On December 1 every year, Rwanda joins the rest of the world to mark World AIDS Day. Creating awareness on HIV prevention and commitment to end the spread of the virus, as well as ending the stigma and discrimination faced by those living with the condition, have been the messages shared on the day over the years.

Internationally, this year’s theme is, ‘Right to health’, while nationally, it will be celebrated under the theme, ‘Get tested for HIV. If positive, start and stay on life-saving treatment’.

According to Ernest Nyirinkindi, the in charge of information, education and behavioural change communication at Rwanda Biomedical Centre (RBC), they are doing their best to ensure that the entire population is tested so that people know their status.

"We are going to do this using different messages through entertainment, leaders, free HIV testing and family planning services, exhibitions by different partners, as well as launching of the HIV self-testing and new condom kiosks,” he says.

Nyirinkindi says a lot has been done by the government in fighting HIV, but the focus is strategies to strengthen the fight.

For instance, he points out that the prevalence rate is still at 3 per cent since 2005, adding that this has been achieved because of the numerous strategies in place.

A yearly data collection done by RBC indicates that new infections each year are at 0.27 per cent. Also, a study conducted last year indicated that the rate of mother-to-child transmission is at 1.56 per cent, against the 2 per cent target set by WHO.

Prevention and risk factors

According to Dr Jean Damascene Makuza, the STI care and treatment senior officer at RBC, one of the main ingredients in this year’s activities is how to stay healthy.

He notes that people should stay away from sexually-transmitted diseases including HIV by avoiding un-protected sex, not sharing razors, syringes and other materials that can expose them to HIV.

"The population is being encouraged to get tested at least every three months, so that in case they test negative, they continue with prevention measures, and incase positive they start on medication immediately,” he says.

On the other hand, Makuza says studies have shown that circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60 per cent.

He therefore advises that men should use the opportunity of free circumcision offered by the government to prevent themselves from such infectious diseases.

Makuza says sex workers and homosexual relations remain major risk factors for HIV.

"Intravenous drug users, having multiple sexual partners, as well as having unprotected sex, are also among the major predisposing factors to HIV,” he says.

Dr Jean Batiste Habumuremyi, the head of Gatanga Health Centre, Kicukiro, says when it comes to treatment of HIV, they are using antiretroviral therapy.

"However, it’s not necessary to wait for other conditions like a low CD4 count or clinical signs to start the treatment. The earlier you test the earlier it helps when it comes to treatment and prevention,” he says.

Habumuremyi says the fight against mother-to-child transmission is important and they continue to teach the youth and couples how to stay safe.

"Expectant mothers are also encouraged to go for testing. When one is HIV-positive, they are followed up and this gives them a chance to give birth to a healthy baby. Also, the treatment helps to reduce the strength of the virus,” he says.

Data from RBC indicates that 95 per cent of expectant mothers who are HIV-positive access treatment even after birth.

Nyirinkindi adds that babies born to HIV-positive mothers are closely followed up until after the period of breastfeeding, which also helps reduce cases of new infections.

Why palliative care is important

As with diabetes, cancer and high blood pressure, Erick Kabisa, the clinical coordinator, Rwanda Palliative Care and Hospisis Organisation (RPCHO), Kigali, says HIV/AIDS patients need palliative care because the disease is chronic.

However, he points out that much as the illness requires dealing with symptoms, the patient also faces a high possibility of developing depression and anxiety. This, according to Kabisa, should be taken care of through palliative care to help such patients die in dignity.

"In palliative care, we deal with end of life care. For instance, those patients with HIV at stage four normally have opportunistic infections, which are a leading cause of death among the patients,” he says. Such infections include tuberculosis, candidiasis, and cryptococcal meningitis, among others.

Kabisa notes that palliative care is the combination of physical, psychological, spiritual and social support. The aim is to control the symptoms and improve the quality of life for the patients.

For instance, he says in the first stage most people don’t know when they’ve been infected with HIV, but a short time later, they may have symptoms.

The symptoms are similar to those of other viral illnesses, but last a short time and go away. At this stage, he says though such patients can be under palliative care, it’s not a must.

Stage four

Kabisa explains that if a person develops certain serious opportunistic infections or diseases as a result of damage to their immune system from advanced stage 3 HIV infection, they are said to have AIDS, which is stage four of the disease.

He says in most cases this comes about because of the patients not following and sticking to the prescription of their medication as provided by their doctors.

"Without proper treatment, HIV infection advances in stages and gets worse over time. It destroys the immune system causing acquired immunodeficiency syndrome (AIDS). At this stage, it’s necessary that such patients get palliative care so that they get medicine to ease the pain as well as other necessary support,” he adds.

Psychological support

Kabisa notes that other than medication for such patients, follow up them up is equally important.

"Patients with HIV have families and talking to them and finding out how they are living with the patient is as well vital,” he says.

Kabisa says, in most cases, patients always develop stress, depression and anxiety, the reason they need psychological support.

He says there are cases where such patients lose hope of living and keep on asking when they will die, to which he adds that giving them help and advising them to follow right medication is important.

"We have seen a lot of patients recovering and coping well with their illness. Patients suffering from any chronic illness should be supported well,” he advises.

Challenges

According to Habumuremyi, the main challenge they are facing is that most people who are HIV-positive come from poor families, which makes it hard for them to cope up with their situation.

He explains that even with the right treatment at the right time, if such patients don’t get good feeding, it’s possible to worsen their condition.

He says another challenge is that of the movement of people from place to place for jobs or other reasons.

"It’s not easy for such patients to stick to one health centre and this is a challenge because when it comes to follow up, it’s not easy and can even lead to one developing other conditions due to poor treatment,” he says.

Nyirinkindi also says the other challenge when it comes to prevention is the poor mindset of people.

He explains that although most people are aware on how to protect themselves from the disease, they ignore the measures. He adds that even some of them don’t make use of the free services put in place by government like free testing and many others.