Chronic PTSD and HIV in Rwanda

The 1994 Rwandan genocide resulted in more than 800,000 massacred and 535,000 women raped. Thirteen years later, 160,000 Rwandan women are HIV infected. The Rwandan Women's Interassociation Study and Assessment (RWISA) is a cohort study of HIV infected and uninfected women who survived the 1994 genocide. This presentation will describe a women's HIV clinic's efforts to address the issues of chronic PTSD. The project tasks were completed by a multidisciplinary team of Americans and Rwandans, and included: working with women's associations and local non-governmental organizations; assessing health resources; and the adaptation and translation of the Harvard Trauma Questionnaire (HTQ) for documentation and diagnosis of trauma. 891 HTQs were completed. Common trauma events included surviving war (94.2%), lacking food or water (81.5%), no access to medical care (75.5%), death of relative or friend (70.8%), homelessness (62.8%), and rape (49.2%). Other traumatic events included sleep deprivation (67.3%), starvation (67.3%), being held hostage or confined (47.1%), and beatings (40.7%). The mean score on the PTSD scale was 2.28, with 35.5% of the women meeting the criteria for PTSD (using a 2.5 cutoff). In addition to the chronic traumatic stress documented in this sample of Rwandan women, social conditions of poverty, incidence of domestic violence and other abuses, and stigmatization of HIV/AIDS contribute to the list of problems needing to be addressed. A model of multidisciplinary care that addresses medical and psychosocial needs within the Rwandan context is needed to address these intersecting health issues.