The world will come together on December 1, to mark World AIDS Day under the theme, "Hands up for HIV # prevention”. Millions of lives lost to the pandemic will be commemorated and the day will serve as a platform to gauge the current status and the way forward in preventing the killer disease.

Years ago, being HIV-positive equalled to a death sentence, but this has changed over time, thanks to the efforts from the various stakeholders. However, society has not made it any easier for people living with the virus, and this is still a thorn in the fight against HIV/AIDS.

Experts say stigma remains one of the factors that are still holding back the fight against HIV.

Bertilde Gahongayire, a Kigali-based counselor, says stigma against a person living with HIV can be more agonising than the disease itself.

"HIV is an infection many people fear, which to some extent leads to them having a negative attitude towards those who have it. This can lead to rejection and isolation for those infected,” she says.

Gahongayire adds that though various sensitization drives have been carried out on how HIV is transmitted, some people still have a wrong perceptions towards those with the virus. The assumption is that having HIV is a shame because many associate it with risky sexual behaviour and promiscuity.

"Some still think that through sharing a cup or plate with a patient they can contract HIV. Others think that through sweat they can still get it, hence keeping a distance from the infected, which deeply affects the patient emotionally and takes a huge toll on their health,” she says.

Gahongayire says stigma comes in different forms.

"For example, at home the patient can be given separate utensils, at work the person gets to have a few friends and even those who try to be friends with them keep a certain distance, which makes the patient feel dejected,” she says.

"In most cases this discrimination is not easily seen but it affects the victim so much psychologically and can lead to trauma, stress and in some cases suicidal feelings,” she adds.

Gahongayire advises people living with HIV to accept the condition they are going through, urging them to have faith that they can have a long life just like the others if they seek proper and earlier treatment.

She also calls for more public sensitisation on how stigma affects the victims such that its occurrence reduces.

Fighting stigma

Dr Sibongile Dludlu, the country director of UNAIDS, says stigma and discrimination based on HIV status discourages persons from accessing testing services, which is the cornerstone in managing the HIV pandemic.

"HIV-positive individuals may not want to disclose their status and, therefore, may not access treatment and care services. Under these circumstances, these individuals would also be less likely to receive support from family and the community, support which has been shown to be important for treatment adherence and retention in care,” she says.

"For these reasons, among others, UNAIDS continues to advocate strongly for the rights of people living with HIV as part of the organisation’s vision of zero discrimination,” Dludlu adds.

Dr Diane Gashumba, the Minister for Health, says that they are doing their best to fight HIV and also to put in place measures to help fight the stigma associated with people living with HIV.

"As a ministry we consider all people equal whether HIV positive or not. For instance, this can be seen during antenatal visits, where all expecting mothers whether HIV positive or negative are given services and counselling together. By doing this, it’s hard for someone to find out who is positive and who’s not,” she says.

Privacy for both outdoor and indoor patients is also guaranteed, and this way, they cannot shy away from accessing antenatal care and treatment.

The Minister emphasises that the issue of integration of services is essential when it comes to treatment. "All patients ought to be treated the same without discrimination and that this is done in all health facilities.”

Silencing HIV in general

Rwanda has made significant progress in the fight against HIV/AIDS, according to statistics from Rwanda Biomedical Centre with the rate of new infections declining by 50 per cent.

Roughly 80 per cent of adults in need of antiretroviral treatment are receiving it, while mother-to-child transmission rate at 18 months has reduced to less than 2 per cent.

Dr Placide Mugwaneza, the director of HIV Prevention Unit at Rwanda Biomedical Centre, says these results have been achieved through continuous leadership from the national HIV response team, as well as strong partnership and implementation of evidence-based interventions.

She, however, notes that despite all the efforts, HIV remains a public health problem and that new HIV infections are still occurring.

"We need to focus on HIV prevention through a combination of interventions, community mobilisation, increased coverage and utilisation of biomedical and treatment services in order to reach all individuals,” Dr Mugwaneza says.

She points out that it is in this context that this year’s national theme "Get up all against HIV/AIDS-Still there” was chosen to be in line with the global theme.

"The theme is a call of action for everyone at all levels; communities, government institutions, private sector and others to play their role in reducing new HIV infections,” she says.

Mugwaneza says that for the continued support in fighting the virus, community mobilisation will be done through different communication channels, for instance, radio talkshows, drama and distribution of HIV education tools.

"In addition, HIV outreach services will be conducted focusing on HIV testing and antiretroviral treatment initiation, condoms distribution and voluntary medical male circumcision,” she says.

Statistics on HIV

According to statistics from UNAIDS, in 2015, 1.1 million people died from AIDS-related causes worldwide.

An estimated 36.7 million people were living with HIV (including 1.8 million children) in the same year. Global HIV prevalence was 0.8 per cent and the vast majority of this number live in low and middle-income countries.

In the same year, there were roughly 2.1 million new HIV infections, 150,000 of which were among children.

Statistics from Rwanda Biomedical Centre indicate that HIV prevalence among the general population aged 15-49 years has remained stable at 3 per cent for the last decade.

The HIV comprehensive knowledge is low in the general population (30 per cent) and even lower in young people (26.7 per cent).

The 2013 Rwanda AIDS Indicator and HIV Incidence Survey showed that HIV incidence in Rwanda is 0.27 per cent in general, and is higher in urban areas than rural areas.

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THEIR SAY...

Mutabazi Gakuba, studentFirst, we should educate people with HIV that it is just like any other disease. Also, communities should help the victims in any way they can. Counselling patients can help, but the patients should form their own cells as a way of giving support to each other.

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Wilbur Bushara, medical practitionerThe community should be educated that having HIV is not a choice and that anyone can get it. Patients should be advised not to disclose their status to everyone, but rather to only those people who are close and supportive.

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Simon Kalisa, entrepreneurThe government should step up its game in sensitisation because some people, especially those from rural areas, still have certain myths in regards to HIV. For instance, some believe that being close to an HIV infected person can make them catch the disease which makes them isolate the sick.

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Charles Shyaka, studentPeople should be considerate with those who are infected because isolating victims makes them depressed. A little sensitization to the public in general would be good; this way they will know how to handle those infected.