Trauma, Mental Health, and Health Care Experiences of Lesbian and Bisexual Women in Rwanda

Lesbian and bisexual women (LBW), regardless of where they live in the world, are at increased risk for traumatic experiences and negative mental health sequelae. LBW in Rwanda are an underresearched, at-risk population group that likely experiences substantial trauma associated with their sexual identity (and in some cases their nontraditional gender presentation). We interviewed 20 Rwandan LBW about their stressful and traumatic experiences, perceptions of their mental health, and their experiences with health care providers. Thematic analyses revealed multiple traumatic and stress ful experiences related to harassment, violence, and abuse, including rape and other forms of sexual violence; marriage to a male partner (forced or chosen); rejection or abandonment by family and friends; and being forced to break up or end a relationship with a female partner. Participants reported feelings of stress, sadness, hopelessness, and depression; suicidal thoughts; and social isolation. While a few participants reported positive experiences with health care providers, many reported concealing their sexual identity from health care providers or experiencing discrimination-factors that limited receipt of needed care. These results suggest a need for expanded systemic support for lesbian and bisexual women, and the broader sexual and gender minority community in Rwanda. Cultural acceptance and legal protections, as well as enhanced training opportunities for health providers is recommended. Public Significance Statement Findings from this study, based on interviews with 20 women in Rwanda who identified as lesbian or bisexual, suggest that traumatic experiences are common and have substantial impact on health and well-being. Although health care was reported to be generally available, these women felt the need to conceal their sexual identity to avoid discrimination in health care settings, which limits opportunities to receive needed care. Cultural acceptance, legal protections, and professional training are needed to better serve this population (and the broader sexual and gender minority community) and support their health and well-being.