JAN. 11, 2010

Improving lives of Rwandan orphans is aim of Stanford research project

BY RUTHANN RICHTER

More than 100 Rwandan orphans still recovering from the trauma of the 1994 genocide are participating in a new Stanford University School of Medicine study that aims to improve their psychological health and reduce their chances of contracting HIV/AIDS.

The pilot study, a collaboration with a Rwandan nonprofit organization, recognizes that children who lost parents to the genocide won’t be able to succeed in life and will be more vulnerable to disease, including HIV/AIDS, unless their issues of psychological trauma are addressed, said Andrew Zolopa, MD, professor of medicine and acting chief of infectious diseases at Stanford.

“The key thing is the impact of post-traumatic stress on these children’s lives,” said Zolopa, an HIV/AIDS specialist. “When they tried to integrate the children into job training or schooling, they failed. The kids dropped out. They were too stressed. Imagine you’ve lived through this horror. You have no parents, no family. They try to reintegrate into society but this psychological trauma is still there and it bubbles to the surface.”

Through the study, the youngsters will receive individual and group counseling aimed at improving their self-esteem, promoting healthy sexual development, encouraging safe sex practices and preventing self-destructive behaviors that can lead to personality disorders and other health problems down the road, the researchers said. Most of the children don’t have adult role models in their lives, so the researchers will work to match them with adults in the community who can serve as mentors.

The genocide, which left nearly a million people dead, created an enormous community of orphaned children. An estimated 600,000 youngsters lost their parents during the calamity, and roughly half now live in households headed by other children, said Annie Talbot, MD, a visiting clinical professor at Stanford and a collaborator on the project.

These youngsters, all between the ages of 15 and 25, now are coming of age sexually. Because of psychological trauma or lack of economic support, they are more likely to engage in unsafe or high-risk sex practices that could lead to HIV infection, Zolopa said. Though the incidence of HIV in Rwanda is relatively low—about 3 percent nationally—compared with other countries in sub-Saharan Africa, that figure could easily increase if there is no intervention, he said.

“Here’s a group of people directly affected by the genocide who could be the next wave of the HIV epidemic, a kind of aftershock of the genocide,” Zolopa said.

Stanford is collaborating in the project with a local nonprofit, Uyisenga N’Manzi, that is helping to build homes for the orphans, send them to school and train them to run income-generating businesses, such as goat-rearing and farming. In a videotape produced by the nonprofit, the youngsters stand up one by one to talk about their experiences with the group and express their hopes for the future.

“I used to say no other genocide survivor lived as miserable a life as I do,” one young man says. “But when I reached here, I met a child of 10 who stays alone in a house. I really felt sympathy for him. I said, ‘I still have hope to survive.’”

The study has already been fully enrolled with 120 youths. The participating youth all were tested for HIV at the start of the study, which began in November, and five were found to be HIV-positive, said Debbie Slamowitz, RN, the study coordinator. One tested positive for syphilis and one girl was found to be pregnant at baseline screening for the study; none of the children previously had been aware of these conditions. They have been referred to a local hospital for medical care, she said. The participants also will be screened for HIV, sexually transmitted diseases and pregnancy at the end of the one-year study.

The researchers will monitor the progress of the youngsters during the course of a year, interviewing them every three months and asking them to fill out questionnaires to assess their HIV knowledge, drug and alcohol use, sexual behaviors, generalmental health and level of post-traumatic stress disorder.

Some of the youngsters now live together in a collection of small cinderblock homes, forming a kind of surrogate family, though others are homeless and move from place to place.

Though the youth live under extraordinarily difficult circumstances, Zolopa said he has been impressed by their remarkable energy and their resilience. “The children are amazing—they come to you with such brightness,” he said. “They are so giving. They will do a dance performance or recite a poem on your arrival. They have so much exuberance.”

He said he and his colleagues hope to develop a model project that could be used elsewhere to improve the psychological health and reduce the incidence of HIV among at-risk youth. He also said the project could be the beginning of a larger relationship between Stanford and the Rwandan Ministry of Health, with whom the Stanford researchers have established a link. He hopes ultimately to bring Rwandan investigators to Stanford to do lab training, or send Stanford postdoctoral fellows to Rwanda to do HIV prevention and treatment, clinical trials or epidemiologic surveys of HIV drug resistance.

“We feel there’s a lot of potential for a long-term relationship between Stanford and Rwanda,” he said. In fact, the pilot study which was presented at the annual National HIV meeting in Kigali, Rwanda, and was awarded the “most innovative project” from the Ministry of Health. The study is funded by a grant from the Gilead Foundation.

Stanford University Medical Center integrates research, medical education and patient care at its three institutions - Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu/.