1 December 2017

Rwanda: World Aids Day - How Far Has Rwanda Come?

Photo: Daily News
War on HIV/ AIDS: A sign showing that 'one cares.'
analysis

As the world marks World AIDS Day today, stakeholders are calling on everyone to play their part in the fight against HIV/AIDS.

This year's global theme, "Right to health," highlights the need for all people living with HIV and those who are vulnerable and affected by the disease to reach the goal of universal health coverage.

The World AIDS Day serves as a platform for the world to come together and celebrate the milestones taken so far in the fight against the virus and also grasp the way forward.

Rwanda is observing the day under the theme, "Get tested for HIV. If positive, Start and Stay on life-saving treatment."

As part of the celebrations, Rwanda Biomedical Centre (RBC) is unveiling a new oral HIV self-testing method. A three-month HIV awareness programme will also be rolled out among other prevention undertakings such as scaling up on condom kiosks.

Ernest Nyirinkindi, the in-charge of information, education and behavioural change communication at RBC, said it is on such a day that the world gets to remember people lost to the deadly virus, what has been overcome and the strategies to strengthen the fight.

He applauded the strides taken by government in fighting HIV.

The prevalence rate is still at 3 percent since 2005 and this has been achieved because of the numerous strategies in place.

A yearly data collection done by RBC indicates that new infections each year are at 0.27 per cent while 13 per cent don't know their status.

Research conducted by RBC last year indicates that the rate of Mother-to-Child Transmission is at 1.56 per cent. The target set by World Health Organisation is that all countries get to below 2 per cent.

Nyirinkindi said that though Rwanda has managed to take enormous strides in fighting HIV more needs to be done.

He said approaches like continuous sensitisation, HIV testing, use of condoms and male circumcision among others will be strengthened moving forward in the fight against HIV.

"The Government has managed to do its part, it's mostly the mindset that is still a challenge, because not all people perceive things the same but we are not losing faith we are fighting this. We are continuing with the education such that people understand how the problem is and how they can handle," he said.

'Timely theme'

Dr Brenda Asiimwe Kateera, the country programme manager at AIDS Healthcare Foundation Rwanda (AHF), said this year's global theme is timely because much as a lot of advances have been made in HIV fight there are still specific groups that do not have access to timely quality health services.

She said everyone has a right to access and receive comprehensive quality health services.

"This year's theme is also to address the stigma for the particular populations facing it and continue advocacy against it," Kateera said, adding that the global theme for this year's celebration is in sync with the Rwandan population.

"This theme calls for everyone to know their status, and start treatment immediately if they are positive, currently almost all the health centers offer HIV testing," Kateera said.

On stigma, Kateera said that although the problem is not that bad it is still something that needs to be addressed.

She said the other challenge in fighting HIV is identifying those people who are living with HIV but don't know their status.

"The other challenge is getting people to stay on treatment, it's a lifelong treatment so adherence may be a challenge. And then on the side of adolescents, they are not getting tested, not taking medication. I believe it's a special group that we need to target," she said.

Kateera called on the public to endeavour to test for HIV and then start treatment immediately if positive.

Achievements registered

Rwanda has recently made remarkable progress in this area with factors such as expansion of access to antiretroviral therapy.

A 2015 study by Medicine for Global Health shows that Rwanda first achieved universal coverage in 2008, with 80 per cent of HIV-positive persons receiving antiretroviral therapy under a CD4 eligibility criterion of 200 cells per unit or less.

In 2010, WHO released new guidelines for eligibility criteria to 350 cells per unit or less, saying starting early on treatment was the best way to manage the disease.

Information from RBC indicates that the AIDS related mortality in Rwanda has reduced by 82 per cent in the last 20 years.

There has also been scale up of HIV preventive and treatment services to more than 90 per cent of health facilities across the country.

Reduction of HIV transmission from mother to child has reduced from 10 percent to 1.8 per cent, also new infections have reduced by 50 per cent.

There is provision of Anti-retroviral treatments to all HIV positive people in need and for free.

Through a series of strategic decisions, the formation of strong partnerships and global mobilisation of resources, Rwanda has made remarkable progress at scaling up access to antiretroviral therapy and improving the delivery of care and support to an estimated 204,899 people living with HIV in the country.

Prior to 2002, there were less than 100 people on antiretroviral therapy (ART), today more than 150,000 patients are on treatment.

This scale-up occurred by raising the CD4 threshold for access to treatment. Rwanda first achieved universal coverage of ART at a CD4 cell count threshold of 200 cells per cubic metre in 2007, increased the threshold to at least 350 cells per cubic metre in 2008, and 2013 guidelines raised it to at least 500 cells per cubic metre.

With exceptions for immediate therapy for key populations, in 2015, guidelines recommended offering immediate treatment to all patients regardless of CD4 eligibility. It is this scale-up that has helped strengthen the fight.

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