Every 1st December, the world celebrates the World Aids Day. Rwanda joined the rest of the world to commemorate the day under the theme, “Stop Aids; Keep the promise-Leadership”.
Rwanda has made significant steps in scaling down the Human Immunodeficiency virus - HIV and the Acquired Immunodeficiency Syndrome - Aids. But the country’s challenges live on even with the different accolades it has been awarded in recognition of its efforts.
Since Aids was first reported in Rwanda in the mid 1980s, many people have succumbed to the deadly epidemic, and the fact that there is no cure known for the devastating illness has not helped much.
A chronological history of the diseases that is mostly transmitted through sexual intercourse with an infected person has shown that the disease has had far reaching effects in African communities mostly in sub-Saharan Africa for the last 25 years.
The first case of infection was reported in 1982 in Africa. More than a decade ago, any human being who contracted the HIV virus was expected to die.
At that time, there was no affordable treatment for the disease to most people living with it in countries like Rwanda and the rest of Africa.
But in recent time’s government and non government organisations have taken significant steps to avail hope to people who other wise would have been expected to die from the disease.
Rwanda Women Net work (RWN) is one such NGO that has for ten years been engaged in helping victims of HIV/Aids. In doing this, the NGO provides treatment and care to the victims and their families.
According to the Executive Director of the organisation, Mary Balikungeri their services are community based and people driven.
This in her words is aimed at ensuring that the needs of the patients and their dependants are properly catered for. The organisation runs four Polyclinics of Hope (PoH) across the country.
“For Example, we have the Village of hope in Gasabo where we bring the services closer to the people and so they are at the centre stage of resolving their own problems with our support” says Balikungeri.
Such services which are replicated in different parts of the country by such organisations and government supported health centres have helped to give hope to people who in the past would have seen an HIV positive diagnosis as a death sentence.
So many women have been put on ARV treatment in Health centres and by polyclinics run by such organisations as RWN.
Epidemiology of HIV in Rwanda
The 2007 UNAIDS updated version indicates that antenatal clinic surveillance in 2005 showed 4.1% of pregnant women were HIV positive, with the prevalence highest in Kigali (13%). On average about 5% in other urban areas and a little over 2% in rural areas.
Substantial declines in HIV prevalence were observed in Rwamagana (from 13% to 4% between 1998 and 2005) and in Gikondo in the city of Kigali (14% to 8%) (Ministère de la santé du Rwanda, 2005).
The declines in HIV prevalence among pregnant women in urban areas in Rwanda were strongest in the late 1990s and infection levels appeared to have stabilized subsequently.
According to information available from the Rwandan government body responsible for combating the spread of Aids-National Aids control commission (CNLS), the first case of HIV/Aids in the country was registered in 1983.
Three years later in 1986 the first study of HIV Prevalence was carried out. At that time the prevalence rates were 17.8 percent among the urban community people while the rural population was 1.3 percent.
It goes without saying that urban communities have borne the brut of the Aids pandemic more than the rural people. Another survey carried out in 2005 among female population aged 15-49 and male population aged 15-59 indicated that the prevalence rate at national level was standing at 3 percent.
The prevalence rate in the urban areas was indicated to be at 7.7 percent while in the rural areas it was at 2.3 percent. From the demographic surveys, women remain most infected by the Aids pandemic.
The prevalence rate among women is at 3.6 percent with the prevalence rate among men standing at 2.3 percent. The survey further indicated that the age group with lowest levels of HIV infection was 15-19 which has a prevalence rate of 0.5 percent.
The age group 40-44 registered the highest rate of HIV prevalence at 6.6 percent. The Rwandan government adopted a strategy that has seen HIV prevalence levels reduced to a great extent.
This, according to CNLS boss, Dr. Agnes Binagwaho, is a result of the ABC strategy that was embraced by the government as the best hope for combating and scaling down the HIV/Aids pandemic.
Many other countries especially in Africa have embraced this as the best mechanism and strategy to defeat the pandemic. In fact the ABC strategy receives a lot of support from the American government present in Africa.
The ABC strategy is based on emphasizing Abstinence, Being faith full and the use of Condoms; this has been the cornerstone of fighting HIV/Aids in the country.
Abstinence is specifically aiming the young adolescents who may not have had sexual relations before. Youth are more likely to engage in unprotected sex.
This is evidenced by data available from CNLS which shows that only ten percent of sexually active young people take the necessary precaution of using protection in form of a condom when engaging in pre-marital sexual relations.
This is in comparison to seventy four percent among long distance truck drivers and ninety percent among sex workers.
This implication illustrates the fact that the youth are rightly the age group supposed to embrace more abstinence as an intervention to defeat the AIDS pandemic.
Rwanda’s effort to stamp out Aids is globally recognized
On two occasions, Rwanda has been recognized in its efforts to defeat the scourge. The Treatment and Research Aids Centre (TRAC), has an Information Communication Technology ICT system that it employs in its battle against the deadly disease.
It is known as TRACnet. This system has recently won accolades for the country on the global scene in as far as the struggle is concerned.
TRACnet is system that uses cell phones, text messages and a SQL Server database. It has radically transformed and “revolutionised’ the way health care workers treat AIDS patients in Rwanda.
TRACnet was recognized as a winner at the 9th Annual African ICT Achievers Awards ceremony held at a Gala Event on the 17 November 2007, at the Sandton Convention Centre in Johannesburg, South Africa.
Here, Rwanda was recognised for her efforts using ICT to provide treatment to Aids patients, where the winners of the awards were announced in a ceremony that has been termed as being informed by a true African style.
TRACnet was awarded as one of the top seven Public sector bodies embracing ICT in Africa in 2007. At the same Gala dinner, TRAC was awarded the overall winner for TOP ICT organisation award.
At the same occasion, His Excellency the President of Rwanda Paul Kagame was awarded with a the Lifetime Achievers Award for his dedication to the proliferation of the ICT industry in Rwanda and across the continent as well as the promotion of the use of technology within governments for better service delivery to citizens in fighting the epidemic.
Early this year, according to the same press release available to the public on the Trac web site, TRACnet was “internationally recognized as a practical and sustainable model for the application of information technology to health program management” and as such won the UNECA’s technology in Government in Africa (TIGA) award for “improved health services through ICT”.
TRAC, decided to dedicate these achievements to His Excellency the President of the Republic of Rwanda for his proliferation of ICT in Rwanda.
This shows that the efforts of the Rwandan political leadership in the promotion of ICT In the country have had a spill over effect.
This has been to the benefit of Aids patients who have been given a new lease on life as a positive result and consequence.
Awards for such efforts have also gone to civil society organisations. A case in point is the Rwanda Women Network.
In 2006 RWN received the UNDP and UNAIDS Red Ribbon Award under the theme, Celebrating Community Leadership and Action on Aids.
This was followed earlier this year by UN-Habitat Dubai International Award in recognition of best practices to improve the living environment for child headed households and genocide widows and their families.
In a country where many adults have succumbed to Aids it is not rare to find child headed homes. RWN has been applauded for its efforts to help such households as seen by these awards.
Political leaders at the forefront
For the last five years, the office of the First Lady created an organisation named, Protection and Care for Families against HIV/Aids-(PACFA). It has a number of responsibilities which revolve around the measures to be adopted to scale down the Aids pandemic.
PACFA was created following a meeting of first ladies in sub-Saharan African countries that was held in Kigali in 2001. It was specifically organised to deal with the issue of Aids among children in the region.
Since its launch, PACFA has organised several campaigns against stigma and discrimination which have always been directed towards people living with HIV/Aids.
In collaboration with other organisations like CNLS and SIPPA, this organisation has been at the fore front in the anti Aids campaign.
These efforts saw the country host the HIV/Aids implementers’ conference that was held in Kigali, Mid July 2007.
This, it can be argued, was a result of the recognition of the fact that Rwanda has emerged at the top in the efforts to fight the pandemic.
According to its annual publications, the organisation has created national initiatives to protect young children from getting infected with HIV and Aids.
It has played a leading role in sensitisation and encouraging everyone to treat every child as if they are their biological children.
As a result, districts have adopted strategies to protect children. More still private initiatives have been undertaken in the same spirit-of protecting the young ones from the scourge.
Advent of anti-retroviral therapy
During the 1994 Genocide in Rwanda, a number of women were raped and infected with AIDS. This created a situation where they produced children with the disease.
This is not limited to rape victims but many children are born with HIV. However the preceding evidence suggests that Rwanda has made tremendous steps in scaling down the rate especially of mother to child transmission.
In achieving this, the different bodies charged with fighting HIV/Aids in Rwanda have played a leading role in providing and availing antiretroviral treatment to pregnant mothers.
This is done with a view of reducing the number of infants born to HIV positive mothers from acquiring the virus, be it during pregnancy or through breast feeding.
Medical publications show that antiretroviral treatment is given depending on different criteria and progress of the disease in a patient.
Accordingly, antiretroviral treatment regimens have changed with the passage of time. Early recommendations attempted a “hit hard-hit early approach.”
A more conservative approach according to medical experts considers the use of 350-500CD4+T cells. Current guidelines for antiretroviral therapy (ART) from the World Health Organization recommend that in resource limited settings which are synonymous with developing countries like Rwanda and the rest of Africa, ART treatment should be started when HIV has been confirmed in a patient and most especially when Aids has developed.
A number of challenges are presented in as far as providing ARVS is concerned. According to RWN director Balikungeri the fact that the treatment is given at specific health centres creates a situation whereby some people shy away from going for treatment.
Some people would want to receive treatment from private clinics where they may want to keep their HIV status a confidential issue with their private doctors according to The RWN Executive Director.
Balikungeri adds that the challenge is whether these health centres can provide a holistic approach to treatment of Aids patients. This she believes can be done by collaboration between all stake holders in the struggle against Aids.
In her view programs of NGOs like RWN should be supported at the health centres since they are in position to give other interventions like post ARV accompaniments to the people affected.
In her view this would avoid a situation where by patients sell off their ARVS in order to buy nutritious food, which is required by people on treatment.
Balikungeri also believes there is need to care for families of those who come for treatment. This is because Aids patients are not able to support their families like before.
It is also important in her view to create a community based care givers network. This is something that goes beyond the health centres.
Aids and the rest of Africa
Sub-Saharan Africa remains the region in the world that is most affected by HIV/Aids. South Africa is the country with the largest number of HIV infections in the world.
HIV prevalence data collected from the latest round of antenatal clinic surveillance suggest that HIV infection levels might be levelling off, with prevalence among pregnant women at 30% in 2005 and 29% in 2006 (Department of Health South Africa, 2007).
In addition, the decrease in HIV prevalence among young pregnant women (15-24 years) suggests a possible decline in the annual number of new infections.
The epidemic varies considerably between South African provinces, from 15% in the Western Cape to 39% in the province of KwaZulu-Natal. This is according to the South African Department of Health report, 2007.
At one time South African President Thambo Mbeki raised a lot of controversy when he postulated that Aids in Africa can be attributed to poverty that is wide spread on the continent especially in Sub Sahara Africa.
This unorthodox view was not well received among anti –Aids advocates across the world. Other countries in Southern Africa have for long bore the brut of Aids. Botswana remains a country with the highest percentage of the population infected with the virus.
What compounds problem for the African people is that, Aids in most cases is accompanied by the deadly Tuberculosis.
More still poverty is another problem that hinders good nutrition that is required by people infected with the HIV virus.
However, it has been argued that nothing should be used as an excuse for not availing treatment and other interventions against the disease.
“Treatment is technically feasible in every part of the world. Even lack of infrastructure is not an excuse. I do not know a single place in the world where the real reason AIDS treatment is unavailable is due to the health infrastructure which has exhausted the capacity to deliver it.
It is not knowledge that is the barrier, it is the political will.” Peter Poit, Executive Director is quoted form the UNAIDS report, 2007.
This clearly illustrates the fact that Aids can be scaled down in any country of the world including poor countries. The experience of Rwanda and several other countries is an illustration of this fact.
The putting up of factories to produce generic ARVS in Africa is seen as a factor that will help to avail treatment to several people infected with the disease on the African continent.
On the whole studies have indicated that AIDS has had a far reaching impact on the economic growth of African countries.
Tony Barnnett and Allan Whiteside’s work on “Aids in the twenty first century: Disease and Globalization,” notes that the economic impact of Aids is noticed in slower economic growth, a distortion in spending, increase in aid inflows and a changing demographic pattern.
It’s scaling down through preventive mechanisms and treatment will definitely bring back to form the future economic development of African countries like Rwanda.