Tomorrow, Rwanda will join the rest of the World to commemorate World AIDS Day under the global theme, ‘The time to Act is now’.  However the cure for the disease remains elusive with a glimmer of hope lying in antiretroviral therapy, counselling and prevention of mother to child transmission. With such services in place, one would say that the battle to eliminate HIV is headed for a milestone of progress but sufferers now face the stumbling block of stigma and discrimination.

Within comminities some patients live in fear or at worst suffer the wrath of rejection from the society. This means that the only alternative is to keep one’s condition a secret and even shun certain services such as treatment.

In his message for the World AIDS Day, Dr Micheal Sidibe, the UNAIDs executive director, points out that, ‘the job is not done and the world may face a rebound of the disease if the fight is halted’.

"We still have millions of people left out, over 22 million drug users with HIV hide themselves and some sex workers do not know what to do, we need society to understand that they have a right to access services. It is a defining moment for us, we need to understand that AIDS is a battle for social justice, maternal and global health, it is a battle of the world, let us end this pandemic,” Dr Sidibe says.

Such messages always come around and are delivered annually to focus on behavioural change within society in a bid to end practices such as stigma against HIV/AIDs patients.

What is stigmatisation?

According to the World Health Organisation (WHO), HIV-related stigma and discrimination refers to prejudice, negative attitudes and abuse directed at people living with HIV and AIDS.

From such practices, there are consequences.  Unfortunately, they are wide-ranging as family, peers and the wider community shun some people, while others face poor treatment in healthcare and education settings, erosion of their human rights, and psychological damage. A summation of these limits access to HIV testing, treatment and other HIV services.

Still according to WHO, in sub-Saharan Africa, for example, heterosexual sex is the main route of infection, meaning that HIV-related stigma in this region is mainly focused on infidelity and sex work.

Rwanda dealing with stigmatisation

The latest Stigma Index Report reveals that 53 per cent of people living with HIV face discrimination and a higher proportion remains unaware of their rights or miss certain services.

It is such findings that are forcing experts to come out to condemn the act of discriminating people because of their health status.

Dr Solange Hakiba, the permanent secretary at the Ministry of Health, explains that discrimination against individuals living with HIV is wrong and damaging for those who come out to reveal their positive status.

"It is important that people understand that being HIV-positive is not a death sentence. HIV today can be managed; a person living with HIV can live long enough to fulfill their goals like everyone else. People who come out and sensitise others are doing a great job and the reception should be supportive,” Hakiba says.

She adds that whereas the public may alienate others, the most important thing is to understand and be cautious of the ways through which the infection is contracted.

"The ways of contracting HIV are clear and contact with a person is not one of them. People living with HIV are active in the society and still have hope in them, so they should not be discriminated,” she adds.

Unlike most infections, the early stages of HIV are hard to deal with, especially before accessing treatment. Symptoms like swollen lymph glands, unusual lesions on the tongue; skin rashes and bumps, nausea, vomiting, and diarrhea, cough and shortness of breath, chronic fatigue, fever, chills, and night sweats, rapid weight loss, blurred or distorted vision are likely to manifest.

It could be any of these signs and symptoms that may trigger society to judge and discriminate someone.

Figures from the Rwanda AIDs Indicator and HIV Incidence Survey reveal that HIV/AIDS is prevalent in 3 people out of 100.

However, prevalence is higher among women at 3.7 per cent, compared to men at 2.2 per cent, and is higher in urban areas, such as Kigali, at 7.1 per cent than is the case in rural areas.

However, according to the Rwanda Stigma Index, 45 per cent of people living with HIV are ashamed of their status and this notwithstanding the discrimination forces from society.

According to Rwanda Biomedical Center Director General, Dr James Kamanzi, there is a need to continuously sensitise people that those who have acquired HIV are not any different.

"You cannot get HIV because you have shaken hands or live with someone who has the disease. The message is that people with HIV are the same and they cannot transmit the disease by working together or in other unusual ways,” Kamanzi says.

Addressing myths about HIV

Most times people have gone ahead to suggest that when you contract HIV, you are as good as dead. However, several experts point out that those are just myths deep-rooted in public perceptions.

Kamanzi instead urges the public to participate in massive sensitisation programmes than hanging in balance with myths about the disease.

"We tell people that one can only get HIV through sexual transmission or blood contact, and we basically focus on educating people understand the truth about the disease,” he adds.

Also Dr Placide Mugwaneza, the acting head of HIV Unit at Rwanda Biomedical Centre, says although stigmatisation is still a challenge in the fight against the disease, the public can benefit from sensitisation programmes.

World AIDS Day in Rwanda will be celebrated at Camp Kigali Stadium under the theme, ‘It’s everyone’s responsibility to prevent, treat HIV among our children and adolescents’.

How should people with HIV/Aids be treated?

Boniface Nsekanabo, a resident of Kigali

I always help them get the required counselling. People with the HIV virus are still normal human beings too. I believe they require all the support and care as the ones who are not infected. I also go for testing after every three months to be sure of my status.

Erick Nsengiyumva, a student

Things have changed now and there is minimal stigmatisation against people who are HIV-positive. People who stigmatise others need to be educated about HIV so that they appreciate that it can be transmitted to any person.

Jeanette Mukamazimpaka, a nurse

I know many people who are HIV-positive, but it’s hard to tell they are infected by looking at their physique. This is because they are on medication and feed properly. Some even look ‘healthier’ than those without HIV because most uninflected people suffer from malnutrition due to ignorance.

Alphonce Muhizi, the in-charge of HIV services at Avega Clinic

I treat them the same as others without the virus. This is because the disease is not transmitted through sharing, socialising or even shaking hands. When they come for consultation and medicine, I play my role professionally without making them feel dejected.

John Muhire, a mechanic

I don’t know anyone who is infected with HIV. I think some infected people look healthy because they are offered a lot of education on feeding and general healthcare. However, even if I knew any, I would never mistreat them based on their status.

Drucella Mugurwanyana, a nutritionist

What those people need is help and advice from the society, and what I do is to encourage them to live a healthy life, take medication, avoid stress and most importantly stick to a nutritious diet.