Love, power, resilience and vulnerability: relationship dynamics between female sex workers in Ghana and their intimate partners.

Little is known about female sex workers' daily lives or emotional relationships. Using relational-cultural theory, this study explored the relationship dynamics between sex workers and their intimate partners in Kumasi, Ghana. We collected qualitative data from 37 male intimate partners through 24 in-depth interviews and two focus group discussions (FGDs) with 13 male partners. We also conducted three FGDs with 20 women involved in sex work. Relationships between sex workers and their intimate partners were mutual, reciprocal and transactional. Male partners provided protection for financial support, a place to sleep and intimacy. Both men and women described their relationships in terms of friendship, love and a hopeful future. Women were reluctant to quit sex work because they depended on it for income. Most respondents did not use condoms in these romantic relationships, citing trust, love, faithfulness and commitment. Both men and women described high levels of violence in their relationships. The context of sex work heightens vulnerability but also appears to facilitate resilience and creative coping strategies. The relational dynamics between sex workers and their intimate partners in Ghana merit further exploration to examine the extent to which women involved in sex work hold and exert power within these relationships.

Piloting a Social Networks Strategy to Increase HIV Testing and Counseling Among Men Who Have Sex with Men in Greater Accra and Ashanti Region, Ghana.

The 2011 Ghana Men's Study identified a high prevalence of HIV among men who have sex with men (MSM) in Accra/Tema (34.4 %) and in Kumasi (13.6 %), whereas the HIV rate among MSM referred through peer educators (PEs) to HIV testing and counseling (HTC) services in these two sites was substantially lower (8.4 %). These findings raised questions about possible limitations of the peer-education strategy to reach high-risk MSM. Therefore, a pilot study was conducted to assess the feasibility of using a social network strategy (SNS) to identify and refer MSM to HTC services. Within 3 months, 166 MSM were reached and referred to HTC services: 62.7 % reported no recent exposure to PEs; 61.5 % were unaware of their recent HIV serostatus; and 32.9 % were newly diagnosed HIV positive. This pilot study suggests that an SNS could be an important strategy to reach MSM and to increase the uptake of HTC.

A short history of HIV prevention programs for female sex workers in Ghana: lessons learned over 3 decades.

BACKGROUND: Female sex workers (FSWs) in Ghana have a 10-fold greater risk for acquiring HIV than the general adult population, and they contribute a substantial proportion of the new HIV infections in the country. Although researchers have conducted behavioral and biological surveys, there has been no review of the contextual, programmatic, and epidemiological changes over time. METHODS: The authors conducted a historical review of HIV prevention programs in Ghana. We reviewed the use of different interventions for HIV prevention among FSWs and data from program monitoring and Integrated Biological and Behavioral Surveillance Surveys. In particular, we looked at changes in service access and coverage, the use of HIV testing and counseling services, and the changing prevalence of HIV and other sexually transmitted infections. RESULTS: HIV prevention interventions among FSWs increased greatly between 1987 and 2013. Only 72 FSWs were reached in a pilot program in 1987, whereas 40,508 FSWs were reached during a national program in 2013. Annual condom sales and the proportion of FSWs who used HIV testing and counseling services increased significantly, whereas the prevalence of gonorrhea and chlamydia decreased. The representation of FSWs in national HIV strategic plans and guidelines also improved. CONCLUSIONS: Ghana offers an important historical example of an evolving HIV prevention program that-despite periods of inactivity-grew in breadth and coverage over time. The prevention of HIV infections among sex workers has gained momentum in recent years through the efforts of the national government and its partners-a trend that is critically important to Ghana's future.