As the world marks the 25th anniversary of the Rwandan genocide, NITA BHALLA, of the Thomson Reuters Foundation, reports on how it changed the country’s response to AIDS…
Muhanga, Rwanda
Thomson Reuters Foundation
It would be ridiculous to ask 48-year-old Assoumpta who infected her with the AIDS virus. In the 100 days that spanned Rwanda’s genocide in 1994, she doesn’t know the number of times she was raped, let alone which men raped her.
“I only remember the first. He was my neighbour. Someone we knew and trusted. That’s why I remember it,” she said in the stone-walled compound of her village home in Muhanga district, about 50 kilometres south-west of Rwanda’s capital Kigali.
Genocide survivor Assoumpta, 48, stands outside her home in Muhanga district, about 50 kilometres from the Rwandan capital, Kigali on 7th April, 2019. PICTURE: THOMSON REUTERS FOUNDATION/Nita Bhalla
“He came to the camp where we were sheltering and picked me out – pointing at me with his machete. The other perpetrators? I didn’t know them. There were many men. Different ones at different times.”
Rwanda is this week commemorating the 25th anniversary of a dark chapter of human history: a time when extremist ethnic Hutus slaughtered more than 800,000 Tutsis and moderate Hutus – one 10th of the population – over three months.
“Before the genocide, there was little awareness about AIDS other than it was deadly. They called it ‘slimming disease’ but there was no real treatment available other than to keep patients in isolation wards. But we learned quickly because of it. Rwanda was the first country in the world to achieve universal access to antiretrovirals in 2008.”
– Sabin Nsanzimana, HIV/AIDS division manager at the Ministry of Health.
As people across this small, mountainous, east African nation honour the dead by laying wreaths at memorials, thousands of survivors like Assoumpta – victims of a brutal systematic campaign of mass rape – are still living with the aftermath.
According to government officials, about 250,000 mostly Tutsi women were raped by Hutu government soldiers and allied extremist militia. And as a result, about one in four victims contracted the HIV/AIDS virus.
Many women died, unable to get treatment in time.
Others have survived to lead healthy lives a quarter of a century on – largely due to Rwanda’s speedy response in recognising high prevalence rates, and acting quickly to curb the spread of the virus.
“Before the genocide, there was little awareness about AIDS other than it was deadly. They called it ‘slimming disease’ but there was no real treatment available other than to keep patients in isolation wards,” said Sabin Nsanzimana, HIV/AIDS division manager at the Ministry of Health.
“But we learned quickly because of it. Rwanda was the first country in the world to achieve universal access to antiretrovirals in 2008.”
Mortality rates for people with HIV/AIDs have dropped below five per cent today, compared to 60 per cent at the end of the genocide, he added.
The genocide began on the night of 6th April, 1994, when a plane carrying then-Rwandan President Juvenal Habyarimana and his counterpart Cyprien Ntaryamira of Burundi – both Hutus – was shot down.
The attack sparked a rampage by Hutu government soldiers and allied extremist militia, with the aim of exterminating the Tutsi minority whom they blamed for killing Habyarimana.
In the lush, hilly communities across the densely populated country, neighbour turned on neighbour as people were hacked to death, burned alive, clubbed and shot.
Clothes of some of an estimated 5,000 people who were slaughtered inside a church during Rwanda’s 1994 genocide at the Ntarama Genocide Memorial, about 25 kilometres from Kigali. Taken on 7th April. PICTURE: THOMSON REUTERS FOUNDATION/Nita Bhalla
Sexual violence was used as a weapon of war – and Hutu leaders took AIDS patients from hospitals, jobless youth and petty criminals to form “rape squads” and infect Tutsi women.
“Many were drug users hanging out on the streets, frequenting sex workers who were infected,” said Nsanzimana, who co-wrote a research paper on HIV/AIDS transmission in genocide.
“The militia leaders would order those they knew were infected and say ‘Come and transmit your disease to these Tutsi women.’ They knew this was a death sentence.”
There are also reports that Hutu militia leaders would instruct nurses to inject infected blood into victims, he added.
“The militia leaders would order those they knew were infected and say ‘Come and transmit your disease to these Tutsi women.’ They knew this was a death sentence.”
– Sabin Nsanzimana, HIV/AIDS division manager at the Ministry of Health.
The fighting ended in July 1994, when the Rwandan Patriotic Front, a Tutsi-led rebel movement that swept in from Uganda, marched on Kigali and seized control of the country.
But it left hundreds of thousands of women traumatised by the horrors of their ordeal, many of them pregnant with children born from their rape – and infected with the HIV/AIDS virus.
Transmission of the virus spread with millions of people fleeing for refuge in and out of Rwanda in the years that followed the genocide – making it difficult for authorities to detect and control the spread of new infections.
The genocide decimated healthcare infrastructure such as hospitals, clinics and laboratories and generated a mass exodus of skilled medical personnel. Erratic power supply compromised blood safety, data management and drug storage.
Academics estimate that by the end of the genocide, nearly 80 per cent of physicians had either been killed or had fled the country. Those who remained were so traumatised, they were in no position to care for others.
While immediate health priorities were focused on providing food, clean water, and treating sicknesses such as diarrhoea and malaria, President Paul Kagame in 2000 recognised that curbing the spread of the virus was a national priority.
Genocide survivor Assoumpta, 48, shows her anti-retroviral medication for AIDS treatment at her home in Muhanga district, about 50 kilometres from the Rwandan capital, Kigali on 7th April. PICTURE: THOMSON REUTERS FOUNDATION/Nita Bhalla
Supported by donor funding, screening and treatment centres were established across the country, providing free access to anti-retroviral drugs to all patients.
“They also provide transportation costs for them to get to the clinics to get their medication,” said Nishimwe Marthe from Sevota, a charity which supports female survivors.
According to UNAIDS, new HIV infections in Rwanda dropped by 20 per cent between 2010 and 2017 from 9,300 to 7,400.
AIDS-related deaths almost halved in the same period, from 6,000 to 3,100, largely due to the provision of medication.
Assoumpta, who discovered she was HIV-positive six years after the genocide, had believed she was destined to die.
“I am thankful to be alive and be able to help others,” said Assoumpta, who is now married with three children and gives counselling to other women as a community worker for Sevota.
“They raped and killed other women during the genocide. I survived that. And I will survive AIDS.”
