Kagaju hurries to join a group of young ladies sitting in a circle. It is evident that members of the group are eager to start their meeting. One can hardly know that this group of young women is formed by mothers, who, at an early age, became victims of early pregnancy and HIV infection.

Kagaju was rejected by her family in 2015 when she became pregnant and knew she was HIV infected.

Her lover, the father of her child, rejected her as well and declined the responsibility of a father. She had no one to turn to.

"I was disoriented by the spate of gloomy twists my life was taking. As a young girl, I believed it when he said he loved me. When he discovered that I was pregnant and HIV positive, I was all by myself,” narrates Kagaju.

Kagaju is 22 years living in Kagarama sector in Kicukiro District. She was diagnosed and found HIV positive at Murambi health center in Kicukiro district where she had gone for antenatal care.

The early testing in May 2015 was a blessing because the knowledge of her status prompted her to start treatment immediately.

"I was a very young sick girl with no money and no family to look after me. One day a friend of my mother saw me at Masaka Hospital and advised me to go to a local NGO that runs a medical clinic "We Actx for Hope” located in Nyarugenge saying they help and treat people in my condition,” she explains.

Kagaju joined the Special Young Mothers Group at WE Actx for Hope that is made up of 22 members who started treatment after being diagnosed with HIV. The group meets every Thursday for different trainings including; entrepreneurship, stress management and other topics related to health and business.

"It was a blessing for me to join We Actx for Hope because we are shown a lot of care. The staff are friendly and we also get financial and moral support plus good counsel which helped me to feel that life was worth living even though I had HIV” says Kagaju.

According to the Clinical Director Chantal Benekigeri, the clinic created a program for the young mothers, supporting them when they have emergency cases while undergoing treatment for HIV.

"We meet them every Thursday in a support group and we give them snacks. We visit them to advise them on how they can improve their living conditions, take them gifts, organize some time stress management sessions, which are all very helpful for them,” says Benekigeri.

From December 2016, the clinic also started a Differentiated Service Delivery Model of ARTs (DSDM) like other clinics countrywide, as one of the national strategies for the Rwandan HIV program.

Ntibimenya, 63, resident of Kiruhura sector, a populated locality in Kigali Province in Nyarugenge District who has been on HIV treatment at WE ACTx for Hope clinic for the last seven years says life on ARVs requires respecting time regimes and following doctor’s orders.

Ntibimenya has five kids from his previous marriage and is married to his second wife who also has five kids from her previous marriage.

Having lost his first wife to HIV back in 2009, Ntibimenya married a second wife with whom they live as discordant couples.

As a young man, Ntibimenya says he was always scared of HIV and was careful not to get the virus though he lived with a group of reckless young men in Kigali at the time. However during the 1994 Genocide against the Tutsis, he fled to Zaire with his then pregnant wife and kids.

"Am sure we got sick during that time. My wife delivered in the camp at Kahindo which lacked proper health facilities yet had many patients and very few doctors. In 1996 when the baby was two years my wife fell sick with malaria and reaching Gisenyi, I took her for treatment and after tests, it was revealed that we were HIV positive” says Ntibimenya.

Ntibimenya says the news of their sickness was like a blow to them especially his wife who was wary of taking drugs.

"I accepted the fact that we are sick and decided to start treatment. Though my wife pretended to be taking the drugs, we later discovered that she wasn’t which led to her early death in 2000 leaving me with the children,” he narrates.

Treatment

Treatment adherence, staying on the treatment plan is important for keeping healthy, failure of which AIDS related death occur.

If left untreated, HIV attacks the immune system making it easy for opportunistic infections. If the patient’s CD4 cell count falls , risks of getting opportunistic infections increases. These are infections that don’t normally affect people with healthy immune systems but that can infect people with immune systems weakened by HIV infection. According to the Director of HIV Care and Treatment Unit at RBC, Dr Muhayimpundu Ribakare, the top priority is treatment for all identified cases regardless of their CD4 count, "Treat All” strategy

"Today because of the "treat all” approach, 82% of all Rwandan infected with HIV are on treatment. Those not tested and identified are the ones not on treatment. This approach has already increased our coverage in terms of patients treated. It is no-longer necessary to wait for their CD4 count to drop. We treat as soon as we identify a case of HIV,” explains Muhayimpundu.

Working with health care provider to develop a treatment plan helps patients learn more about HIV, manage it effectively, and make decisions that help you live a longer, healthier life.

"HIV treatment also greatly reduces risk of transmitting HIV to partner(s) if taken consistently and correctly. Media should play a big role in creating awareness on HIV prevention and care and treatment” explainS Dr Muhayimpundu.

HIV Care and treatment services

HIV Care and treatment services in Rwanda have been improving over time. Prior to 2002, there were less than 100 people on ART.

In 2016, HIV guidelines recommended offering immediate treatment to all patients regardless of CD4 count eligibility.

Since July 2016, Rwanda implemented the "Treat all HIV positive”, being among the first countries in Africa to implement the strategy.

As of June 2016, more than 160,000 patients were on ART. This increase in treatment use occurred by incrementally raising the CD4 threshold as eligibility criteria to start ART.

Previously, patients who were in their later stages of the infection were the ones who had access to ARV’s.

The Government of Rwanda (GoR) successfully launched the national Differentiated Service Delivery Model (DSDM) for HIV/AIDS treatment and service provision on December 1, 2016, at a national event marking World AIDS Day.

"Today, out of the 220,000 identified cases of HIV in Rwanda, 181,000 people are on treatment,” says Dr. Muhayimpudu.

The DSDM, also known as differentiated care, aims to increase capacity to provide HIV care and treatment to all patients, while focusing more intensive services towards complicated cases and reducing the frequency of routine patients visits for stable patients. The scale-up of ART in Rwanda has resulted in an increase of 25 years of the life expectancy between PLHIV and reduced 78% of AIDS related deaths.

Besides HIV prevention, care and treatment services, national HIV program also implemented interventions targeting STIs and other blood borne infections, mainly Hepatitis B and C.

Follow-ups

All patients enrolled into HIV care and treatment services are followed to the clinic on monthly or 3months basis for drugs refill, screening of OIs and STIs.

Clinical and biological exams are also performed based on national recommendations to assess clinical, immunological and virological status of the patient.

Progress

Rwanda has made significant progress in the fight against AIDS and the rate of new infections has declined by 50%, more than 80% of patients infected by HIV are receiving treatment, mother-to-child transmission rate at 18 months has reduced to less than 2%.

These results have been achieved through continuous leadership from high level in national HIV response, strong partnership and implementation of evidence-based interventions.

In terms of prevention, voluntary counseling and testing is available at health facility level which are also providing a complete package of HIV services including, PMTCT and ART services.

It is important to have groups like this one in order to improve the adherence to treatment, thereby maximizing the benefits of ARVs says Kagaju "That is why the government has put an emphasis on psychosocial care with a focus on HIV status disclosure and support groups for children and adolescents like the one at We Actx for Hope” she adds.

Despite all the efforts, HIV remains a public health problem; new HIV infections are still occurring and the above data shows the importance of focusing on HIV prevention through a combination of interventions; community mobilization, increased coverage and utilization of biomedical and treatment services in order to reach all individuals.