Abstract

Returning home, but stepping back: increasing access to sexual and reproductive health and HIV services for returnees in Rwanda and Burundi

Presented by Laurien Nyabienda (Rwanda).

D. ter Huurne¹, J. Hopkins¹, L. Nyabienda<sup>2

1</sup>IPPF, HIV, London, United Kingdom, ²Association Rwandaise pour le Bien-Etre Familial (ARBEF), Kigali, Rwanda

Issues: Refugees' vulnerability to HIV is widely recognised. Upon return, this vulnerability is often exacerbated by social and political factors. Yet, returnees often fall off the radar of (international) organizations. Providing them access to SRH services requires a unique, comprehensive approach to service delivery.
Description: Two national organisations in Rwanda and Burundi worked to increase returnees' access to HIV and SRH information and services. Trained peer educators conducted IEC activities in the communities - reaching more than 80,000 people. Healthcare providers received additional training on HIV and SRH, while (government) clinics were supplied with commodities. A voucher system was introduced to provide more than 32,000 people with free VCT, STI treatment and/or family planning.
What set the experiences apart was the fact that the Rwandan organization assisted the returnees to come together as a community and discuss issues of their concern. The unexpected result was collective action against and significant reductions in domestic violence (from 49-60% to 20-29%), and increased gender equality.
Lessons learned:

• Like refugees, returnees experience increased vulnerability to HIV (due to lack of livelihoods, social networks, and access to basic services), but they are often overlooked in HIV responses;
• Returnees need to be acknowledged as vulnerable populations in national HIV policies and programmes;
• Strategic partnerships with different (N)GOs should be forged to address the long-term needs of returnees (e.g. livelihoods and access to basic services);
• A process of 'community building' may be needed, before 'community mobilization' can take place;
• Health interventions can provide an entry point to address wider development needs (e.g. empowerment, gender equality, livelihoods, justice)

Next steps: Increase advocacy efforts towards local and national governments to ensure multisectoral responses to returnees' needs and vulnerabilities. Strengthen partnerships to address limitations of the programmes around income-generation, ART access and adherence (e.g. through nutrition and transport support).