Rwanda has made enormous progress in reducing the impact of HIV over the last 15 years. New infections have reduced by 70% while AIDS related deaths have dramatically declined by 60% since 2010. In 2023; 13,222 AIDS deaths were averted because of access to antiretrovirals. This has been made possible through offering free antiretrovirals to all those who test positive. Additionally in 2023, 1742 new infections among children were averted as a result of the Prevention from Mother to Child transmission program that is in place, Prevention tools have also been made available to key and vulnerable populations. Differentiated service delivery strategies have been put in place to ensure access for all. As a result, Rwanda has been able to achieve the targets set for 2025 and is well positioned to achieve the goal of ending AIDS as a public health threat by 2030.

A new UNAIDS report released ahead of World AIDS Day, called Take the Rights Path, shows that upholding rights is the pathway to an HIV response that is inclusive and sustainable. This is one of the areas where Rwanda has been progressive in terms of enabling policy and legal environment whereby people living with and those at risk of HIV are not criminalized, which has greatly contributed to the success of a program that is well grounded on human rights.

Despite this progress some populations still require more attention. Based on UNAIDS 2023 estimates; Adolescent Girls and Young Women (AGYW) are more at risk with 1 out of 4 new HIV infection coming from females aged 15 to 24. Overall, females are disproportionately affected amounting to 63.5% of the total number of people living with HIV in the country with an HIV prevalence of almost double compared to the HIV prevalence among men. The National Institute of Statistics has reported over 19,000 teenage pregnancies in 2023. This reflects the volume of exposure by girls to the risk of acquiring HIV. While aggregate progress has been reported in terms of HIV testing, and treatment and care coverage among adults, the same cannot be said about children whereby only 71% of children living with HIV in Rwanda know their status.

The overall 2.2% national prevalence of HIV among adults only tells part of the story. The prevalence is higher in Kigali City (4.5%) and Eastern Province (2.4%) and among Key and vulnerable population such as Female Sex Workers (35%) and Men having Sex with Men (6.5%). The Ministry of Health and RBC are reprogramming and intensifying the HIV response accordingly.

So how can Rwanda attain more progress to achieve the last mile and protect the gains already made against HIV

Recently RBC has been leading national efforts to discuss and agree with key stakeholders on the sustainability of the HIV program within the broader national health financing efforts. This exercise is critical as it will define the strategic shifts and transformations that are required to achieve the last mile; address the gaps among girls, young people and key populations and ensure a sustained response by 2030 and beyond.

The recently presented draft law by Hon. Minister of Health with a provision to revise the age of consent for health care services to 15 years is a big stride that will contribute to more young people finding out their HIV status and accessing HIV related services without the need for parental consent which is found to be a key factor that hinders young people from seeking for HIV testing and other health services.

Further investments in the capacities of civil society organizations and strengthening community systems and structures are key. As HIV prevention efforts and service delivery lie heavily on the shoulders of CSOs, their empowerment and meaningful engagement are critical for the last mile and beyond. So is the need to have a stronger coordination system that brings them together to ensure complementarities and reduce overlaps and maximize outcomes. Strategies such as social contracting of CSOs will certainly contribute to having community driven solutions and resilient community-based service delivery systems that are cost effective and sustainable.

The recently endorsed National Strategy for Transformation (2) includes HIV as one of the cross-cutting areas mandating all government Ministries and sectors to integrate HIV. Strong governance and coordination structures of these efforts are key to reduce transactional costs and ensure greater impact.

HIV is not only a health issue. It is very much connected to inequalities that may lead to vulnerabilities. As such it is important to address gender inequalities and intersecting social determinants and structural barriers that may render women and girls vulnerable to HIV. Programs that address the triple threat of HIV, teenage pregnancy and gender-based violence should align jointly to tackle the cycle of risks and vulnerabilities associated with all three issues together and not in isolation. By understanding and addressing the connections between HIV, teenage pregnancy and GBV we can more effectively support adolescent girls and young women in leading healthy, empowered lives. The ongoing development of the National HIV prevention roadmap and the launch of the Strategy and Operational Plan for AGYW program, both bringing in the intersectoral dimensions of HIV, SGBV and teenage pregnancies is indeed a step in the right direction.

Rwanda’s success story in reversing the trajectory of HIV situation in the last 3 decades is one that needs to be documented and shared. It provides a clear roadmap for the path to end AIDS; the rights path. Having been in the country for two years and working closely with stakeholders, I have witnessed first-hand the high level leadership and commitment, the program’s expertise and dedication, the vibrant and robust work of communities and youths and the one element that is common in all of them is the sense of duty and urgency to serve the people.

Hind Hassan Abdalgalil is the UNAIDS Country Director- Rwanda