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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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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

CES-D:

Center for Epidemiological Studies-Depression Scale

HAART:

Highly active antiretroviral therapy

HIV:

Human immunodeficiency virus

HQOL:

Health-related quality of life

HTQ:

Harvard Trauma Questionnaire

PLWH:

Persons living with HIV

PTSD:

Post-traumatic stress disorder

QOL:

Quality of life

RWISA:

Rwandan Women’s Interassociation Study and Assessment

SF-21:

Short form-21

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA

    Tracy L. Gard

  2. Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Bronx, NY, USA

    Tracy L. Gard

  3. Statistics and Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA

    Donald R. Hoover

  4. New York Medical College, Valhalla, NY, USA

    Qiuhu Shi

  5. Department of Medicine, Stroger (Cook County) Hospital, Rush University, Chicago, IL, USA

    Mardge H. Cohen

  6. Women’s Equity in Access to Care and Treatment (WE-ACTx), Kigali Health Institute, Kigali, Rwanda

    Eugene Mutimura

  7. Centre for Public Health Sciences, Albert Einstein College of Medicine, Bronx, NY, USA

    Adebola A. Adedimeji

  8. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Adebola A. Adedimeji & Kathryn Anastos

  9. Department of Medicine, Montefiore Medical Center, Bronx, NY, USA

    Kathryn Anastos

Authors
  1. Tracy L. Gard
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  2. Donald R. Hoover
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  3. Qiuhu Shi
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  4. Mardge H. Cohen
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  5. Eugene Mutimura
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  6. Adebola A. Adedimeji
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  7. Kathryn Anastos
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Correspondence to Tracy L. Gard.

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Gard, T.L., Hoover, D.R., Shi, Q. et al. 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. Qual Life Res 22, 2073–2084 (2013). https://doi.org/10.1007/s11136-012-0328-y

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  • DOI: https://doi.org/10.1007/s11136-012-0328-y

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