Rwanda has made progress in tackling the human immunodeficiency virus, also called HIV, which targets the body’s white blood cells and weakens or damages the immune system so that it becomes easier to get sick with diseases like tuberculosis, infections and some cancers. ALSO READ: Rwanda’s bold path to ending AIDS, progress, challenges, and the road ahead If HIV isn't treated, it can take years before it weakens the immune system enough to become the acquired immunodeficiency syndrome, also called AIDS, which is the most advanced stage of the disease. According to latest official data, 95% of people living with HIV are aware of their status, 95% of those diagnosed are receiving antiretroviral therapy (ART), and 95% of those on ART are achieving viral suppression. However, the HIV prevalence among people aged 15-49 stands at 2.7%, with 0.5% of children under 15 living with the virus, according to Dr. Vanessa Mupenzi, the Director of HIV Epidemiology, Surveillance, and Research at Rwanda Biomedical Centre (RBC). ALSO READ: What to know about Rwanda’s new preventive HIV drug Despite these statistics, the fight against HIV is far from over. Myths and misconceptions about the virus persist, posing challenges to prevention and care efforts. The myths often fuel stigma, making it more difficult for individuals to seek help, get tested, or access the treatment they need. According to Dr. Gilbert Mbaraga, a medical officer at AIDS Healthcare Foundation (AHF) Rwanda, several people still mistakenly believe that HIV can be transmitted through casual contact such as when hugging, or even shaking hands, which is simply not the case. The virus is only spread through specific bodily fluids like blood, semen, vaginal fluids, and breast milk. Casual contact, such as hugging or sharing meals, does not pose a risk of transmission. ALSO READ: Rwanda observes World AIDS Day with renewed commitment to ending HIV, stigma The myths and misinformation about how it is spread has led to widespread discrimination, with people living with HIV often facing unnecessary isolation. “These misconceptions contribute to fear and stigma. People with HIV may be unfairly judged or rejected due to these misunderstandings about how the virus is transmitted,” Dr. Mbaraga explained. Another common myth is the belief that mosquitoes can spread HIV. There is no scientific evidence to support this. Mosquitoes, like other insects, cannot transmit the virus. The virus is specific to human-to-human transmission, Dr. Mbaraga added. Another harmful myth he noted, is the idea that HIV can be passed on by animals, stressing that HIV is a human-to-human virus. It cannot be spread by animals, insects, or any non-human species, Dr. Mbaraga stressed. ‘Undetectable = Untransmittable’ “Perhaps the most dangerous misconception is the idea that HIV is a death sentence, with modern antiretroviral therapy (ART), individuals living with HIV can live long, healthy lives. ART suppresses the virus to undetectable levels, and once undetectable, HIV cannot be transmitted to sexual partners. This principle is known as “Undetectable = Untransmittable” (U=U), an important message in reducing stigma and encouraging treatment adherence,” Dr. Mbaraga said. Another common and dangerous belief that has no basis is that traditional medicine can cure HIV. Dr. Mbaraga clarifies that there is no scientific evidence to support the use of herbal remedies or alternative treatments as a cure for HIV. ART remains the most effective treatment available. Understanding how HIV is transmitted Deo Mutambuka, the Executive Secretary of Rwanda Network of People Living with HIV (RRP+), said that HIV is primarily spread through certain bodily fluids—blood, semen, vaginal fluids, rectal fluids, and breast milk,” Unprotected sexual intercourse is the most common route of transmission. This can include vaginal, anal, or oral sex, and each type of exposure carries a risk, with anal sex being the highest risk due to the vulnerability of the rectal lining. “HIV can be transmitted through direct contact with infected blood, such as through sharing needles, unsterilized medical equipment, or receiving contaminated blood transfusions,” said Mutambuka. While the risk of transmission through blood transfusions has decreased due to strict screening procedures, sharing needles, particularly among people who inject drugs, remains a major risk factor, he added. Mutambuka also noted that HIV can be passed from a mother to her child during pregnancy, childbirth, or breastfeeding. However, with proper medical care such as ART during pregnancy and delivery, the risk of mother-to-child transmission can be greatly reduced. Mutambuka stressed: “You cannot contract HIV from hugging, shaking hands, sharing meals, or through saliva, sweat, or tears unless blood is involved, this is crucial in reducing the stigma surrounding people living with HIV.” Prevention methods For individuals at risk of HIV, Mutambuka noted that the most effective and simple method is consistent and correct condom use during all forms of sexual activity. “Condoms provide an effective barrier that prevents the exchange of bodily fluids and reduces the risk of HIV transmission,” he explained. Pre-exposure prophylaxis (PrEP) is another critical tool for those at high risk, he said, explaining that PrEP is a daily medication that, when taken as prescribed, can reduce the likelihood of contracting HIV by up to 99%. Pre-exposure prophylaxis, is medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use. “This is particularly important for people with HIV-positive partners, people who inject drugs, or those in high-risk communities.” Testing also plays a central role in preventing the spread of HIV. Regular HIV testing helps individuals know their status and, if positive, seek treatment early. Post-exposure prophylaxis (PEP) is an emergency medication that can prevent the virus from establishing itself if taken within 72 hours of potential exposure, Mutambuka noted. Post-exposure prophylaxis, also known as post-exposure prevention, is any preventive medical treatment started after exposure to a pathogen in order to prevent the infection from occurring. For people already living with HIV, ART is essential. “When ART is taken as prescribed, the virus is suppressed to undetectable levels. This not only protects the individual’s health but also reduces the risk of transmission to others,” Mutambuka said. Need for continued education Dr. Mupenzi highlighted that while Rwanda made significant progress in HIV treatment and care, stigma remains a barrier. As noted, despite reducing HIV-related stigma from 60% in 2009, to 13% in 2020, discrimination still discourages many people from going for testing, seeking treatment, and support. This is particularly true for adolescents and young people, who often feel a false sense of security about HIV, influenced by risky behaviours glamorized on social media, she added. “Young people often face a growing sense of complacency about HIV. We need to continue emphasizing prevention and the importance of testing and treatment,” Dr. Mupenzi said. Effort to improve services, reach key populations Dr. Basile Ikuzo, the Director of the HIV Prevention Unit at RBC, underlined Rwanda’s efforts to improve HIV prevention and care, especially for key populations. “Our focus is on ensuring that everyone, including marginalized groups like men who have sex with men, and sex workers, have access to the services they need,” Dr. Ikuzo explained. He added that RBC is working to expand the availability of preventive measures such as PrEP, PEP, and condom distribution. Additionally, the use of voluntary medical male circumcision (VMMC) and improved outreach for high-risk groups are central components of the prevention programme, Dr Ikuzo added. However, he also noted that the country faces challenges due to the increasing number of new infections among youth, particularly young women. “There are still gaps, and we are addressing these through targeted interventions. Integrating HIV care with services for non-communicable diseases (NCDs) is another key strategy moving forward.”
