Why HIV infection rates remain high in urban areas

Urban centres by their nature come with a big population, making them a haven for many conditions arising from these numbers. For instance, In Rwanda, HIV prevalence among the general population aged 15-49 years has remained stable at 3.0 per cent for the last decade. The prevalence is higher among women (3.6 per cent) than men (2.2 per cent), and higher in urban areas such as Kigali, at 7.1 per cent than in rural areas at 2.3 per cent, according to the Demographic and Health Survey (DHS) 2014-2015. Dr Diane Gashumba, the Minister for Health, says the number is still high because of some factors that still make urban dwellers more vulnerable to HIV transmission than their rural counterparts. “Among the reasons is the fact that a lot of naïve young and illiterate youths, and even adults, move from villages to urban areas in search for jobs. This makes urban areas densely populated, in turn leading to high chances of the spread of HIV,” she says. Dr Gashumba adds that living conditions and relatively high rates of social interaction in urban settings makes the spread of the virus and also other infectious diseases high. Boniface Nsekanabo, the in charge of data at Avega Clinic in Kigali, points out that it’s in the city where people tend to have a lot of money compared to rural areas, which alone increases the chances of most of them involving in risky behaviour, including commercial sex. He also notes that the number of female sex workers is high in urban centres, which contributes to the high numbers of infections. Nsekanabo says long distance track drivers and tourists may be another reason for high cases of HIV as these people are likely to bring in infections from elsewhere. Intervention measures to curb the spread The Ministry of Health, Dr Gashumba says, government puts emphasis on sensitising people on how to prevent new infections. “For instance, we normally target places where people are living in groups, like at Umudugudu level, where we provide education on HIV/AIDS,” she says, noting that the teaching is structured depending on the age group, so that the targeted people get the right information at the right time. Dr Gashumba also says that they avail condoms in different public places around the city, adding that the Ministry is collaborating with the owners of entertainment places such as pubs, to offer condoms free of charge. Ernest Nyirinkindi, the in charge of information, education and behavioral change communication at Rwanda Biomedical Center (RBC), says there is mobilisation and sensitisation on prevention measures that has been set around the City of Kigali to ensure that people do not contract HIV. “The good thing about this is that when the population decides to follow and use our advice, the virus is 100 percent preventable,” he says. He says there are condom display centres in some areas of Kigali that operate all day and night, namely, Giporoso, Nyamirambo and Remera. This is to ensure that people to always use protection. Nyirinkindi adds that there is free HIV/AIDS testing and treatment offered around all health facilities. He says through voluntary medical male circumcision method (VMCM), they are trying to ensure people stay safe from contracting the virus. “The method is meant to reduce the lifetime risk of male acquisition of HIV. This strategy is also a component of a comprehensive strategy towards achieving an AIDS-free generation,” he says. The 2015 DHS statistics showed that 30 per cent of Rwandan men age 15-59 (20 per cent) are circumcised, an increase of 17 per cent, according to RDHS 2010. Nyirinkindi explains that widows and young girls of between the ages of 14 to 18 are among those that are more vulnerable to HIV/AIDS. “They are the victims of HIV transmission because of their status of life, which puts them at the risk of sleeping with any one as long as they are supported financially,” he says, adding that this trend is more pronounced in urban areas than rural ones. Nyirinkindi adds that sensitisation is being done across the country to mobilise people to go for free HIV testing and medication to avoid further spread.