DECLARATIONI, Cyprien HABINSHUTI a student of University of Rwanda, Huye

Campus, College of Business and Economics, School of Economics,

Department of Applied Statistics, hereby declare that the work

done and presented in this dissertation entitled “ASSESSEMENTOF

THE IMPACT OF HIV/AIDS COUNSELING SERVICES ON RURAL AREA

POPULATION” is my own work and has not been presented anywhere

for any academic qualification. Any reference in terms of books

or any other written and electronic materials made concerning

other people’s work are indicated in the references.

Signature: ………………………… Date: ……………………………………….

Name of Student: Cyprien HABINSHUTI

Supervisor signature: ……………………… Date: ……………………………….

Name of Supervisor: Dr Dieu Donne MUHOZA

i

DEDICATION

ii

I dedicate my dissertation

work:

To Almighty Powerful God

To my family and my friends,A special feeling of gratitude to my loving relatives: Adrien

MUHIGIRWAFather Pie NEMEYAMAHOROMy loving Aunt M. Jeanne

IRAGUHA,

Grandmother whose words of encouragement are still in my ears, to my esteem friends:

Augustin NSHUTI IYAMUREMYE andValentine IMANISHIMWE.

I also dedicate this dissertation to my parents who

give me way of live.I will always appreciate all

they have done.

AcknowledgementThis laborious work would not have been a success without such

intervention: moral, financial support, ideas and guidance from

various persons to whom I would like to thank.

Firstly, I thank God for protecting me during this work and wholemy life. This work is the greatest effort result provided bydifferent people to whom I appreciate.

My sincere thanking is addressed to the Dean of School of

economics, Dr Dieu Donne MUHOZA who, for his demonstrations,

elaboration of new concepts and clarification of concepts not

well understood and for his unfailing help by proper guidance,

effective comments and with a good support

I am very grateful to him for giving me the benefits of his

experience and suggestions.

I actually thank the Head of RANGO health center who for hispermission to data collection,

Great thanks also to the Heads of Department of Applied

Statistics Prof. Sai Kumar CHINTALAPUDI and Mr. Charles RURANGAiii

I dedicate my dissertation

work:

To Almighty Powerful God

To my family and my friends,A special feeling of gratitude to my loving relatives: Adrien

MUHIGIRWAFather Pie NEMEYAMAHOROMy loving Aunt M. Jeanne

IRAGUHA,

Grandmother whose words of encouragement are still in my ears, to my esteem friends:

Augustin NSHUTI IYAMUREMYE andValentine IMANISHIMWE.

I also dedicate this dissertation to my parents who

give me way of live.I will always appreciate all

they have done.

for the interventions allowed this research to be carried out

smoothly and under good conditions

I really accord my deepest gratitude to all of my family members

because of their advices, love, endless patience, care, and

constant encouragement, financial and moral support they gave me

when it was most required.

My Special thanks to my colleagues we shared the experience andto all my classmates in the department of Applied Statistics fortheir collaboration during our studies.

In general, I thank all people participated near or far so that Icould accomplish my intended task in the convenient time andspace.

Cyprien HABINSHUTI

Signnature……………………, date………………

ContentsDECLARATION..........................................................i

DEDICATION..........................................................ii

Acknowledgement....................................................iii

List of abbreviations..............................................vii

LIST OF TABLES......................................................ix

iv

LIST OF FIGURES......................................................x

Abstract............................................................xi

CHAPTER I: GENERAL INTRODUCTION......................................1

I.1 Background......................................................1

1.2 Back ground to the study........................................1

1.3 Problem statement...............................................3

1.4 Objectives of The study.........................................4

1.4.1 General Objectives..........................................4

1.4.2 Specific objectives.........................................4

1.4 Research Questions..............................................4

1.5 Research hypothesis.............................................4

1.6 Scope of the Study..............................................4

1.7. Arrangement of the study.......................................5

CHAPTER TWO: LITERATURE RIVIEW.......................................6

II.0. DEFINITION OF KEY TERMS.......................................7

II.1.The History of HIV/AIDS........................................7

II.2. Definition of HIV/AIDS globally...............................7

II.3. HIV/AIDS STATUS...............................................8

II.3.1. HIV/AIDS Status all over the World........................8

II.3.2. HIV/AIDS status in EAST Africa............................9

II.3 .3. HIV/AIDS status in Rwanda...............................11

II.4. Health services regarding HIV/AIDS alleviation in Rwanda.....11

v

II.5. Rwanda’ strategies to reduce the increment of HIV/AIDS among Rwandans...........................................................12

CHAPTER THREE.......................................................14

RESEARCH METHODOLOGY................................................14

3.1. Introduction..................................................14

3.2 Research Design................................................14

3 .2.1 .The analytical research..................................14

3.3. Study Area....................................................14

3.4. Study Population..............................................15

3.5. Sampling techniques...........................................15

3.5.0. Sample size...............................................15

3.5.1 Sample size calculation....................................15

3.5.2. Purposive sampling........................................17

3.6. Techniques of Sample selection................................17

3.6. Source of Data................................................18

3.6.1. Primary data..............................................18

3.6.2. Secondary Data............................................19

3.7. Techniques of Data collection.................................19

3.8. Research instruments..........................................19

3.8.1. Questionnaire.............................................19

3.8.2. Interview.................................................19

3.8.3. Observation...............................................19

3.9. Data processing and analysis..................................20

vi

3.9.1. Editing...................................................20

3.9.2. Coding....................................................20

3.9.3. Tabulation................................................20

3.10. Limitations of the study.....................................21

CHAPTER IV: ANALYSIS AND DISCUSSION OF FINDINGS....................22

4.0. Introduction..................................................22

4.1. The structure and number of focusing population...............24

Figure 4.1 The figure below showing the distribution of HIV/AIDS status among male and female.......................................25

4.2. Social demographic characteristics............................25

4.2.1 HIV+ and HIV- of clients to counselors within their age and education levels.................................................27

4.2.2 Occupation of population who access to counseling services. 28

4.3. Characteristics of Service Providers interviewed..............29

4.4 The data analysis and data presentation........................32

4.4.1 The analysis and interpretation..............................34

CHAPTER V: RECOMMENDATION AND CONCLUSIONS...........................36

5.1. Introduction..................................................36

5.2 Conclusion.....................................................37

5.3 Recommendation.................................................38

Bibliography........................................................40

QUESTIONNAIRES......................................................41

vii

List of abbreviations5 C: Consent, Confidentiality, Counseling, Correct

AIDS: Acquired Immune Deficiency Syndrome

ARS: acute retroviral syndrome

ART: antiretroviral therapy

CDC: Disease Control and Prevention

CSS: Care and Support Services

EGPAF: Elizabeth Glaser Pediatric AIDS Foundation

H1: The alternative hypothesis

HIV/AIDS: Human Immunodeficiency Virus for Acquired ImmuneDeficiency Syndrome

HIV: Human Immunodeficiency Virus

HIV-: Human Immunodeficiency Virus negative

HIV+: Human Immunodeficiency Virus positive

Ho: The null hypothesis

HSCP: HIV Clinical Services Program

MIYCN: Maternal Infant and Young Child Nutrition

MOH: Ministry of Health

viii

NGO: Non-governmental Organization

NUDIPU: National Union of Disabled Persons of Uganda 

PEP: Post- exposure prophylaxis

PEPFAR: President’s Emergency Plan for AIDS Relief

PIT: Provider Initiated Testing

PLHIV: People Living with HIV

PMTCT: Prevention of Mother-to-Child Transmission

RBC: Rwanda biomedical center

RSPA: Rwanda Service Provision Assessment

SIV: simian immunodeficiency virus

SPSS: statistical package for social sciences

STIs: sexually transmitted infections

TB: tuberculosis

UNAIDS: Joint United Nations Program on HIV/AIDS

USAID: United State Agency for International Development

USAID: United States Agency for International Development

VCT: Voluntary Counseling and Testing

WHO: World Health Organization

ix

LIST OF TABLESChapter II

Table 1: table which shows HIV/AIDS distribution in Africa..........11

Chapter III

Table 2: table showing how the sample was selected in cellules.....18

Table 3: table showing cellules in tumba with their Villages........23

Chapter IV

Table 4: table showing structure of focusing population.............24

Table 5: show the social characteristics of respondents.............26

Table 6: showing clients (HIV+ and HIV-) with their occupation......28

Table 7: showing the distribution of counselors and their age.......30

Table 8: table showing respondents and way of getting information. . .33

x

LIST OF FIGURESChapter IV

Figure 1: shows the distribution of HIV+ and HIV- from january 2015. 25

Figure 2: shows the distribution of respondents within their life status..............................................................26

Figure 3: shows demographic characteristics of clients with their age,....................................................................28

Figure 4: showing the distribution of clients with their occupation. 29

Figure 5: showing the counselors distribution and their level of education...........................................................31

xi

figure 6: showing counselors distribution and their gender..........32

Figure 7: figure showing respondents and means of information.......34

ABSTRACT

Persons with or at risk for human immunodeficiency virus (HIV)

infection need client-centered counseling and information about

the disease. One of the best opportunities to provide counseling

xii

and information is during an HIV testing encounter. New testing

guidelines from the Centers for Disease Control and Prevention

encourage less counseling before and after testing. We review the

evidence regarding voluntary counseling and testing (VCT).

There is clear endorsement in peer-reviewed scientific

information for VCT as part of an evidence-based bundle of

interventions to prevent HIV infection. For persons who test

seropositive, VCT has an impact, but it is hard to uncouple the

impact of counseling from that of testing. For persons who test

seronegative, counseling has a beneficial impact on risk

behaviors and sexually transmitted disease incidence and costs

very little to implement.

This study investigated the different ways through which

counseling was constructed for clients. To access HIV/AIDS

counselling services in Huye District. The counseling impact was

investigated through four different ways. First, it was examine

the extent to which the institutions deriver services to the

people in need. Secondly it was through to find out the

characteristics of people living with the infection of HIV/AIDS

in community. Thirdly, it was through to evaluate whether the

counseling services have an effect on life of the infected

persons and non-infected. Fourth, it was through to find the

challenge faced by infected persons and institutions in charge of

counseling services.

xiii

A cross- sectional study design was used for collection of data.

The study was conducted in one health center (RANGO Health

center) that under the control of KABUTARE Hospital. Five (5)

cellules of Tumba sector were selected, where the health center

locate, and are namely (Rango B, Gitwa, Cyimana, Cyarwa, Mpare).

These cellules are the base to select the respondents used in

primary data collection of this study.

The results of the study revealed that 11counselors showed that

they do not give the counseling on HIV/AIDS and other 7counselors

they do in case of client in need. To access on the services

4HIV- clients used television, 2 HIV+ newspaper or billboards,

4news or schools, 26 HIV- used news and schools, 7counselors try

to give the information on HIV/AIDS by public talk, 2HIV+ clients

used public talk, 9HIV- clients used public talk as a means of

information.

The study recommended that in order to empower counseling

services, there was need to create and maintain situations. The

sensitization should maid to people in need of HIV/AIDS services

using counselors and giving them time in public meeting. The

hospital also must provide training support to the counselors on

the way they care clients. The hospital should also give to

counselors the facility in order to perform their work as best

they can.

xiv

CHAPTER I: GENERAL INTRODUCTION

I.1 BackgroundIn many countries the people living with HIV/AIDS experience asituation of discrimination from others, such kind of situationand its levels of discrimination continue to broom to peopleliving with HIV, it will lead to harm and increase in stigmaamong those affected people.

Many international level studies conducted on HIV/AIDSprevalence and services delivery had shown that people in need,should not access to the services., some organizations cannotdeliver appropriate services needed by affected people (WHO,NUDIPU 2003).

In fact the extent to which people with Human Immune DeficiencyVirus counseling or care services is questionable, still they arehighly affected to HIV/AIDS infection. Most people might besubjected to poverty, discrimination, and stigmatization. This study aimed to examine how services are being to be drawn inmultiple activities for people living with HIV/AIDS relatively toaccess HIV/AIDS counseling services in Rwanda especially HuyeDistrict.

1.2 Back ground to the studyMany international working groups, including representative fromthe World Health Organization (WHO), the United National Programon HIV/AIDS (UNAIDS), the United Agency for InternationalDevelopment (USAID), and other entities such as NGOs thatimplement HIV/AIDS services, has developed common indicators formeasuring the quality of HIV/AIDS services provided through theformal health sector such that Capacity to provide basic servicesfor HIV/AIDS, Capacity to provide advanced services for HIV/AIDS,

1

Availability of recordkeeping systems for monitoring HIV/AIDScare and support, Capacity to provide services for prevention ofmother-to-child transmission (PMTCT) of HIV and Availability ofyouth-friendly services.Services and resources provision interventions in community maybe assumed that people meet similarities of inequality and commonneeds for being access to the needed services. In any communitydifferences arise and people are categorized within those livingwith HIV/AIDS prevalence. Service and resource provisioninstitutions as No-Government institution (NGO’s), Government andprivate institutions (WHO, 1999). They include those who providecounseling, Testing, care and other governance support to thepopulation living with HIV/AIDS prevalence.

Some services like counseling are accessed by few personincluding AIDS patients due to stigmatization and their socialunit club in the community rural and urban population are alike,infected and non-infected, currently access the pervasive andpopular HIV/AIDS counseling services and treatment. Out ofexpectation, it is highly probable that people live with HIV/AIDSexperience the discrimination event in Rwandan community.

Rwanda has been considered one of the African countries mostaffected by the HIV/AIDS epidemic. The first case of HIV/AIDS inRwanda was seen at the Centre Hospitalier de Kigali in 1983. Theinfection spread rapidly and widely throughout the country. TheHIV/AIDS epidemic has devastated the economy and the health caresystem of the country. It is estimated that 49,000 people diedeach year because of AIDS and related conditions, and as of 2003,an estimated 260,000 children had been orphaned by AIDS, thoughthe real figure could be much higher. AIDS cases occupy 60percent of all hospital beds (ROR and WJCF, 2003).

Rwanda survey on services provision of 2007 shows that More thanhalf (55%) of all facilities offer care and support services

2

(CSS), which is defined as any care for HIV/AIDS-relatedillnesses (e.g. opportunistic infections) or provision ofcounseling or social support services for people living withHIV/AIDS. Three-quarters of government-assisted facilities offerCSS compared to only half of government facilities and 27% ofprivate, NGO, and community facilities

Most HIV/AIDS services in the country are concentrated inhospitals; however, there are only 42 hospitals. As not allRwandans have easy access to hospitals, expanding HIV testing andprovision of ART to other facilities may lead to an increase inaccess to care.

The health care on HIV/AIDS relate to Voluntary ConfidentialCounseling and Testing in Rwanda that the survey defines afacility as having an HIV testing system or offering counselingand testing if: (1) before and/or after HIV testing ,Clients arecounseled on the prevention of HIV, the meaning of the test,transmission of the virus, living with HIV/AIDS, care andsupport, and other aspects of the condition; and (2) clients areoffered an HIV test conducted within the facility or by anaffiliated lab, or the facility has a system for referringclients to an external testing site and receives test resultsback from that external site in order to follow up clients aftertesting. A facility that simply refers clients elsewhere,expecting the other location to counsel and follow up on testresults, is not defined as having an HIV testing system oroffering HIV counseling and testing.

Rwanda Care and support services (CSS) Care and support servicesinclude any services that are directed towards improving the lifeof an HIV-infected person. These most often include treatment foropportunistic infections and illnesses that are commonlyassociated with or worsened by HIV infection, such astuberculosis (TB), sexually transmitted infections (STIs), and

3

malaria. Care and support services also may include palliativecare and socioeconomic and psychological support services (RSPA2007 final report).

The African situation revealed that HIV/AIDS pandemic wasspreading in heterosexual intercourse, while propagated bycultural practices such as marriage and polygamy. HIV/AIDScounseling services and treatment were few and unaffordable andtherefore available to only those who were economically empowered(Barnet, 1992). In Rwanda the extreme fatality of HIV/AIDSdeserved emergency establishment of counseling and treatmentcenters which began in 2009, with the Ministry of Healthspearheading Centers for Disease Control and Prevention (CDC)-Rwanda began transitioning the management of clinical servicesfrom international NGOs to the Rwanda MOH. A Transition TaskForce was created under the joint leadership of the Rwanda MOH,making HIV/AIDS counseling services accessible to both men andwomen, (UNAIDS, 2001).

Health care providers are on the forefront of preventing HIVtransmission and caring for people already infected. Post-exposure prophylaxis should be made more widely available tohealth care providers. PEP along with proper infection preventionpractices can keep health care providers safe from inadvertentinfection with HIV/AIDS

Worldwide, voluntary counseling and testing (VCT) is nowrecognized as an important element of HIV/AIDS prevention, careand support programmes and services, and indeed an entry pointfor the control of HIV transmission (Republic of Eritrea, 2005).HIV/AIDS counseling services presently offered include Freestanding counseling and testing services, Integrated counselingand testing services, and Post-test counseling services (WHO,2002).

4

1.3 Problem statementIt has stated that at international level that institutions couldnot give the appropriate services in need by affected people andthose who are rejected (WHO, 1999). The research identificationin this study is to study whether the services and resources areequally distributed or accessed. By taking reference on otherresearch conducted, some studies had shown that institutionsdeliver services and resources in unequal way (NUDIPU), the levelby which people affected access to the resources and services itis not known. As the infection new cases continues to be observedthis will lead to poverty due to an increase in number ofHIV/AIDS infection, this also lead to stigmatization anddiscrimination among people that will affect the services andresources accessibility.

The affected people may meet the problem of non-accessibility tothe services and resources especially in counseling and treatmenton HIV/AIDS when the issue of restriction arises due socialbehavior or stigmatization among the community people.

1.4 Objectives of The study

1.4.1 General ObjectivesThe overall objective of the research is to evaluate how servicesoffered to people infected and non-infected living with HIV/AIDSinfected people throughout the access of HIV/AIDS in a given areaof Huye District.

1.4.2 Specific objectivesThe study objectives are:

5

1. To examine the extent to which the institutions deriverservices to the people in need.

2. To find out the characteristics of people living with HIV/AIDSinfection in community.

3. To evaluate whether the counseling services have an effect onlife of the infected persons and partners of infected persons.

4. To find the challenge faced by infected persons andinstitutions in charge of counseling services.

1.4 Research QuestionsIn the following the foregoing the specific objectives, theresearch will seek to answer the following questions:

1. How institutions in charge of services deriver those serviceswhere it is required?

2. What are the working capacities or characteristics of peopleliving with HIV/AIDS?

3. What are the effects of counseling services on life ofinfected people?

4. What are the challenge faced by infected person andinstitution in charge of counseling services?

1.5 Research hypothesisThere is a positive impact of counseling services on infected andnon-infected people.

1.6 Scope of the StudyThe study is entailed to examine the effect of counseling

services on infected alongside non-infected person while

accessing services in Huye district, Tumba sector within Rango

6

Health Center. It seeks to know the extent to which the

counseling services providers bring the effect to both infected

and non-infected.

1.7. Arrangement of the studyThis first chapter provided a highlight of the background to the

study, research problem and purpose of the study, objectives,

research questions, scope and the significance of the study. The

second chapter is concerned with the review of related literature

and the theoretical framework and conceptualization of the study.

The third chapter outlined how the study was carried out,

indicating the research design, the methods that were employed

in the study, how the selection of study population, sample size

and sampling procedures, data collection methods, data analysis,

presentation and ethical consideration to be applied. The

fourth chapter will be dealing with the discussion on the

research findings under form of presentation of analysis done

about the research. The fifth chapter will provide the summary,

conclusions drawn from the study and gave recommendations for all

interested people

7

CHAPTER TWO

LITERATURE RIVIEW

This chapter presents the analysis of mentioned literature on the

multiplicity of people living with HIV/AIDS and the services of

HIV Testing and Counseling. The aims of this analysis are to see

the contribution of counseling services and to highlight the gaps

and weaknesses existing on both infected and non-infected people.

This literature review focuses on themes of the study which

include multiplicity of differences, Institutionalized

difference norms and practices, services inequalities as

constructed by society and family, institutions/organizations,8

Rules and Norms, unequal delivery of HIV/AIDS of Counseling

services and exclusion and restriction from recognition.

History shows that HIV Testing and counseling services have

helped millions of people learn their HIV status and for those

testing positive, learn about options for long term care and

treatment. In 2012, an estimate of 118 million people in 124 low-

and middle-income countries received HIV testing and counseling

in the past 12 months and learned their test result (by WHO).

HIV testing should be voluntary and the right to decline

testing should be recognized. Mandatory or coerced testing by

a health-care provider, authority or by a partner or family

member is not acceptable as it undermines good public health

practice and infringes on human rights.

Some countries have introduced, or are considering, self-

testing as an additional option. HIV self-testing is a process

whereby a person who wants to know his or her HIV status

collects a specimen, performs a test and interprets the test

results in private. HIV self-testing does not provide a

definitive diagnosis; instead, it is a screening test for HIV.

All testing and counseling services must include the 5 C’s

recommended by WHO: informed Consent, Confidentiality,

Counseling, Correct test results and linkage to Care,

treatment and other services.

9

While every nation has in some way been affected by this

pandemic, it is in Africa that the grip of HIV and AIDS has been,

by far the deadliest. Twenty-eight million people in Africa are

living with HIV/AIDS and Southern Africa has the Highest HIV

adult prevalence in the world. Well over two thirds of the

HIV/AIDS related Deaths (S18million, or 72%) are from Africa

(World Bank, 2002), although infection rates in individual

countries such South Africa, Botswana, Malawi and Swaziland are

much higher.

II.0. DEFINITION OF KEY TERMS

II.1.The History of HIV/AIDS Scientists identified a type of chimpanzee in West Africa as the

source of HIV infection in humans. They believe that the

chimpanzee version of the immunodeficiency virus (called simian

immunodeficiency virus, or SIV) most likely was transmitted to

humans and mutated into HIV when humans hunted these chimpanzees

for meat and came into contact with their infected blood. Studies

show that HIV may have jumped from apes to humans as far back as

the late 1800s. Over decades, the virus slowly spread across

Africa and later into other parts of the world. We know that the

virus has existed in the United States since at least the mid- to

late 1970s.

II.2. Definition of HIV/AIDS globallyHIV disease has a well-documented progression. Untreated, HIV is

almost universally fatal because it eventually overwhelms the10

immune system—resulting in acquired immunodeficiency syndrome

(AIDS). HIV treatment helps people at all stages of the disease,

and treatment can slow or prevent progression from one stage to

the next.

A person can transmit HIV to others during any of these stages

three,

Acute infection: Within 2 to 4 weeks after infection with HIV,

you may feel sick with flu-like symptoms. This is called acute

retroviral syndrome (ARS) or primary HIV infection, and it’s the

body’s natural response to the HIV infection. (Not everyone

develops ARS, however—and some people may have no symptoms.)

During this period of infection, large amounts of HIV are being

produced in your body. The virus uses important immune system

cells called CD4 cells to make copies of itself and destroys

these cells in the process. Because of this, the CD4 count can

fall quickly. Your ability to spread HIV is highest during this

stage because the amount of virus in the blood is very high.

Eventually, your immune response will begin to bring the amount

of virus in your body back down to a stable level. At this point,

your CD4 count will then begin to increase, but it may not return

to pre-infection levels.

Clinical latency (inactivity or dormancy): This period is

sometimes called asymptomatic HIV infection or chronic HIV

infection. During this phase, HIV is still active, but reproduces

11

at very low levels. You may not have any symptoms or get sick

during this time. People who are on antiretroviral therapy (ART)

may live with clinical latency for several decades. For people

who are not on ART, this period can last up to a decade, but some

may progress through this phase faster. It is important to

remember that you are still able to transmit HIV to others during

this phase even if you are treated with ART, although ART greatly

reduces the risk. Toward the middle and end of this period, your

viral load begins to rise and your CD4 cell count begins to drop.

As this happens, you may begin to have symptoms of HIV infection

as your immune system becomes too weak to protect you.

AIDS (acquired immunodeficiency syndrome): This is the stage of

infection that occurs when your immune system is badly damaged

and you become vulnerable to infections and infection-related

cancers called opportunistic illnesses. When the number of your

CD4 cells falls below 200 cells per cubic millimeter of blood

(200 cells/mm3), you are considered to have progressed to AIDS.

(Normal CD4 counts are between 500 and 1,600 cells/mm3.) You can

also be diagnosed with AIDS if you develop one or more

opportunistic illnesses, regardless of your CD4 count. Without

treatment, people who are diagnosed with AIDS typically survive

about 3 years. Once someone has a dangerous opportunistic

illness, life expectancy without treatment falls to about 1 year.

People with AIDS need medical treatment to prevent death.

12

II.3. HIV/AIDS STATUS

II.3.1. HIV/AIDS Status all over the WorldSince the beginning of the epidemic, almost 78 million peoplehave been infected with the HIV virus and about 39 million peoplehave died of HIV. Globally, 35.0 million, the 33.2 to 37.2million people were living with HIV with the end of 2013. Anestimated 0.8% of adults aged 15–49 years worldwide are livingwith HIV, within this situation, the burden of the epidemiccontinues to vary considerably between countries and regions.Sub-Saharan Africa remains most severely affected, with nearly 1in every 20 adults living with HIV and accounting for nearly 71%of the people living with HIV worldwide.

II.3.2. HIV/AIDS status in EAST AfricaIn generally sub-Saharan Africa contains only about 11 percent ofthe Earth's population; the region is the world's epicenter ofHIV/AIDS. The numbers are daunting. Adult HIV prevalence is 1.2percent worldwide (0.6 percent in North America), but it is 9.0percent in sub-Saharan Africa. UNAIDS estimates that at the endof 2001, there were 40 million people living with HIV/AIDS, 28.5million of them from sub-Saharan African. Five million adults andchildren became newly infected with HIV in 2001, 3.5 million ofthem from sub-Saharan Africa. Three million people died fromAIDS-related causes in 2001, and 2.2 million of these deaths wereamong sub-Saharan Africans.2 (July 2002)

AIDS is now the leading cause of death in sub-Saharan Africa.(Worldwide, AIDS is the fourth leading cause of death). Lifeexpectancy at birth has plummeted in many African countries,wiping out the gains made since independence. The combinationof high birth rates and high AIDS mortality among adults,including many parents, has meant that more than 90 percent ofchildren who have been orphaned as a consequence of theHIV/AIDS epidemic are in this region.

13

These statistics disguise an important part of the story,however. Most of the worst affected countries form an "AIDSbelt" in eastern and southern Africa. This belt consists ofabout 16 countries3 and stretches from Djibouti and Ethiopiadown the east side of the continent through South Africa.These countries constitute only a little more than 4 percentof the world's population but account for more than 50 percentof HIV infections worldwide.

According to UNAIDS, all the worst affected countries (withprevalence rates over 20 percent) are contiguous to oneanother in the lower part of the continent. These includeSouth Africa, Lesotho, Swaziland, Botswana, Namibia, Zambia,and Zimbabwe. Botswana, Lesotho, Swaziland, and Zimbabwe haveprevalence rates above 30 percent.

Elsewhere, Somalia, Eritrea, Djibouti, and Sudan have littleor no data, and Madagascar remains an interesting case.Despite tourism, an active commercial sex trade, and highrates of other sexually transmitted infections (STIs), anddespite being separated from the African mainland by only 60kms of water, adult HIV prevalence remains below 1 percent.

Though having overall adult prevalence rates lower than in theeastern and southern parts of the continent, the middle partof Africa is undergoing a serious and generalized HIV/AIDSepidemic. Among the countries in the region, the DemocraticRepublic of Congo, Chad, and Equatorial Guinea show adult HIVprevalence rates under 5 percent. Angola has been war-torn andchaotic for so long that it is difficult to know exactly whatis transpiring with the epidemic there. However, UNAIDS placesthe adult prevalence rate at 5.5 percent. Elsewhere in theregion, UNAIDS reports prevalence rates of 7.2 percent in theCongo, 11.8 percent in Cameroon, and 12.9 percent in theCentral African Republic. Many of the worst affected countriesin middle Africa have the highest rates of other STIs on thecontinent.

14

Further north in the AIDS belt, Mozambique, Malawi, Burundi,Rwanda, Kenya, Tanzania, and Ethiopia all have adultprevalence rates in the 6-15 percent range. Adult prevalencein Uganda is estimated to be around 5 percent. Uganda is theone country in the region that has probably achieved alongstanding decline in HIV prevalence. Prevalence in Ugandamay have peaked in the 12-13 percent range in the early 1990sbefore the onset of this decline.

In fact, HIV prevalence in East Africa is generally moderate tohigh, and second behind southern Africa. However, generalprevalence has been in decline for the past two decades. Forexample, Kenya has seen its HIV prevalence drop from a high of 14percent to nearly 6 percent. Uganda and Tanzania also haveprevalence over 5 percent, with the lowest seen in Madagascar(0.5 percent) and Mauritius (1.2 percent).

Despite of this progress, there are new areas of concern with HIVprevalence on the rise among vulnerable groups including peoplewho inject drugs (PWIDs), prisoners and uniformed services (suchas the armed forces and the police)

Table below shows Estimated Number of People in the African “AIDSBelt” especially in eastern Africa Living with HIV/AIDS, end of 2001.

Total Adults andChildren

Total Women(15-49)

Adults (15-49)rate (%)

GlobalTotal

40 million 18.5 million 1.2

Ethiopia 2.1 million 1.1 million 6.4

Uganda 600,000 280,000 5.0

15

Kenya 2.5 million 1.4 million 15.0

Tanzania 1.5 million 750,000 7.8

Rwanda 500,000 250,000 8.9

Burundi 390,000 190,000 8.3

Mozambique

1.1 million 630,000 13.0

Malawi 850,000 440,000 15.0

Botswana 330,000 170,000 38.8

Swaziland 170,000 89,000 33.4

Lesotho 360,000 180,000 31.0

SouthAfrica

5.0 million 2.7 million 20.1

Table 1: table which shows HIV/AIDS distribution in Africa

Source: UNAIDS, Report on the Global HIV/AIDS Epidemic: July 2002.

II.3 .3. HIV/AIDS status in RwandaRwanda’s population and health care system have suffered from theHIV epidemic due to lack of infrastructures. The first case ofHIV/AIDS was seen at the Centre Hospitalier in Kigali in 1983.Since then, the infection has spread throughout the country. Anestimated 49,000 people have died each year due to HIV infection

16

and related conditions, and HIV infection cases occupy 60% of allhospital beds.

II.4. Health services regarding HIV/AIDS alleviation in RwandaImmunization coverage has stalled since 2000, with the percentageof children receiving all vaccines remaining at 75%, thoughfalling in urban areas. Sustained sensitization campaigns in therural areas may explain why rural rates of immunization are nowhigher than urban.

HIV prevalence is estimated at 3% of adults. A national campaignwas Conducted to reduce perceptions about the stigma of HIV andthe accompanying discrimination and there are now 234 healthcenters with Voluntary Counseling and Testing (VCT), andtreatment of PLHIV has increased (72% of pregnant PLHIV areestimated to receive a complete course of ARVs). However,concern remains in several areas including: low condomutilization among youth and groups at higher risk of HIVexposure, the rural versus urban ratio of HIV prevalence andincreasing transmission amongst married couples and the culturalnorms associated with this. Thus, Rwanda must strive to take thenecessary precautionary steps now so that increasing rates ofinfection do not erode the impressive gains made in the last fiveyears (Rwanda poverty reduction 2008-2012)

Services and resources provision interventions in community maybe assumed that people meet similarities of inequality and commonneeds for being access to the needed services. In any communitydifferences arise and people are categories within those livingwith HIV/AIDS prevalence. Service and resource provisioninstitutions as No-Government institution (NGO’s), Government andprivate institutions (WHO, 1999). They include those who providecounseling, Testing, care and other governance support to thepopulation living with HIV/AIDS prevalence.

17

II.5. Rwanda’ strategies to reduce the increment of HIV/AIDS among Rwandans Rwanda implements the program of reducing HIV/AIDS prevalenceamong Rwandans in accordance of Elizabeth Glaser Pediatric AIDSFoundation (EGPAF) program and its focus in Rwanda.The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) began itssupport for HIV clinical services in Rwanda in 2001 withtechnical and financial support to the Treatment and ResearchAIDS Center (today known as the Rwanda Biomedical Center [RBC])for scale-up of Rwanda’s prevention of mother-to-childtransmission of HIV (PMTCT) program. The HIV Clinical ServicesProgram (HSCP), funded by the U.S. Agency for InternationalDevelopment (USAID) and the President’s Emergency Plan for AIDSRelief (PEPFAR) began in June 2007. Under the HCSP, EGPAF was thelead PEPFAR technical partner in the Eastern Province of Rwanda,working closely with Rwandan governmental institutions at thedistrict level, the Ministry of Health (MOH), other partners, andlocal organizations.

EGPAF/Rwanda’s HIV program was developed to respond to Rwanda’sdevelopment vision for its health programs, which is comprised ofa strategic plan (Rwanda Vision 2020), the Economic Developmentand Poverty Reduction Strategy (EDPRS), and other health sectorstrategies. The program also is aligned with donor mandates andbilateral accords such as the partnership framework between theU.S. and Rwandan Governments that focuses on HIV/AIDS prevention;care and treatment; quality of care; health systems strengthening(HSS); and transitioning of financial and technical managementcapacity to local institutions.EGPAF/Rwanda assists in implementing comprehensive, integratedHIV clinical services at the site and central levels, providingtechnical expertise to health institutions to build theircapacity to maintain high-quality HIV services in theirdistricts. These include:

Prevention of Mother-to-Child Transmission of HIV (PMTCT)18

Voluntary Counseling and Testing (VCT) Provider Initiated Testing (PIT) Care and Treatment services Support for tuberculosis screening and testing Maternal Infant and Young Child Nutrition (MIYCN) Maternal and Child Health / Family Planning / Sexual and

Gender-Based Violence / Water and Sanitation (all supplementedwith funding from USAID)

EGPAF/Rwanda is committed to sustainable, locally-owned programs,and works closely with the MOH, districts, and health facilitiesto address priorities and build local staff capacity. To thisend, EGPAF/Rwanda offers grants, mentorship, and training todistricts, health facilities, and community members.

The United States Agency for International Development (USAID) isthe foreign assistance agency of the United States Government.USAID supports $150 million of development assistance annually toRwanda, with programs in health, economic development, education,and democracy and governance.

Rwanda has stepped up efforts to prevent new HIV infections toachieve the 2015 global target of zero new infections andgovernment has put in place several initiatives to ensure a 0%record of new infections by 2015- such as the circumcisioncampaign, we would reduce new infections by 50%.

Other areas of focus have been seen in containing the HIVincidents that lead to new infections mainly in some targetgroups like the commercial sex workers of whom the HIV/AIDSprevalence is 51% and campaigns to ensure a reasonable reductionin the transmission of Mother to Child Infections.

Rwanda’s HIV/AIDS prevalence is 3% an equivalent of about 400,000people from 7% in 2002 when the government set up measures to

19

address the issue of HIV/Aids at a large scale by involvingcommunities and local leaders.

CHAPTER THREE

RESEARCH METHODOLOGY

3.1. IntroductionThis chapter indicates an explanation of the methodology that

will be used in the study ; the research design, the study

population, sample size and sampling methods and procedures, data

collection methods, data analysis and dissemination, ethical

consideration and study limitations. Kenneth D. Bailley (1978:

83) defines the methodology as the set of methods and principles

that are used when studying a particular kind of work. A method

is composed of all intellectual process in orderly system or

arrangements that enable a researcher to reach an aspect of

knowledge by using various techniques.

20

3.2 Research DesignResearch design focuses on an outline, plan or strategyspecifying the procedure to be used in investigating the researchproblem. (Christensen, 199:269). The researcher collects relevantdata needed to test the researcher hypothesis. The design of thestudy is analytical in nature.

3 .2.1 .The analytical researchAccording to (Jill and Roger Hussey, 1997: 11) the analytical

research design is continuation of the descriptive research. The

researcher goes beyond merely describing the characteristics to

analyzing and explaining why and how it is happening. Thus, this

research aims to understand the use of accounting ratios by

measuring causal relation among them in decision making.

This study will adopt a cross sectional study design that will

use qualitative and quantitative methods to collect required data

outcomes so as to come up with recommendations that will address

the research problem. It is cross-sectional because it

encourages in investigating the positive change on rural

population who seek to access HIV/AIDS counseling services at

this point in time in selected sector in Huye District.

3.3. Study AreaThe selected sector for the study is found in Huye district. Thecriteria for selection of these institutions will be based onability to have population who get HIV/AIDS services and/orcounseling services by one of medical institutions found in HuyeDistrict.

21

3.4. Study PopulationGrinnell and Williams, 1990: 118, said that, «a population can be

defined as the totality of persons or objects with which a study

is concerned». The study population is from several selected

households in Tumba sector that whoever has access on HIV/AIDS

services. Mainly the research will be concerning the people who

are beneficiaries of HIV/AIDS delivered services for improving

their lives.

They are targeted because they are deemed knowledgeable and

expected to provide relevant information concerning to access on

HIV/AIDS counseling services. Population that is supposed to

access on those services in Tumba sector is estimated to be 1479

while service respondents of interest are 65 in 5 cellule; in

choosing this targeted population some criteria have been

followed.

The first criterion for choosing my sample population has been

availability and willingness to answer my questions. However, in

the selection of my subjects I had to take into consideration the

availability of my population of the study. As far as the latter

is concerned, Cohen and Manion (1994:77) explain that the

researcher handpicks cases to be included in his sample

population on the basis of his judgment of their typicality. The

second criterion has been the fact that the population to be

questioned is located around the residence. The representativity

of my sample has also been taken into account. 22

3.5. Sampling techniques

3.5.0. Sample sizeThe research will use 65 respondents who are including in 5cellules with33 villages of all those cellule, it mean at least 2respondents for every village 1 in one village of mpare cellule.The total respondents is 65, this sample is selected because theyare more knowledgeable about the study it means they have beenselected basing on the information they have.

3.5.1 Sample size calculationThe question then is, how large of a sample is required to infer

research findings back to a population?

Standard textbook authors and researchers offer tested methods

that allow studies to take full advantage of statistical

measurements, which in turn give researchers the upper hand in

determining the correct sample size. Sample size is one of the

four inter-related features of a study design that can influence

the detection of significant differences, relationships or

interactions (Peers, 1996)

As a part of this discussion, considerations for the appropriate

use of Cochran’s (1977) sample size formula for both continuous

and categorical data will be presented.

Cochran (1977) addressed this issue by stating that “One method

of determining sample size is to specify margins of error for the

items that are regarded as most vital to the survey.

Cochran’s (1977) formula uses two key factors:

23

1. The risk the researcher is willing to accept in the study,

commonly called the margin of error, or the error the

researcher is willing to accept

2. The alpha level, the level of acceptable risk the researcher

is willing to accept that the true margin of error exceeds

the acceptable margin of error i.e., the probability that

differences revealed by statistical analyses really do not

exist.

Alpha Level: The alpha level used in determining sample size in

most educational research studies is either .05 or .01 (Ary,

Jacobs, & Razavieh, 1996)

In general, an alpha level of .05 is acceptable for most

research.

An alpha level of .10 or lower may be used if the researcher is

more interested in identifying marginal relationships,

differences or other statistical phenomena as a precursor to

further studies.

Cochran’s sample size formula for continuous data is presented

here along with the explanations as to how these decisions were

made:

Where t: value for selected alpha level of

0.05 from t-student table

(P)(q): estimate of variance in the

24

Population

P: percentage picking a choice, expressed as

decimal (0.5 used for

Sample size needed)

and q=1-p

D: acceptable margin of error for mean

being estimated, so

the confidence interval, in decimals (0.05 level

of significance) or

error researcher is willing to except).

No: the sample size

For our study we have population of 1479

Level of significance

α=0.1

T=1.645

P=0.5

= =67.650625

Required sample size according to Cochran’s formula:

= = =64.69

Where N: population size (population of interest).

25

Many researchers could benefit from a real-life primer on the

tools needed to properly conduct research, including, but not

limited to, sample size selection. This manuscript will describe

common procedures for determining sample size for simple random

and systematic random samples. It will also discuss alternatives

to these formulas for special situations. This manuscript is not

intended to be a totally inclusive treatment of other sample size

issues and techniques. Rather, this manuscript will address

sample size issues that have been selected as a result of

observing problems in published manuscripts. (James E Bartlett)

3.5.2. Purposive samplingThis will be used to select the respondents from key persons from

the local residence which are the villages of Tumba sector. This

is because of their participation in HIV/AIDS counseling

services. So, they have the necessary information needed by the

researcher. Also, purposive sampling will be used in order to

obtain the more accurate data.

3.6. Techniques of Sample selectionA sample is a part of population, which is deliberately selected

for the purpose of investigating the population. It involves the

determination of the sample size from the targeted population.

Therefore, purposive sampling will be applied to the local

beneficiaries; it will help the researcher to get reliable

information, because all population are not informed about

26

HIV/AIDS counseling services, only informants people are

considered by the researcher.

The total population of interest in Tumba sector 1489

people .Therefore, the sample size is 65 respondents. All these

selected population are concerned with the research and are aware

HIV/AIDS counseling services. This means that, they are selected

purposively.

Table 3.1: Sample selection

Categoryofpopulation

Name ofcellule

Totalnumberincellule

Sampleselectedofbeneficiaries

Sampleofcounselors

Basisofselection

Technique used

HIV/AIDSCounselingservices’beneficiaries

Total

1. RangoB

14 10 4 Theyarenearthecounselingservicesplaceandhavesomeinformationon thedeliveredservices

Purposivesampling

2. Gitwa 10 6 43.Cyimana

10 7 3

4.Cyarwa

10 8 2

5. Mpare 13 10 4

27

Table 2: table showing how the sample was selected in cellules

Source: Primary data, April, 2015

In this study, participants were selected basing upon Yamanemethod where every population must be selected based on thecharacter of interest and the condition of being selected or mustbe the desired population have typical characteristicsnecessary to provide information but rare and very difficult tolocate and recruit for a study. The sampling will be done frompopulation whoever had the HIV/AIDS Services and take servicesfrom one of the hospital in Huye District.

3.6. Source of Data

3.6.1. Primary dataThe primary data according to Bailley (1987:2) are eye witness

accounts written by people who experienced a particular event or

behavior.

3.6.2. Secondary Data Secondary data is information that has been collected for a

purpose other than your current research project but has some

relevance and utility for your research.

3.7. Techniques of Data collection To collect relevant information and appropriate data required for

the study, the researcher used documentary analysis, observation,

interview and questionnaire as research instruments

28

3.8. Research instruments

3.8.1. Questionnaire  Kakinda (1990:25) defines Questionnaire as a set of related

questions designed to collect information from a respondent. This

was employed in obtaining views and opinions with individual

respondents. In this research English questionnaire was used and

translated into Kinyarwanda version.

3.8.2. Interview This is intended to add quality that provided by the

questionnaire. Face-to-face interview will be conducted with the

help of the interview schedule during data collection. Structured

and non-structured interview were used. Under unstructured

interview, the respondents were given the subject of the whole

issue in general and the respondents were asked to relict the

information without any bias. The interview will be used

especially to the leaders of beneficiaries ‘cooperative .On the

other hand, the structured interview schedule the respondents are

given answers from which they would choose. The researcher used

both structured and unstructured interviews, in order to avoid

limitations in their responses.

3.8.3. Observation The researcher used the Observation technique in data collection,

which is the primary technique for collecting data. Observation

29

most commonly involves sight or visual data collection via other

senses such as hearing, touching and smelling.

3.9. Data processing and analysis “Data processing is concerned with classifying responses into

meaningful categories called codes”(Roth, 1989: 58). It consists

of editing, schedules and coding the responds. The data

processing begins with editing, coding and finally ended with

tabulation. Nachmias (1976: 143) assert that, data processing is

a link between data collection and data analysis. It involves the

transformation of the observation gathered from the fields into

the system of categories and the transformation of these

categories into codes and amenable to quantitative analysis and

tabulation.

Not all data can be presented in their entity. The variables to

be presented are those most central to the goals of the study;

generally variables include specifically in the research

questions (Bailey, 1978: 321). The researcher will have

technically processed data before performing proper analysis so

as to become more meaningful for interpretation. Data processing

will be done in accordance with general and specific objectives

of the research study. The data will be analyzed by using

computer program SPSS and Microsoft excel.

30

3.9.1. EditingEditing is the process of going through the questionnaire to

ensure that the `skip patterns' were followed and required

questions are filled out according to Daniel and Gates (1991:

387), Editing involves the inspection and if necessary,

connections of each questionnaire or observation form; the basic

purpose of editing is to impose some minimum quality standards on

the raw data (Churchill, 1992:608).

3.9.2. CodingMoses and Kalton (1971: 415), states that the purpose of coding

in the survey is to classify the answers acquired were coded and

tallies used to determine the frequencies of each response and

according to Churchill (1992: 612), coding is the procedure by

which data are categorized. It involves the categorization of

similar responses according to their different categories.

3.9.3. Tabulation Tabulation refers to the part of technical process on

statistical analysis of data that involves counting to determine

the number cases that fall into various categories according to

Selltiz et al. (1965: 406-407), Tables with corresponding

calculations will be used to indicate the frequency of particular

answers. Percentages also will be used to express the data in a

ratio form. For making the data easily and clearly understood,

each table will be followed by small explanation of the nature of

relationship indicated in the table.31

3.10. Limitations of the studyThe scope of this study has been continuously narrowed downbecause of many factors, namely:

The time constraint; such a study normally requires enoughtime without any interruption but it is requires to do twooverlapping activities (to study and conducting researchlike this one.

By far the most limiting factor to the effective conduct of

the research work, the financial resources will not enable

us to make a thorough collection and analysis of data as we

expect.

During this study, the expected constraints are not many.

Even though there are there the effort will be applied so as

to reach the best success of this study

32

CHAPTER IV

ANALYSIS AND DISCUSSION OF FINDINGS

4.0. IntroductionThis chapter provides the analysis and discussion of research

findings collected in the study conducted during the period

between April and May, 2015. The study tends to show how the

counseling services impact lives of population of rural area who

access to HIV/AIDS Counseling services in selected health

institution in Huye District.

First, the study seeks to examine the level to which

institutional rules and norms take people who try to access

HIV/AIDS counseling services. Secondly, the study set out to

examine the extent to which the structural positioning of HIV+

persons in society and how they access to HIV/AIDS counseling

services.

Thirdly, the study intended to analyze the extent to which the

interaction between rural population and HIV/AIDS counseling

service providers create and reinforce with different way in

access to and control over resources.

As said above, this analysis is based on the information (primary

source) from one of many heath centers under the control of

KABUTE hospital. The health center used is counselors from

33

different 5 cellules and 33 villages, each village it has 3

counselors.

In fact the total number of counselors that supervised by RANGO

heath center are almost 99 counselors. The table below shows the

total number of villages in TUMBA sector where those counselors

belong.

Name of the

cellule

Villages’names

1. RANGO B Ntangarugero, Akakanyamanza, Akabeza, Kigarama,

Byimana, Urugwiro, Impuhwe

2. GITWA Rebero, Rimba, Berwa, Agasenyi, Nyarurembo

3 .CYIMANA Amahoro, Ubumwe, Ubwiyunge, Abizerwa, Akamuhoza

4. CYARWA Agasengasenge, Kabeza, Mukoni, Agateme, Agahora,

Kigarama,

Taba, Icyili, Agasharu

5. MPARE Akabuga, Rwanyanza, Runyinya, Musange,

Akarugirinka,

Kigarama, Agasharu.

Table 3: table showing cellules in tumba with their Villages

Source: Primary sources

34

Rango health center is one among many health centers under the

control of KABUTARE Hospital and the one with program of VCT

(Voluntary Counseling and Testing) and PMTCT (Prevention of

Mother-to-Child Transmission). Those two services are concerned

with HIV/AIDS counseling and testing.

Hereafter the photo of the RANGO heath center hall that they use

when they are providing services to the clients.

The photo of RANGO Health Center hall.

4.1. The structure and number of focusing populationThe specific objective of the study was to examine the extent to

which the structural positioning of HIV+ in society affects their

access to HIV/AIDS counseling services.

In the context of this study, positioning is defined as placement

in society of a homogeneous Category of persons with similar35

defining characteristics, whether socially, culturally,

economically or otherwise. The number of population of interest

was delivered by data manager of the health center in order to

facilitate us in our study. Hereafter a table showing the total

population who participate in services related to HIV/AIDS

(counseling, voluntary testing,….. )

sex January February March Aprilmale HIV+ 5 3 0 5

HIV- 106 208 42 220femal

e

HIV+ 3 3 3 7HIV- 263 233 63 206

Total

population

tested

377 447 108 437

Table 4: table showing structure of focusing population

This table shows how population access on HIV/AIDS services in

Rango Health center from the beginning of the year 2015 up to

April of this year.

Those given numbers of 1370 respondents derived in the above

table, 99 counselors were added on the population of interest as

the service providers and more knowledgeable in those services.

36

Figure 4.1The figure below showing the distribution of HIV/AIDS status among male and female.

Figure 1: shows the distribution of HIV+ and HIV- from January 2015

Source: primary source

From the graphic above and based on the primary given by RANGO

health center, in January the men were more HIV+ than women (5

males and 3 females were HIV+), in February both male and female

they equate (3 males and 3 females), in March the number of

female HIV+ were higher that men (0 male and 3 female), in April

the number of HIV+ female increase by 4 and HIV+ male increased

by 5(5male and 7 female. With those number the female are tend to

be more HIV+ than men.

As our study is the assessment of counseling on HIV/AIDS, it

couldn’t be possible to explore the whole population because of

time limits and the costs, the sampling method have been applied

to select a population representative (sample).

37

4.2. Social demographic characteristics The analysis and associated discussion of findings starts with

description and analysis of demographic characteristics in this

study in order to provide background information that was

considered essential for purposes of making reliable

interpretation and conclusions on population of interest in this

study.

The primary information of this section were derived from

materials used (questionnaires) that were filled with

intervention of service providers, and different responses

obtained from people who were being given the services by service

provider in the first part of materials in order to provide

background information about their occupation, age, sex, levels

of education, in addition to their marital status. A total of 65

Respondents were interviewed of whom eighteen (18) and on who

don’t gave information, in fact 19 were service providers

(counselors) all are HIV-, nine (9) of clients are HIV+, thirty

eight (38) of them are HIV- clients. The SPSS graphic below

shows all distribution of our population.

38

Frequency Percent

ValidPercent Cumulative Percent

Valid counselor 18 27.3 27.7 27.7

clientsHIV + 9 13.6 13.8 41.5

clientHIV - 38 57.6 58.5 100.0

Total 65 98.5 100.0

Missing

System 1 1.5

Total 66 100.0

Table 5: show the social characteristics of respondents

The graphic that give a summary of the whole population

interviewed.

Figure 2: shows the distribution of respondents withintheir life status

39

This figure above shows the status of all respondents, counselors

and their clients.

4.2.1 HIV+ and HIV- of clients to counselors within their age andeducation levelsHIV+ and HIV- interviewed were from the population of interest in

HUYE district from rural area that around the district.

Table 4.3.1 this the summary table of clients in HIV/AIDS

consoling

Count

respondents status

Total

clients

HIV +

client HIV

-

age 11-20 2 2 4

21-30 2 29 31

31-40 2 8 10

50- 2 0 2

Total 8 39 47

Table: table showing clients and their age

40

Figure 3: shows demographic characteristics ofclients with their age,

Findings in Table 4.1 and its graph show a summary of the

selected sample of 65 respondents and; 47 is clients and 8 HIV

positive and 39 HIV negative. The graph below shows it very nicer

4.2.2 Occupation of population who access to counseling services

Table 4.4.2 table showing occupation of population who access to

counseling services

41

Count

working status

public

sector

private

sector

unemploy

ed Total

respondent

s status

clients

HIV +0 0 8 8

client

HIV -6 7 26 39

Total 6 7 34 47

Table 6: showing clients (HIV+ and HIV-) with their occupation

42

Figure 4: showing the distribution of clients with theiroccupation

Table 4.4.2 and the corresponding graph show the occupation of

clients to counselors respondents who were involved in this study.

These included clients of( HIV+ and HIV-), clients of HIV+ are

eight all are unemployed, clients with HIV- are thirty nine(39)

with six(6) of public sector, seven(7) of private sector and twenty

six(26) of unemployed level.

4.3. Characteristics of Service Providers interviewedThis study was conducted in one of Huye District institutions

which give counseling services to people in need. The findings

that are used come from visited institution of KABUTARE Hospital,

as counseling centers or organization supposed to offer

43

counseling services to all categories of people including HIV+

and HIV negative.

Service providers interviewed from the institutions where the

research was conducted included counselors, co-ordinator HIV/AIDS

programme and editor.

Counselors constituted great contribution the services provision

by Service providers. The respondents interviewed of whom only

27.7% were counselors as well as all could use sign language and

their status of life.

Further, service providers were requested to provide their

educational background levels in order to establish their ability

population with HIV+ no HIV+ as they seek to access HIV/AIDS

counseling services. Below is Tables 4.3.0 and 4.3.1 summarizing

the sex and levels of education of the respondent service

providers (counselors).

Table 4.3.0 table of numbers of counselors and their education

levels

44

Count

respondents status

counselor Total

education

levels

primary 11 11

secondar

y7 7

Total 18 18

Table 7: showing the distribution of counselors and their age

Figure 5: showing the counselors distribution and their level of education

Results showed that service providers who attained either a

primary or secondary school are 11 for primary school and

7attained secondary school. Findings further showed that most of

the respondent service providers attained primary school.

45

They were well familiar with the society, honest and understood

the questions that were asked in the questionnaires. Their

responses and information given was therefore consideredreliable.

Table 4.3.1table showing number of counselor and

their gender

Count

Respondents status

counselor Total

sex male 4 4

female 14 14

Total 18 18

46

Figure 6: showing counselors distribution andtheir gender

4.4 The data analysis and data presentationResults above showed that service providers who participated in

the research were male and female. With 14 females and 4 males,

Findings further showed that most of the respondent service

providers were female.

Being female for the majority of these service providers was

probably an extension of their way of improving their

participation in public services from the private to public

sphere.

47

Table 4.4.1 Characteristics of respondents by the means of

informationCount

information status

nocounselingaboutHIV

television

Newspaper

,billboards

news,schools

publictalk(counselor) Total

respondentsstatus

counselor 11

00 0 7 18

clientsHIV + 0 1 2 4 2 9

clientHIV - 0 3 0 26 9 38

Total 11 4 2 30 18 65

48

Table 8: table showing respondents and way of getting information

Figure 7: figure showing respondents and means ofinformation

The table 4.2.1 above and its graph show a summary of the 65

respondents, and how they managed to access on the information in

order to be a part of servicers whether (clients or counselors)

or how services providers treat the clients by means of

information.

The results reveal that 11counselors showed that they do not give

the counseling on HIV/AIDS and other they do. To access on the

services 4HIV- clients used television, 2 HIV+ newspaper or

billboards, 4HIV+ used news or information from their schools, 26

HIV- used news and schools, 7counselors try to give the

information on HIV/AIDS by public talk, 2HIV+ clients used public

talk, 9HIV- clients used public talk as a means of information.

49

4.4.1 The analysis and interpretation

Step 1: set the hypothesis

Ho: the number of clients depends on the counseling information

from providers (counselors)

H1: the number of clients depends on the counseling information

from providers (counselors)

Step2: level of significance (α=0.05)

Step3: calculation

Chi-square of independence has been used and finds the results in

the table below

50

Chi-Square Tests

Value df

Asymp.Sig.(2-sided)

Pearson Chi-Square 56.349a 8 .000

LikelihoodRatio 60.063 8 .000

Linear-by-LinearAssociation

13.787 1 .000

N of ValidCases 65

P-value is 0.000

step4: compare p-value and the level of significance.

Reject Ho; if P-value<level of significance

Otherwise fail to reject Ho.

step5: conclusion

As p-value (0.000) is less than level of significance (α=0.05),

we reject the null hypothesis in favor of alternative hypothesis.

As conclusion, at level of significance of 0.05 we infer that the

number of population in services or clients does not depends on51

the information or counseling from the service providers, but it

depends on others sources of information.

CHAPTER V

DISCUSSION OF FINDINGS, CONCLUSION AND RECOMMENDATIONS

5.1. Introduction

This chapter presents summary and conclusions derived from the

study and subsequent recommendations. In addition, the chapter

points out each specific objective and its relevance conclusion.

The general objective of the study was to evaluate how servicesdrawn to people infected and non-infected living with HIV/AIDSinfected people throughout the access of HIV/AIDS counseling in agiven area of Huye District. Specifically for populations ofTumba sector as indicated in Chapter 1 section 1.4.1.

The specific objectives were. To examine the extent to which theinstitutions deriver services to the people in need, To find outthe characteristics of people living with the infection ofHIV/AIDS in community; To evaluate whether the counselingservices have effect on life of the infected persons and non-infected; To find the challenge faced by infected persons andinstitutions in charge of counseling services.

The study was conducted in Huye District in many health centersunder the control of KABUTARE hospital, Rango health center, thisis specifically for services of VTC and PMTCT where generallythey are serving communities irrespective as indicated in thefindings.

52

The study employed the use of both quantitative and qualitativemethods, observation and case studies to enrich the findings. Thefindings of the study were based on a sample population of sixty-five (67) respondents. The study relied on Institutional theoryand Social relations Framework which generally argue thatindividuals and social groups, where people who need otherservices are not interested.

The first objective sets out .How institutions in charge ofservices deriver those services where it is required. As normsand regulations used by those institution, they derive theservices to people who pretend to get based on their will.

The second objective was to find out the characteristics ofpeople living with HIV/AIDS, in fact people living with HIV/AIDSmost of them are like isolated and live as to die tomorrow.Generally, discriminatory actins revealed as inequality asconstructed by society and family, institutions making HIV+ evenmore unequal in society by the means of being served asparticular client.

The Third objective was to the effect of counseling services onlife of infected people, the Findings revealed that communicationbarrier was advanced as an immense challenge followed by HIV+ notbeing accessible. In addition the level of education and feel notcomfortable when consulting the counselors because clients do notwish their status be know by anybody else. Those issue also wasconsidered as the prime hindering factor for HIV+ or HIV-‘saccess to HIV/AIDS counseling services.

The fourth objective was to know the challenge faced by infectedperson and institution in charge of counseling services, thefindings revealed that most of clients faced some challengeswhile accessing the HIV/AIDS services, like the means ofcommunication to counselors, no consultancy office for

53

counselors, most of counselors are women. Generally, based on thestudy clients in HIV/AIDS showed that the means of accessing toservices is difficult due to many challenges that they had facedand stated above.

Generally, to be a part of services clients is not mainly due tocounseling services and information rather than other mainchannels of information arise in research as means ofcommunication; news, newspaper, billboards, meetings and publictalk,… The key source of information used by clients is publictalks and news as big number of respondents approved it.

5.2 Discussion of findings

Persons with or at risk for human immunodeficiency virus (HIV)

infection need client-centered counseling and information about

the disease. One of the best opportunities to provide counseling

and information is during an HIV testing encounter. New testing

guidelines from the Centers for Disease Control and Prevention

encourage less counseling before and after testing. We review the

evidence regarding voluntary counseling and testing (VCT).

The study of U.S national library of Medicine of evaluation the

efficiency of rural health centers in Rwanda in delivering the

three key human immunodeficiency virus/acquired immunodeficiency

syndrome services: Antiretroviral Treatment(ART), Prevention of

Mother-To-Child Transmission(PMTCT), and voluntary counseling and

testing(VCT) using data envelopment analysis, and assesses the

impact of community-based health insurance (CBHI) and

performance-based financing on improving the delivery of the

three services. Results show that health centers average

54

efficiency of 78%, and despite the observed variation, the

performance increased by 15.6% from 2006 through 2007. When the

services are examined separately, each 1% growth of CBHI use was

associated with 3.7% more prevention of mother-to-child

transmission and 2.5% more voluntary counseling and testing

services. Although more health centers would have been needed to

evaluate performance-based financing, we found that high use of

CBHI in Rwanda was an important contributor to improving human

immunodeficiency virus/acquired immunodeficiency syndrome

services in rural health centers in Rwanda.( By.)

In my findings, 16.9% of respondents who are counselors confess

that no counseling on HIV/AIDS they give, 27.7% of respondents

(7counselors, 2HIV+, 9HIV-) infer that counseling or information

on HIV/AIDS services is done in public talk, 46.2% of respondents

confess that they knew information from news and schools (26HIV-,

4HIV+), 3.1% in newspaper, billboards means (2HIV+cliens), 6.2%

of respondents they knew information from television (4HIV-

clients).

As the above research showed the results Voluntary Testing and

counseling on HIV/AIDS and how must be associated with testing to

efficacy of its contribution. The findings from their research

showed that voluntary testing and counseling contributes 2.5% in

services efficiency. This support positively my findings revealed

that counseling itself doesn’t contributes to the decision of

clients to be part of clients HIV/AIDS services where only 16.9%

55

of counselors revealed that no counseling done in their village

and 27.7% of respondents get information on HIV/AIDS in public

talk (meeting in the village), hence they are motivated by

curiosity to know their status and prefer testing and in such

situation they get counseling on the way services could be drown

to them.

5.2 Conclusion

Persons in an advanced stage of HIV/AIDS are usually seriously

ill and require a more advanced level of treatment and follow-up

than is available at many health facilities. Hospitals and health

center with services of PMTCT (prevention of mother-to-child

transmission) and VCT (Voluntary Counseling and Testing) should

be the first among all types of facilities to be equipped with

the capacity to provide all of the advanced care and support

services needed for monitoring and treating HIV/AIDS clients.

As service development expands, how-ever, it is expected that

many of these services will become available outside of

hospitals, in lower level facilities as well.

The main elements of advanced-level services for HIV/AIDS include

the management of opportunistic infections and provision of

advanced palliative care for the people living with HIV/AIDS

including the availability of treatment medications for severe

opportunistic infections, antiretroviral therapy (ART), a

referral system for psychosocial and socioeconomic care and56

support services, conditions to support home care services,

counseling and have a good way of information for the clients.

Care management throughout and across these disciplines is

essential. However, as we have described, much of this service

provision and all of the care coordination are not reimbursable

by insurers. The findings revealed that 26 of HIV- clients get

information from news and schools, 9 of HIV- clients in Public

talk, 4 HIV+ clients in news and schools, 2 HIV+ clients in

public talk, 2 HIV+ clients newspaper and billboards, 7 of

counselors in public talk and 11 confess that no counseling given

about HIV/AIDS, it is done only for voluntary to the services.

5.3 Recommendation

After data collection, analysis and reviewing the findings,

research come up taking account counseling as positive way of

sensitization of people to HIV/AIDS services. To support the

decision makers, the research point out the following

recommendation:

To KABUTARE Hospital of Rwanda

Researcher recommends sensitizing people on HIV/AIDS services

using counselors and giving them time in public meeting. The

hospital also must provide training support to the counselors on

how the way they may care the clients. The hospital should also

57

give to counselors the facility in order to perform their work as

best they can.

To Counselors

Researcher recommends the counselors to be aware of the

population and have enough capacity to handle issue related to

HIV/AIDS services and advise the clients to consult medical care

as well as possible. The counselors should use the total

confidence that people given them.

To clients

The researcher recommends the clients to have continuous

dialogues and discuss how they may consult medical doctor and

take into accounts the advice that they got from their doctor and

follow them.

Researcher recommends also Member of households (clients)

intervention with its great important as it gives couples an

opportunity to confidentially discuss risk of HIV infection and

be assisted to learn HIV status for purpose of prevention, care

and treatment.

To other researcher

Researcher recommends to other researcher to expand the advocacy

and show the reality as HIV and AIDS present multi-dimensional

challenges to individuals, families and communities. These58

challenges may present as feeling of hopelessness, rejection and

stigma at various levels of the community.

Many concepts out of the conceptual framework in this study could

not be examined. Therefore, it is recommended that for further

study it would be desirable to include some additional variables

such as factors associated with counseling belief and its

consideration by the community, attitude and behavior regarding

hospital based deliveries, and factors associated with health

care providers, in order to capture the whole aspect that may

influence delivery status of the clients.

Bibliography1. (http://www.ubuzimabwacu.com/urusobe-rw%e2%80%99ubuzima/5837/usaid-

impressed-rwandas-progress-fighting hiv/ )23th March 26, 2015, 10h00.

2. http://mak.ac.ug/documents/Makfiles/theses/Nantumbwe_Miriam_Ssebuliba.pdf. (2006/ HD14/ 6380U). MULTIPLICITYOF DISCRIMINATION. NANTUMBWE MIRIAM SEBULIBA FAITH.

3. http://study.com/academy/lesson/secondary-data-in-marketing-research-definition-sources-collection.html Accessed on 25 march,2015 at 1:49.

4. http://www.statistics.gov.rw/system/files/user_uploads/files/survey-reports/RSPA%202007%20FINAL%20REPORT-ENGLISH_0.pdf.(sempter 2008, p 204/205). Rwanda services provision assessment. nationalinstitute of statistics of rwanda.

59

5. http://www.statistics.gov.rw/system/files/user_uploads/files/survey-reports/RSPA%202007%20FINAL%20REPORT-ENGLISH_0.pdf.(septempber 2008, p 203). rwanda services provision report. NationalInstitute of Statistics of Rwanda.

6. James E Bartlett, I. Determining Appropriate Sample Size in Survey Research.http://www.opalco.com/wp-content/uploads/2014/10/Reading-Sample-Size.pdf.

7. James E. Bartlett, I.http://www.opalco.com/wp-content/uploads/2014/10/Reading-Sample-Size.pdf. JoeW. Kotrlik,.

8. (2008-2012). Rwanda poverty reduction 2008-2012).

9. (http://www.statistics.gov.rw/system/files/user_uploads/files/survey-reports/RSPA%202007%20FINAL%20REPORT-ENGLISH_0.pdf, sempter 2008, p 204/205)

10. http://www.pedaids.org/ by 26th march 205 at 17h57.

11. (July 2002.). Report on the Global HIV/AIDS Epidemic. UNAIDS, Report onthe Global HIV/AIDS Epidemic.

12. (september 2008).http://www.statistics.gov.rw/system/files/user_uploads/files/survey-reports/RSPA%202007%20FINAL%20REPORT-ENGLISH_0.pdf. national institute ofstatistics.

13. cochran.http://www.opalco.com/wp-content/uploads/2014/10/Reading-Sample-Size.pdf.

14.(http://cid.oxfordjournals.org/content/45/Supplement_4/

S240.long

15.http://www.nlm.nih.gov

60

Appendices

QUESTIONNAIRESQUESTIONNAIRE FOR COUNSELLOR

RESEARCH TOPIC: “THE IMPACT OF HIV/AIDS COUNSELING SERVICES ONTHE POPULATION OF RURAL AREA”

RESEARCH’S PREPARATOR: Cyprien HABINSHUTI

QUESTIONNAIRE NO……………..

I am working as a student in University of Rwanda, College of

Business and Economics, School of Economics, Department of

Applied Statistics and I have to write a research paper.

In this respect, I am carrying out a study on “the impact of

HIV/AIDS counseling services on the population of rural area.

This research is intended to provide information that will be

useful in examining how HIV/AIDS counseling services on the

population of rural area is constructed through multiple actions

as they try to access HIV/AIDS counseling services in selected

sector ……………...

This questionnaire is to facilitate the collection of data from

sector with population who access HIV/AIDS counseling services.

You are requested to provide information in order to facilitate

the study. All the information you have given will be kept with

high confidentiality.

61

Thank you for your good cooperation!!!

Respondent demographic characteristics,

1. Respondent status: (a) Counselors………… (b) Clients (HIV+

……………

(C) HIV - ) …………………….. (d) Partner of HIV+………………………..

2. Age of Respondent.............................

3. Sex...................

Female Male

4. Marital Status.......................

Single Married separated

widower

5. Working status

Private sector Public sector

unemployed

6. Educational level

None Primary level Secondary level

Undergraduate and above

7. Date of completing

form..........................................................

Section A: the structure of access of HIV/AIDS counseling

Services.

8. What type of services does the institution offer to the

clients?

62

.................................................................

.................................................................

....................

.................................................................

.................................................................

..........

9. Does the institution provide favorable services regularly?

Yes………. No……….

If Yes, What does it specify?

.................................................................

.................................................................

....................

10. have you ever attend any training to handle counseling

services and related issue?

Yes.......................

No....................

If not, please explain how you manage to be a part of consoling

services providers?

.................................................................

.................................................................

....................

.................................................................

.................................................................

..........

11. Do you think all organization’s service providers have any

formal qualifications in HIV/AIDS counseling? 63

Yes …………… No

………………………..

12. How often do populations seek counseling services in your

organization a week?

Time a week responseOnce twiceSeveral time

QUESTIONNAIRE FOR CLIENTS

RESEARCH TOPIC: “THE IMPACT OF HIV/AIDS COUNSELING SERVICES ONTHE POPULATION OF RURAL AREA”

RESEARCH’S PREPARATOR: Cyprien HABINSHUTI

QUESTIONNAIRE NO……………..

I am working as a student in University of Rwanda, College of

Business and Economics, School of Economics, Department of

Applied Statistics and I have to write a research paper.

In this respect, I am carrying out a study on “the impact of

HIV/AIDS counseling services on the population of rural area.

This research is intended to provide information that will be

useful in examining how HIV/AIDS counseling services on the64

population of rural area is constructed through multiple actions

as they try to access HIV/AIDS counseling services in selected

sector ……………...

This questionnaire is to facilitate the collection of data from

sector with population who access HIV/AIDS counseling services.

You are requested to provide information in order to facilitate

the study.

All the information you have given will be kept with high

confidentiality.

Thank you for your good cooperation!!!

Respondent demographic characteristics,

1. Id number of

respondent.......................................................

..............

2. Age of Respondent.............................

3. Sex...................

Female Male

4. Marital Status.......................

Single Married separated

widower

5. Working status

Private sector Public sector

unemployed

6. Educational level

Primary level Secondary level

Undergraduate and above65

7. Date of completing

form..........................................................

CLIENTS SECTION

Section B: Society impacts on infected population.

1. How does society react to population infected?

……………………………………………………………………………………………

2. To what extent did you manage to get information to be a

part of counseling services clients of the institution you

belong to?

Method responseTelevisionNews papers, posters, billboardsInformation, education, training

and cooperative By interview

3. Do you belong to any HIV+ affected cooperative?

Yes No

If yes go to question 4, if not go to question 6

4. Which kind of help do you get from the cooperative?

- …………………………………………………………..…………………………………….

…………………………………………………………………………………………………

5. Are you satisfied with the services offered by the

cooperative?66

Period Response excellent (as you

want)good (ordinary=

ibisanzwe)No good (bitari

byiza cyane)

.

6. What is the general attitude of the counselors towards you?

………………………………………………………………………………………

7. What problems do you encounter when you visit HIV/AIDS

Counseling services?

………………………………………………………………………………

………………………………………………………………………………

………………………………………………………………………………

8. can education level affect the use of the services?

Yes No

9. If yes, what is the most education level affect the use?

Education level respons

ePrimary

67

secondaryUniversity and

high learning

and above

10. Are the services offered by your organization show a

great importance to the beneficiaries?

1) Yes ……………

2) No....................................

INSANGANYA Y’UBUSHAKASHATSI: KUREBA ICYO UBUJYANAMA KUNDWARA YA SIDA BWAFASHIJE ABATURAGE BO MUBYARO.

UTEGURA UBUSHAKASHATSI: Cyprien HABINSHUTIUBUSHAKASHATSI NO: ………………

Nitwa HABINSHUTI Cyprien, Ndi umunyeshuri muri kaminuza y’u Rwanda, ishuri ry’ubukungu n’icunga mutungo, ishami ry’icunga mutungo, agashami k’ibarurishamibare nkaba ndimo kwandika igitabonkuko biteganywa namategeko yakaminuza.

68

Ni muri urwo rwego ndimo gukora ubushashatsi kureba icyo ubujyanama ku ndwara ya sida bwafashije abaturage bo hirya y,umujyi nabomucyaro, bityo bikaba bizamfasha kunoza no kurangiza neza amasomo yanjye. Ibazwa ryateguwe rizadufasha kubona amakuru ngenderwaho mukureba koko niba hari impinduka nziza ubujyanama bwazaniye abaturage muri rusange.Amakuru yatanzwe abikwana ubunyanga mugayo. Murakoze kubufatanye bwanyu!

Ibiranga umufatanya bikorwa.1. Numero y’usubiza……………2. Imyanka…………….3. igitsina

Gabo Gore4. imimerere rusange

Ingaragu yarashatse umupfakazi yatandukanye nuwo bashakanye bitemewe namategeko

5. Aho akora Umukozi wa leta ibigo byigenga ntakora

6. Amashuri yizeAbanza ayisumbuye kaminuza ntiyize 7. Itariki amakuru yatangiweho……………………

Igika cya kabiri: uko umuryango rusange ufata ababananubwandu bw’agakoko gatera SIDA (Abagenerwa bikorwa).

1. Nigute sosiyesi (society) ifata ababana na gakoko gatera SIDA?………………………………………………………………………………………………………………………………………………………………..

2. Ni mubuhe buryo mwamenye amakuru kugira mufate icyemezo cyo kubaumugenerwa bikorwa muri serivisi?

Uburyo bwakoreshejwe igisubizo

69

Insakaza mashusho(television)Ibinyamakuru, inzandiko, amatangazoAmakuru, ishuru, amahugurwaIbiganiro, ubujyanama

3. Hari ishyirahamwe(cooperative) ry’ababana n’ubwandu bwa gakoko gatera virisi ya SIDA ubarizwamo?Yego oya

Niba ari yego, jya kukibazo cya 4, niba ari oya jya kuri 6

4. Ni ubuhe bufasha ishyirahamwe (cooperative) ryaba ribagenera?…………………………………………………………………………………………………………………………………………………………………………………………

5. Ese ubufasha ishyirahamwe(cooperative) ribaha buhagaze bute?ubufasha igisubizoBwiza cyaneIbisanzweButari bwiza cyane

6. Mubona abajyanama babakira gute?............................................................................................................................................................................................................................................................................................

7. Ni ibihe bibazo muhuranabyo mugihe muhabwa izo serivizi?.......................................................................................................................................................................................................................................................................................................

70

...........................................................

...........................................................

.............8. Ese mubona amashuri umuntu yize hari uruhare afite

mukubahiriza serivi muhabwa/yego oya Niba ari yego, komeza nicya 9, niba ari oya komeza nicya 10.

9. Ni ikihe cyiciro cyamashuri kigiramo uruhare runini/Icyiciro cy’amashuri igisubizoAbanzaAyisumbuyekaminuza

10. Hari umumaro mubona serivisi muhabwa yabamariye ?1) Yego……………..2) Oya……………..

INSANGANYA Y’UBUSHAKASHATSI: KUREBA ICYO UBUJYANAMA KU NDWARA YASIDA BWAFASHIJE ABATURAGE BO MUBYARO.

UTEGURA UBUSHAKASHATSI: Cyprien HABINSHUTIUBUSHAKASHATSI NO: ………………

Nitwa HABINSHUTI Cyprien, Ndi umunyeshuri muri kaminuza y’u Rwanda, ishuri ry’ubukungu n’icunga mutungo, ishami ry’icunga mutungo, agashami k’ibarurishamibare nkaba ndimo kwandika igitabonkuko biteganywa namategeko yakaminuza.

Ni muri urwo rwego ndimo gukora ubushashatsi bugamije kureba icyoubujyanama ku ndwara ya sida bwafashije abaturage bo hirya y’imijyi n’ibyaro, bityo bikaba bizamfasha kunoza no kurangiza neza amasomo yanjye.

Ibazwa ryateguwe rizadufasha kubona amakuru ngenderwaho mukureba koko niba hari impinduka nziza ubujyanama bwazaniye abaturage babugenewe muri rusange.

Amakuru yatanzwe abikwana ubunyanga mugayo.71

Murakoze kubufatanye bwanyu!

Ibiranga umufatanya bikorwa.

1. Numero y’usubiza……………2. Imyanka…………….3. igitsina

Gabo Gore

4. imimerere rusange

Ingaragu yarashatse umupfakazi

5. Akazi akora Umukozi wa leta ibigo byigenga ntakora

6. Amashuri yize

Abanza ayisumbuye kaminuza ntiyize

7. Itariki amakuru yatangiweho……………………

Igice cyambere(A): uburyo serivisi zitangwa (ababajyanama bubuzima).

8. Ni izihe servisi muha ababagana?………………………………………………………………………………………………………………………………………………………………

9. Ese izo servisi zitangwa burigihe uko bikwiyeYego oya Niba ari yego, ni izihe zitangwa burigihe?………………………………………………………………………………

10. Hari amahugurwa ajyanye nubujyanama mwigeze muhabwa mbere yo gutanga iyi serivisi?Yego oya Niba ari oya, nubuhe buryo mukoresha mukwakira ababagana?………………………………………………………………………………………………………………………………………………………………..

72

11. Ese abakozi bose bikigo baba bafite ubumenyi kubujyanama kundwara ya SIDA?Yego oya

12. Ni kangahe mucyumweru mwakira ababagana?

Inshuro k’umweru igisubizo

rimwe

kabiri

Inshuro nyinshi

73