It was January 2020 when Janvier Igabe walked into a salon in Kigali for a haircut and noticed a beautiful woman, Josiane Tuyishimire. He was instantly drawn to her and told her he was interested in starting a relationship. Before their conversation could go any further, Tuyishimire shared that she was living with HIV. ALSO READ: How discordant couples can live happily together “She told me about her status right away, and I was scared. I didn’t know much about HIV and had never met anyone I knew living with it. But I was certain I wanted to be with her for the rest of my life. I loved her honesty; she seemed kind and really beautiful,” Igabe said. Igabe is HIV negative, while Tuyishimire is living with HIV. They are married and serve as youth ambassadors with the Rwanda Network of People Living with HIV (RRP+), mentoring couples on how to navigate life safely with differing HIV status. ALSO READ: What’s driving the decline in new HIV infections? After getting married in 2021, the couple shared their story on a YouTube channel, including their phone numbers, seeking guidance on how discordant couples (where one partner is living with HIV and the other is HIV-negative) could live safely together. This led to contact with the Rwanda Network of People Living with HIV (RRP+), which connected them to clinicians affiliated with the Rwanda Biomedical Center (RBC). Through these clinicians, Igabe learned about pre-exposure prophylaxis (PrEP), a daily pill for HIV-negative people that helps prevent infection. “I was uncertain how long I would take it or how effective it was, but because I loved her, I had already decided to be with her,” he said. The couple dated for a year, taking care to avoid sexual contact out of caution. In 2021, they married, still learning how to live safely as a discordant couple. Through counselling and training with RRP+ and linked health experts, they gained in-depth knowledge of antiretroviral therapy (ARVs), viral load monitoring, PrEP, and the principle of U=U (undetectable equals untransmittable). This means that when a person living with HIV takes their antiretroviral treatment consistently and maintains an undetectable viral load, the virus cannot be transmitted to a sexual partner. “The first thing doctors emphasised was discipline. My wife has to take her ARVs without missing a dose. My role is to support her. They also told me I could take PrEP to protect myself,” Igabe said. Tuyishimire resumed consistent treatment and regular viral load testing, while Igabe took daily PrEP. After a month, doctors confirmed her viral load was suppressed. “The doctor told me I was healthy and that we could have unprotected sex and even plan for children,” Tuyishimire said. Eight months into their marriage, they began trying to conceive. Today, they have two daughters, aged four and two, both of whom are HIV negative. “Our babies are healthy, my wife continues her ARVs, and I also go for testing every three months. We live a normal life,” Igabe said. Igabe, 38, is an engineer, while Tuyishimire, 29, is studying culinary arts. They live in Gasabo District. Living a life without purpose, finding hope Tuyishimire’s life before meeting Igabe was characterised by hardships. She contracted HIV at the age of seven after being repeatedly raped by her father, who had separated from his three wives and was living alone with her. Tuyishimire said she did not learn about her HIV status until she was 16. Her father had become ill and went for a medical checkup, where he was found to be living with HIV. He then took her for testing, and she, too, was diagnosed with the virus. However, he did not disclose her status to her until she turned 16. Until that time, Tuyishimire had never been with anyone else. Following the disclosure, she made the difficult decision to leave her father’s home and move in with a friend. “I had lost hope and purpose. Life was tough for me. I started treatment in 2014 but stopped in 2018, and during that time I struggled with depression and attempted suicide three times.” In 2019, Tuyishimire found support at Ndineza Organization, founded by gospel singer Aline Gahongayire, which helped her return to treatment and rebuild her confidence. Igabe met her the following year, and they married in 2021. After marriage, Tuyishimire accessed mental health services and later engaged with RRP+. Now, Igabe says his wife has a reason to live. Their family gives her purpose, and he encourages her to stay on treatment. “My husband is my main support. He is my family, my parents are alive, but they do not want to know what is happening in my life. He stands by me,” Tuyishimire said. After going public with their story, the couple faced challenges. Some relatives and friends struggled to understand how Igabe could be married to someone living with HIV, and stigma emerged. He stood firm, insisting that his wife and their family be treated with respect. The couple mentors other discordant couples through RRP+. “We have helped eight couples get married. Knowledge reduces fear, when someone adheres to ARVs and reaches undetectable levels, HIV cannot be transmitted,” Igabe said. The government plans to introduce lenacapavir, a long-acting injectable for HIV prevention, in the last quarter of the year. Igabe said the injection will protect him and other HIV-negative people, as well as those at higher risk, including sex workers, and could help reduce the stigma associated with taking daily ARVs. The couple said that their greatest lesson over the years has been to use their story to help other discordant couples enjoy marriage and support one another, showing that living with HIV is not a death sentence and that it is possible to live a happy, fulfilling life with the right support. Healthy living for couples with different HIV statuses Dr Jean Claude Kwizera, HIV/AIDS Adult Care and Treatment Senior Officer at RBC, said the first and most important step for couples where one partner is living with HIV is to initiate and continue antiretroviral therapy (ART) immediately. “Strong adherence to ART helps achieve and maintain viral load suppression. When this is sustained, a person living with HIV can live a healthy life just like someone without the virus,” he said. He added that consistent adherence and regular viral load monitoring, once a year for those with viral suppression in Rwanda, are essential. “Achieving and maintaining an undetectable viral load reduces the risk of sexual transmission to the HIV-negative partner. This is the basis of the U=U principle,” Dr Kwizera explained. He added that for additional protection, couples are encouraged to use condoms consistently, especially if viral suppression has not yet been achieved. Dr Kwizera explained that the HIV-negative partner can also consider pre-exposure prophylaxis (PrEP), particularly during periods when the partner living with HIV has not yet reached viral suppression or when planning a pregnancy. He advised regular couple counselling and family planning support, as well as routine follow-up visits to maintain long-term wellbeing. The health expert urged that the HIV-negative partner be tested regularly and that both partners be routinely screened and treated for sexually transmitted infections.
