Why HIV infections among young people remain alarmingly high

HIV infections among young people continue to rise despite the government’s significant progress in managing the epidemic, a trend health experts describe as “a serious concern” requiring sustained attention. Dr Basile Ikuzo, Director of the HIV Prevention Unit at Rwanda Biomedical Center (RBC), said the data shows that “youth represent a disproportionate share of new infections,” even though overall prevalence remains higher among older adults. National figures stress the challenge. “Adult prevalence stands at around 3 per cent for those aged 15 to 64,” he said, noting that prevalence among people aged 15 to 49 “remains between 2.6 and 2.7 per cent.” The Rwanda Population-based HIV Impact Assessment reported a 1.2 per cent prevalence among young women aged 15 to 24 and 0.5 per cent among young men. ALSO READ: Rwanda's fight against HIV/AIDS: A closer look at key gains, gaps Numbers from the National Institute of Statistics of Rwanda illustrate the scale of the problem. In 2023, about 380,000 young people were tested and roughly 1,600 were found positive. Other reports recorded more than 9,000 new infections among those aged 15 to 24, nearly 35 per cent of all new cases. Dr Ikuzo said a mix of biological, social and behavioural factors continues to push infections higher. “Adolescent girls and young women remain more vulnerable,” he said, citing relationships with older partners and situations driven by financial need. He added that “urban nightlife, alcohol use and peer pressure continue to expose many young people to high-risk situations.” Stigma and low risk perception also remain major barriers. “Many youth underestimate their risk or fear of being seen accessing condoms, testing or PrEP,” he said. Such fears, he warned, limit prevention efforts and could undermine national progress. “Rwanda has a large youth population, so persistent new infections in this group threaten long-term epidemic control.” ALSO READ: Rwanda’s aging HIV population needs special attention - experts To respond, sexual education programmes in schools and communities are being strengthened, alongside youth-friendly services offering “privacy, flexible hours and integrated sexual and reproductive health care.” Rwanda is also expanding the availability of condoms and HIV self-testing kits in schools, universities, youth centres and hotspots, while increasing access to PrEP for those at higher risk. Digital platforms are becoming central to outreach. “Social media, influencers and peer educators are helping normalise testing and prevention,” he said. But he acknowledged that “some youth still hesitate due to fear of judgement,” even as youth-led initiatives continue improving engagement. Dr Gilbert Mbaraga, Medical Manager at AIDS Healthcare Foundation (AHF) Rwanda, said the rise in infections reflects deeper issues. “Low risk perception remains one of the biggest challenges,” he said, pointing to reduced condom use, limited sexual-health education and socioeconomic pressures that “directly affect prevention behaviours.” ALSO READ: Why Rwanda is beefing-up support for people aging with HIV He added that poverty, unstable housing and gaps in youth-friendly services reduce access to testing and care. “Stigma in schools and health facilities keeps many young people away from services,” he said, noting that substance use also fuels risky behaviour. Behavioural factors are “among the strongest contributors,” Dr Mbaraga said. “But social determinants—poverty, limited education access, unstable family structures—carry just as much weight.” Gender inequality, he added, “significantly elevates risk among adolescent girls and young women,” while low PrEP coverage remains “a critical gap.” Reversing the trend, he said, requires comprehensive sexual education covering “consent, contraception, safer sex and stigma reduction,” alongside expanded youth-friendly services offering confidential testing, same-day PrEP initiation and “non-judgmental, welcoming” clinical environments. He emphasised the importance of easy access to condoms, targeted programmes for high-risk groups and initiatives supporting young women facing economic vulnerabilities. “Peer navigators and youth ambassadors make a strong difference because they reduce stigma and increase trust,” he said. Dr Mbaraga added that broader policy changes are essential. “Reducing stigma in schools and healthcare settings, improving gender equity and expanding economic opportunities for young people will all contribute to lowering new infections.” Young people who test positive face additional challenges. Many experience “psychological distress, fear of being judged and difficulties with disclosure,” he said, alongside struggles with daily medication, transport to clinics and transitioning from paediatric to adult HIV care.

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Why HIV infections among young people remain alarmingly high