In Rwanda, HIV prevalence is approximately two times greater among adolescent girls and young women (AGYW) between 15-24 compared to their male counterparts(1.2% vs 0.5%)¹. AGYW are more vulnerable to HIV infection due to structural and social determinants including early sexual debut, higher rates of gender-based violence, and lower rates of school completion. Young women aged 18-19 are ten times more likely to acquire HIV than young men of the same age².

Description

The USAID/PEPFAR funded ACHIEVE/Rwanda project aims to reduce vulnerability to HIV and HIV incidence among AGYW in two districts of Kigali City using evidence-based comprehensive packages of interventions on avoiding risks of acquiring HIV. Prior to enrollment, ACHIEVE through DREAMS mentors identifies potential beneficiaries using a standardized screening questionnaire. This tool assesses AGYW HIV related risks to determine enrollment eligibility. Screening is conducted in homes with AGYW between 10-24 using a door-to-door approach. Mentors also conduct outreach to assess the hard-to-reach AGYW employed in the hospitality sector and female sex workers.

Results

From November to December 2020, 29,546 AGYW were screened, of which 21,058 were enrolled. The most common vulnerabilities identified during screening were experience of physical/emotional violence (19%), being out of school(15%), and having experienced sexual violence(13%). The first two risk factors were dominant at enrollment(respectively 23% and 16%) followed by orphanhood(13%). AGYW with multiple risk factors were prioritized for enrollment.

A bivariate analysis using a chi-square test was done to examine the association between risk factors. For AGYW between 10-14, orphanhood is associated with ever-having sex and alcohol use. For AGYW between 15-19 years, having multiple sexual partners is associated with misusing alcohol and orphanhood with transactional sex. For AGYW between 20-24, alcohol misuse is associated with no or irregular condom use.

Recommendation

Screening enabled ACHIEVE to determine AGYW vulnerabilities and associated HIV acquisition risks and prioritizing the AGYW most at risk for enrollment. This approach can be adopted for interventions targeting AGYW and associated data used to tailor age-specific services to address the identified risk factors.

¹Rwanda Population based HIV Impact Assessment 2018-2019

²Gender Assessment of Rwanda’s National HIV Response 2013