While diverse global participants with differing beliefs and values look forward to sharing knowledge about global progress in stopping the epidemic that has lived for centuries, there is more they can learn about Rwanda’s approach towards preventing new HIV infections while raising the life expectancy of people living with HIV. And this is a tremendous story.
It is 11 am in Kigali, people of different gender and age sit on a wooden bench waiting their turn to be attended to. It does not take long for the seemingly lengthy queue to lessen, leaving almost an empty space, though more people keep coming in and out to access services.
This is not a bank or a market, it is a lifesaving facility located at the University Teaching Hospital of Kigali (CHUK). It is Rwanda’s first-ever HIV clinic, where the ruthless fight against the deadly virus began. To this clinic, most people living with HIV owe their lives. It is here that Rwanda’s great story of increasing the life expectancy of people living with HIV began, while care and treatment services were studied critically and decentralised throughout the country.
“Right here is where the battle against HIV began. HIV mortality was high because treatment was inaccessible, patients died of the wasting away syndrome and opportunistic diseases caused by advanced AIDS,” explains Dr Leopold Bitunguhari, the head of HIV and Infectious Disease department at CHUK.
A 23-year-old female patient could not agree more as she takes me through her journey of discovering her HIV positive status at the age of 12 after her parents disclosed the voluntary HIV test they took years ago when she was nine.
“Much as I was a child, I fell into despair, I kept wondering if I would ever live an extra year, I realised that the daily medication I had taken for several years was because I had such a deadly disease,” she narrates.
With over 13 years of antiretroviral therapy, her story has changed. She hopes to live a normal, healthy and longer life just like any other human being. She is enrolled in university and hopes to become a successful businesswoman and have a family someday.
In unison, the over 120 patients who visit the facility daily can attest to a positively changed healthy life, where they contribute to the development of their family and country without worrying about their HIV positive status.
Inaugurated in 2003, the CHUK HIV clinic not only served as a treatment and care centre for people living with HIV, it was a research centre that gave a baseline on how to arrest the epidemic. Currently through a decentralised HIV countrywide programme, over 510 public health centres offer HIV programmes, which include treatment and care, plus voluntary counselling and testing.
As a result, life expectancy for people living with HIV (PLHIV) has increased by 25 years in the last 10 years. According to a recent research, PLHIV can live for as long as 65 years and more compared to between 35 to 47 years which was the national life expectancy in 2008 for PLHIV.
The recent Rwanda Population-based HIV impact assessment survey estimating Rwanda’s progress towards achieving the UNAIDS 90-90-90 goals by 2020 also affirms that Rwanda has indeed achieved; 83.8 per cent adults living with HIV know their status, 97.5 per cent of those individuals self-report being on anti-retroviral therapy (ART) while 90.1 per cent of those on ART have viral load suppression.
The United Nations Program on AIDS (UNAIDS) targets to test 90 per cent of the population against HIV , to enrol 90 per cent of the HIV positive people on antiretroviral drugs and suppress viral load by 90 per cent for those on ARVs. In Rwanda, the country has worked hard to meet and surpass these goals.
When HIV became a major killer in 1983, most African countries barely knew what it was or how to tackle the issue. Like with other countries in Africa, HIV claimed quite a number of lives in Rwanda, it was extremely difficult to afford HIV treatment between 2000 and 2002.
“I sold all I had to be able to buy ARVs in neighbouring Uganda, I had nothing more to sell, so I took the hard decision of isolating myself from family so I could die a peaceful death without them having to see me waste away,” says another 57-year-old patient. “This HIV clinic and later the national HIV programs came in as my rescue,” he adds.
Rwanda started with only treating the opportunistic diseases that came with HIV, such as tuberculosis, until an even better solution came up. This solution came in the form of the first line of ARVS to help suppress the viral load. Currently, Rwanda boasts of three lines of antiretroviral drugs, when a patient resists one, they easily channel them to the next line. Meanwhile to ensure suppression of viral load and to prevent mortality due to AIDS, Rwanda initiated three very key programmes, including Voluntary Counselling and Testing (VCT), treatment and care and psychotherapy services to patients. This way, patients are followed up on a monthly basis. Initially receiving ARVs from all health facilities is done once a month for starting patients while patients who have showed commitment and a suppressed viral load for years can get a three-month dose at a visit. Meanwhile, viral load is checked upon every six months for each patient and counselling is provided according to the findings.
“In case of an increased viral load, we find out the cause. If it is the patient’s body resisting the treatment, we adjust accordingly, but if a patient has not accepted their HIV status, hence ignoring the medicine, we put them on routine monitoring and usually get them a support group,” says Dr Bitunguhari.
Meanwhile, since 2016, Rwanda treats all HIV positive patients regardless of the viral load. Previously, ARV therapy was given to patients whose CD4 count had dropped to less than 350 cells, which would expose them to higher chances of death due to opportunistic diseases resulting from lost immunity. A suppressed viral load has also played a role in preventing new HIV infections, as patients with a small amount of the virus have a very small chance of infecting others.
Other successful pillars in HIV/AIDS treatment include decentralising HIV testing and treatment services to over 510 public health facilities, which has brought VCT close to the population, testing all pregnant women for HIV during their first antenatal care visit — prior to delivery and making follow-up tests after birth, which has reduced mother-to-child transmission to less than two per cent.
With a goal to achieve an AIDS-free generation, Rwanda has hyped prevention; mobile condom kiosks are dispatched in hotspots where sexual activities are high, male circumcision increased from 13 per cent in 2010 to 30 per cent in 2015 as a way of reducing the risk of getting HIV by 60 per cent among men. Meanwhile, Rwanda’s non-discriminatory policy provides HIV interventions for key populations regardless of their sexual orientation. Key populations include; men having sex with men, commercial sex workers, serodiscordant couples and the youth.
This way, Rwanda has kept HIV prevalence at three per cent for more than a decade. Indeed ICASA comes in timely to share these best practices in fighting HIV. Meanwhile, the international conference is an avenue for every Rwandan who would love to contribute to the global cause of ending HIV/AIDS.