The impact of HIV status, HIV disease progression, and post-traumatic stress symptoms on the health-related quality of life of Rwandan women genocide survivors
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We examined whether established associations between HIV disease and HIV disease progression on worse health-related quality of life (HQOL) were applicable to women with severe trauma histories, in this case Rwandan women genocide survivors, the majority of whom were HIV-infected. Additionally, this study attempted to clarify whether post-traumatic stress symptoms were uniquely associated with HQOL or confounded with depression.
The Rwandan Women’s Interassociation Study and Assessment was a longitudinal prospective study of HIV-infected and uninfected women. At study entry, 922 women (705 HIV+ and 217 HIV−) completed measures of symptoms of post-traumatic stress and HQOL as well as other demographic, clinical, and behavioral characteristics.
Even after controlling for potential confounders and mediators, HIV+ women, in particular those with the lowest CD4 counts, scored significantly worse on HQOL and overall quality of life (QOL) than did HIV− women. Even after controlling for depression and HIV disease progression, women with more post-traumatic stress symptoms scored worse on HQOL and overall QOL than women with fewer post-traumatic stress symptoms.
This study demonstrated that post-traumatic stress symptoms were independently associated with HQOL and overall QOL, independent of depression and other confounders or potential mediators. Future research should examine whether the long-term impact of treatment on physical and psychological symptoms of HIV and post-traumatic stress symptoms would generate improvement in HQOL.
KeywordsQuality of life Post-traumatic stress disorder HIV Women Rwanda
Center for Epidemiological Studies-Depression Scale
Highly active antiretroviral therapy
Human immunodeficiency virus
Health-related quality of life
Harvard Trauma Questionnaire
Persons living with HIV
Post-traumatic stress disorder
Quality of life
Rwandan Women’s Interassociation Study and Assessment
- 1.Human Rights Watch. (1999). Leave none to tell the story: Genocide in Rwanda. New York: Human Rights Watch.Google Scholar
- 3.Degni-Segui, R. (1996). Question of the violation of human rights and fundamental freedoms in any part of the world, with particular reference to colonial and other dependent countries and territories. Special Rapporteur of the Commission on Human Rights. www1.umn.edu/humanrts/commission/country52/68-rwa.htm.
- 8.Zraly, M., Rubin-Smith, J., Betancourt, T. (2011). Primary mental health care for survivors of collective sexual violence in Rwanda. Global Public Health, 6, 257–270.Google Scholar
- 11.Hays, R., Cunningham, W., Sherbourne, C., Wilson, I., Wu, A., Cleary, P., et al. (2000). Health-related quality of life in patients with human immunodeficiency virus infection in the United States: Results from the HIV cost and services utilization study. American Journal of Medicine, 108, 714–722.PubMedCrossRefGoogle Scholar
- 15.Louwagie, G., Bachmann, M., Meyer, K., Booysen, F., Fairall, L., & Heunis, C. (2007). Highly active antiretroviral treatment and health related quality of life in South African adults with human immunodeficiency virus infection: A cross-sectional analytical study. BMC Public Health, 7(244), 1–10.Google Scholar
- 24.Safren, S. A., Hendriksen, E. S., Smeaton, L., Celentano, D. D., Hosseinipour, M. C., Barnett, R., et al. (2012). Quality of life among individuals with HIV starting antiretroviral therapy in diverse resource-limited areas of the world. AIDS Behavior, 16, 266–277.Google Scholar
- 27.American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
- 28.Mollica, R., McDonald, L., Massagli, M., & Silove, D. (2004). Measuring trauma, measuring torture. Cambridge: Harvard Program in Refugee Trauma.Google Scholar