According to the ministry of health, Twenty-four years ago (1983), the first Aids case was diagnosed at the Central Hospital of Kigali (CHK). Since then the virus has continued to spread throughout the country especially during the aftermath of the Genocide. According to UNAIDS, HIV/Aids is the fourth leading cause of death worldwide. The estimated death toll of the disease since the epidemic began exceeds 20 million; the organisation also estimates that an additional 68 million will die of HIV –related causes by 2020 unless immediate and full scale prevention and treatment efforts are implemented. Apparently, the surge of Aids deaths has set off a precipitous decline in life expectancy, dropping to the age of 40 in Rwanda, Angola, Botswana, Lesotho, Malawi, Mozambique, Zambia and Zimbabwe according to the Population Reference Bureau in Washington. Women are at the centre of the epidemic. They are particularly susceptible to HIV infection, and carry the burden of caring for family members living with HIV/Aids. Whereas men were most infected at the beginning of the epidemic, women’s rates of new infection now surpass men’s, especially in countries like Rwanda where women live in poverty and have relatively low status. According the population Bulletin (a publication of Population Reference Bureau in Washington), in sub-Saharan Africa, there are 12 to 13 infected women for every 10 infected men. And, the gender gaps are especially pronounced among young people younger than 25 years, infection rates are five times higher among young women than young men. Most infections in young women are as a result of unprotected sex and reflect a power imbalance that limits women’s ability to negotiate or control sexual interactions, especially with older men. HIV in Rwanda is primarily spread through heterosexual contact (75 percent) and mother to child transmission (20 percent). Young women and middle-aged men have the highest rate of infection according to information from the ministry of health. Biological, cultural, and social economic conditions contribute to women’s greater vulnerability to HIV /Aids. During unprotected vaginal intercourse; a woman’s risk of becoming infected is up to four times higher than that of a man. The vagina’s greater area of susceptible tissue (compared with the male urethra) and micro trauma during intercourse make women physiologically vulnerable to HIV. In addition, HIV –infected semen typically contains a higher viral concentration than do vaginal secretions. A final biological factor that makes women more vulnerable to HIV involves the synergy between HIV and other sexually transmitted infections (STIs). Research shows that an untreated STI in either partner can increase the risk of HIV transmission as much as 10 folds. This is especially significant for women because most STI cases in women are untreated. Women’s symptoms are often latent or difficult to see and many women who have been diagnosed with STIs have no access to medical treatment. Socio-economic factors, including women’s lack of access to education or personal income, perpetuate women’s lower status and create even greater vulnerability to HIV infection. Many women fear that they will be abandoned by their husbands or supporting partners if they try to exert control over how and when they have sex and whether their partner uses a condom. Moreover, widespread poverty drives some women into the sex industry, where sexual trafficking and worker rotations promote continued exposure of new sex workers (and their clients) to HIV. Furthermore, men control the main tool for reducing the risk of sexual transmission of HIV, the male condom. Cultural traditions such as forced and early marriage, older men’s preference of young women, and genital mutilation contribute to women’s lack of power. Throughout the world, prevailing views about masculinity encourage men to undertake risky sexual behaviour such as having multiple sexual partners, alcohol consumption prior to intercourse, and sexual violence that makes women more vulnerable to HIV and other STIs. Young girls are at even greater risk of sexual coercion because of their social vulnerability and because some men assume that young girls are virgins and free of infection. A cultural myth in South Africa holds that sexual intercourse with a virgin can heal some one of HIV infection. This belief has led to child rapes and to men seeking sex with very young girls. The rising HIV infection rates among women expose children to increased HIV risk even before they are born. With such gruesome figures, preventing HIV infection among women is critical to slowing the epidemic since women are more vulnerable in all aspects (biologically, socially and economically). The consequences of the Aids scourge on lives of ordinary Rwandans and the development efforts are far reaching. Rwanda is currently engaged in a rapid scale up of AIDS care, including anti-retroviral therapy to reduce viral load and prevent opportunistic infections. However policy makers must ensure that all Aids programmes be geared towards bridging the gender gaps in the face of the pandemic. It is useful to identify women as the most vulnerable group as far as HIV/Aids pandemic is concerned. In addition to creating awareness about effective ways of avoiding contracting HIV; effective use of condoms, sexual abstinence, mutually monogamy among couples, it is of great importance if more attention is given to mother to child transmission of HIV. This includes creating awareness that HIV can be transmitted through breast feeding and that the risk of transmission can be reduced by special drugs. ubernie@gmail.com
