M.P.H. student brings home lessons from Rwanda

For a tiny agricultural nation in East Africa that was devastated by genocide 26 years ago, Rwanda could teach the rest of the world some big lessons about ending the AIDS epidemic and treating people living with HIV.

That was among the take-aways for Mariah Schrack, a student in DMU’s master of public health (M.P.H.) degree program, who completed her applied practice experience at the Rwanda Biomedical Center in 2018 and her integrative learning experience project at the Rwanda Network of People Living with HIV (RRP+) in 2019. The project included evaluation of adherence with antiretroviral therapy (ART) among people living with HIV in Rwanda and the nation’s use of peer educators and home health visits in serving this population. She planned both trips to Rwanda through DMU’s global health program.

Mariah Schrack, second from right, with colleagues at RRP+

Mariah, who is president of Human Dignity in Medicine at DMU and is set to complete her M.P.H. degree this spring, plans to return to Rwanda in March to give a final presentation to her preceptor there.

“What surprised me the most is how Rwanda is more advanced than the United States in some areas,” she says. To wit: The country was one of the world’s first to ban plastic bags, and its Vision 2020 program seeks to integrate green growth and climate resilience strategies. As of last October, women made up 62 percent of its national legislature, far more, proportionally, than any other country.

Mariah also learned that Rwanda is ahead of the United States in achieving the 90-90-90 targets launched in 2014 at the 20th International AIDS Conference, which have the goals of having 90 percent of people living with HIV know their status; 90 percent of people living with HIV who know their status to be on treatment; and 90 percent of people on treatment being “virally suppressed,” or prevented from transmitting the virus.

In a presentation Mariah gave on campus in January, she reported that of the 227,896 people living with HIV in Rwanda, 89 percent know their status; 92.3 percent of those identified are being treated with ART; and 91 percent are virally suppressed. According to 2016 data from the Centers for Disease Control and Prevention, of the 1,122,900 people living with HIV in the United States, 73 percent received some HIV medical care; 57 percent were retained in continuous HIV treatment; and – in 2015 – 60 percent were virally suppressed.

Rwanda’s progress toward the targets are remarkable considering its 1994 genocide, in which nearly one million people perished in 100 days. It destroyed the nation’s public health and health care infrastructure, sparked a massive cholera epidemic and saw the use of mass rape to spread HIV as a weapon. Women who became infected and impregnated passed the disease on to their babies.

Since then, a decentralized health care system has emerged, with trained community health workers in villages to provide basic and preventive treatment and referrals as needed to rural health posts and larger health centers. ART medication is free. And because so many people contracted HIV due to rape or unclean blood transfusions, the stigma is less negative than in the United States.

“We need to be culturally competent as health professionals,” Mariah said in her January presentation. “Have an open mindset, and advocate for people living with HIV by empowering them and ensuring them HIV is not a death sentence. Everyone needs to feel safe in a health care setting to receive care and treatment.”

Mariah, who hopes to work for a state or large county health department and to serve refugee populations, added: “Don’t write off a country torn apart by genocide.”

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