Water, the source of life, can sometimes spark death in people with HIV. Three years ago in Milwaukee, 400,000 people were sickened by an outbreak of water-borne Cryptosporidium, a diarrhea-causing parasite. Of the 110 people who died, the vast majority were PWAs. Earlier this year, the National Association of People with AIDS (NAPWA) reported that 28 of 31 U.S. cities surveyed were at risk for a public health emergency due to inadequate testing and/or treatment for water-borne disease in their drinking water. Among the cities cited were New York, San Francisco, Los Angeles, Dallas and Washington. (See POZ No. 16, p. 20). A clean-water bill passed by Congress this summer will require local water departments to report annually to customers on water safety.
What's scary is that you can't tell by the look, smell or taste of tap water whether it contains disease-causing micro-organisms such as Giardia, Microsporidium or Cryptosporidium. The water that most municipalities provide is (supposedly) designed to be just clean enough for people with normal health. For immune-compromised people, such as those with HIV, a water-borne illness can be life-threatening. Since Crypto can lodge in the gut inactively and be activated as immune function declines, experts recommend the following precautions for all HIV positive people. If the whole list seems too onerous, NAPWA suggests at least using a "risk reduction" approach-the less exposure, the less risk.
Boil your tap water to kill any micro-organisms in it. The Centers for Disease Control and Prevention recommend bringing water to a rolling boil for one minute.
Use boiled or filtered water when cooking, unless you're sure the food is going to cook long enough at sufficient heat to destroy micro-organisms.
Make ice cubes out of boiled or filtered water, and avoid tap water and ice in restaurants.
When washing fruits and vegetables to be eaten raw, the last rinse should be with water which has been boiled and cooled, or filtered.
Make sure dishes and utensils are dry before you use them, but don't wipe them with a towel.
If you use a water cooler or dispenser, make sure it's cleaned regularly.
Don't assume that bottled spring water is free of microorganisms-in this country it isn't legally required to be. According to Gay Men's Health Crisis, the brands that filter their water safely include Deer Park, Great Bear, Naya, Poland Springs, Saratoga, Vivanti and Wissahickon. To check a brand, ask if the company filters to "one micron absolute," treats by reverse osmosis or obtains the water from a protected underground source.
Distilled water is another option: It has been steamed, condensed and cooled. It's free of dangerous parasites (unless contaminated after the distilling process) but lacks natural water's beneficial trace minerals.
Bottled juices are safe if pasteurized, as are bottled seltzer and carbonated soft drinks (but not those from fountains).
Consider investing in a high-quality water filtration system to screen out troublesome micro-organisms. It's much cheaper long-term than bottled water. To prevent passage of such water-borne bugs as Crypto, filter openings must be labeled "one micron absolute" (not simply "one micron"). The products should have the National Sanitation Foundation certification "NSF Standard 53" for "cyst removal" or "cyst reduction." Multi-Pure, Everpure and Culligan are some of the companies whose devices meet this standard; their products range from $150 to $900. For those devices to function properly, it is very important to change the replaceable inner filter-which sells for $30 to $40-on schedule, ranging from every three to six months. A cheaper but still adequate filtering system called "Pur Plus," sold by the Pur Company for about $60, fits right onto the end of the faucet; it's inner filters are around $15, but need frequent replacement. (Don't confuse this model with another called simply "Pur," which does not filter out Crypto.)
Brush your teeth with boiled or filtered water.
Avoid swallowing water in baths or showers.
If you have a catheter, cover the entry point with plastic tape such as Tegaderm before you shower or bath.
Avoid swimming in rivers, lakes or public swimming pools. Chlorine in normal amounts doesn't kill Crypto.
Don't let these precautions you from drinking adequate amounts of liquids. People taking the protease inhibitor Crixivan (indinavir) should drink at least six eight-ounce glasses of liquid per day to minimize the chance of developing kidney stones. Use water or juice, because Crixivan must be taken separately from foods or drinks with fat content, like whole milk or soy milk.
Water is crucial to many body functions, especially those that help the body detoxify. So drinking ample amounts of pure water or other safe beverages should be part of everyone's program of nutritional wellness.
For more information, contact: Environmental Protection Agency (EPA) at 800.426.4791 (Safe Drinking Water Hotline); or NSF at 800.673.8010 (filter systems).