Domestic Violence: Successful Interventions in an HIV Clinic in Rwanda

Gender based violence is a global public health problem. Women with HIV commonly experience domestic violence (DV), which may impact their illness. In post-conflict/developing countries, few resources are dedicated to this problem. Methods: The Women's Equity in Access to Care and Treatment (WE-ACTx) provides primary HIV care to 1860 women in Kigali. During 2009, trauma counselors screened patients for DV. Women reporting violence were referred to the psychiatric nurse, support groups, and/or legal counselor. Screening stopped as support groups filled to capacity. At patients' requests, staff conducted a men's support group. Results: Of 414 women, 256(62%) reported a history of violence. Trauma counselors facilitated 3 support groups, for 62 patients. Most women reported physical and sexual abuse; some also complained of emotional abuse. Emotional abuse included the patients' husband refusing HIV care, but using her supply of antiretroviral therapy, or the patients' husband withholding money for food/rent. Psychoeducation helped women better understand the cycle of violence and challenge cultural beliefs which find male violence tolerable. Over 80% of the women live with their abusive partner. Women acquired negotiating skills that helped produce household peace and reduce abuse. Several of the patients' husbands stopped taking the patients medications and began attending HIV clinics for antiretrovirals. Conclusions: Women respond well to talking about DV in support groups after being screened in a Rwandan HIV primary care clinic. Addressing domestic violence for women with HIV through support groups and counseling may reduce abuse and increase the number of male partners attending HIV clinics.