By Lydia Atieno;
Jean-Daniel, second name withheld, a Kigali-based bar attendant attests that he can now access free condoms from established kiosks at any time without having anyone to judge him. Something that never used happen.
“In the past, condoms were mostly sold on shelves with small essential goods such as sugar in nearby shops. Most customers experienced challenges to buy them whenever they run out or before shops closed,” Jean-Daniel said.
Due to his nature of work, the 34-year-old says it’s obvious that customers would often send them to buy condoms, a habit that would see most of them perceived as prostitutes or bad influences from those selling and even people seeing them now and then in shops or pharmacy.
Rwanda with a HIV prevalence rate of 3.1 percent among adults aged 15 to 49 years has identified several targeted HIV prevention strategies, such as promotion of condom use and provision of antiretroviral therapy (ART).
The East African nation has prioritized condom use as a safer tool in curbing new HIV/AIDS infection increase among key populations who are predisposed to this epidemic and pledged to consistently increase efforts in prevention to protect the future generation.
The key population consists of Female Sex Workers (FSWs), men having sex with men (MSM), Lesbians, and clients of FSWs. Reports by Rwanda Biomedical Center (RBC) indicate that, every year, 20 million condoms are distributed, 15 million in shops, others distributed through Community Health Workers across the country.
Things improved especially in 2016 following the launch of condom kiosks, a comprehensive roll-out of access to free condom campaign implemented by a non-profit organization, in partnership with Rwanda health officials.
Many of those in Kigali who agreed to be interviewed on the topic attest that although there are many who still fear buying condoms from shops due to the embarrassment, and inaccessibility of shops selling them, condom kiosks have eased things and that pressure is going down.
Stigma and inaccessibility to free condoms according to health experts saw many people, especially youth risk having unprotected sex, exposing them to sexually transmitted infections (STIs), HIV, and early pregnancies.
Things have changed with the condom kiosks, since the 24/7 condom distribution kiosks initiative (24/7 CK) was put in place by AIDS Healthcare Foundation (AHF) in partnership with the City of Kigali and the ministry of health.
Anastase Nzeyimana, prevention officer at AHF-Rwanda says this has been an innovative approach to ensure easy access to condoms in HIV hotspots in the country.
The access to free condoms initiative involved the strategic placement of ‘condom kiosks’ mostly targeting key populations in four HIV high-risk areas of Kigali, namely; Migina (Gasabo District), Magerwa and Giporoso (Kicukiro District), and Nyamirambo in Nyarugenge District.
Packed with big and smaller boxes of condoms inside the kiosk and a small space for the attendant, the kiosk is branded with HIV/AIDS preventive messages and details on the use of condoms.
Operating 24hours particularly throughout the night, the kiosk is managed by at least two people working in shifts who are trained on how to educate clients on the use of condoms, prevention of HIV, STI and other sexually transmitted diseases.
Angilique Narambe, who works at a condom Kiosk in Remera-Kigali, says from her experience, kiosks are the only place customers feel free and comfortable as most of them say no one is going to judge them or have a bad perspective about their lives.
Her clientele range from teenagers to adults both male and female, although the number of males is a bit higher than that of women.
Sonia, a sex worker in the same area says there is always a need to reach out for condoms at any given time, therefore, their accessibility matters a lot to people like her.
According to her, it was quite challenging to buy condoms at local shops every day, the stigma that came along with it sometimes made them use plan B, which was having unprotected sex.
“I was used to people talking and even giving gestures every time I am trying to access them, even though this never stopped me from doing so. However, younger people, would rather wait until night or end up having unprotected sex to just avoid being rumored of what they do. At the moment, we have access to free condoms near our working place, and we are rarely judged,” she says.
With no criteria required to access condoms, anyone above 18 years can just go to the kiosk and can take a minimum of 12 condoms at once, and this depends on the needs of the person.
Dr. Alain Zimulinda, an Infection Prevention and Control (IPC) Specialist at RBC says there had been an issue of limited availability and accessibility to condoms by key and vulnerable populations across the country living in hot spots identified by a mapping conducted by RBC in collaboration with partners.
He says the mapping identified eight hotspots along areas with predominant sex workers and at least each has been installed with a condom kiosk. Also, an assessment of condom availability in those areas showed that existing dispensers were located in premises where female sex workers and mobile populations have limited access.
“Stigma and fear to buy condoms from public shops had become a routine among many communities in Rwanda, giving efforts to the quick spread of new HIV/AIDS infection and STIs,” he says.
Dr Charles Berabose, in charge of HIV, Hepatitis, and other infectious diseases treatment at RBC says condoms have been put in high risk areas as well as given useful information about STIs and HIV.
The program aims at helping reach the zero new infections target and end unwanted pregnancies, as well as make sure that these condoms are supplied free of charge and are accessible and properly utilized.
According to the Rwanda DHS 2015, HIV prevalence is common in the population aged 15-49 years and concentrated in some high risk groups such as female sex workers.
In the City of Kigali, the prevalence rate remained higher than anywhere else in the country, at 6.3 percent, while it averaged 2 percent in the rest of the country.
Since the establishment of condom kiosks in 2016, there has been increasing in the availability and accessibility to condoms.
Currently, Dr Berabose says a total of nine operational kiosks are providing free-of-charge condoms through the eight areas identified, three of them being upcountry. They can be accessed at Remera – Giporoso, Remera – Migina (front of Amahoro Stadium), Gisimenti (weekend’s car-free zone), and Gikondo – Magerwa.
Out of Kigali, there are condom kiosks in Huye District (South), Rusizi District as well as Rubavu District (West).
So far, 7,953,130 condoms have been distributed across the country since 2018. According to Nzeyimana from AHF-Rwanda, around 1,700,000 to 1,800,000 condoms are distributed in kiosks across the country on an annual basis.
Kigali Hope Organisation (NGO) which manages the kiosks in partnership with AHF-Rwanda restocks them twice weekly depending on the area’s demand while those with low uptake are restocked once a week.
Challenges still prevail
Anaclet Bizimana, a 22-year-old resident of Remera in Kigali says that, although he is aware of the existing numerous kiosks around him, he chooses to still not make use of them because he doesn’t want her girlfriend to have doubts about their relationship.
“I and my girlfriend have been dating for six months now and using a condom, it would mean that I don’t trust her, the same case applies to me if she wants to use a condom, and we don’t want to ruin our relationship because of trust issues,” he says.
Marie Clare Uwimana, a former sex worker says from her experience, most sex workers would prefer to consume drugs that prevent HIV infection to be able to have unprotected sex.
“This is so because most male customers pay a good amount of money when they don’t use condoms. It’s quite understandable that a person working as a prostitute will do that in order to earn more because, at the end of the day, it’s money that you are after,” she adds.
Dr Zimulinda says the running cost of condom kiosks is quite expensive, yet there is still a high demand: as the number of hot spots are emerging in Rwanda, the demand for condom kiosk installation becomes high.
He says stigma still exists on accessing and using condoms, especially among young people.
Dr Berabose says although condom use in combination with other preventive measures has contributed to the reduction of STIs and new HIV infections, there is still more to be done.
Meanwhile, the number of people found with Sexually Transmitted Infections, apart from HIV and Hepatitis, has increased from 2.7 percent in 2015 to 4.2 percent in 2022, according to RBC.
The report shows that between 4.8 million individuals and 6.6 million individuals have been screened for STIs per year.
Since then, communities have been empowered to make informed decisions about sexual reproductive health.
For Novatta Niyomwungeri, a young female dweller in the village, gaining the confidence to negotiate with a partner served as an advantage.
“In our society women are taught to be submissive in many ways. But through access to information and condoms, I can protect myself better by expressing my views. I have a voice in my health and body,” Niyomwungeri said.