HIV/AIDS in Rwanda

On this, World AIDS day, I'd like to share a few statistics about HIV/AIDS in Rwanda.

Rwanda, like other Sub-Saharan African countries, sees the greatest incidence of infection via heterosexual transmission and mother-to-child transmission. Rwanda has a generalized epidemic at a low to moderate level: official records state about 3% prevalence in the country, which is lower than levels in Washington, D.C and lower than all of Rwanda's neighbors. The brunt of Rwanda's AIDS epidemic is in cities: 7.3% in urban areas (11.5% in Kigali and 5% in other urban areas) with only 2.2% prevalence in rural areas.

Rwanda has made great strides in recent decades in lowering transmission rates, through sex and especially from mother to child. The age of first sexual encounter here is about 20, which is older than Rwanda's neighbors. Rates of risky sex are also lower here. During the course of a year Rwanda manages to test about 10% of the population, including required testing for pregnant mothers. ARVs here are free, although the fact that 2/3 of ARV patients are women implies that there are some men who are reluctant to seek testing or treatment. Stigma is relatively low at this point in the epidemic, but it does exist.

The largest and growing risk group is 15-19 year olds in Kigali. Risk factors include that it's a regional transportation hub, Kigali's appeal to young Rwandans looking for jobs, the sugar daddy/sugar mommy phenomenon, and Rwanda's rapid urbanization. The Sugar Daddy issue, in which girls in secondary school receive tuition and other goods like cell phones and phone credit from much older men in exchange for sex and have little power to ask to use condoms, explains the otherwise counterintuitive fact that there is a higher prevalence in HIV among women achieving secondary education: 6.4%.

There are other challenges: some people believe the HIV/AIDS rate is underreported here and may be as high as 10% (and that neighboring countries also have underreported rates). Also, Men who have Sex with Men (MSM) are at a huge risk for HIV around the world, but recognition that they exist at all has been slow to come, let alone services tailored to educating this group and reducing their risk.