(introduction...)

2000 Update

Country Information

Population pyramid, 1999

Indicators	Year	Estimate	Source
Total Population (thousands)	1999	7,235	UNPOP
Population Aged 15-49 (thousands)	1999	3,338	UNPOP
Annual Population Growth	1990-1998	-0.7	UNPOP
% of Population Urbanized	1998	6	UNPOP
Average Annual Growth Rate of Urban Population	1990-1998	0.9	UNPOP
GNP Per Capita (US$)	1997	210	World Bank
GNP Per Capita Average Annual Growth Rate	1996-1997	-5.6	World Bank
Human Development Index Rank (HDI)	1999	164	UNDP
% Population Economic Active
Unemployment Rate
Total Adult Literacy Rate	1995	61	UNESCO
Adult Male Literacy Rate
Adult Female Literacy Rate
Male Secondary School Enrollment Ratio	1997	14.9	UNESCO
Female Secondary School Enrollment Ratio	1997	11.5	UNESCO
Crude Birth Rate (births per 1,000 pop.)	1999	41	UNPOP
Crude Death Rate (deaths per 1,000 pop.)	1999	17	UNPOP
Maternal Mortality Rate (per 100,000 live births)	1990	1,300	WHO
Life Expectancy at Birth	1998	41	UNPOP
Total Fertility Rate	1998	6.1	UNPOP
Infant Mortality Rate (per 1,000 live births)	1999	121	UNICEF/UNPOP

UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance

Global Surveillance of HIV/AIDS and sexually transmitted infections (STIs) is a joint effort of WHO and UNAIDS. The UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, initiated in November 1996, guides respective activities. The primary objective of the working group is to strengthen national, regional and global structures and networks for improved monitoring and surveillance of HIV/AIDS and STIs. For this purpose, the working group collaborates closely with national AIDS programmes and a number of national and international experts and institutions. The goal of this collaboration is to compile the best information available and to improve the quality of data needed for informed decision-making and planning at national, regional and global levels. The Epidemiological Fact Sheets are one of the products of this close and fruitful collaboration across the globe.

The working group and its partners have established a framework standardizing the collection of data deemed important for a thorough understanding of the current status and trends of the epidemic, as well as patterns of risk and vulnerability in the population. Within this framework, the Fact Sheets collate the most recent country-specific data on HIV/AIDS prevalence and incidence, together with information on behaviours (e.g casual sex and condom use) which can spur or stem the transmission of HIV.

Not unexpectedly, information on all of the agreed-upon indicators was not available for many countries in 1999. However, these updated Fact Sheets do contain a wealth of information which allows identification of strengths in currently existing programmes and comparisons between countries and regions. The Fact Sheets may also be instrumental in identifying potential partners when planning and implementing improved surveillance systems.

The fact sheets can be only as good as information made available to the UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance. Therefore, the working group would like to encourage all programme managers as well as national and international experts to communicate additional information to the working group whenever such information becomes available. The working group also welcomes any suggestions for additional indicators or information proven to be useful in national or international decision-making and planning.

Contact address:

UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance
20, Avenue Appia
CH-1211 Geneva 27
Switzerland
Fax: +41 22 791 4878
email: surveillance@UNAIDS.org
http://www.who.ch/emc/diseases/hiv
http://www.unaids.org

Estimated number of people living with HIV/AIDS

In 1999 and during the first quarter of 2000, UNAIDS and WHO worked closely with national governments and research institutions to recalculate current estimates on people living with HIV/AIDS. These calculations are based on the previously published estimates for 1997 and recent trends in HIV/AIDS surveillance in various populations. A methodology developed in collaboration with an international group of experts was used to calculate the new estimates on prevalence and incidence of HIV and AIDS deaths, as well as the number of children infected through mother-to-child transmission of HIV. Different approaches were used to estimate HIV prevalence in countries with low-level, concentrated or generalized epidemics. The current estimates do not claim to be an exact count of infections. Rather, they use a methodology that has thus far proved accurate in producing estimates that give a good indication of the magnitude of the epidemic in individual countries. However, these estimates are constantly being revised as countries improve their surveillance systems and collect more information.

Adults in this report are defined as women and men aged 15 to 49. This age range covers people in their most sexually active years. While the risk of HIV infection obviously continues beyond the age of 50, the vast majority of those who engage in substantial risk behaviours are likely to be infected by this age. The 15 to 49 age range was used as the denominator in calculating adult HIV prevalence.

Estimated number of adults and children living with HIV/AIDS, end of 1999

These estimates include all people with HIV infection, whether or not they have developed symptoms of AIDS, alive at the end of 1999

Adults and children		400000
	Adults (15-49)	370000	Adult rate (%)	11.21
	Women (15-49)	210000
	Children (0-14)	22000

Estimated number of deaths due to AIDS

Estimated number of adults and children who died of AIDS during 1999:

Deaths in 1999

40000

Estimated number of orphans

Estimated number of children who have lost their mother or both parents to AIDS (while they were under the age of 15) since the beginning of the epidemic:

Cumulative orphans

270000

Estimated number of children who have lost their mother or both parents to AIDS and who were alive and under age 15 at the end of 1999:

Current living orphans

172398

Assessment of epidemiological situation - Rwanda

HIV information among antenatal clinic attendees is available from Rwanda since the late 1980s. In Kigali, the major urban area, 32 percent of antenatal clinic attendees tested in 1988 were HIV positive. HIV prevalence has ranged between 25 and 33 percent among antenatal clinic attendees in Kigali through 1995. In 1997, HIV prevalence ranged from 10 to 28 percent among antenatal clinic women tested at two sites. HIV information by age is available for 1989, 1991 and 1992-93. Peak HIV prevalence of over 35 percent was seen among 20-24 year old antenatal clinic attendees in both 1989 and 1992-93.

Outside of Kigali, HIV prevalence among antenatal clinic attendees ranged from 10 to 8 percent from 1989-90 to 1997. In 1996, HIV prevalence among antenatal attendees tested in 6 sites outside of Kigali ranged from 4 to 17 percent. During this year, peak prevalence was seen among the 20-29 year old antenatal attendees.

Information on HIV prevalence among male STD clinic patients is available from Kigali since 1986. HIV prevalence reached 55 percent among male STD clinic patients tested in 1988-1990. In 1996, 29 percent of STD clinic patients tested in Kigali and 55 percent of patients in Biryogo were HIV positive. Among female STD clinic patients tested, HIV prevalence ranged from 69 to 77 percent between 1986 and 1991.

HIV sentinel surveillance

This section contains information about HIV prevalence in different populations. The data reported in the tables below are mainly based on the HIV data base maintained by the United States Bureau of the Census where data from different sources, including national reports, scientific publications and international conferences is compiled. To provide for a simple overview of the current situation and trends over time, summary data are given by population group, geographical area (Major Urban Areas versus Outside Major Urban Areas), and year of survey. Studies conducted in the same year are aggregated and the median prevalence rates (in percentages) are given for each of the categories. The maximum and minimum prevalence rates observed, as well as the total number of surveys/sentinel sites, are provided with the median, to give an overview of the diversity of HIV-prevalence results in a given population within the country. Data by sentinel site or specific study on which the medians were calculated are printed at the end of this fact sheet.

The differentiation between the two geographical areas Major Urban Areas and Outside Major Urban Areas is not based on strict criteria, such as the number of inhabitants. For most countries, Major Urban Areas were considered to be the capital city and - where applicable - other metropolitan areas with similar socio-economic patterns. The term Outside Major Urban Areas considers that most sentinel sites are not located in strictly rural areas, even if they are located in somewhat rural districts.

HIV prevalence in selected populations in percent (for blood donors: 1/100 000)

Group	Area		1984	1985	1986	1987	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999
Pregnant women	Major Urban Areas	N-sites					1	2	1	4	2	1		1	4	2
		Minimum					32	23.2	26.2	20.6	26.1	33.4		25.4	8.8	10
		Median					32	26.75	26.2	26.85	28.9	33.4		25.4	22.7	19
		Maximum					32	30.3	26.2	29.7	31.6	33.4		25.4	32.6	28
Pregnant women	Outside Major Urban Areas	N-sites							1	10	2				6	3
		Minimum							10.2	0.5	1.8				3.6	6
		Median							10.2	2.5	6.7				8.6	7.5
		Maximum							10.2	8.9	11.6				16.8	12
Group	Area		1984	1985	1986	1987	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999
Sex workers	Major Urban Areas	N-sites
		Minimum
		Median
		Maximum
Sex workers	Outside Major Urban Areas	N-sites
		Minimum
		Median
		Maximum
Group	Area		1984	1985	1986	1987	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999
Injecting drug users	Major Urban Areas	N-sites
		Minimum
		Median
		Maximum
Injecting drug users	Outside Major Urban Areas	N-sites
		Minimum
		Median
		Maximum
Group	Area		1984	1985	1986	1987	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999
STI patients	Major Urban Areas	N-sites			2		2	2	2	2	1				2
		Minimum			43.1		55.1	55.4	56.4	48.2	39				29.1
		Median			60.1		62.45	64.8	65.45	58.65	39				41.8
		Maximum			77		69.8	74.2	74.5	69.1	39				54.5
STI patients	Outside Major Urban Areas	N-sites
		Minimum
		Median
		Maximum
Group	Area		1984	1985	1986	1987	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999
Blood Donors	National	N-sites
		Minimum
		Median
		Maximum
Blood Donors	Major Urban Areas	N-sites
		Minimum
		Median
		Maximum
Group	Area		1984	1985	1986	1987	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999
Blood Donors	National	N-sites
		Minimum
		Median
		Maximum
Blood Donors	Major Urban Areas	N-sites
		Minimum
		Median
		Maximum
Group	Area		1984	1985	1986	1987	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999
Men having sex with	Major Urban Areas	N-sites
men		Minimum
		Median
		Maximum

Maps of HIV sentinel sites

Mapping the geographical distribution of HIV sentinel sites for different population groups may assist interpreting both the national coverage of the HIV surveillance system and explaining differences in levels and trends of prevalence. The UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, in collaboration with the UNICEF/WHO HealthMap Programme, has produced maps showing the location and HIV prevalence of HIV sentinel sites in relation to population density, major urban areas and communication routes. Maps illustrate separately the most recent results from HIV sentinel surveillance in pregnant women and in sub-populations at higher risk of HIV infection.

SENTINEL SURVEILLANCE IN PREGNANT WOMEN

SENTINEL SURVEILLANCE IN HIGH RISK POPULATIONS *

The boundaries and names shown and the designations used on these maps do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

WHO 2000, all rights reserved.

Reported AIDS cases

AIDS cases by year of reporting

1979	1980	1981	1982	1983	1984	1985	1986	1987	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999	Total	Unkn
0	0	0	0	10	73	161	501	236	299	1005	2204	2089	2908	1220	0	0	3847	1350			15903

Date of last report: 31/Dec/97

Following WHO and UNAIDS recommendations, AIDS case reporting is carried out in most countries. Data from individual AIDS cases is aggregated at the national level and sent to WHO. However, case reports come from surveillance systems of varying quality. Reporting rates vary substantially from country to country and low reporting rates are common in developing countries due to weaknesses in the health care and epidemiological systems. In addition, countries use different AIDS case definitions. A main disadvantage of AIDS case reporting is that it only provides information on transmission patterns and levels of infection approximately 5-10 years in the past, limiting its usefulness for monitoring recent HIV infections.

Despite these caveats, AIDS case reporting remains an important advocacy tool and is useful in estimating the burden of HIV-related morbidity as well as for short-term planning of health care services. AIDS case reports also provide information on the demographic and geographic characteristics of the affected population and on the relative importance of the various exposure risks. In some situations, AIDS reports can be used to estimate earlier HIV infection patterns using back-calculation. AIDS case reports and AIDS deaths have been dramatically reduced in industrialized countries with the introduction of HAART (Highly Active Anti-Retroviral Therapy).

AIDS cases by mode of transmission

Hetero: Heterosexual contacts.

Homo/Bi: Homosexual contacts between men.

IDU: Injecting drug use. This transmission category also includes cases in which other high-risk behaviours were reported, in addition to injection of drugs.

Blood: Blood and blood products.

Perinatal: Vertical transmission during pregnancy, birth or breastfeeding. NS: Not specified/unknown.

Sex	Trans. Group	<96	1996	1997	1998	1999	Unkn	Total	%
All	Total
	Hetero
	Homo/Bi
	IDU
	Blood
	Perinatal
	Other Known
	Unknown
Male	Total
	Hetero
	Homo/Bi
	IDU
	Blood
	Perinatal
	Other Known
	Unknown
Female	Total
	Hetero
	IDU
	Blood
	Perinatal
	Other Known
	Unknown
NS	Total
	Hetero
	IDU
	Blood
	Perinatal
	Other Known
	Unknown

Aids cases by age and sex

Sex	Age	<96	1996	1997	1998	1999	Unkn.	Total	%
All	All
	0-4
	5-9
	10-14
	15-19
	20-24
	25-29
	30-34
	35-39
	40-44
	45-49
	50-54
	55-59
	60+
	NS
Male	All
	0-4
	5-9
	10-14
	15-19
	20-24
	25-29
	30-34
	35-39
	40-44
	45-49
	50-54
	55-59
	60+
	NS
Female	All
	0-4
	5-9
	10-14
	15-19
	20-24
	25-29
	30-34
	35-39
	40-44
	45-49
	50-54
	55-59
	60+
	NS
NS	All
	0-4
	5-9
	10-14
	15-19
	20-24
	25-29
	30-34
	35-39
	40-44
	45-49
	50-54
	55-59
	60+
	NS

Curable Sexually Transmitted Infections (STIs)

The predominant mode of transmission of both HIV and other STIs is sexual intercourse. Measures for preventing sexual transmission of HIV and STI are the same, as are the target audiences for interventions. In addition, strong evidence supports several biological mechanisms through which STI facilitate HIV transmission by increasing both HIV infectiousness and HIV susceptibility. Significant also is the observation of a sharp decline in the concentration of HIV in the genital secretions when the infection is treated. Monitoring trends in STI can provide valuable information on the sexual transmission of HIV as well as the impact of behavioural interventions, such as promotion of condom use.

Clinical services offering STI care are an important access point for people at high risk for both AIDS and STI, not only for diagnosis and treatment but also for information and education. Therefore, control and prevention of STI have been recognized as a major strategy in the prevention of HIV infection and ultimately AIDS. One of the cornerstones of STI control is adequate management of patients with symptomatic STIs. This includes diagnosis, treatment and individual health education and counselling on disease prevention and partner notification. Consequently, monitoring different components of STI control can also provide information on HIV prevention within a country.

Estimated incidence and prevalence of curable STIs

	Incidence				Prevalence
STI’s	Year	Male	Female	All	Year	Male	Female	All
Chlamydia trach.
Gonorrhoea
Syphilis
Trichomonas

Comments:
Source:

STI Incidence, men

Prevention Indicator 9: Proportion of men aged 15-49 years who reported episodes of urethritis in the last 12 months.

Year	Area	Age	Rate	N=
1996	All	15-49	27.2

Comments:
Source: PNLS/AIDSCAP

STI Prevalence, women

Prevention Indicator 8: Proportion of pregnant women aged 15-24 years attending antenatal clinics whose blood has been screened with positive serology for syphilis.

Year	Area	Age	Rate	N=
1993	Urban	15-24	5.0

Comments:
Source: V. Leroy, A. De Clercq, J. Ladner et al. Prospective Study done at the Centre Hospilier de Kigali (CHK)

STI Case management (counselled)

Prevention Indicator 7: Proportion of people presenting with STD or for STD care in health facilities who received basic advice on condoms and on partner notification.

Year	Area	Age	Rate	N=
1996	All		56.0

Comments:
Source: PNSL/AIDSCAP

STI Case management (treatments)

Prevention Indicator 6: Proportion of people presenting with STD in health facilities assessed and treated in an appropriate way (according to national standards).

Year	Area	Age	Rate	N=
1996	All		63.0

Comments:
Source: PNLS/AIDSCAP

Health service indicators

HIV prevention strategies depend on the twin efforts of care and support for those living with HIV or AIDS, and targeted prevention for all people at risk or vulnerable to the infection. These efforts may range from reaching out to vulnerable communities through large-scale educational campaigns or interpersonal communication; provision of treatment for STIs; distribution of condoms and needles; creating and enabling environment to reduce risky behaviour; providing access to voluntary testing and counselling; home or institutional care for persons with symptomatic HIV infection; and preventing perinatal transmission and transmission through infected needles or blood in health care settings. It is difficult to capture such a large range of activities with one or just a few indicators. However, a set of well-established health care indicators - such as the percentage of a population with access to health care services; the percentage of women covered by antenatal care; or the percentage of immunized children - may help to identify general strengths and weaknesses of health systems. Specific indicators, such as access to testing and blood screening for HIV, help to measure the capacity of health services to respond to HIV/AIDS - related issues.

Access to health care

Indicators		Year	Estimate	Source
% of population with access to health services - total:
% of population with access to health services - urban:
% of population with access to health services - rural:
Contraceptive prevalence rate (%):		1990-1999	21	UNICEF/UNPOP
	% of births attended by trained health personnel:	1990-1999	26	UNICEF
	% of 1-yr-old children fully immunized - DPT:	1995-1998	77	UNICEF
	% of 1-yr-old children fully immunized - Polio:	1995-1998	77	UNICEF
	% of 1-yr-old children fully immunized - Measles:	1995-1998	66	UNICEF
Proportion of blood donations tested:
	% of ANC clinics where HIV testing is available:
HIV/AIDS Hospital Occupancy Rate (Days):

Male and female condoms are the only technology available that can prevent sexual transmission of HIV and other STIs. Persons exposing themselves to the risk of sexual transmission of HIV should have consistent access to high quality condoms. AIDS Programmes implement activities to increase both availability of and access to condoms. The two condom availability indicators below are intended to highlight areas of strength and weakness at the beginning and end of the distribution system so that programmatic resources can be directed appropriately to problem areas.

Condom availability (central level)

Prevention Indicator 2: Availability of condoms in the country over the last 12 months (central level).

Year	Area	N	Rate
1997	All	360000	0.1

Comments:
Source: PSI/Annual Report, 1997

Condom availability (peripheral level)

Prevention Indicator 3: Proportion of people who can acquire a condom (peripheral level).

Year	Area	N	Rate

Comments:

Source:

Knowledge and behaviour

In most countries the HIV epidemic is driven by behaviours (e.g.: multiple sexual partners, intravenous drug use) that expose individuals to the risk of infection. Information on knowledge and on the level and intensity of risk behaviour related to HIV/AIDS is essential in identifying populations most at risk for HIV infection and in better understanding the dynamics of the epidemic. It is also critical information in assessing changes over time as a result of prevention efforts. One of the main goals of the 2^nd generation HIV surveillance systems is the promotion of regular behavioural surveys in order to monitor trends in behaviours and target interventions.

Knowledge of HIV- related preventive practices

Prevention Indicator 1: Proportion of people citing at least two acceptable ways of protection from HIV infection.

Year	Area	Age Group	Male	Female	All

Comments:

Source:

Reported non-regular sexual partnerships

Prevention Indicator 4: Proportion of sexually active people having at least one sex partner other than a regular partner in the last 12 months.

Year	Area	Age Group	Male	Female	All
1988	All	15-50			2827

Comments:

Source:

Reported condom use in risk sex (gen pop)

Prevention Indicator 5: Proportion of people reporting the use of a condom during the most recent intercourse of risk.

Year	Area	Age Group	Male	Female	All

Comments:

Source:

Ever use of condom

Percentage of people who ever used a condom.

Year	Area	Age Group	Male	Female	All
1992	All	15-19		0.2
1992	All	20-24		0.9
1992	All	25-29		2.5
1992	All	30-34		1.4
1992	All	35-39		1.4
1992	All	40-44		1.6
1992	All	45-49		0.3

Comments:
Source: Demographic and Health Survey

Median age at first sexual experience

Median age of people at which they first had sexual intercourse.

Year	Area	Age Group	Male	Female	All
1992	All	20-24		20.2
1992	All	25-49		19.7
1992	All	45-49		18.4

Comments:
Sources: DHS/1992

Adolescent pregnancy

Percentage of teenagers 15-19 who are mothers or pregnant with their first child

Year	Area	Age Group	N	Rate
1992	All	15	280	0.4
1992	All	15-17	200	9.0
1992	All	16	311	2.5
1992	All	17	304	7.7
1992	All	18	302	16.5
1992	All	19	267	26.7

Comments:
Sources: DHS/1992

Sources

Data presented in this Epidemiological Fact Sheet come from several different sources, including global, regional and country reports, published documents and articles, posters and presentations at international conferences, and estimates produced by UNAIDS, WHO and other United Nations Agencies. This section contains a list of the more relevant sources used for the preparation of the Fact Sheet. Where available, it also lists selected national Web sites where additional information on HIV/AIDS and STI are presented and regularly updated. However, UNAIDS and WHO do not warrant that the information in these sites is complete and correct and shall not be liable whatsoever for any damages incurred as a result of their use.

Bulterys, M., A. Saah, A. Chao, et al., 1990, Is Oral Contraceptive Use Associated with Prevalent HIV Infection in Rwandan Women?, V International Conference: AIDS in Africa, Kinshasa, Zaire, Oct. 10-12, Poster T.P.C.6.

Bucyendore, A., P. Van de Perre, E. Karita, et al., 1993, Estimating the Seroincidence of HIV-1 in the General Adult Population in Kigali, Rwanda, AIDS, vol. 7, no. 2, pp. 275-277.

Bogaerts, J., C. A. Ricart, E. Van Dyck, et al., 1989, The Etiology of Genital Ulceration in Rwanda, Sexually Transmitted Diseases, vol. 16, no. 3, pp. 123-126.

Karita, E., W. Martinez, P. Van de Perre, et al., 1993, HIV Infection among STD Patients - Kigali, Rwanda, 1988 to 1991, International Journal of STD and AIDS, vol. 4, no. 4, pp. 211-213.

Le Page, P., F. Dabis, A. Serufilira, et al., 1989, Transmission of HIV-1 Virus from Mother to Children in Central Africa: A Study of Cohort in Kigali, Rwanda, IV Internat. Conf.: AIDS and Assoc. Cancers in Africa, Marseille, Oct. 18-20, Poster 243.

Lindan, C., S. Allen, M. Carael, et al., 1991, Knowledge, Attitudes, and Perceived Risk of AIDS among Urban Rwandan Women: Relationship to HIV Infection and Behavior Change, AIDS, vol. 5, no. 8, pp. 993-1002.

Ladner, J., A. De Clercq, C. Ukulikiyimfura, et al., 1992, Seroprevalence de l'Infection par le VIH-1 et Counselling chez les Femmes Enceintes: Une Etude de Cohorte a Kigali, Rwanda..., VII International Conference on AIDS in Africa, Yaounde, Cameroon, 12/8-11, Poster W.P.179.

Ladner, J., A. De Clercq, M. Nyiraziraje, et al., 1993, HIV Seroprevalence and Counselling in Pregnant Women a Cohort Study in Kigali (Rwanda), 1992, IX International Conference on AIDS, Berlin, 6/6-11, Poster PO-D15-3884.

Nziyumvira, A., J. B. Twagirakristu, S. Murorunkwere, et al., 1993, Epidemie de l'Infection au VIH au Rwanda, Resultats de Serosurveillance par Postes Sentinelles, VIII International Conference on AIDS in Africa, Marrakech, Morocco, 12/12-16, Abstract Th.P.C.068.

Ntawiniga, P., V. Leroy, C. Gazille-Rugema, et al., 1995, High Seroprevalence of HIV Infection and Syphilis among Pregnant Women: Kigali, Rwanda, May 1995, IX International Conference on AIDS and STD in Africa, Kampala, Uganda, 12/10-14, Poster TuB573.

Rwanda Ministry of Health, 1998, 1997 Population Based Serosurvey, Ministry of Health, Programme National de Lutte Contre le SIDA, Republic of Rwanda, January, unpublished report.

Seed, J. R., S. S. Allen, T. Mertens, et al., 1993, Male Circumcision, Sexually Transmitted Disease, and Risk of HIV a Study of Urban Rwandan Men, IX International Conference on AIDS, Berlin, 6/6-11, Poster PO-C03-2622.

Twagirakristu, J. B., E. Fox, A. Nziyumvira, et al., 1992, Etat de l'Infection VIH au Rwanda en 1991, VII International Conference on AIDS in Africa, Yaounde, Cameroon, 12/8-11, Poster T.P.014.

Van Hove, D., P. Ntawiniga, I. Ntaganira, et al., 1997, HIV Sentinel Surveillance among Sexually Transmitted Disease Patients in Rwanda, Xth International Conference on AIDS and STD in Africa Abidjan, Cote d'Ivoire, 12/7-11, Poster B.455.

Van Hove, D., P. Ntawiniga, I. Ntaganira, et al., 1997, HIV Sentinel Surveillance among Pregnant Women in Rwanda, Xth International Conference on AIDS and STD in Africa Abidjan, Cote d'Ivoire, 12/7-11, Abstract B.1162.

Van Hove, D., C. Kabagabo, G. Asiimwe, et al., 1998, How Suitable are Antenatal Clinic Attenders as a Sentinel Population to Estimate HIV

Prevalence in Rwanda?, 12th World AIDS Conference, Geneva, 6/28 - 7/3, Poster 43572.

Websites: www.aids.africa.com

Annex: HIV Surveillance data by site

Group	Area		1984	1985	1986	1987	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999
Pregnant women	Major Urban Areas	Kigali (Nyamata)													8.8	10
		Kigali (Several sites)									26.1
		Kigali (Muhina)								25.3
		Kigali (Gikondo)								28.4					23
		Kigali (Biryogo)								20.6					32.6	28
		Kigali (Muhina & Gikondo)						23.2	26.2
		Kigali (CHK)								29.7	31.6	33.4		25.4	22.4
		Kigali					32	30.3
Pregnant women	Outside Major	Butare							10.2
	Urban Areas	Kabgayi													15.9
		Kabutare													9	12
		Kirehe													7.8	6
		Nyagatare													8.2	7.5
		Ruhengeri													9.9
		Ruli													3.6
		Rural areas									1.8
		Semiurban areas									11.6
		Gahini								8.9
		Gakoma								0.5
		Kayove								7.9
		Kirambi								2.6
		Mukoma								2.5
		Mukunga								2
		Musana								3
		Nemba								2.5
		Nyakabuye								2
		Tanda								2.2
Group	Area		1984	1985	1986	1987	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999
Sex workers	Major Urban Areas
Sex workers	Outside Major
	Urban Areas
Group	Area		1984	1985	1986	1987	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999
Injecting drug users	Major Urban Areas
Injecting drug users	Outside Major
	Urban Areas
Group	Area		1984	1985	1986	1987	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999
STI patients	Major Urban Areas	Kigali (1)													54.5
		Kigali (2)													29.1
		Kigali (Males)			43.1		55.1	55.4	56.4	48.2	39
		Kigali (Females)			77		69.8	74.2	74.5	69.1
STI Patients	Outside Major
	Urban Areas
Group	Area		1984	1985	1986	1987	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999
Blood Donors	National
Blood Donors	Major Urban Areas
Blood Donors	Outside Major
	Urban Areas