Integrative HIV and Mental Health Care in Rwanda

The World Health Organization called for a worldwide increase in mental health services, reporting 154 million people suffer from depression. In Rwanda, the Ministry of Health reported a 33% increase in cases served at the national psychiatric hospital from 2002 to 2007. In a recent country probability sample of 1000, 79% reported trauma experiences, 29% had PTSD and 54% had co-morbidity of depression. Another study conducted by Rwandan Women Inter-association Study and Assessment (RWISA) with HIV+ (658) and HIV- (192) women in Kigali found in the HIV+ women 58% suffered from PTSD and 81% from depression and in the HIV- women 66% had PTSD and 65% depression. In response to the RWISA study, Women's Equity for Access to Care & Treatment (WE-ACTx), an HIV and primary health care program, hired a psychiatric nurse to conduct assessments and treat women referred from the clinic nurses. Morning “educational chats” in the clinic waiting room provide psycho-educational information, including one by a legal advocate, and trauma counselors facilitate weekly support groups. In 2009 1,812 women received HIV care in the WE-ACTx clinic. Over nine months, the psychiatric nurse provided assessment and treatment to 162 women and 32 children. 133 women and 19 men participate in weekly support groups. Providing mental health services, including psychiatric care, in the clinic setting creates access and diminishes a gap in treatment. Integrating mental health and HIV treatment utilizing a psychiatric nurse and trauma counselors is a model that can be used in other post-conflict and developing countries.