least contributes to global warming, especially as compared to more industrialized
nations, it is expected to be amongst the hardest by climate change. Water is required for food production and
preparation8, and WI may directly and indirectly influence health outcomes by impacting FI and health. Among
PLWH, WI can lead to dehydration and undermine PLWH’s ability to manage unpleasant side effects
associated with ART, including diarrhea, nausea, and vomiting. In Ghana, one of the most vulnerable countries
to climate change in SSA, flooding affects around 45,000 Ghanaians annually while nearly half of Ghana’s
coastline is vulnerable to erosion and flooding as a result of sea-level rise and atypical rainfall. Further, an
estimated 70% of all disease burden in Ghana is attributed to WI. To effectively intervene, a deeper
understanding of the drivers of and sequelae of WI is critical. Therefore, we propose the first longitudinal
convergent mixed-methods study to quantify and elucidate the impact of WI on HIV, related to climate-related
drivers, infrastructure challenges, water accessibility, and heightened risk of water-borne diseases, to inform
interventions to address WI among PLWH. In Aim 1, we will utilize innovative remote sensing technologies to
investigate the role of climate-sensitive patterns (droughts, precipitation anomalies, and floods, capitalizing on
state-of-the-art satellite technologies) and seasonality on WI in Ghana. In Aim 2, we will determine the impact
of WI on HIV treatment outcomes (ART adherence/viral suppression) and opportunistic infections and
comorbidities, and the mechanisms through which WI may influence these outcomes (nutritional, mental
health, water, hygiene and sanitation, and empowerment pathways). In aim 3, using intervention mapping
framework, we will develop intervention options to mitigate WI and improve health for PLWH, synthesized from
theory and literature. Findings from this R01 will a) provide initial data on the drivers of and sequelae of WI and
it impact on HIV treatment outcome; b) guide the integration of HIV and water access programs; and c) help
identify and prioritize intervention development to addr...

## Key facts

- **NIH application ID:** 11077151
- **Project number:** 1R56MH134671-01A1
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Jerry John Ouner
- **Activity code:** R56 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $722,368
- **Award type:** 1
- **Project period:** 2024-07-01 → 2025-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11077151

## Citation

> US National Institutes of Health, RePORTER application 11077151, Identifying the mechanisms of water insecurity on HIV treatment outcomes (1R56MH134671-01A1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/11077151. Licensed CC0.

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