Medical professionals have cautioned the city of Kigali to take tougher measures against the high prevalence of HIV infections among city residents.
Currently Kigali hosts approximately 32% of all people infected with the disease countrywide, said to Dr Blaise Uhagaze, the director of public health and environment at Kigali City Coucil, presenting the findings of the 2010/11 review of the city's HIV response.
Rwanda's HIV prevalence is estimated at around 3%, equivalent to 400,000 people, but in Kigali city, figures far exceed the national average with 7.1% of the adult population being HIV positive. Women are most affected at 8.7% against 5.4% among adult men.
In addition, female sex workers are identified as the group most at risk with an infection rate of 56%, against 51% among prostitutes at national level.
This high prevalence rate means the authorities have to spend much money and energy not only on preventing more infections, but also on treatment for HIV positive people.
"While there is considerable political commitment and leadership in coordinating the HIV response in the three districts of the City of Kigali, there is an immediate need for more effective coordination and leadership at city level," Uhagaze oberved.
According to the doctor, the high prevalence might be related to the social and structural drivers peculiar to city life such as rapid urbanization, urban migration, urban poverty and the presence of a diverse range of vulnerable groups.
Though mayor Fidel Ndayisaba recognizes the threat, but he also noted that they have been doing a considerable work compared to the rest of East and Southern Africa bloc - all cities of the bloc have a prevalence higher than 7% of HIV, except Ethiopia, he pointed out.
Urban epidemics in cities of East and Southern Africa account for a large share of the HIV epidemic with an estimated 162 cities hosting approximately 5.8 million adult people living with HIV/AIDS, which accounts 41% of the total epidemic. And the 30 biggest cities host an estimated 4.2 million adult people living with HIV, which accounts for 30% of the epidemic in the region and 13.5% of the global epidemic.
Though there have been antiretroviral drugs that help infected people prolong life and stay healthier, the members of the Kigali city advisory council said the focus should remain on intensifying preventive measures.
"If our children know all about sex education, it can be helpful," pointed out Hope Tumukunde, the city's vice-mayor in charge of social affairs, adding that the education is being offered through family dialogue initiated by the ministry of gender and family promotion.
For those who got infected, there are about 450 accredited health centers that provide antiretroviral therapy treatment for free. That however is being paid with aid from donors, without which access to HIV treatment would be very difficult for many people due to its high cost. This is another argument in favor of prevention.
"The treatment is very expensive, and we get it only due to aid," Ndayisaba said. "Our experience has been that relying on aid has never been sustainable. If anything happens to jeopardize these subsides, the situation can worsen for our HIV/AIDS sufferers. That is why we insist on preventive measures."