Global Fund / Rwanda Dr. Anita Asiimwe, MD, MPH Deputy Director General

1. Global Fund / Rwanda Dr. Anita Asiimwe, MD, MPH Deputy Director General Institute of HIV/AIDS, Disease Prevention and Control (IHDPC) Rwanda Biomedical Center (RBC)

2. Background (1)- HIV Prevalence

3. Background (2) -HIV Prevalence (2) Though HIV prevalence data would indicate a generalized HIV epidemic, HIV prevalence rates among high risk groups suggest a concentrated HIV epidemic among most-at-risk populations. According to the Female Commercial Sex Worker (FCSW) Integrated Bio-Behavioral Surveillance Survey (IBBSS) conducted among FCSW in 2010, the HIV prevalence rate was estimated at 51% (95% CIs: 48% - 54%)

5. Background (2) – GF funding in Rwanda

6. GF funding for HIV program in Rwanda • Intended objectives: • Reduced sexual transmission of HIV • Reduced mother to child transmission of HIV • Maintenance of low levels of blood borne transmission of HIV • People living with HIV systematically receive OI Prophylaxis, treatment and other co-infection treatment • People Living with HIV eligible for ART receive it • People living with HIV receive care and support according to needs • Improved economic opportunities and social protection for People infected/affected by HIV(including child headed households) • Reduction of stigma and discrimination of PLHIV and OVC in the community

7. Achieved results- gapTrend in HIV prevalence , Use of condom and Comprehensive knowledge of AIDS in young population, Rwanda, 2005-2010

8. Comprehensive HIV knowledge among youth: Population trends versus NSP Targets, 2005-12 • Gap between data trend based on survey data and projected trends necessary to meet NSP target. • Data suggest that NSP target will not be met for improving comprehensive HIV knowledge at current trends. • Recommendation to scale up HIV education efforts focusing on young men.

9. Percentage of women and men aged 15-24 who reported using a condom the last time they had high risk sexual intercourse: Actual values and NSP targets, 2005-13 • Gap between data trend based on survey data and projected trends necessary to meet NSP target. • Data suggest that the NSP target will be met for young men but not met for young women. • Recommendation to intensify condom education and negotiation skills among young women for remainder of NSP implementation period. Actual values: Men aged 15-24 (DHS, BSS) Actual values: Women aged 15-24 (DHS, BSS)

10. HIV Prevalence among Women aged 15-24: DHS values and NSP Targets, 2005-12 • Gap between data trend based on survey data and projected trends necessary to meet NSP target. • Data suggest that we will not meet NSP target by 2013 at current trends. • Recommendation to focus efforts on young women aged 20-24 for remainder of NSP implementation period. DHS values: Women aged 20-24 DHS values: Women aged 15-24 DHS values: Women aged 15-19

11. PMTCT program achievements • Gap between data trend based on program data and projected trends necessary to meet NSP target. • Data suggest that we will exceed the NSP target for both indicators. Pregnant women tested for HIV in PMTCT (TRACnet) HIV+ pregnant women receiving ART in PMTCT according to need (TRACnet)

12. HIV prevalence among known HIV-exposed infants, 2009-11 & NSP Targets through 2012 • Program data indicate that 89% of know HIV-exposed infants were tested for HIV at 18 months. • Gap between data trend based on program data and projected trends necessary to meet NSP target. • Data suggest that HIV prevalence targets will be exceeded for HIV-exposed infants at 18 months but not for infants at 6 weeks. Actual values: HIV-exposed infants at 18 months (TRACnet) Actual values: HIV-exposed infants at 6 weeks (TRACnet)

13. HIV+ pop receiving treatment according to need, 2009-12 & NSP Targets. • Gap between data trend based on program data and projected trends necessary to meet NSP target. • Data suggest that we will exceed the NSP target for both HIV+ adults and children. HIV+ children on treatment (TRACnet) HIV+ Adults on treatment (TRACnet)

14. Conclusion The above great achievements of Rwanda are mainly attributable to efficient use of allocated resources and funding from national and international sources. Key driving forces were: • Political orientation: Vision 2020, EDPRS, HSSP, NSP, Policies • Strong commitment, country ownership & Accountability of All and at different levels. Both GF and Country accountable for results • Multi sector approach, involvement of Private sector and Civil Society • Community involvement (role of Community Health Workers) • Equity and Human rights, Evidence- based planning and Integrated comprehensive approach as overarching principles guiding implementation of the National HIV response • Strong coordinated partnership (GF, CCM, MOH, DPs and CSOs) avoiding duplication and increasing donor flexibility • Funding channeled to high value-based programme (achieving more with less)

15. Conclusion The World community needs to maintain funding support to close the gap in services provision. However, good governance, Country ownership and efficient partnership (Donors, MOH, DPs and CSOs) should be on focus. Every player should be accountable for results and efficient funding utilization channeled to high value-based programme (achieving more with less)

16. Thanks