SEATTLE, Washington — Governments around the world continue to put a pause on public gatherings to protect the health of the people from COVID-19. However, some activities cannot stop precisely because the health of people depends on it. The pressing case of HIV testing in Rwanda is one of the activities.
UNAIDS In Rwanda
By late 2019, the Centers for Disease Control and Prevention (CDC) and other organizations provided data that showed “Rwanda’s remarkable progress toward achieving HIV epidemic control.” According to the press release, more than three-quarters of the HIV-positive adult population “achieved viral load suppression.” Originally, UNAIDS set the goal for “73% by 2020.”
The UNAIDS program “90-90-90” is a global target to control the AIDS epidemic worldwide. It established this goal in 2015 with the intention of reaching it by 2020. The goals are:
- 90% of all HIV positive persons know their status;
- 90% of all HIV positive diagnosed persons to receive treatment;
- 90% of persons receiving treatment are virally suppressed, meaning the viral load of the person is under control.
By every measure, Rwanda was on track to achieve its goals by 2020. Then, COVID-19 hit the world.
The HIV (human immunodeficiency virus) attacks the body’s defense system, possibly resulting in AIDS (acquired immunodeficiency syndrome), “the final stage of infection with HIV.” However, AIDS can be prevented with proper intervention and treatment. While the CDC acknowledges that it needs more research, it has determined that people living with HIV “might be at an increased risk for severe illness” due to a COVID-19 infection.
Experts know that COVID-19 affects people differently according to existing medical conditions. Patients who are immunocompromised are particularly at risk given that their bodies’ self-defense system is not working at full capacity. The possible, severe effects of COVID-19 on HIV-positive persons is alarming to a country like Rwanda where an estimated 230,000 people (about 1.9% of the population) live with HIV. Controlling COVID-19 should be a priority to Rwanda without halting its HIV prevention measures, which have earned the small country mass praise around the world.
Rwanda has found a way to manage both the pandemic and epidemic at the same time. To prevent the risk of coronavirus infection, HIV testing in Rwanda has shifted from an in-community activity to an individualized process in some places.
The Aids Healthcare Foundation (AHF), along with the Rwandan government, has made available free HIV self-testing kits, distributing the kits through “condom kiosks” that previously existed in hotspot areas. Individuals can just walk up to the kiosk and receive their free self-testing kit. They then can test themselves privately. According to the AHF Rwanda Country Program Manager, 20,000 HIV self-tests have reached the hands of Rwandans as of September.
The innovation of this strategy is in the distribution method, not the kits. The kits have actually been around for some time. However, they still must undergo an awareness campaign. A 2019 study showed that only 21% of the 579 men interview were aware of the self-testing method. Rwanda’s Ministry of Health has been recommending the test since 2017. Furthermore, it has been on sale in Rwandan pharmacies since last year. According to a second study published a month later, “key stakeholders” have been devising methods to increase awareness of the product.
Testing Now and for the Future
Self-testing kits are additionally important for general HIV testing in Rwanda because the individualized process is more likely to reach men, whom experts identify as a hard-to-reach demographic. During the pandemic, these kits will keep people safe from COVID-19, especially those with a possible HIV infection. Beyond the pandemic, the self-testing kits will likely become a normalized method of HIV testing in Rwanda and beyond.
– Luis Gonzalez Kompalic