From choice, a world of possibilities Returning home, but stepping back Increasing access to sexual and reproductive health and HIV services for returnees in Rwanda and Burundi Laurien NYABIENDA Executive Director ARBEF/RWANDA Refugees and Asylum Seekers and HIV: Deportation and Human Rights Violations. 20 July :30-16:00

SOCIO-POLITICAL BACKGROUND International AIDS Conference| Vienna, July 2010

THE ISSUE Re-settlement communities are marked by a lack of livelihood opportunities, weak social networks, and unmet needs for SRH and HIV services Only 2% of respondents in Rwanda reported importance of condom use for HIV prevention; Yet, returnees often overlooked by humanitarian organizations Providing them with SRH and HIV services required an urgent and holistic approach to service delivery International AIDS Conference| Vienna, July 2010

THE INITIATIVE IPPF Member Associations in Rwanda (ARBEF) and Burundi (ABUBEF) took up the task in 2007 and 2008 Aim: to increase returnees’ access to HIV and SRHR information and services Approach: community mobilisation, active integration of HIV and SRH services, and strategic partnerships International AIDS Conference| Vienna, July 2010

ACTIVITIES BURUNDI Training of peer educators Awareness and IEC sessions Training of health care workers Provision of VCT, STI management and family planning Referral for ART and care Formation of women’s groups RWANDA Training of peer educators Awareness and IEC sessions New maternity ward Provision of VCT, STI management, family planning, OI treatment and ANC Referral for IGA and nutritional support International AIDS Conference| Vienna, July 2010

KEY ACHIEVEMENTS (1) Uptake of SRH and HIV services International AIDS Conference| Vienna, July 2010

KEY ACHIEVEMENTS (2) Increased openness about HIV and STIs “I am able to talk to my children and wife – without shame - about HIV and other sexually transmitted diseases…” Male peer educator (aged 50), Burundi Reduced stigma and discrimination against PLHIV More people openly living with HIV Faith-based and community leaders’ actions against stigma and discrimination International AIDS Conference| Vienna, July 2010

KEY ACHIEVEMENTS (3) Reductions in domestic violence and increased gender equality (Rwanda) Reported Violence against Women(%) International AIDS Conference| Vienna, July 2010

“Being beaten was part of our custom, it was even believed to be a sign that our husbands cared, but now we know better.” Head of the women’s association (aged 44), Kageyo, Rwanda International AIDS Conference| Vienna, July 2010

Key challenges Socio-economic, cultural and religious barriers Lack of organisations among returnees Geographic accessibility Scarcity of land International AIDS Conference| Vienna, July 2010

RECOMMENDATIONS: Policy Acknowledge returnees as a vulnerable population in HIV policies and programmes Long-term goal needs to be re-integration into existing communities, rather than re-settlement areas Create a conducive policy environment – and political will – for addressing gender-based violence International AIDS Conference| Vienna, July 2010

RECOMMENDATIONS: Programming Ensure a holistic and sustainable approach to the long-term needs of returning refugees Building in processes for community strengthening, as well as community mobilization Use health interventions as an entry point to address wider development needs International AIDS Conference| Vienna, July 2010

“Now we always have the strength to work hard, confident that we can afford our children’s needs…” Frida (44 years old)

With thanks to… Japan Trust Fund for HIV and AIDS