This paper explores instances of agency in women's responses to intimate partner violence (IPV) in Rwanda. The literature on women's responses to IPV conceptualises agency primarily as an individual's capacity to take action by reporting violence or leaving a relationship, obscuring other ways women may respond to violence in contexts where reporting or leaving are unlikely. We aim to replace this narrow conceptualisation of agency with a social constructivist focus on the meanings women attribute to possible IPV responses. We draw on data from a study of IPV in Rwanda, which includes semi-structured interviews with women experiencing violence and four focus group discussions with women community members (n=39).Our findings highlight socio-cultural, economic, political-legal and historical constraints that shape women's actions in this context. In relation to these constraints, women describe four possible responses to IPV: reporting the violence; seeking emotional support; 'fighting back' against violence (including leaving the relationship); or remaining silent. While reporting and leaving violent relationships are identified, women also discuss the social constraints that make these actions extremely difficult in Rwanda. In designing effective strategies, we conclude that public health strategies need to consider women's understandings of their own actions, particularly in social contexts where certain actions may be highly constrained.

BackgroundThe prevalence, incidence and persistence of human papillomavirus (HPV) types in sub-Saharan Africa are not well established. The objectives of the current study are to describe (predictors of) the epidemiology of HPV among high-risk women in Kigali, Rwanda.MethodsHIV-negative, high-risk women were seen quarterly for one year, and once in Year 2. HIV serostatus, clinical, and behavioral information were assessed at each visit, HPV types at Month 6 and Year 2, and other sexually transmitted infections (STI) at selected visits. HPV prevalence was also assessed in HIV-positive, high-risk women.ResultsPrevalence of any HPV was 47.0% in HIV-negative women (median age 25 years) compared to 72.2% in HIV-positive women (median age 27 years; OR 2.9, 95% CI 1.9-4.6). Among HIV-negative women, cumulative incidence of high-risk (HR)-HPV was 28.0% and persistence 32.0% after a mean period of 16.6 and 16.9 months, respectively. Prior Chlamydia trachomatis and Neisseria gonorrhoeae infection, concurrent low-risk (LR)-HPV infection and incident HSV-2 were associated with HR-HPV prevalence among HIV-negative women; prior C. trachomatis infection and co-infection with LR-HPV and HPV16-related HPV types with HR-HPV acquisition. HPV16-related types were the most prevalent and persistent.ConclusionsHigh HPV prevalence, incidence and persistence were found among high-risk women in Kigali. HPV52 had the highest incidence; and, together with HPV33 and HPV58, were strongly associated with acquisition of other HR-HPV types in HIV-negative women.

As lifelong antiretroviral therapy (ART) for pregnant women is implemented, it is important to understand the attitudes and norms affecting women's postpartum ART adherence. This is a qualitative cross-sectional study of HIV-positive postpartum women (n = 112) enrolled in a 2-year observational prospective cohort in Rwanda. Informed by the Theory of Reasoned Action (TRA), we conducted in-depth interviews with women whose children were 0-6, 7-12, 13-18, or 21-24 months of age to describe factors contributing to adherence and changes over time. Positive ART attitudes reported by women included mothers' health promotion, prevention of infant HIV infection, higher CD4 count, and improved physical appearance. Negative attitudes were few, but included side effects and the lifelong nature of treatment. Learning from people living with HIV (PLHIV) was identified as a norm facilitating adherence; ART adherence was inhibited by fear of disclosure or stigmatization in communities and clinics. Poor adherence behaviors were common immediately after HIV diagnosis, not necessarily during prevention of mother-to-child transmission (PMTCT). Women with older children, most of whom stopped breastfeeding by 13-18 months, reported more barriers and missed doses than women with younger children. The TRA was useful in identifying the collective influence of attitudes, norms, and intentions on behavior. Findings suggest that HIV-positive women are vulnerable to poor adherence following HIV diagnosis and around the time of breastfeeding cessation. Lifelong treatment adherence can be supported through PLHIV exemplifying long-term ART use, fewer and less stigmatizing clinic visits, and counseling messages highlighting the benefits of drugs on appearance and illness prevention and incorporating biological feedback.

In 2015 forest area of Rwanda was only limited to 19.5%. Rwanda's goal is to extend its forests area 30% of its total land area by 2035 in order to meet the requirements of International Tropical Timber Organization (ITTO) and International Union for the Conservation of Nature; ITTO/IUCN guidelines for the conservation and sustainable use of biodiversity in tropical timber production forests published in 2009. Despite reforestation efforts, there has been a drastic reduction in total forest cover in Rwanda during the recent decades. Indeed, forest resources have been under increasingly severe stress, due to high population growth, resettlement of displaced persons, related demands for agricultural land, firewood and other forest related products. Due to a high population density and high population growth, it is becoming harder and harder to meet the needs for settlement, agricultural and other economic activities hence even more difficult for afforestation land availability. In this paper we propose some areas that could be afforested or reforested in order to increase area of conservation of biodiversity in Rwanda and to comply with ITTO/IUCN guidelines of conservation areas protection and degraded area rehabilitation. We used high definition aerial images and applied Geographic Information System (GIS) to study the availability of potential land area that are likely suitable for new forest plantations. The criteria of area selection were most inconvenient land for human settlement and most inconvenient agricultural land. The results have shown that 15.14% of total country area has a slope over 30%. Among the land areas with a slope over 30%, forested land areas occupy 5.25%. According to the results a total land area equivalent to 9.89% is available for forest plantations. This research will help to identify new and suitable land area for forest plantation and it will be useful for policy-makers in Rwanda. The government should encourage the plantation of forests in new identified areas by facilitating farmers to change their land use and discouraging other activities carried out in the identified available land areas.

In this study, the decision-making process management of forest tending in the forestry business is decentralized, and forest tending decision-making activities at different points in time are integrated by decision makers at different geographical locations. The decision-making process was analyzed and optimized from a system perspective. Based on the optimized decision-making process, a forest tending business group decision support system (FTGDSS) was established. We first reviewed and discussed the characteristics and development of the forest tending business and forestry decision support system. Business Process Modeling Notation was used to draw a current state flow chart of the forest tending business, to identify and discover important decision points in the process of tending decision-making. We also analyzed the content and attributes of each decision point, and described the system structure, functional framework, knowledge base structure, and reasoning algorithm of FTGDSS in detail. Finally, FTGDSS was evaluated from the two dimensions of the technology adoption model. FTGDSS integrates different levels of time-space decision-making activities, historical tending data, business plans, decision-makers' management tendencies into the decision-making process and automatically extracts decision-making data from the forest business process management enterprise resource planning system (Smartforest) that improves the ease of use of the decision support system (DSS). It also improves the quality of forest tending decisions, and enables the DSS to better support multi-target management strategies.