Claire Abatoni (not real names), a 29-year-old single mother, was very busy on Friday, June 26, and not so impressed when a health worker informed her that The New Times wished to interrupt her schedule an interview. Nonetheless, despite her busy day she accepted. First, however, she had to help 10 of her female sex worker (FSW) colleagues get requisite medical assistance at a busy community health Centre in an area of the Kimisagara suburb commonly known as Kwa Nyiranuma. After that, she promised, she would be ready to talk, briefly. Abatoni is the FSW team leader in Nyarugenge District and often escorts fellow female sex workers in her zone to the health Centre and ensures they see the doctors they wish to see without any hustle, and no stigma. “My colleagues fear the stigma we face whenever they go out looking for medical assistance. I go with them and ensure everything goes well,” she said. “It’s tough life being a sex worker. And worse when you have HIV. But thanks to the national programme and other support networks, we get necessary medical care and treatment just like any other citizens.” According to Abatoni, sex workers now live an easier life than was the case in the past. Years back, she says, when one contracted sexually transmitted infections (STIs), life would become unbearable “but that’s no more” since they now benefit from family planning workshops, among others. “Nowadays we are taught how a condom is used. In the past, we didn’t know that a woman has a role in this. We thought this was a man’s job and this put many women at risk,” she said, thanking Society for Family Health (SFH), a non-profit organisation that implements diverse public health interventions in HIV/AIDS, reproductive health, and other areas. Abatoni’s story explains how Rwanda’s national HIV programmes and policies contributed significantly towards reducing new infections and ensuring people living with the virus are linked to and sustained on its treatment. Special measures are in place for the City of Kigali when it comes to tackling HIV prevalence there, Dr Dominique Savio Habimana, Director of Care and Treatment in the HIV Division at the Rwanda Bio-Medical Centre (RBC), told The New Times. This is because the HIV prevalence in the country is highest in Kigali (4.3%), with a prevalence between 2.2% and 3.0% in the other four provinces, as per latest official statistics. Dr Habimana said: “We have special programmes focusing on key populations such as female sex workers, and men who have sex with men, by providing free condoms, and free lubricants. And we are trying to establish special care health facilities for them.” According to results from the Rwanda Population-based HIV Impact Assessment (RPHIA) released in 2019, HIV prevalence is 2.6% among adults between 15-49 and 3.0% among adults between 15-64. In general, prevalence of HIV is higher among women, with a prevalence of 3.7% for women between 15-64 as compared to 2.2% for men between ages 15-64. HIV prevalence is significantly higher in females compared to males in the age groups 20-24, 25-29 and 30-34. The incidence of HIV in Rwanda is 0.08 infections per 100 for adults between 15-64. Dr Habimana indicated that countrywide, measures put in place are bearing fruit as the number of infections are on the down. As noted, Rwanda is approaching the point when the number of new HIV infections will remain lower than total deaths. There were 5,265 new infections in 2019 and, “the projections of the whole 2020 based on registered deaths so far” point to 5,113 new infections in 2020. Again, while there were 2,841 deaths due to HIV last year, he noted, this year’s projections point to 2,764 deaths. Generally, the national programme includes support for HIV prevention, care and treatment, STIs and viral hepatitis, health system strengthening, strategic information and planning for HIV, and HIV financing and governance. Available statistics also indicate that 86% of people living with HIV in Rwanda are aware of their HIV-positive status and 97% of them are on antiretroviral treatment. Innovative prevention and testing strategies According to the RBC, the country employs innovative prevention and testing strategies to ensure that all people living with HIV are aware of their status and that those who are negative stay negative. Strategies implemented include self-testing, index testing and partner notification services, case-based surveillance, regency testing, prevention of mother-to-child transmission, voluntary medical male circumcision, early infant male circumcision, mass campaigns to promote HIV awareness, and specialized programming to reach key populations in the community and at health facilities across the country. Between July 2018 and June 2019, 25,904 female sex workers were enrolled in prevention programming. Of those reached, 7,467 tested HIV positive and were linked to care and treatment. In the ongoing Covid-19 crisis, Dr Placidie Mugwaneza, the Acting Division Manager for HIV, said that to ensure the continuity of patients’ treatment, “the national programme has adapted accordingly.” “Despite the continuity of health service delivery during the lockdown period, movement of patients living with HIV like other patients were limited. Patients that usually receive monthly ARV drug pick up are now receiving drugs for two months while others continue to receive ARV drugs for three months,” Dr Mugwaneza said. “This shift allowed patients to reduce health facility visits and contribute to their prevention of Covid-19. But HIV services such as male circumcision, and testing reduced slightly during lockdown especially due to restriction of movement.” HIV Care and treatment a priority Dr Habimana stressed that HIV care and treatment is “a priority” of the national HIV programme. The Government, he said, is committed to initiating all people living with HIV on treatment “regardless of CD4 count.” The plan is to “treat all.” As of October 2019, there were 197,909 people living with HIV (approximately 86%) who were supported on anti-retroviral treatment in Rwanda. Retention levels are consistently above 90% for all age groups, supporting high levels of viral suppression among people on treatment. Officials say that the differentiated service delivery model (DSDM), a client-centered approach to patient care that focuses on the preferences and expectations of people living with HIV, is a cornerstone of the HIV programme in Rwanda. The national programme also focuses on integration of HIV treatment with co-morbidities (presence of one or more additional conditions) such as Hepatitis, non-communicable diseases, tuberculosis, and mental health. Among others, a social impact mitigation programme provides support for people infected with and affected by HIV. The programme works to improve socioeconomic status, ensure that they are protected, prevent sexual and gender-based violence, and reduce HIV related stigma and discrimination. The national programme supports activities to prevent sexually transmitted infections (STIs), including awareness campaigns, sensitization, mass screening and vaccination campaigns. From July 2018 to June 2019, more than 190,000 cases of STIs were diagnosed and treated and more than 35,000 partners were notified and received treatment.
