Although Rwanda is experiencing a period of relative peace, much of its population still feels the effects of long-lasting trauma as a result of the 1994 genocide. For women who are living with HIV/AIDS, this trauma is compounded by the added psychological stressors of being HIV-positive and, for many, having experienced rape. These women may experience symptoms of headaches, general malaise, heart palpitations, nervousness, feelings of helplessness and hopelessness, thinking too much about painful experiences, shame, sadness and sleep problems. However, with much of the population of Rwanda living below the poverty line, there are few resources available for psychosocial care. There are only a handful of trained psychiatrists in Rwanda, reflecting the fact that Rwandan medical schools lack the facilities to provide psychiatric training of primary care providers.

Project summary

Comprehensive Mental Health Services for Women Living with HIV/AIDS in Rwanda is a training and treatment project implemented by Heartland Alliance and its local partner, WE-ACTx—Women's Equity in Access to Care and Treatment, and is designed to assist Rwandan women who are living with HIV and are victims of sexual violence. The project's goal is to create a replicable model for integrated mental health services for HIV-positive traumatized women and children to reduce depression and anxiety symptoms, to improve adherence to HIV medications and to promote improved general health and nutrition. The project has been training female trauma counselors and peer advocates working with a cohort of 950 HIV-positive women participating in the project, while taking into account the effects of psychological trauma on immune system response. It has also been providing ongoing technical assistance on the translation into Kinyarwanda of a Trauma-Focused Cognitive Behavioral Therapy manual, which may be used for training in the rest of Rwanda, as well as neighboring post-conflict communities in Burundi and the Democratic Republic of the Congo.

Activities

To address the gap in psychosocial services available to HIV-positive Rwandan women who have experience trauma, Heartland Alliance is:

• Training mental health providers (Rwandan trauma counselors and peer advocates) in cognitive-behavioral interventions using a train-the-trainer model to expand training potential and capacity in Rwanda;

• Training and supervising current health providers to recognize depression and trauma symptoms, and to treat them with selective serotonin reuptake inhibitors (SSRIs);

• Monitoring progress in group meetings;

• Interpreting and translating Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) key terms and concepts into Kinyarwanda;

• drafting a TF-CBT manual in Kinyarwanda.