Researchers, activists, practitioners and policy-makers have grappled with the challenge of providing people living with HIV (PLHIV) with an adequate amount of safe water. Comprising 13% of the overall population of South Africa in 2018, 7.52 million PLHIV need water for drinking and taking medication; preparing food; and personal hygiene and cleaning to minimise infections. This article examines the responses of the different stakeholders to this challenge and their impact on the water and health policy process. It finds that activists were able to emphasise the dimensions of the challenge; practitioners worked to implement provision more effectively within existing policy frameworks; and a range of stakeholders made a thoughtful and promising policy proposal for direct action, which the Department of Water and Sanitation ultimately failed to embrace. This article is based on an extensive review of academic research and publications by development agencies on HIV and water as well as engagement with policies and documents in the South African water sector related to water services delivery for PLHIV. While the widespread provision of antiretrovirals from 2004 has changed the context, the above findings are significant in understanding and reviewing the impact of various stakeholders on the water and health policy process. They raise questions regarding the effectiveness of NGO advocacy, the means of delivering improved services to specific populations, and the ability of a range of stakeholders to inform the policy approaches of government departments.

Researchers, activists, practitioners and policy-makers have grappled with the challenge of providing people living with HIV (PLHIV) with an adequate amount of safe water. Comprising 13% of the overall population of South Africa in 2018, 7.52 million PLHIV need water for drinking and taking medication; preparing food; and personal hygiene and cleaning to minimise infections. This article examines the responses of the different stakeholders to this challenge and their impact on the water and health policy process. It finds that activists were able to emphasise the dimensions of the challenge; practitioners worked to implement provision more effectively within existing policy frameworks; and a range of stakeholders made a thoughtful and promising policy proposal for direct action, which the Department of Water and Sanitation ultimately failed to embrace. This article is based on an extensive review of academic research and publications by development agencies on HIV and water as well as engagement with policies and documents in the South African water sector related to water services delivery for PLHIV. While the widespread provision of antiretrovirals from 2004 has changed the context, the above findings are significant in understanding and reviewing the impact of various stakeholders on the water and health policy process. They raise questions regarding the effectiveness of NGO advocacy, the means of delivering improved services to specific populations, and the ability of a range of stakeholders to inform the policy approaches of government departments.