The use of rape as a weapon of war during the 1994 Rwandan genocide left hundreds of thousands of women with deep emotional scars that are yet to heal.
"The traditional family support structures that existed in Rwanda - the close family and community networks - were destroyed by the genocide," Jane Abatoni Gatete, executive secretary of the Rwandan Association of Trauma Counsellors (ARCT-Ruhuka), told IRIN/PlusNews. "This has created a need for additional psychological support, especially because genocide survivors experienced torture, rape and other traumatic experiences."
An estimated 250,000 to 500,000 women were raped during the genocide. A 1999 study by Avega Agahozo, an umbrella organisation for genocide widows, found that 80 percent of women surveyed had reported symptoms of trauma.
ARCT-Ruhuka, based in the capital, Kigali, provides counselling to those still living with the memories of the three-month pogrom that left an estimated 800,000 people dead.
The symptoms of post-traumatic stress disorder include flashbacks, episodes of lost time, overwhelming emotions, or numbness and dissociation. Gatete said women who were raped and contracted HIV were particularly vulnerable, left with a permanent reminder of their trauma.
"These women are carrying a heavy burden; many of them were raped in public, in front of their children, their communities," Gatete noted. "They feel anger, fear, denial, self-blame and self-hatred, and many are stigmatised for being HIV-positive."
Cecile Mahoro (not her real name) was gang-raped during the genocide, when she was three months pregnant. During her ordeal, her rapist said he was infecting her with HIV. Her 14-year-old son disappeared during the killing and his body has never been found, which remains a source of anguish to her.
Mahoro still bears the physical scars of the violence. Beneath her headscarf she reveals deep grooves on her scalp from being hit by a nail-studded club - a common tool of torture during the genocide.
"I hated all men after the genocide, I blamed all of them for what happened to me," she said. "I had constant flashbacks and I drank a lot of alcohol; I never slept without the aid of alcohol for five years after the genocide."
Mahoro's symptoms are common among people suffering from post-traumatic stress disorder. Johns Hopkins University reported that exposure to traumatic events can lead to increased risk-taking behaviour, including substance abuse and unsafe sexual practices.
ARCT-Ruhuka's Gatete agrees: "HIV/AIDS is both a cause and a consequence of trauma," she said. "Its diagnosis leads to denial, self-hatred, but at the same time, when a woman is raped and suffers psychological trauma, she may behave in risky ways sexually that can lead to her becoming infected."
In 2001, after several months of feeling physically unwell and losing weight, Mahoro was diagnosed with HIV and encouraged by her counsellor to visit ARCT-Ruhuka. She has regular one-on-one sessions at their Kigali centre, and says she now sleeps much better and has stopped excessive drinking.
"What we do at ARCT-Ruhuka is buy back the women's trust and their confidence, so that they are able to look at their situation realistically and understand that they had no control over what happened to them," said Gatete. "We then encourage them to seek medical treatment for their injuries, which in some cases they have had for years."
"Trauma counselling should be made part of the national HIV programmes because of the scale of rape that we saw during the genocide," she added. "The whole package is needed - physical as well as psychological support."
ARCT-Ruhuka treated more than 22,000 people in 2005, 97 percent of whom were women. Gatete said an estimated 13 percent of the women struggled with the double psychological impact of rape and HIV infection.
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