Important note: Information in this article was accurate in 2001. The state of the art may have changed since the publication date.

Reuters NewMedia - Thursday November 29, 2001
David Mageria

Many are AIDS orphans, learning the skills to cope with the legacy of an epidemic made harsher by the devastating impact of the country's 1994 genocide.

"The AIDS problem is big in Rwanda, call it a silent genocide," said Robert Limlim, the United Nations Children's Fund's HIV/AIDS programme officer in Kigali.

For thousands of children forced to survive in the streets after AIDS or the killings claimed their parents, centres operated by churches or civic groups and supported by aid agencies such as UNICEF teach carpentry and painting and offer education on the AIDS pandemic.

"HIV is a big problem by now, because among our beneficiaries, we have around 20% who are orphans due to the HIV problem," said Epimaque Kanamugire, the coordinator of the Tabakunde Centre in Kigali, which cares for 169 children.

The centres offer the only hope for a better life in a country where the epidemic ravaging Africa has an even more sinister twist, with the effects of the genocide speeding the spread of infection.

Roughly one in nine Rwandans have HIV/AIDS, or about 11% of the population of 8 million. The prevalence was put at 1.6% in 1987.

During 100 days of killing, millions of people were displaced as they crossed the tiny country's green hillsides to escape bands of murderous militiamen. Children lost parents and health services were shattered, making access to information on AIDS difficult.

"With the war and genocide people were forced to live in refugee camps. There was a lot of uncontrolled sex and that increases the chances of infection," David Awasum, the resident representative for the Johns Hopkins University centre for communication programmes in Kigali, told Reuters.

Hutu extremists who massacred up to 800,000 ethnic Tutsis and Hutu moderates used mass rape as a weapon. Young girls looking for protection sometimes paid with sexual favours.

"Most of those who were raped have now been found to be HIV-positive and many people are dying every day," Limlim said.

CHILDREN BEAR THE BRUNT

It is Rwanda's young that bear the brunt of the rising number of AIDS cases and grinding poverty.

"The main group is the youth, who are the most productive people, they are the ones hit the most," said Theophane Nikyema, UNICEF head in Rwanda. The orphans are the most vulnerable. If not on the streets, they act as parents taking care of their younger siblings. Teenagers head households, living and behaving as adults.

Most of them depend on small pieces of land to grow maize, beans, potatoes and bananas due to lack of employment, but scraping together a living is a daily battle.

"Since my parents died, I'm living by God's grace. Often we go without food," said 19-year-old Julliene Kandamiza, whose mother died before the genocide and her father afterwards.

Social workers said her parents died of AIDS, leaving her to fend for three siblings. "I don't know what to do but because I am the eldest, I have to take care of the children," she said sitting outside her mud-walled house, busy peeling sweet potatoes to prepare lunch for her siblings.

Orphans like Kandamiza are vulnerable and overwhelmed with domestic responsibilities. They often fall prey to adults who give them financial assistance and sexually exploit them, enhancing their risk of infection, social workers say.

MOTHER-TO-CHILD TRANSMISSION

Rwanda's babies are not spared the HIV/AIDS risk. According to UNICEF, mother-to-child transmission is the main type of HIV infection for Rwandan children under age 12.

The organisation estimates 40,000 infants are born to HIV-infected mothers annually. Half of these children contract the virus in the womb or through breast-feeding.

Aid agencies and the government have been providing antiretroviral drugs to some pregnant women.

They give nutritional counselling to mothers found to be HIV positive, advising them to stop breast-feeding to minimise possibilities of passing the disease to their babies, and offer family planning advice.

Some mothers say the efforts are bearing fruit.

"Before we used to think that we still needed more babies but now we are aware that we are infected we no longer think so," said Jackie, a mother of three who frequents the Kicukiro Health Centre in central Kigali.

People like Jackie suffer despite offers by drug companies to slash prices, experts say. For many Rwandans who can barely afford to feed themselves, prices are still too high.

"The area of treatment of the infected with antiretroviral drugs, as well as treatment of opportunistic infections, is still lagging behind," Limlim said. AIDS drugs cost $622 a month per person, beyond the reach of many Rwandans who earn less than a dollar a day.

AIDS STILL HAS STIGMA

Fighting the AIDS pandemic has been slow because most Rwandans shun talking openly about the disease, and experts point to a sluggish acceptance of using condoms.

There is still widespread denial because of the stigma of the disease and many people who lose their relatives say they died of tuberculosis, malaria or were bewitched.

President Paul Kagame's government has been preaching to Rwandans to abstain from sex or have one partner, with the use of condoms a third option, but the message will take time.

"The acceptance (of condoms) in Rwanda is not easy because it is not in African culture. People ask "how can you chew gum in a packet?" Awasum said.
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