Water Insecurity and Urogenital Infection Risk in Pregnant Women with HIV: A Study from Kenya's Semi-Arid Lands

Pregnant women living with HIV in sub-Saharan Africa face an increased risk of urogenital infections, which threaten maternal and neonatal health. In Kenya's semi-arid lands, chronic water scarcity complicates hygiene maintenance. The specific relationship between water insecurity and infection risk in this group remains unclear. This working paper explores the association between water insecurity and self-reported symptoms of urogenital infections among pregnant women living with HIV in Kenya's semi-arid regions. A cross-sectional, mixed-methods study was employed. Quantitative survey data on water insecurity and urogenital health were collected from a purposive sample of pregnant women attending antenatal clinics. In-depth interviews with a subset of participants provided qualitative context on hygiene practices. Empirical analysis is ongoing. Preliminary thematic analysis of qualitative data indicates that women experiencing greater water insecurity report more difficulty maintaining perineal hygiene. They frequently describe coping strategies—such as reusing or rationing water for washing—that may elevate infection risk. Initial findings suggest water insecurity is a plausible, contextual driver of urogenital infection risk for pregnant women with HIV in arid settings, mediated by compromised hygiene. This highlights the need to integrate water security into maternal health programming. Maternal infection prevention programmes should incorporate targeted water, sanitation, and hygiene (WASH) support. Further research is required to quantify this relationship and to test interventions that combine WASH provision with standard antenatal care. water insecurity, urogenital infections, pregnancy, HIV, Kenya, maternal health, WASH This working paper offers preliminary evidence underscoring the intersection of water insecurity and reproductive health for a clinically vulnerable population, arguing for its consideration in public health practice.