The social impact of HIV infection on women in Kigali, Rwanda: A prospective study

In Rwanda, a central African country, the prevalence of HIV infection now exceeds 30% in urban adults. This study identifies the social services and counseling needs of women who are already infected with the HIV virus, the outcome after disclosure of the woman's HIV test result to her partner and estimates the social support available to the women from their partners and relatives. Fifty-five HIV-positive women in Kagali were interviewed in 1988 and 47 of this group were interviewed again in 1991. The social services most needed by the women in 1988 were housing, employment and money. By 1991, the women prioritised food, housing and money as their current needs and food, childcare and money were their future needs in the event they became ill. The preferred sources of support in 1988 were individual counseling and women's support groups. By 1991, the preferred sources of support were individual counseling and their priest. In 1988, almost 75% of the women did not expect a supportive reaction from their partners after disclosure of the test result. In 1991, acceptance, understanding and sympathy were the most common reactions of the partners after disclosure. However, 8 (21%) had not told their partner their test result. After disclosure, 18 of the 37 partners were subsequently tested. Of those tested, 75% were HIV-positive and 25% were HIV-negative. Condom use was almost twice as high when the partner was informed of the test result, although in couples overall, a third were not using condoms despite knowing the test result. There were 23 births since 1988 and pregnancy was equally likely whether the test result was known or if the partner tested. The women overall reported good morale in 1991, bolstered by their religion. Chronic difficulties with sleep, performing daily routine and feelings of depression were reported by a third of women. Conclusions are the basic survival services are needed for affected families, and a program of testing and counseling for partners is required.