Transgenerational trauma in Rwandan genocidal rape survivors and their children: A culturally enhanced bioecological approach.

Multiple theories, including attachment, family systems, and epigenetics, among many others, have been invoked to explain the mechanisms through which trauma is transmitted from one generation to the next. To move toward integration of extant theories and, thus, acknowledgement of multiple pathways for transmission of trauma, the authors explore the potential of applying a culturally enhanced bioecological theory to transgenerational trauma (TGT). Data from in-depth qualitative interviews in Rwanda more than two decades after the genocide, with 44 mothers of children born of genocidal rape, and in-depth interviews and focus groups with a total of 60 youth born of genocidal rape, were analyzed according to the processes of culturally enhanced bioecological theory. The findings from a hybrid inductive and deductive thematic analysis suggest that a culturally enhanced bioecological theory of human development allows for an integrated, multi-dimensional analysis of individual, family, cultural, and societal factors of transmission of TGT. Some facets of the data, however, are not accounted for in the theory, specifically, how some mothers were able to create and sustain a positive bond with their children born of genocidal rape, despite societal and family pressure to abandon or abort them. Nonetheless, the findings demonstrate how a culturally enhanced bioecological theory can be an important overarching framework for developing policies and practices to help interrupt or mitigate TGT, strengthen resilience, and facilitate healing for children born of genocidal rape, their mothers, and their families.

'Those tablets, they are finding an empty stomach': a qualitative investigation of HIV risk among sexual and gender minority migrants in Cape Town, South Africa.

ABSTRACTObjectives: HIV prevalence among sexual and gender minority (SGM) individuals in South Africa is among the highest in the world; however, SGM migrants, an especially vulnerable subgroup of both the SGM and migrant populations, have frequently been overlooked in the country's robust public health response. This qualitative study, guided by syndemics theory, explored the processes by which SGM migrants in South Africa are exposed to HIV risk and those that may reduce this risk.Design: We conducted 6 focus groups with a total of 30 SGM migrants living in Cape Town. Participants were men who have sex with men, women who have sex with women, and transgender women. Transcripts were analyzed using grounded theory.Results: Participants identified a number of interrelated factors (insecure immigration status, financial and housing instability, food insecurity, stigma and discrimination, and lack of social support) contributing to HIV risk. While some took PrEP or HIV medication, adherence could be affected by structural and psychosocial barriers.Conclusion: Interventions that respond to the syndemic impacts on HIV outcomes are needed to reduce disease burden among SGM migrants in South Africa.

A Scoping Review of the Experiences of Violence and Abuse Among Sexual and Gender Minority Migrants Across the Migration Trajectory.

Violence against sexual and gender minority (SGM) individuals has continued to proliferate globally. Yet, less is known about victimization among subgroups of SGM individuals, especially SGM immigrants, refugees, and asylum seekers. There has been a steady increase in this vulnerable group of migrants over the years, and emerging evidence has pointed to their heightened risk of victimization. We conducted a scoping review of the peer-reviewed literature that examined violence, abuse, and mental health among SGM individuals who migrate internationally. One hundred ninety-nine articles were identified by searching five scholarly databases and hand searching. Twenty-six articles met inclusion criteria. We first used the migration framework, which outlines the distinct phases of the migration trajectory (predeparture, travel, interception, destination, and return), to categorize findings and then identified four overarching themes to capture SGM migrants' experiences at each phase: severe and prolonged violence and abuse related to sexual orientation or gender identity (predeparture); continued victimization and high-risk for sexual violence (travel); detainment- and deportation-related violence and abuse (interception and return); and new manifestations of violence and abuse while living with past trauma (destination). Violence and abuse began in childhood and continued in the host country, where they faced discrimination while managing posttraumatic stress disorder and depression. Findings indicate that SGM migrants are extremely vulnerable to victimization. There is an immediate need for policies to protect SGM individuals worldwide and for affirmative, culturally informed practices to help SGM migrants manage trauma and the structural barriers impeding recovery.

Understanding COVID-19 through a Complex Trauma Lens: Implications for Effective Psychosocial Responses.

The psychosocial impact of COVID-19 on individuals, families, and communities will likely persist for years to come. While briefing notes informed by disaster psychology and crisis management have been released to guide social workers and other mental health professionals in their work during the pandemic, the far-reaching impacts of COVID-19 may require inclusion of additional theories of trauma and resilience. Thus, this article first examines the application of complex trauma theory as an effective framework for assessing the psychosocial impacts of the pandemic, especially among individuals with prior trauma exposure, those with preexisting mental illness, and communities affected by marginalization and historical trauma. Authors then discuss the importance of using trauma-informed practice to address the effects of the pandemic on both individual and community levels during this unprecedented moment in history.

"We are children like others": Pathways to mental health and healing for children born of genocidal rape in Rwanda.

Despite the well-documented prevalence of rape as a strategy of war, little is known about the specific psychological consequences to children born of conflict-related sexual violence. The results of data analysis of 7 focus groups and 60 in-depth interviews with children born of genocidal rape in Rwanda indicated that they are carrying the trauma of their own stigmatization and marginalization, are burdened with their mothers' trauma, and, we conclude, symbolize unresolved collective trauma for the society. Analysis also reveals that healing for these young adults requires interpersonal and intrapersonal compassion and acceptance, a meaningful connection with a peer group, societal recognition, and empowerment to help contribute to and transform their lives and societies. Each of these pathways to healing-intrapersonal, interpersonal, and social-is contingent upon the other, and none can be considered in isolation. To support this largely invisible population striving to fulfill their potential, opportunities need to be created for self-acceptance and acceptance by mothers, families, and communities; sharing and building emotional and social bonds with their cohort group; formal recognition; official social rituals to validate their experiences and those of the mother-child dyad in the context of culture and community; and for socioeconomic opportunities to enable them to fully participate in building the future of Rwanda.

"I Asked Myself If I Would Ever Love My Baby": Mothering Children Born of Genocidal Rape in Rwanda.

The 1994 Rwandan genocide was characterized by brutal acts of widespread sexual violence against women that, for some, led to unwanted pregnancy, childbirth, and motherhood. This study explores the perspectives and experiences of 44 Rwandan women with children born of genocidal rape through in-depth qualitative interviews. Emerging from the data are the themes of identity and belonging, ambivalence, and truth-telling in the mother-child relationship. Findings highlight the lasting and intergenerational legacy of genocidal rape, and practice and policy implications are discussed.

Traumatic Stress Among Sexual and Gender Minority Refugees From the Middle East, North Africa, and Asia Who Fled to the European Union.

In 2015, more than 600,000 individuals from Syria, Iraq, and Afghanistan fled to Europe in search of protection. Among the most understudied of this population are individuals who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ). These individuals have not only fled war but also violence due to their sexual and/or gender identities. At the same time, LGBTQ individuals from other parts of the Middle East, Central and South Asia, and North Africa have also fled to Europe to escape persecution. The purpose of this multimethod study was to understand how traumatic stress shaped the experiences of 38 LGBTQ individuals who fled to Austria (n = 19) and the Netherlands (n = 19) from these regions. We assessed participants for posttraumatic stress disorder (PTSD) and conducted qualitative interviews to understand their migration experiences. Of the 37 participants assessed for PTSD, 33 (89.2%) reported that their most distressing event occurred prior to migration. For the 24 (64.9%) participants who met criteria for a provisional diagnosis of PTSD, 15 reported that the precipitating event was related to their sexual and/or gender identities and 9 reported that it was related to another type of event (e.g., war). Grounded theory was used to analyze qualitative data. Themes demonstrated that participants encountered targeted violence and abuse throughout migration and upon their arrival in Austria and the Netherlands. Findings indicate that LGBTQ refugees may be vulnerable to ongoing trauma from other refugees and immigration officials. Recommendations for protecting and supporting LGBTQ refugees during humanitarian emergencies are provided.

Promoting the wellbeing of lesbian, gay, bisexual and transgender forced migrants in Canada: providers' perspectives.

Researchers are beginning to document the experiences of lesbian, gay, bisexual and transgender (LGBT) forced migrants in settlement. However, studies exploring the perceptions of service providers working with this vulnerable population are limited. These may shed light on the challenges of meeting the needs of LGBT forced migrants, especially mental health issues and problems. This qualitative study elicited the views of 22 Canadian service providers, including advocates, lawyers and mental health practitioners, who serve LGBT forced migrants. Grounded theory analysis revealed the following four themes: facilitating safety, buffering rejection; tracking avoidance patterns; interpreting mental health; and negotiating identity paradigms. Participants' accounts suggest that LGBT forced migrants may be best served by providers who understand the exigencies of establishing trust and safety for their clients; recognise their clients' nuanced social support needs; facilitate the refugee claims process; grasp the complexity of their clients' mental health challenges; and interrogate their own cultural biases regarding sexual orientations and gender identities.

A Qualitative Exploration of the Premigration Victimization Experiences of Sexual and Gender Minority Refugees and Asylees in the United States and Canada.

Progress in analyzing and interpreting the concepts of sexual orientation and gender identity in the context of refugee law has contributed to a rise in individuals seeking asylum in such countries as the United States and Canada. However, few studies have examined the victimization experiences of sexual- and gender-identity forced migrants prior to their arrival in North America. This qualitative study used thematic analysis to explore the premigration adult victimization experiences of 26 lesbian, gay, and transgender individuals who obtained refugee, asylee, or withholding-of-removal status in the United States or Canada based on persecution for their sexual orientation and/or gender identity. Participants originated from countries in Asia, Africa, the Caribbean, Eastern Europe, Latin America, and the Middle East. Analysis revealed the following themes: living on the edge, adopting concealment strategies, routine victimization, and protectors as perpetrators. Participants described living in a constant state of hypervigilance, and they adopted numerous strategies to protect themselves from victimization. Despite the use of such strategies, participants experienced victimization by community members and state actors, leaving them no choice but to flee to ensure their safety and well-being. Findings are discussed using the ecological framework outlined by the World Health Organization (WHO). The discussion concludes with implications for international policy and clinical practice.

'The darkest times of my life': Recollections of child abuse among forced migrants persecuted because of their sexual orientation and gender identity.

Numerous studies demonstrate that lesbian, gay, bisexual, and transgender (LGBT) children and youth are likely to experience abuse by peers, parents, and other adults and that these experiences correlate with a host of mental health problems. However, there is little understanding of the experiences of LGBT children and youth living in countries where social and legal protections for sexual and gender minorities are limited or nonexistent. This qualitative study used thematic analysis to explore the child and adolescent abuse experiences and their impact on the pre-migration mental health of LGBT forced migrants. We analyzed 26 interviews with individuals who obtained refugee or asylee status in the United States or Canada on the basis of sexual orientation or gender identity. Participants originated from countries in Asia, Africa, the Caribbean, Eastern Europe, Latin America, and the Middle East. Analysis revealed the following themes: abuse by parents and caregivers, abuse by peers and school personnel, having nowhere to turn, and dealing with psychological distress. Findings indicate that participants experienced severe verbal, physical, and sexual abuse throughout childhood and adolescence and that this abuse occurred at home, in school, and in the community. Furthermore, there were no resources or sources of protection available to them. Participants linked their abuse to subjective experiences of depression, anxiety, and traumatic stress, as well as suicidal ideation and suicide attempts. We conclude with implications for refugee adjudication practices, mental health care, and international policy.