Country situational analysis

According to the 2010 UNAIDS Report on the global AIDS epidemic, there were 170,000 people living with HIV in Rwanda at the end of 2009, which corresponds to 2.9% prevalence.

Sentinel Surveillance surveys from 2005 show that Kigali continues to have a very high HIV prevalence (12.8%) compared to around 5% in other urban centres.1 By contrast, the average prevalence in rural areas is 2.2%.

HIV prevalence among young women aged 15-24 is 1.4% compared to 0.5% among men in the same age group.

According to UNAIDS data, 76,726 people were on antiretroviral treatment at the end of 2009, which corresponds to 88% coverage of all those in need. The percentage of HIV positive pregnant women receiving antiretroviral treatment to prevent mother-to-child transmission of HIV was 65% in the same time period.

Key elements of the national response

Rwanda fully adheres to the “Three Ones” principles: the existence of one national coordinating body, one strategic national plan of action and one sole monitoring and evaluation framework.

The Rwandan National Commission against AIDS (CNLS) ensures multi-sector coordination through the implementation of the National Multisectoral HIV and AIDS Policy and Strategic Plan for 2005-2009. The Strategic Plan encompasses government’s support of decentralisation, which offers enhanced opportunities for involving community-level actors and CSOs in national development priorities.

The key reference documents for the HIV and AIDS response in Rwanda are:

• the Government of Rwanda‟s Vision 2020, which includes the six pillars describing strategies for achieving the country‟s long-term development objectives
• the Economic Development and Poverty Reduction Strategy (EDPRS) 2008-2012, the medium term strategy for achieving Rwanda‟s Vision 2020. The EDPRS provides the framework for multi-sectoral action on HIV and AIDS, and the strategic plan for each economic sector includes areas of action on HIV and AIDS. The EDPRS sectors incorporate all actors, including the private sector and communities, with each sector under the leadership of a government Ministry
• the National Strategic Plan (NSP) on HIV and AIDS 2009-12, the reference document for all sectors, institutions and partners involved in the fight against HIV and AIDS, outlines the contribution required of each to ensure that Rwanda achieves its ambitious targets. The NSP aims to make Universal Access to HIV Prevention, treatment, care and support a reality. The overarching results that this plan will achieve by 2012 are: first, halving the incidence of HIV in the general population; second, reduced morbidity and mortality among people living with HIV; and third, that people infected and affected by HIV have the same opportunities as the general population
• the Health Sector Strategic Plan (HSSP) 2009-2012, which defines the Government of Rwanda‟s health strategy. The HSSP II aims to strengthen institutional capacity, to increase the quantity and quality of human resources, to ensure that health care is accessible to the entire population, to increase the availability and accessibility of drugs, to improve the quality of services in the fight against diseases and to hold up the demand for such services
• the TRACPlus HAS unit Strategic Plan 2009-2012.

The National Strategic Plan for 2009-12 is closely aligned with Rwanda‟s Economic Development and Poverty Reduction Strategy 2008-2012 (EDPRS). The multi-sectoral EDPRS includes the Health Sector Strategic Plan (HSSP II), which is also one of the bases of the NSP.

Key achievements

• Free access to antiretroviral therapy since 2005. Since 2002, the number of facilities providing antiretroviral treatment has increased dramatically from 76 in 2005 to 165 at the end of 2007. The number of people being receiving ART has increased from 7,000 in 2004 to 76,726 in 2009
• Increased involvement of faith-based organisations and disabled people, improved interventions for orphans and other vulnerable children (OVC)
• Increased understanding of HIV from a human rights perspective
• In 2009, male circumcision was included in the 2009-2012 National Strategy Plan to fight HIV and AIDS.

Key Challenges

• Alignment of partners and effective implementation of the NSP 2009-2012. Funding by the Global Fund to the National Strategy Application is a new funding mechanism and it may require some adjustment and/or learning period. The scale up of implementation will need consequent human resources and capacity building
• Build national capacity to provide HIV prevention services as a comprehensive package and ensure full geographic coverage and continuity, in particular for youth and for most at risk population (sex workers, MSM, prisons inmates). Design specific outreach strategies adapted to the different situations of these population groups and build CSOs capacity to work with these populations
• Strengthen coordinating bodies (human resources) in particular for non-health EDPRS sectors for more effective HIV mainstreaming. Additionally, HIV institutions in Rwanda are undergoing profound changes with the creation of a Rwanda Biomedical Centre under the MOH that will include both the National AIDS Commission (CNLS) and TRACPlus. Partners will need to adjust to these institutional changes
• Enhance the decentralized coordination structures; increase the capacity of CDLS to coordinate all district partners and civil society implementing organizations and to take an active role in fund allocation and decision making. Currently, there is a need to reduce
  high turnover of staff and to ensure salaries in a sustainable way since development partners rarely support salaries for human resources
• Ensure quality of these PMTCT and ART services and follow-up of patients, in particular for children and adolescents
• The needs of most vulnerable children (OVC) are enormous, and access to even the minimum package of services is very limited. There is also a lack of reliable data both to estimate the actual needs and to assess the degree of access to needed services for OVC. Coordination of OVC activities at both district and national levels requires improvement. MIGEPROF is in charge of implementation, though they have a limited number of staff for this ambitious activity. It is urgent to conduct an audit of district-level OVC lists to see how many children on list meet national definition of “OVC”.
• Addressing sexual and gender based violence remains a challenge, in particular for children. There is a need for more training to health staff on GBV issues and to ensure availability of kits for emergency treatment in all health centers.

Useful links

• National Strategic Plan
• Comite National de Lutte contre le Sida (CNLS)
• PMTCT and Paediatric Care and Treatment Fact Sheet  
• 2010 UNGASS Report

Contacts