Health problems associated with Sexually Transmitted Diseases and unwanted pregnancies are more prevalent among high risk populations and lower among the youth than in the general population in Rwanda.
The main risk factors that fuel spread of these illnesses and challenges among the youth include: promiscuity and sexual abuse, bi/homosexual activities, prostitution, drug use and abuse and low levels of using condoms during sexual intercourse.
Most of the young people that I interviewed had different opinions on the use of condoms with some saying they always use condoms while others say they never use them.
What the youth say
For the 25 year old truck driver, Mugisha Anthony says one of the main benefits of condom use is the condom’s protective function against disease.
“It is not only about getting infected but people should always think of protecting others from sexually transmitted infections and so opt to use a condom. For HIV-positive people, condoms should always be used to prevent transmission of HIV to others and to protect against re-infection or infection with other sexually transmitted diseases,” says Mugisha.
Some youth use condoms for fear of the financial burdens that come with pregnancy. “What I have realized is that with boys, the use of condoms is important to us in the prevention of HIV and STDs, so, you have to deal with the whole concept of being healthy.
But most of our women partners, condoms are used for the prevention of unwanted pregnancies which come with the burden of additional spending for supporting the baby,” Mugisha says . This presents a number of consequential challenges which need to be pragmatically addressed.
The Government of Rwanda has committed to creating awareness on condom use through a number of approaches, including working with community health workers, promoting peer education, distribution in high risk zones, creating access in the process.
According to Dr Placidie Mugwaneza the Director of HIV Prevention Unit at RBC, distributing condoms in high risk zones is a key strategy) for the prevention of new HIV infections for both key and general populations.
“To ensure easy access to condoms, they have been made available within public health facilities for free distribution and through social marketing whereby branded condoms are sold at an affordable price,” explains Dr. Mugwaneza.
She says, 24/7 Condoms distribution kiosks come as an additional condoms distribution channel. The later is prioritized in the high risk areas (hot spots), initiated in the City of Kigali in 2016 and now extend to other 3 hot spots located in Rusizi, Huye and Rubavu. The 24/7 condoms kiosks are meant to enable free access
Also made available are educational materials with general information on HIV and safe sex practice.
Currently, Rwanda has many brands of condoms with innotex from France at Rwf1000 being the recent to enter the market. However, the most used are Prudence, Plaisir due to their affordability.
The Ministry of Health and its partners have not relented in creating awareness on the importance of condom use, for there are some individuals that are yet to fully embrace the practice.
What the government is and its partners are doing
The Ministry’s placing condom kiosks in high risk zones is expected to contribute to the reduction of new HIV infections.
The Ministry has ensured that condom kiosks are strategically placed in four HIV high-risk areas within Kigali city: Gasabo-Remera, Gikondo-Magerwa, Nyarugenge-Nyamirambo and Kicukiro-Giporoso.
Partnerships have, too, been created with different institutions to ease distribution, create awareness on condom use and disseminate other forms of information on reproductive health. One such institution is the Aids Healthcare Foundation (AHF).
According to AHF 14,662,424 condoms were distributed by implementing partners and 118,843 through new initiative of condom kiosks last year.
Hakizimana Etienne, the Prevention Program Manager at AHF that provides health services to over 21,000 people, in 20 health facilities, across 8 Districts in Rwanda says that from May 2016-May 2017, 2,012,678 condoms were distributed , with 1, 483,092 dispensed through condom kiosks.
“Currently, there are 4 condom kiosks that are operational in High risk zones in Nyamirambo-Mironginne, Magerwa, Remera–Migina and Giporoso-Muricorridorri.
Another 4 are being added to the existing 4 making the number eight: one in Nyabugogo, another in Rubavu –Petti barriari bordering Rwanda and Congo, another in Tumba sector- Kumukoni in Huye District, while the last will be installed inRusizi District in a local place called Cite” says Hakizimana
Also the Government through many NGO’s has done a lot in sensitizing the youth and creating awareness in order to reduce new HIV infections in the country.
The Department-HIV/Aids Prevention and community-based organisations (CBOs) management at Society For Family Health (SFH) Rwanda is well equipped with a mobile video unit session and has always organized concerts and road shows (using local artistes to give out message on HIV prevention) on a regularly basis to promote Hiv/Aids awareness.
However more sensitization is needed for the youth to change their mentality and to understand the importance of condoms. Take Nsegiyumva Hassan, for example.
The 21 –year old man living in Kabeza, a suburb of Kigali city, doing transportation of passenger on motorcycle for a living, says that though he hates condoms, it is important to always use condoms with strangers when having sex. “Like me, there are other men who do not like to use condoms because they significantly reduce the feel of pleasure.
I personally, do not like to use condoms because I just don’t like the way they reduce on the intensity of pleasure, so I don’t use them,” admits Nsegiyunva.
In a recent survey conducted by Rwanda Biomedical Centre (RBC), it was indicated that there is a decline in condoms usage mainly in the high risk groups with only 25 percent of those who had casual reporting to have used a condom whilst only 33.1 percent for those who tested HIV positive said they used condoms regularly.
Condom use at last sex among adolescents and young adults reporting multiple partners is low, especially among adolescent girls, where it is way below the target of 75 per cent in 2014.
Kagaju Anita (not real names), a sex worker who lives in Nyamirambo, one of the risk zones in Kigali, confided that various situations in their trade influence whether they use condoms or not. “Sometimes we need to exchange sex, where we trade sex for drugs, money, or basic needs.
Some men insist on having unprotected sex and take advantage of you because of your dire need of money. Completing the transaction is sometimes the main priority, even if it means having unprotected sex to avoid losing the partner and the payment,” explains Kagaju.
She also says that the nature of their work and lack of permanent residences makes it hard for them to be sober and most of the time they have no control and make poor decisions when intoxicated by not being able to make safer choices during sex.
However some other people linked the use of alcohol and drugs to male same-sex behavior of shying away from the use of condoms.
The prevention officer at AHF Narcisse Nteziryayo says they have conducted different awareness campaigns in different domains on prevention of HIV targeting the youth.
“Our main purpose is HIV prevention. That’s why we organize street dance, talk shows on radios and TV stations and newspaper to create awareness. Because our target is the youth, we entice them by bringing artists they love” says Narcisse
He goes on to say that through aggressive and consistent behavior change communication (BCC), Rwandans will slowly stop shying from demanding for condoms publicly to have safe sex by using correctly and consistently condoms and save their lives while saving others.
In the last two weeks in collaboration with the City of Kigali, AHF has conducted awareness campaigns in different schools around the City like Kabuga High School, Kagagu High school, St Famille High School and Rugando High school.
“We were targeting young girls and boys aged between 15 and 24. Our aim was to talk to them about HIV prevention and reproductive health” said Ntaziryayo
He concludes that condom use in the country will increase tremendously in the near future given the strategies that are currently being implemented in partnership with community-based organisations and technical leadership of the Ministry of Health through Rwanda Biomedical Centre.