Family-focused integrative care of trauma and HIV/AIDS with Rwandan families

The 1994 genocide in Rwanda left a legacy of trauma and HIV/AIDS. In an initial assessment conducted in 2005 by Women's Equity in Access to Care & Treatment (WE-ACTx), 65% of 912 women responding to the Harvard Trauma Questionnaire (HTQ) met the criteria for Post Traumatic Stress Disorder. Additionally, 76% of 819 women screened positive with depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D) during a primary care visit. The high levels of psychological distress signal a strong need to address the mental health of women in a post-conflict society, many who are living with HIV/AIDS. This presentation will describe a family-focused integrative model of care that includes peer advocates, trauma counselors, a psychologist, nurses, and physicians working together to provide medical, mental health, and social services to more than three hundred women and their families living with HIV/AIDS in Kigali, Rwanda. 35% of the families are single parent households and 17% are child-headed households. A peer advocate or trauma counselor assesses the psychological functioning and social needs of the family by conducting home visits. In addition to the residual trauma of the genocide and living with HIV/AIDS, poverty related issues such as hunger are prevalent with 43% of the families reporting eating one meal a day. Other traumatic events such as domestic violence and sexual abuse are also being identified. Home visit assessments allow the treatment team to identify non-medical obstacles to care with psychosocial interventions and promote adherence to treatment.