Tucked into the hillside of Kigali’s Nyamirambo neighbourhood, the Health Development Initiative (HDI) Outreach Centre stands as a quiet beacon of compassion. A bold sign marks the entrance: “Outreach Centre – Free Call: 3530.” Inside, the red floors are polished, the staff greet you in white coats and warm smiles, all have been trained to be sensitive to the needs of their clients and a large purple mural reminds every visitor: “Harm Reduction Saves Lives.”

Rwanda’s public health gains are striking: the country has reached the 95-95-95 UNAIDS targets, meaning that 95% of people living with HIV know their status, 95% of those diagnosed are on treatment, and 95% of those on treatment are virally suppressed. Making it one of 7 countries to have reached this impressive milestone. An estimated 240,000 people —adults and children—are currently living with HIV. But behind these numbers lies the critical work of community organisations like the HDI, ensuring that the most marginalized are not left behind. 

From Vision to Action: HDI’s Story

Founded in 2005 by medical students, HDI has grown into a health and human rights powerhouse, advocating for policy reform and building stigma-free care spaces. It now operates three outreach centres across Rwanda, serving over 70,000 young people annually via its hotline, and thousands more through in-person HIV testing and counselling.

While sex work only became effectively decriminalized in 2017, Rwanda has never criminalized consensual same-sex relationships—making it a legal outlier in the region.  HDI played an active role here as vital for expanding HIV services. The organisation also champions harm reduction for people who use drugs, a critical population given Rwanda’s rising heroin use. While drug use remains criminalised and needle exchange programs are not yet permitted, HDI continues to press for reform, building bridges with law enforcement and the Ministry of Justice. Through peer-led outreach, psychosocial counselling, legal aid, and referrals to mental health and HIV care, HDI provides lifesaving services while advancing a rights-based approach to harm reduction. 

“Use properly the medication that reduces the strength of the virus that causes AIDS—save your future.“ IAS 2025, the 13th IAS Conference on HIV Science. Kigali, Rwanda. Monday 14 July 2025 / Media site visit In the photo: Umumararungu Sylvie, a sex worker and client seeking HIV testing and other services at Health Development Initiative (HDI), poses for a photo. ©Jean Bizimana/IAS

Sex Worker Voices: The Reality on the Ground 

At a recent HDI roundtable, a group of women shared their unfiltered experiences with sex work, safety, stigma—and health services.

“It could be twice a week—that’s how often we face physical violence. But sometimes it’s worse. You go to a man’s house thinking it’s just him… and find four men waiting. There’s nothing you can do.” Another participant shared how even when they report violence, justice feels out of reach: “Even when we go to the police, they ask: ‘Why don’t you stop this work? Find something normal to do.’ Even if the man is arrested, they tell us to negotiate. They say, ‘You agreed on your own—now fix it.’” They also raised concerns about changes in access to HIV prevention. All the women said they were currently using oral PrEP (HIV pre-exposure prophylaxis), a daily pill that reduces HIV risk by over 90%. But they expressed new frustrations: “Before, we used to get three months of pills. Now, it’s only one month at a time. We don’t know why that changed. It makes it harder to stay consistent, especially when some of us travel or can’t always come back to the clinic.”

Recent funding cuts have affected PrEP supplies. Despite ongoing stigma from some health providers—where moral judgment can replace medical care—HDI’s presence makes a difference. One woman said: “Sometimes, when you walk into a public clinic, the nurse starts preaching to you—telling you to change your life. But when HDI sends us, it’s different. They already know who we are. We don’t have to explain ourselves all over again.” 

Rwanda’s fight against Viral Hepatitis—both B and C—is also Remarkable  

According to the World Health Organization, over 7 million people aged 15 and above have been screened for hepatitis C, with more than 60,000 initiated on treatment. National prevalence of hepatitis C has now fallen below 1%. Efforts to eliminate hepatitis B are similarly advancing, with over 8,000 people treated for chronic infection and national birth-dose vaccination rolled out. HDI aims to integrate hepatitis B and C testing and care into its services alongside HIV. “We’re not there yet—regulatory barriers and funding gaps persist,” explained Dr. Aflodis Kagaba, Executive Director of HDI. “But it’s the next step.” 

Dr. Aflodis Kagaba, Executive Director of HDI

The Power of Partnership—Despite the Cuts 

HDI’s work is supported by Swedish aid, Expertise France, and the Global Fund, among others. But in 2025, HDI has lost a $US 750,000 grant from the U.S. CDC. As a consequence, outreach work by community health workers has dropped by 60% as the organisation can no longer pay them.

“They told us to remove any mention of gender diversity. We couldn’t do that,” Dr. Kagaba explains. Still, services continue—and the community keeps showing up. 

This resilience echoes a moving moment at IAS 2025 in Kigali, where community activists took the stage during the opening ceremony, carrying signs and declaring: “We will not be erased.” They condemned widespread funding cuts and demanded that key populations must remain visible in the HIV response. 

Evidence-Based, People-Centred 

HDI is not just service delivery—it is evidence generation for change. Dr. Kagaba summed it up: “Whenever we advocate, government asks: ‘Where is the evidence?’ That’s why we document. We don’t guess who the MSM community is—we know. We don’t guess who uses drugs—we have them in our cohort. We don’t build programs in theory—we do the work first.”

The goal isn’t to open hundreds of centres. It’s to use these models to influence national health system’s policies and services —and to normalize inclusive, respectful, and rights-based care.   

From Advocacy to Action—And Hope 

The visit to HDI’s centre in Kigali took place on the sidelines of IAS 2025, where the dominant theme was both urgency and uncertainty. Community organizations spoke out about devastating funding cuts, particularly to key population programs. The HIV movement—long a model of community-led health equity—is now at risk of faltering just as we approach the final mile. 

But amidst that, there was some hope.

IAS 2025, the 13th IAS Conference on HIV Science. Kigali, Rwanda. Monday 14 July 2025. Opening session In the photo: Protesters are seen giving speeches and demonstrating during the opening ceremony of IAS 2025, the 13th IAS Conference on HIV Science. ©Jean Bizimana/IAS

At the same conference, MPP announced an expansion of its licence with ViiV Healthcare to cover long-acting injectable cabotegravir (CAB-LA) not only for prevention—but also for treatment. This voluntary licensing agreement could pave the way for more affordable access to first WHO-recommended long-acting HIV treatment regimen in low- and middle-income countries. 

It’s exactly the kind of innovation that offers renewed possibility for people like those we met in Kigali—women who have endured violence and stigma, people who use drugs in criminalized settings, and LGBTQ+ communities often denied safe access to care and for whom adherence to treatment can be difficult.

With the needs of vulnerable populations and the services of organisations like HDI in mind, MPP continues to strive to ensure that such life-changing interventions don’t remain out of reach—but are made available, accessible, and affordable for all.

Because the global HIV response cannot leave behind the very people most impacted.