Special Report

SPECIAL REPORT: A Look Into Rwanda’s HIV/AIDS Status

How do Rwandans perceive HIV/AIDS and its patients?

Well, 9.9% of Rwandan adults aged 15-49 responded ‘no’ when they were asked whether they would buy fresh vegetables from a vendor if they knew that she or he lived with HIV.

The question was asked during the Demographic and Health Surveys (DHS) 2014-2015 by the UNAIDS Rwanda.

The question was one of the tools to assess the discrimination against people living with HIV/AIDS and the awareness of HIV/AIDS infection ways in Rwanda.

As Rwanda joined the rest of the world to commemorate the World AIDS Day on Friday, December 1, Taarifa spoke to different people who to gauge their knowledge.

“One can get AIDS by having unprotected sex. I learned it from school because they teach us about it,” said Omar Duhirwe, an 11 years old boy in P4.

However, asked about other ways through which HIV is transmitted, Duhirwe said he does not know any.

Betty Nyirakamana, a resident of Kacyiru in Kigali City says that she has just learnt about HIV transmission. She said that she didn’t have sufficient information on HIV/AIDS, but recently she learnt that HIV is transmitted through different ways, mainly unprotected sex.

“You cannot get infected by a physical contact with someone living with HIV, instead, by having sex with him or her,” she said.

According to 2016 UNAIDS HIV/AIDS estimates, around 210,000 adults aged 15 and above live with HIV in Rwanda.  Of them, 120,000 are women and 85,000 are men. Children aged 0 to 14 living with HIV count for 11,000.

The prevalence rate for women aged 15 to 49 is at 3.8% while the prevalence rate for men aged 15 to 49 is at 2.3%.

At the moment, the percentage of Rwandans living with HIV who know their status is 87 while among them those who are on Antiretroviral therapy drugs are 80.

Among 180,000 people who are on ARVs drugs, the USA, through PEPFAR, pays drugs for  94,000 people which represents 52%, according to the US Ambassador to Rwanda, Erica Barks-Ruggles.

Meanwhile, according to UNICEF, only 49% of males and 43% of females know how to use condoms as one way to prevent new infections.

Young women aged 15-24 who have knowledge about HIV prevention, in general, are 52.6% while young men who have aged the same are 47.4% according to UNAIDS.

Rwanda, like other countries, wants to reach the UNAIDS 90-90-90 goals by 2020, meaning 90% of people living with HIV diagnosed, 90% of them are on treatment and 90% of those on treatment with a fully suppressed viral load.

However Ambassador, Erica Barks-Ruggles, told journalists, on November 14, 2016, that, “reaching the 90-90-90 goals and moving to an AIDS free generation will be challenging.”

“As many of you know, HIV in Rwanda is mainly spread through sexual contact, and having more than one sexual partner is shown in the recent Demographic Health Survey of 2015 as the greatest risk factor of becoming infected with HIV,” she noted.

Notably though, AIDS-related deaths among adults aged 15 and above count to 2700 per year according to year 2016 numbers. For women aged 15 and above, AIDS kills 1700 women whereas it kills more than 1000 men of the same age, being 1000 for children aged O to 14.

UNAIDS, quoting Integrated HIV bio-behavioral surveillance (IBBS) of 2015, shows that HIV prevalence rate among sex workers is 45.8% while, among them, those who know their HIV status are estimated at 95.1%, quoting Behavioral Surveillance Survey 2015 and the condom use, by sex workers, rates at 84.3%.

Among estimated 5000 men who had sex with men by 2016, 83% of them, knew their HIV status while their condom use rated at 71.4%.

The 2017 World AIDS’ Day is celebrated under the theme “Increasing Impact through Transparency, Accountability and Partnerships.”

Why prevalence declined

In Rwanda, HIV prevalence has been stable since 2005 and remains at 3% among adults aged 15–49 (4% among women and 2% among men). The prevalence of HIV is higher in urban areas (6%) than rural areas (2%); HIV prevalence is 6% in the capital city of Kigali and 2–3% in each of the other provinces.

It is 3.8% in women and 2.3% in men according to 2016 estimates.

In 2013, Rwanda introduced testing using “finger prick” blood collection in all health facilities. The number of health facilities offering voluntary counseling and testing has increased from 15 in 2001 to 493 in 2013. According to Global AIDS Response Progress Report 2014.

Prevention of mother to child transmission (PMTCT) services have been  increased  with 97% of all facilities provide PMCTC services by 2013 countrywide.

From 2009 to 2013, 5 million more condoms have been distributed.

In 2014, the prevalence of male circumcision was 30% between the ages of 15-49.Voluntary medical male circumcision was added to the 2013–2018 National Strategic Plan of HIV.

Surgical kit for voluntary medical male circumcision were provided to all facilities and two healthcare workers were trained per facility. These services are now regularly provided.

Public and external funding sources for HIV/AIDS in Rwanda in fiscal year 2011–2012 totaled USD 234.6 million.

Of the total funding, US$17.7 million (7.6% of total HIV/AIDS spending) came from public funding, and US$216.8 million (92.4% of total HIV/AIDS spending) came from external funding.

This total funding excludes out-of-pocket and private sector contribution.

Vulnerability 

Prevalence among sex workers was 51% in 2010, while it decreased to 45.8% in 2016.

This was due to the fact that national guidelines for HIV prevention in this vulnerable population were developed and disseminated as a part of the HIV National Strategic Plan 2013–2018. ROADS II.

HIV prevalence is higher in women (3.8%) than in men (2.3%.) in Rwanda, because of the biological make up of the female genital tract.

According to Ugandan academic Dr David Tigawalana, in Africa, young girls have sex with older men (sugar daddies), for money, gifts or status. Even culturally, women are found to marry men who are much older than them and more sexually experienced, thus exposing them to the risks of HIV.

In many African cultures there is tolerance for multiple sexual partnerships, including extra-marital sex by men. Marriage and monogamous relationships do not protect women. Ironically, an unmarried woman will be more protected than a married one because of the unfaithfulness of men.

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