At least 20 Civil Society Organisations (CSOs) in the country yesterday completed a two-day training on how to implement pre-exposure prophylaxis for HIV prevention among key populations.  The training was organised by Health Development Initiative, HDI-Rwanda, a local non-governmental organisation dedicated to promoting community-based health care development. Pre-exposure prophylaxis (PrEP) is a new strategy of preventing HIV in negative people using anti-retroviral, especially for those who are at high risk of contracting HIV such as discordant couples who would wish to conceive. Pre-exposure prophylaxis (PrEP) can also be defined as using a known medicine for an infection you do not have but fear to get. In an interview with The New Times, Afflodis Kagaba, the executive director of HDI, said there is need to incorporate and roll out the new biomedical strategies as additional ways of preventing new HIV infections along with the existing ones. He said policymakers therefore need to plan for demonstration studies on PrEP and other biomedical interventions to determine the most appropriate groups and best delivery approaches. According to Kagaba, civil society should play an active role in fighting HIV with target interventions for particular groups such as sex workers, sero discordant couples and homosexuals. "Our government has applied many interventions in fighting the HIV epidemic; however these alone are not enough to prevent new infections. Therefore we would like them to also consider others such as pre-exposure prophylaxis in the HIV prevention national strategic plan,” he added. Kagaba said that this will help in the reduction of  the number of new HIV infections from 15000 infections to zero new infections by 2015 (as per the global goal), wide scale interventions need to be put in place. The rates of new HIV infections in Rwanda also reduced from 25,000 new infections annually five years ago to 15,000 infections now. Currently, some of the HIV prevention measures in Rwanda include condom use, being faithful, male circumcision as well as abstinence. Speaking at the same training, UNAIDS Country Coordinator, Dr Dludlu Sibongile stressed the need to combine all strategies in HIV fight. "No single HIV strategy stands alone. They should all be incorporated in order to reach the goal of zero new HIV infections and deaths,” Dr Dludlu said. Calling for the acceleration of other HIV prevention strategies, she reaffirmed UN’s commitment to continue supporting HIV prevention strategies that are effective. One of the Pre-exposure prophylaxes strategies that has been recommended by experts is the use of Tenofovir drug that is said to reduce risk of HIV infection.  The use of Tenofovir drug, before having sexual intercourse with an HIV infected person, reduces risk of infection by almost 50 per cent, according to a recent trial dubbed the Bangkok Tenofovir study, conducted in Thailand. According to the findings, published in the medical journal The Lancet last week, daily use of Tenofovir which is already used among the combinations to treat HIV can reduce the risk of acquiring HIV. In this study, daily oral tenofovir reduced the risk of HIV infection in people who inject drugs. Pre-exposure prophylaxis with tenofovir can now be considered for use as part of an HIV prevention package for people who inject drugs. Dr Sabin Nsanzimana, the coordinator of HIV and Sexually Transmitted Infections care and treatment department at Rwanda Biomedical Centre, said there are so many studies looking at using ARV’s as prevention of HIV such as Tenofovir as a pre- exposure. He noted that all anti-retrovirals reduce HIV spread both at individual and community levels as the Thailand study confirmed that with data. He however declined to recommend the use of Tenofovir for prevention of HIV infection between an HIV positive and negative person. "I can’t recommend exposure to HIV when a negative person has unprotected sexual intercourses with an infected person even on anti retroviral as there are still chances of getting infected and worse with a mutant virus,” said Dr Nsanzimana. According to information from the Health Development Initiative in Rwanda, studies have proven that pre-exposure prophylaxis can reduce the risk of HIV transmission by up to 73 per cent in heterosexual couples and 44 per cent in MSM and transgender couples respectively. Pre-exposure prophylaxis, therefore, can significantly reduce the rate of new HIV infections. The Bangkok study tested a daily oral pill of Tenofovir and concluded that the risk of HIV had been reduced by 49 per cent. In Rwanda, 3.0 per cent of the general population, aged 15-49, has HIV. Prevalence is higher among women (3.7 per cent) than among men (2.2 per cent). Women have higher HIV prevalence than their male peers in nearly every age group. HDI was supported by AVAC, a global advocacy for HIV prevention, in holding the training about other new HIV prevention measures.