Water may not be the first thing that comes to mind when thinking about sexual health. Yet, growing evidence shows that extreme weather events such as flooding and drought can increase sexual health vulnerabilities, including sexual and gender-based violence, barriers to sexual health services, and elevated HIV acquisition risks. This connection is particularly of urgent concern in regions such as East Africa, where communities face the dual challenges of climate change-related extreme weather events and high HIV prevalence.
The pathways linking extreme weather events and HIV are complex. Drought, flooding, and changing weather patterns can intensify water, food, and sanitation insecurities. These resource shortages can in turn shape migration and mobility patterns, increase reliance on transactional sex, and heighten risks for sexual and gender-based violence.
Across many climate affected contexts—including communities where I work with in research in Uganda and Kenya—gender roles strongly influence how people experience water insecurity. Women and girls are often expected to collect water and prepare food for households. Water is essential for cooking, cleaning, bathing, and drinking. However, during periods of drought and water scarcity, women and girls may have to travel farther and spend more time collecting water. These longer journeys can increase their exposure to harassment, assault, and other forms of sexual and gender-based violence.
Sanitation security is another critical but often overlooked dimension of sexual health. Sanitation security means being able to access toilets and washing facilities that are safe, private, hygienic, and culturally appropriate for managing urination, defecation, and menstruation. Youth participating in our research have described fears of violence when accessing shared toilets or sanitation facilities, particularly at night. At the same time, they have proposed practical and actionable solutions—from improved and safer infrastructure to community-based safety initiatives—that could make water and sanitation environments more secure.
Our research has also documented how resource insecurity—including food and sanitation insecurity—can influence sexual relationships and power dynamics. Among climate affected young women in Kenya, we have observed links between resource scarcity, reduced sexual relationship power, and increased reliance on transactional sex to meet basic needs.
Another important but understudied pathway connecting water and sanitation insecurity to sexual health is menstruation insecurity. Menstruation insecurity occurs when people lack the resources, infrastructure, and supportive social environments needed to manage menstruation safely and with dignity. This includes access to clean water, sanitation facilities, and menstrual products.
Menstruation insecurity can affect sexual and reproductive health, including HIV risks, in several ways. First, in some contexts adolescents and young women report engaging in transactional sex to obtain menstrual products. Second, insufficient menstrual materials and limited access to clean water can increase risks of reproductive tract infections such as bacterial vaginosis—an infection that has been associated with roughly double the odds of HIV acquisition. Third, when young people lack access to water, sanitation facilities, or menstrual supplies, they may miss school during their menstrual periods. Missing school is linked with increased risks of adolescent pregnancy and reduced access to sexual and reproductive health education.
Sexual health is deeply relational. It is shaped by access to power, resources, and opportunities. Gender inequities underpin both the unequal burdens of water collection and the risks of sexual and gender-based violence that can accompany it.
Addressing these challenges requires thinking across sectors. Resource insecurities linked to climate change connect directly to several of the United Nations Sustainable Development Goals: SDG 2 (Zero Hunger), SDG 6 (Clean Water and Sanitation), and SDG 3 (Good Health and Well-Being). At the same time, progress toward SDG 5 (Gender Equality) can play a critical protective role by addressing structural inequities that shape vulnerability.
In the wake of World Water Day 2026, recognizing these connections can help inform more holistic and effective responses to climate change. Strengthening water and sanitation systems, supporting food security, and advancing gender equality are not only environmental or development priorities—they are also essential strategies for protecting sexual health and advancing the wellbeing and rights of communities most affected by climate change and HIV. As this year’s World Water Day theme reminds us, where water flows, equality grows—and protecting access to safe water and sanitation is also part of protecting sexual health, dignity, and rights.
About the author
Dr. Carmen Logie joined the Factor-Inwentash Faculty of Social Work in 2013 as an Assistant Professor and is currently a Full Professor. She is an Adjunct Scientist at Women’s College Research Institute, Adjunct Professor at the United Nations University Institute for Water, Environment & Health, and a Research Scientist at the Centre for Gender & Sexual Health Equity. She is a Tier 2 Canada Research Chair in Global Health Equity and Social Justice with Marginalized Populations. Dr. Logie’s research program advances understanding of, and develops interventions to address, stigma and other social ecological factors associated with HIV and STI prevention and care. She is particularly interested in understanding and addressing intersectional stigma and its sexual, reproductive, and mental health impacts, with a focus on HIV and STI.