Sexual Coercion, Physical Violence, and HIV Infection Among Women in Steady Relationships in Kigali, Rwanda

The relationship between sexual coercion, physical violence, and HIV serostatus was examined at 24 months of follow-up in a cohort of 921 women with steady partners in Kigali, Rwanda. One third of the women reported sexual coercion, and physical violence perpetrated by their male partner was reported by 21%. Sexual coercion was associated with women being HIV-positive, and physical violence was associated with their partner testing HIV-positive. Independent predictors of sexual coercion included the woman being HIV-positive, refusal to have sex, condom negotiation, financial inequality, and male partner's alcohol use. Independent predictors of physical violence were similar to predictors of sexual coercion. Sexual coercion and physical violence are public health issues relevant to HIV prevention, and are associated with financial and sexual gender power differentials. Results suggest the need to expand HIV behavioral interventions to address women's economic and cultural realities.     

Mapping Rwanda public health research (1975–2014)

Background

Since the genocide occurred in 1994, Rwanda has faced up to the challenge of rebuilding. Public health is a main field to understand this rebuilding.

Objectives

In this paper, the aim was to map the scientific research on public health in Rwanda after the genocide and to present the links between different financing systems.

Methods

We used bibliographic analyses with Web of Science of papers published during the period 1975–2014. We performed analyses on journals, most cited articles, authors, publication years, organizations, funding companies, countries, and keywords.

Results

We obtained 86 articles between 1975 and 2014. Most articles were published after 2007. The main countries of research laboratories were the United States of America, Rwanda, England and Belgium and represented the main network collaboration. The relevant keywords were: HIV, woman, child, program, rural and violence.

Conclusions

Public health research on Rwanda appeared 14 years after the genocide. A main field was emerging: the spread of HIV with mother-child transmission, and the policies to take this subject into account in rural zones. The network of institutions developing these studies was USA-Rwanda.     

Anaemia,iron deficiency and a common polymorphism of iron‐regulation,TMPRSS6 rs855791, in Rwandan children

Anaemia in children living in sub‐Saharan Africa is common, but its causes are diverse. In 545 children below 5 years of age from rural southern Rwanda, we assessed the role of iron deficiency (ID) and of the TMPRSS6 736(V) (rs855791) allele, known to reduce iron status and haemoglobin (Hb) levels, in anaemia and Hb concentrations. Anaemia (Hb <11 g/dl) was present in 34.4% of the children and ID (ferritin <12 ng/ml) in 17.6%. The TMPRSS6 736(V) allele was uncommon (allele frequency, 0.096) and not associated with ID. In multivariate analysis, ID was positively associated with anaemia (adjusted odds ratio, 1.67) to an extent comparable with α⁺‐thalassaemia, breastfeeding, inflammation and low household income, but the odds were substantially higher in Plasmodium falciparum infection (adjusted odds ratio, 10.3). These findings were verified in a multivariate analysis of Hb concentrations. The TMPRSS6 736(V) allele only tended to be associated with low Hb levels. TMPRSS6 736(V) is comparatively rare among Rwandan children and may only slightly contribute to low Hb concentrations. Preventable causes of anaemia, notably ID and P. falciparum infection, largely outweigh its impact and need to be addressed to improve the haematological status of children in the study area.     

Urine testing to monitor the impact of HPV vaccination in Bhutan and Rwanda

Bhutan (2010) and Rwanda (2011) were the first countries in Asia and Africa to introduce national, primarily school‐based, human papillomavirus (HPV) vaccination programmes. These target 12 year‐old girls and initially included catch‐up campaigns (13–18 year‐olds in Bhutan and ninth school grade in Rwanda). In 2013, to obtain the earliest indicators of vaccine effectiveness, we performed two school‐based HPV urine surveys; 973 female students (median age: 19 years, 5th‐95th percentile: 18–22) were recruited in Bhutan and 912 (19 years, 17–20) in Rwanda. Participants self‐collected a first‐void urine sample using a validated protocol. HPV prevalence was obtained using two PCR assays that differ in sensitivity and type spectrum, namely GP5+/GP6+ and E7‐MPG. 92% students in Bhutan and 43% in Rwanda reported to have been vaccinated (median vaccination age = 16, 5th–95th: 14–18). HPV positivity in urine was significantly associated with sexual activity measures. In Rwanda, HPV6/11/16/18 prevalence was lower in vaccinated than in unvaccinated students (prevalence ratio, PR = 0.12, 95% confidence interval, CI: 0.03–0.51 by GP5+/GP6+, and 0.45, CI: 0.23–0.90 by E7‐MPG). For E7‐MPG, cross‐protection against 10 high‐risk types phylogenetically related to HPV16 or 18 was of borderline significance (PR = 0.68; 95% CI: 0.45–1.01). In Bhutan, HPV6/11/16/18 prevalence by GP5+/GP6+ was lower in vaccinated than in unvaccinated students but CIs were broad. In conclusion, our study supports the feasibility of urine surveys to monitor HPV vaccination and quantifies the effectiveness of the quadrivalent vaccine in women vaccinated after pre‐adolescence. Future similar surveys should detect increases in vaccine effectiveness if vaccination of 12 year‐olds continues.     

Collaboration or renunciation? The role of traditional medicine in mental health care in Rwanda and Eastern Cape Province,South Africa

Traditional medicine (TM) and biomedicine represent parallel health systems in many developing countries; the latter dominating in public policies, while the former still retain considerable influence among the general public. This study investigates how mental health care professionals responsible for mental health care implementation comprehend and relate to the intersection between TM and biomedicine in the cases of Rwanda and the Eastern Cape Province, South Africa. The material is based on semi-structured interviews with mental health care stakeholders in Eastern Cape, South Africa and Rwanda. The findings confirm an impact of TM in the treatment of mental health issues in Rwanda and South Africa due to TM being more accessible than biomedical medicine, widespread traditional perceptions of mental illness in society, and the lack of knowledge of biomedical treatments. Furthermore, the respondents identified three strategies to manage the impact of TM; improved accessibility of biomedical facilities, outreach education about mental illness, and, in the Eastern Cape case, collaboration between traditional healers and biomedicine. The study points to the necessity to take TM into consideration as an important component of health systems and policies in the Global south.     

The ethics of researching intimate partner violence in global health: A case study from global health research

There has been an increase in attention to intimate partner violence (IPV) as a health issue that contributes to the spread of HIV, physical and emotional stress, depression, substance use, serious injuries, and higher rates of mortality in low-income settings. This paper explores the ethical implications raised by research on IPV by global health scholars. Drawing on Hedgecoe’s work on critical bioethics to analyse a qualitative study of IPV in Rwanda, this paper discusses the risks and benefits of conducting research on IPV as part of the global health agenda. We discuss ethical issues that have become evident through our work in this area, including: raising IPV as an issue of concern in women’s lives in settings where economic support for women experiencing IPV may not exist; recording interviews and focus group discussions in contexts with significant government surveillance; ethical tensions in appropriating local voices in ways that position women as ‘victims’ of violence; and the risks associated with framing IPV as a global health issue separate from feminist advocacy. We recommend more tailored approaches to ethics in IPV research, which considers the specificity of the social, cultural and economic context.     

Joining and leaving sex work: experiences of women in Kigali,Rwanda

Although sex work can bring significant economic benefit there are serious downsides, not least vulnerability to adverse sexual health outcomes. Focus-groups discussions and in-depth interviews were conducted with 70 female sex workers to explore the context in which they started sex work, their motivations to leave, and their experiences of trying to leave. The pathway to becoming a sex worker was underscored by poverty, with disruptive events leading to increasing vulnerability and increasingly difficult life choices. A sizeable minority of women became sex workers while working as house-girls, a position associated with financial, physical and sexual vulnerability. The majority of participants were still working as sex workers, citing financial reasons for not leaving. Motivations to leave sex work included experiencing a frightening incident, peer pressure and concerns about dependent children. Those who left often described a change in their financial circumstances that enabled them to leave. Some had left but had returned to sex work following a financial crisis or because they found their new life too hard. House-girls are particularly vulnerable and therefore an appropriate focus for prevention. Programmes assisting women to leave need to include financial safety nets so that a time of financial difficulty does not necessitate a return to sex work.     

A question of maturity: The participation,decision-making and rights of children in the context of HIV/AIDS

This article examines international, regional and national sources of law with respect to the rights of children and considers how a strict age of majority affects adolescents' access to health care. Using Rwanda as a case study, this article outlines how a high age of majority, combined with mandatory parental consent, creates barriers for Rwandan adolescents to prevent human immunodeficiency virus (HIV) transmission, learn their status and receive treatment for the disease. It further examines the relevant legal and policy framework of the Rwandan Government in order to suggest successful methods to gauge a child's maturity level for Rwanda and other countries. The article argues for the improvement of adolescents' level of participation in making health decisions, and thereby also increasing their access to HIV/acquired immune deficiency syndrome (AIDS) services.     

Environmental barriers experienced by stroke patients in Musanze district in Rwanda: a descriptive qualitative study

Background

Patients with stroke experience a number of environmental barriers, limiting their re-integration. Information regarding the barriers experienced by patients with stroke in a specific setting such as the Musanze district in Rwanda would assist with the development of rehabilitation programmes that would take into consideration the barriers experienced by the clients.

Objective

To explore the barriers experienced by patients with stroke residing in Musanze District.

Methods

In-depth face-to-face interviews were used to gather the data which were analysed using a thematic approach.

Results

Three major themes of the environmental barriers experienced by the study participants that emerged were social, attitudinal and physical barriers. Sub-themes that arose within the social barriers theme included lack of social support and inaccessible physiotherapy services. In terms of attitudinal barriers, the participants reported negative attitudes of others towards them. The sub themes related to physical barriers as described by the participants were inaccessible pathways and toilets.

Conclusion

The findings of this study highlight the need for interventions that include awareness and education of communities about disability and advocating for accessible services and physical structures for persons with disabilities.