Not as easy as ABC:

Emmanuel Gahutu, 42, spends most of his day telling people to abstain from sex, be faithful to their partners or use condoms, commonly known as the ABC strategy, to avoid HIV. Despite this, he tested positive to the virus that causes AIDS. “ABC is the main message we pass on to those who are still negative,” says Gahutu. The ABC strategy has been the main thrust of the anti-AIDS campaign since the epidemic was first detected in the mid-eighties. Recently, the Bush administration increased support to governments and organisations in Africa that encourage this strategy. But people continue to get infected as a result of low use of condoms and many young people are sexually active. Recent studies indicate that prevalence rates are rising in rural areas. Information from the National AIDS Control Commission shows that in 1986, 17.8 per cent of urban Rwandans were infected with HIV and 1.3 per cent of people in the countryside were infected. The second study, carried out in 2005, showed that the urban prevalence rate had dropped to 7.7 per cent and the rural rate had increased to 2.3 per cent. This study involved females between the ages of 15-49 and males between the ages of 15-59. The prevalence rates have gone up in rural areas despite the efforts of the ABC strategy. Worth noting is the fact that the strategy was already being implemented in 2005 when the study was carried out. The same study found that condom use remains low especially among females. Only 19.7 per cent of women use condoms compared to 40.9 per cent of men. Dr. Anita Asiimwe, the head of the AIDS Treatment and Research Centre, acknowledges that young people who are told to abstain ultimately reach a point when they become sexually active. She contends that in this situation, they have to be sensitised about condom use. The challenges of the ABC strategy are well understood by the leadership of the county. Speaking at the East African and Indian Ocean regional meeting of the Global Fund to Fight Aids, TB and Malaria in November 2005, President Paul Kagame said that the ABC strategy is not enough. “I strongly believe that instead of focusing on the ABC strategy alone, we should now give equal support and attention to E, which stands for Education,” he explained. This, according to the President, underlines the fact that AIDS, like many pandemics on the African continent, is a disease linked to poverty and ignorance. Gahutu’s story is telling. He explains: “I got married over seventeen years ago and since then I have never had extramarital sex.” He believes that he got the virus from his wife. Together they have six children, one of them HIV positive. He believes that his wife may not have been faithful. Although they never went for testing before getting married, his first born, a 17-year-old daughter, is HIV negative. “This implies that we must have been negative when we married, but later on when my wife was pregnant two years ago, she tested positive and I was advised to have a test, which came out positive,” says Gahutu. Emma Baana, the technical officer of Nyamagabe District Aids Control Commission (CDLS), explains that a number of people are now sensitised about the issue of HIV/ Aids because of the ABC campaign. She says that despite this, young people are still being infected. Mbuga Health Centre tested 358 teenagers in May; 10 were infected with HIV. Baana explains that this indicates that a number of young people are not adhering to the strategy or have not benefited from it. Providing condoms to sexually active people in Nyamagabe is still challenging according to the CDLS officer. “Many people are shy to come and pick condoms. We have decided to put them in public toilets and people pick them from there.” Though CDLS and its partners endeavor to provide condoms for free, not every one can be reached. Steven Kaliisa, 19, is the president of the anti-AIDS club at Nyamagabe Secondary School. He says that although many people tell them to use the ABC strategy to avoid contracting HIV, none provides condoms to them. “The problem is that they do not provide condoms in any way at the school and we do not have the money to buy the condoms on our own, yet some students are sexually active,” says Kaliisa. Failure to provide condoms is not only because of lack of capacity but there appears to be a problem of perception. Teacher Rose Uwamahoro says that providing condoms to secondary school students would encourage them to indulge in pre-marital sex. She says that for students, the main message is abstinence, but if not possible, they are encouraged to use condoms. Uwamahoro admits that in the mixed school there is a high possibility that students are sexually active. Veneranda Mukarurangwa, 31, a nurse at Ineza pharmacy in Gikiongoro town, says that it is rare for women to buy condoms. “It is only men who come to buy condoms and most of them insist on the Lifeguard brand. If we do not have it they just go without buying any other brand.” She explains that many men report that their female partners do not like other brands like Prudence, saying that it smells bad. It is apparent that women lack the ability to negotiate safe sex and leave it to men. Gahutu urges his own children to use condoms when they become sexually active. He hopes that the ABC strategy will protect them better than it protected him. Ends