Rwanda’s response to the HIV epidemic over the last decade has been widely regarded as one of the most successful in sub-Saharan Africa. The country has implemented a number of innovative, effective and contextually correct strategies to combat the spread of HIV/AIDS and improve the health outcomes of those living with the virus.
According to the last Demographic and Health Survey (DHS) in Rwanda, since 2005, HIV prevalence has remained stable at 3% corresponding to about 210,200 adults living with HIV in Rwanda, and new HIV infections have declined from 27 to 8 per 10,000 population.
Preventing HIV is a complex issue that involves balancing the risks of HIV transmission with risky sexual activity. While abstinence may often be promoted as the best way to prevent HIV, it is not always a practical or realistic option, especially for many young people.
Despite the progress made, we are seeing some ambivalences and other problems that are persistent in the field of HIV prevention since this is an area that involves multiple types of knowledge, feelings and perceptions in youth.
For many young people today, HIV has always been a part of their world and their understanding of sexual health. The HIV epidemic has been ongoing for several decades and although some young people may not fully understand the severity and complexity of HIV, many are well-informed and understand that HIV is a serious health condition that requires ongoing attention and management.
When we talk of HIV prevention strategies in youth, many of these strategies will largely depend on or rely on an accurate perception of risk. It’s very important that the perception of risk is understood to help young people protect themselves better.
In many strategies for HIV prevention, there is the assumption that a higher risk perception has a causal effect on youth engaging in different protective behaviour. However, in many instances, factual knowledge alone appears not to change preventive behaviour because this is influenced by a wide range of individual, social, economic, and environmental factors that go beyond factual knowledge alone.
Social norms, cultural beliefs, economic factors, and access to healthcare can all impact a person’s behaviour related to HIV prevention and treatment. Additionally, stigma and discrimination related to HIV can make it difficult for individuals to access information, testing, and treatment, and can contribute to fear and misinformation.
Underestimating the risk of HIV infection in the youth or a lower perception of risk, even in places with a relatively high prevalence of HIV, can have grave consequences. This is also compounded by some young people exhibiting compulsive and unplanned behaviour which are often part of experimentation, or even identifying building or responding to peer pressure or alcohol use. This continues to be an area of concern and they continue to bear the brunt of the pandemic and remain at risk of infection. In sub-Saharan Africa, 71% of new infections are in adolescents. As the population of adolescents grows, particularly in East and Southern Africa, high incidence among young people will equate to a rise in the absolute number of new infections. Unfortunately, this burden is disproportionally higher in adolescent girls and young women.
Another factor that may contribute to a lack of engagement with HIV prevention among young people is a sense of complacency or fatigue around this issue of HIV prevention.
In most parts of Africa, HIV has been a major public health concern for many years, and younger generations may feel that the issue has been overemphasised or that it does not affect them personally. This may lead to a decreased interest in HIV prevention messages that have been persistently exposed to youth over the years.
Have the youth gotten bored of HIV? We have potential opportunities within this challenge; we need to continuously engage youth in different platforms like social media and other digital platforms that can reach larger audiences to consciously disseminate HIV prevention information, and raise awareness about the importance of not underestimating the risk of getting infected with HIV.
Addressing the continued engagement of the youth will require renewed efforts to implement effective prevention strategies across multiple sectors, including educational, social, policy, and healthcare systems that influence prevention knowledge, service use, and treatment options for youths. We also need to have a more intricate voice of the youth when developing newer HIV prevention messages to correctly capture their perceptions, unique needs or newer experiences. We cannot afford to be complacent in this fight.