Prevalence and Predictors of Posttraumatic Stress Disorder and Depression in HIV-Infected and At-Risk Rwandan Women


Cohen, Mardge H., Mary Fabri, Xiaotao Cai, Qiuhu Shi, Donald R. Hoover, Agnes  Binagwaho, Melissa A. Culhane, Henriette Mukanyonga, Davis K. Karegeya, and Kathryn Anastos. 2009. "Prevalence and Predictors of Posttraumatic Stress Disorder and Depression in HIV-Infected and At-Risk Rwandan Women." Journal of Women's Health 18 (11): 1783-1791.

Authors: Mardge H. Cohen, Mary Fabri, Xiaotao Cai, Quihu Shi, Donald R. Hoover, Agnes Binagwaho, Melissa A. Culhane, Henriette Mukanyonga, Davis K. Karegeya, Kathryn Anastos


OBJECTIVE: During the 1994 Rwandan genocide, rape was used as a weapon of war to transmit HIV. This study measures trauma experiences of Rwandan women and identifies predictors associated with posttraumatic stress disorder (PTSD) and depressive symptoms.

METHODS: The Rwandan Women's Interassociation Study and Assessment (RWISA) is a prospective observational cohort study designed to assess effectiveness and toxicity of antiretroviral therapy in HIV-infected Rwandan women. In 2005, a Rwandan-adapted Harvard Trauma Questionnaire (HTQ) and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess genocide trauma events and prevalence of PTSD (HTQ mean > 2) and depressive symptoms (CES-D > or = 16) for 850 women (658 HIV-positive and 192 HIV-negative).

RESULTS: PTSD was common in HIV-positive (58%) and HIV-negative women (66%) (p = 0.05). Women with HIV had a higher prevalence of depressive symptoms than HIV-negative women (81% vs. 65%, p < 0.0001). Independent predictors for increased PTSD were experiencing more genocide-related trauma events and having more depressive symptoms. Independent predictors for increased depressive symptoms were making < $18 a month, HIV infection (and, among HIV-positive women, having lower CD4 cell counts), a history of genocidal rape, and having more PTSD symptoms. 

CONCLUSIONS: The prevalence of PTSD and depressive symptoms is high in women in the RWISA cohort. Four of five HIV-infected women had depressive symptoms, with highest rates among women with CD4 cell counts < 200. In addition to treatment with antiretroviral therapy, economic empowerment and identification and treatment of depression and PTSD may reduce morbidity and mortality among women in postconflict countries.

Keywords: mental health, HIV/AIDS, posttraumatic stress disorder, depression, genocide, war rape

Topics: Gender, Women, Genocide, Health, HIV/AIDS, Mental Health, PTSD, Trauma, Post-Conflict, Sexual Violence, Rape, SV against Women Regions: Africa, Central Africa, East Africa Countries: Rwanda

Year: 2009

The Less They Know, the Better: Abstinence-Only HIV/AIDS Programs in Uganda


Cohen, Jonathan, and Tony Tate. 2006. "The Less They Know, the Better: Abstinence-Only HIV/AIDS Programs in Uganda." Reproductive Health Matters 14 (28): 174-8.

Authors: Jonathan Cohen, Tony Tate


Widely hailed as a leader in the prevention of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), Uganda is redirecting its HIV prevention strategy for young people away from scientifically proven and effective strategies toward ideologically driven programs that focus primarily on promoting sexual abstinence until marriage. Although endorsed by some powerful religious and political leaders in Uganda, this policy and programmatic shift is nonetheless orchestrated and funded by the United States government. Pioneered in the United States in 1981, “abstinence until marriage” programs (also known as “abstinence only” programs) teach that abstaining from sex until marriage is the only effective method of HIV prevention and that marriage between a man and a woman is the expected standard of human sexual behavior. Numerous U.S.-funded studies have shown these programs to be ineffective at changing young people’s sexual behaviors and to cause potential harm by discouraging the use of contraception. The effect of Uganda’s new direction in HIV prevention is thus to replace existing, sound public health strategies with unproven and potentially life-threatening messages, impeding the realization of the human right to information, to the highest attainable standard of health, and to life.

Keywords: HIV/AIDS


Abstinence-only HIV/AIDS programs have no relevance for LGBT individuals in Uganda, as the government denies the very existence of LGBT individuals. This report recommends that “the special needs of vulnerable populations [including lesbian, gay, bisexual, and transgender persons] are explicitly recognized in national and local HIV prevention policies and programs.” (178)

Topics: Gender, Health, HIV/AIDS, Reproductive Health, Sexuality Regions: Africa, East Africa Countries: Uganda

Year: 2006


© 2023 CONSORTIUM ON GENDER, SECURITY & HUMAN RIGHTSLEGAL STATEMENT All photographs used on this site, and any materials posted on it, are the property of their respective owners, and are used by permission. Photographs: The images used on the site may not be downloaded, used, or reproduced in any way without the permission of the owner of the image. Materials: Visitors to the site are welcome to peruse the materials posted for their own research or for educational purposes. These materials, whether the property of the Consortium or of another, may only be reproduced with the permission of the owner of the material. This website contains copyrighted materials. The Consortium believes that any use of copyrighted material on this site is both permissive and in accordance with the Fair Use doctrine of 17 U.S.C. § 107. If, however, you believe that your intellectual property rights have been violated, please contact the Consortium at

Subscribe to RSS - HIV/AIDS