HIV/AIDS is a critical problem in Rwanda, as it is throughout sub-Saharan Africa. Out of a population of approximately 8.1 million people in 2002, approximately 900,000 were estimated to be HIV positive. Planners estimate that in 2002 there were 80,000 new HIV infections, 49,000 deaths attributable to HIV/AIDS, and 40,000 HIV-exposed infants born. Under the leadership of President Paul Kagame, the government convened a number of working groups early in 2003 with the purpose of defining the current and future need for HIV/AIDS services and developing a roadmap for developing the infrastructure to support treatment and care throughout Rwanda.

Rwanda was assisted in this effort by the William Jefferson Clinton Foundation, which has provided technical support to the planning effort and will be assisting the government to obtain financing for its efforts. One of the Clinton Foundation's lead agents in this process has been the Pangaea Global AIDS Foundation, which helped convene the working groups, advised on the development of care and treatment programs, and assisted the compilation of working group findings into a comprehensive plan for care and treatment. (For more information on the Clinton Foundation/Pangaea partnership, read "Pangaea Partners with Clinton Foundation on Countrywide AIDS Treatment Programs" in the April 2003 edition of Global View.)

This national system of care and treatment will include HIV testing and counseling, services coordination, medical treatment including antiretroviral ("ARV") drug therapy, clinical monitoring and adherence support, psychosocial care, community and home-based care, ancillary support services, and prevention education and counseling. The five-year plan calls for the rapid scale-up of HIV treatment and care. In the first year, there would be approximately 25,000 persons living with HIV/AIDS under treatment, with approximately 4,200 of that population receiving ARVs. By end of the fifth year, the plan is to have over 380,000 people living with HIV/AIDS under treatment, with 59,000 on ARVs. The cost of the plan over five years will be approximately $219 million and will require expansion of HIV/AIDS medical personnel from approximately 250 in the first year to almost 1,800 five years later.

Pangaea Chief Executive Officer Dr. Eric Goosby, who is working closely with the Rwandan government on the plan, commented: "The Rwandan effort was really quite extraordinary. The government created 12 working groups in February, made up of Rwandan experts in fields ranging from treatment to transportation. These working groups answered questions that explicitly defined the needs of the HIV population in Rwanda and matched them against the medical infrastructure already in place to define the unmet need for HIV/AIDS services. From this we calculated the drug needs, medical human resource needs (including training for nurses and physicians) and the managerial support needs of all 365 community health centers, all 33 District Hospitals and 5 reference hospitals, down to the number of paper clips needed. The plan was defined from the 12 work group perspectives with the technical assistance of Pangaea and the Clinton Foundation, and compiled into a 'Business Plan,' which was approved by the Rwandan cabinet. This has been an extraordinary effort on the part of the people and government of Rwanda. I've never seen such ownership of the healthcare planning process."

Dr. Goosby says that the Clinton Foundation will be working with the Rwandan government to secure funding for the plan. The national plan will seek to coordinate funding commitments from a number of sources, including the Global Fund to Fights AIDS, Tuberculosis and Malaria, the World Bank, as well as other bilateral aid donors to realize a comprehensive national response including care and treatment. Dr. Goosby concluded: "We are hoping that the government of Rwanda and the Clinton Foundation will be successful in securing these commitments quickly and that money will be flowing before the end of 2003."