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Helping Rwandan orphans recover from trauma and avoid HIV

In the time I spent with people caring for orphans in Africa, I observed how they were focused on the absolute essentials, like keeping the kids alive and reasonably well cared for. Food, shelter and access to schooling: These were the priorities. Rarely were the kids' psychological issues addressed, despite the fact that the children had suffered much trauma. Many had watched their parents die painful, undignified deaths and then had to struggle with the consequences of living with little or no outside support.

So I was delighted to meet recently with some Stanford researchers who have piloted a successful project offering mental health care to orphans in Rwanda. These children not only lost their parents, but the losses occurred in the context of the horrific mass killings of 1994. These youth, now in their teens and early 20s, are still suffering the consequences and are considered at risk for a variety of health problems, including infection with HIV.

But the researchers showed that with mental health intervention and adult mentoring, these youth could remain healthy and better cope with daily life challenges. By the end of the year, there was not a single youth in the study group of 120 who developed HIV infection. Only two developed STDs. And none of the young women became pregnant. The participants also saw a reduction in their trauma symptoms and were less likely to be involved in risky behaviors, such as sex with multiple partners, according to Annie Talbot, MD, clinical assistant professor of medicine and first author of the study.

"We proved is that mental health intervention is linked to less risky behavior," Talbot told me. She presented the results today at the 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, held in Rome.

Talbot and her colleagues worked with a Rwandan nonprofit, Uyisenga N'Manzi, which has provided housing, school and vocational training for some 4,000 Rwandan orphans. The group has a $1 million grant from the European Union to scale up the pilot project, which it will offer at children's centers around the country, Talbot said.

This is a great model, and I hope that other children in Africa can reap the benefits of a program like this, which is sorely needed.

Previously: Helping Rwandan orphans avoid HIV
Photo courtesy of Andrew Zolopa, MD, and Annie Talbot

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