Published on March 31, 2023

By Gaston K. Rwaka

The campaign to fight and eradicate HIV spread in the country by the government and other private organizations is bearing fruits with the most vulnerable sections of society like sex workers taking this fight in their own hands to save themselves and live positively. 

Sex workers are now forming leadership cells among themselves. The cells are being used to sensitize them on using protection, embracing medication as prescribed by health personnel, taking a balanced diet and positive living.

It is due to such efforts that government statistics indicate that the HIV prevalence rate among sex workers is reducing as well as the mortality rate.

Migina, Remera sector, is one such area that is infamously known to have many sex workers in the city of Kigali and this fight against the killer disease is taking center stage right there.

The ladies of the night in this suburb have come together and elected their leaders in collaboration with Rwanda Biomedical Center (RBC) and they testify that since the formation of these groups there is progress registered in fight against the epidemic.

These clusters can consist between 30 to 60 people living with HIV or even more for easy monitoring by the cluster leaders who themselves are living with HIV.

The idea was birthed by sex workers because they are among the most vulnerable categories when it comes to HIV/AIDS. The group acted to protect themselves and their children since many of them are single mothers.

In order to make the initiative more efficient and beneficial to the victims, cell leaders move door to door on a monthly basis. They also call for general meetings twice a month where they are sensitized about positive living. However, cell leaders also encourage victims to visit health centers once in three months to check their CD4 count.  

Alice Uwase, the representative of the Tuzamurane Association which consists of Female sex workers (FSWs) in Muhanga District in the Southern Province, says that in the last 10 years, they have lost many of their friends, including those who were not on medication as well as those who refused to go for medical examination. 

“We have been sensitized by various groups about the importance of treatment and positive living. We have elected leaders amongst ourselves who remind us of when to take our ARVs, when to go to the hospitals and this has saved many lives and improved our health in general,” said Uwase.

Rwanda, is one of the countries who offers free antiretroviral therapy to all patients in the country and it has been widely praised for its progress in controlling HIV. The country has kept HIV prevalence at 3% for more than a decade and the number of new infections has dropped.

This program was initiated by the Ministry of Health in 2013 and brought together 12,000 Sex Workers from all over the country to train them for five days every year to encourage them to take medication properly and to establish the leadership of the groups they met.

The initiative which constitutes RBC encourages sex workers to take care of their health in order to stay healthy and fend for their families.

In each sector in Muhanga district there is a Sex Worker’s association responsible for identifying and monitoring whether a person living with AIDS is taking medication.

Sylvie Ashanti, Coordinator of Let’sChange,  an organization working in Kigali sector shows that they have taken tough measures including punishing those who do not take the medicine as prescribed by medical personnel.

“The fact is that the medicine is  helping us a lot and that’s why we decided to encourage our friends to take it because it is not shameful at all since it helps us live a longer, healthier life,” said.

It is estimated that more than 45% of the approximately 12,000 sex workers in the country live with HIV and not taking the antiretroviral therapy risks spreading the virus.

However, these gains were threatened during COVID-19 pandemic especially several lockdowns where many sex workers did not have food to eat because they could not venture out to meet their clients. Taking antiretroviral drugs requires good feeding.

Although Rwanda tried to distribute food to households under lockdowns, it was not enough to reach as many homes as would have been and this process stopped after three months. Even when lockdowns were lifted, bars remained closed or working hours restricted, yet these are working operational areas

Tina Mukeshimana, Head of the AIDS and Reproduction Unit at UNAIDS says that they are satisfied with the performance of the sex workers’ organizations in Rwanda in mobilizing their colleagues to take medication.

“It has a positive impact on the lives of many people we support, so it motivates us to expand our collaboration,” she said.

According to findings from the Rwanda Population-based HIV Impact Assessment (RPHIA) conducted in 2019, HIV prevalence was approximately two or more times greater in older adolescent girls and young women (15-24 years) than in older adolescent boys and young men, 1.2 percent and 0.5 per cent, respectively.

This is while the latest data from RBC shows that only 59 percent of young women and 57 percent of young men aged 15 to 24 have comprehensive knowledge of HIV/AIDS.

According to Dr. Albert Tuyishime, the Head of HIV/AIDS, Diseases Prevention and Control Department at RBC, he confirms that based on the numbers, it appears that a big step has been taken in the right direction.

“Since 2005, health counselors have helped people change attitudes and start taking anti-retroviral drugs at a higher rate and that’s why the death rate has decreased,” Dr Tuyishime.

In Kibuye Hospital, there are 890 people taking antiretroviral drugs, of which 362 men are 40%, and 528 women are 59%. Among them, 18 are under 15 and 51 are over 51, including 22 boys and 29 girls.

According to members of such groups, joining has helped them adhere to strict measures of taking their medication on time.  

 “Different victims take medication at different times depending on the stage of their illness so cell leaders come to our homes to remind us to take ARVs or make calls to us since we have been provided with phones,” said Emeline Mukansanga, a member of the cell in the city of Kigali.    

However, with all the effort put in place to help sex workers live positively, some of them find it difficult to adhere to this program to the letter.

Ashanti says they don’t send out hard punishments to defaulters but find somewhat convenient methods to put them back in check.

“Those who don’t adhere to this program we call them out publicly in meetings where we shame them. It’s done in a way that it is not considered stigma since they are our colleagues since we all suffer from the same disease,” she said.

She adds that in a move to motivate them to adhere to this program, those who fall short are temporarily suspended from the financial capital that is given to them for small business start-ups that help them fend for their families.  

Although there is significant progress that has been registered from these cells in regard to fighting HIV among sex workers, there remain challenges such as a lack of enough resources to ensure a balanced diet which is necessary especially when one is on ARVs.

Ashanti says that due to little funds that are extended to members of these cells and given that majority don’t have jobs, they end up going back to the streets as well as alcoholism which hampers the fight  

Dr. Albert Tuyishime, the Head of the HIV/AIDS, Diseases Prevention and Control Department at Rwanda Biomedical Center says this effort has supplemented government efforts in fighting against HIV.

“We don’t have enough health workers per patient in our country and this program has taken off pressure from the shoulders of health workers because cell leaders have tried to fill in the gap, especially in sensitization campaigns,” he said.

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