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President’s Emergency Plan for AIDS Relief

HIV/AIDS in Rwanda
Rwanda faces a generalized epidemic, with an HIV prevalence of 3.0 percent among adults ages 15-49. The prevalence rate has remained relatively stable, with an overall decline since the late 1990s, partly due to improved HIV surveillance methodology. In general, HIV prevalence is higher in urban areas (7.3 percent) than in rural areas (2.2 percent), and women are at a higher risk of HIV infection than men.

Response
Recognizing the global HIV/AIDS pandemic as one of the greatest health challenges of our time, United States President George W. Bush announced the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003 – the largest international health initiative in history by one nation to address a single disease.

Worldwide, PEPFAR’s goals over five years are to:

• Provide life-saving treatment to 2 million HIV-positive individuals;
  
• Prevent 7 million new HIV infections; and
  
• Give care to 10 million people living with and affected by HIV/AIDS, including orphans and other vulnerable children.
  
  

Rwanda is one of 15 PEPFAR focus countries and began full implementation of the plan in 2004. Through PEPFAR, Rwanda received more than $39.2 million in Fiscal Year (FY) 2004, $56.9 million in FY 2005, $71.9 million in FY 2006 and $103 million in FY 2007. In FY 2008, Rwanda is projected to receive $123 million. The United States is the largest donor to Rwanda’s HIV/AIDS programs.

PEPFAR’s goals are to support the Government of Rwanda to, by 2008:

• Treat 50,000 HIV-positive Rwandans;
  
• Prevent 158,000 new HIV infections; and
  
• Care for 250,000 Rwandans infected and affected by HIV/AIDS.
  
  

In Rwanda, PEPFAR funds approximately 40 partners – nongovernmental, private voluntary and faith-based organizations – that implement activities in cooperation with the Government of Rwanda and local Rwandan organizations in 22 of the country’s 30 districts.

PEPFAR supports voluntary counseling and testing activities, youth intervention programs, provides antiretroviral (ARV) drugs and treatment for opportunistic infections and supports education and life skills training for orphans and vulnerable children (AIDS has created approximately 210,000 orphans and a high percentage of child-headed households in Rwanda).

PEPFAR not only provides a wide range of HIV/AIDS services, it also builds the Government of Rwanda’s capacity to deliver health services. The program integrates malaria, family planning and tuberculosis services into HIV treatment and care and strengthens the overall health care system in Rwanda.

PEPFAR/Rwanda is a collaborative U.S. Government effort implemented by the U.S. Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), Department of Defense (DOD) and the U.S. Embassy in Kigali.

Results
The partnership between the Government of Rwanda and PEPFAR has led to significant accomplishments, including (all figures are as of September 2007):

• Nearly 45,000 people are receiving antiretroviral treatment in Rwanda (more than 24,000 of those are treated in PEPFAR-supported facilities).
  
• Over 100,000 Rwandans affected and infected by the disease received care and support services through PEPFAR. Services include medical care, psychosocial support, income-generating activities and prevention activities for HIV-positive individuals.
  
• PEPFAR provided voluntary counseling and testing (VCT) services to more than 750,000 people.
  
• Nearly 281,000 pregnant women received VCT services for prevention of mother-to-child transmission and over 14,000 HIV-positive women were provided with antiretroviral prophylaxis.
  
• PEPFAR strengthens the Government of Rwanda’s capacity to address HIV/AIDS by providing technical assistance to create a safe blood supply, supporting procurement and active distribution of essential medicines and drugs to district pharmacies, training nurses, strengthening the abilities of physicians, and supporting the National University of Rwanda’s School of Public Health to train over 40 public health practitioners and program managers.
  
• Over 35,000 orphans and vulnerable children received support through PEPFAR. Services include school fees and materials, food, vocational training, psychosocial support and links to clinical services.
  
• Using “Choose Life” curriculum, more than 400,000 individuals were reached with abstinence and be faithful prevention messages.
  
• PEPFAR led the development of a coordinated national drug purchasing program and strengthened the capacities of the central pharmaceutical organization (CAMERWA) and district pharmacies in collaboration with other donors and the Government of Rwanda.
  
• Performance-based financing for health centers, which increases the quality and quantity of services offered at health centers and improves the efficiency of the facilities.
  
• Before PEPFAR began, few Rwandan military personnel and their families received VCT services. Since the beginning of PEPFAR, more than 10,000 military personnel and their families received VCT services.
  
  

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