COVID-19, pandemic lockdowns and intimate partner violence among HIV-positive women in Ghana.

This study examines the prevalence and risk factors of physical, sexual, psychological, and economic violence during lockdowns associated with COVID-19 among HIV-positive women in Ghana. Data were collected in August 2021 from a cross-section of 538 HIV-positive women aged 18 years and older in the Lower Manya Krobo District in the Eastern region of Ghana. Logit models were used to explore relationships between women's self-reported experiences of physical, sexual, psychological /emotional, and economic violence under lockdown and key socio-economic and demographic characteristics. The findings indicate moderate to high prevalence of intimate partner violence (IPV) under lockdown in our sample: physical violence (30.1%), sexual violence (28.6%), emotional/psychological violence (53.7%), and economic violence (54.2%). IPV was higher on all four measures for educated women, poorer women, employed women, cohabiting and married women, and HIV seroconcordant couples.

The contexts of housing stability and change among HIV-positive persons in the Lower Manya Krobo Municipality, Ghana.

Due to stigma, discrimination and economic insecurity, persons living with HIV/AIDS (PLWHAs) are highly vulnerable to housing instability. For instance, PLWHAs are more likely to either remain stable in inadequate homes or change residence. Yet, few studies explore the contexts of housing stability and change among PLWHAs, especially in sub-Saharan Africa, where the majority reside. This study used qualitative in-depth interviews to explore the narratives of 38 PLWHAs on the contexts of housing stability and the circumstances leading to change in residence. On diagnosis with HIV, the majority of PLWHAs (58%) changed housing locations, mostly from bad to worse conditions. Reasons for change include: eviction due to stigma and discrimination, inability to afford rent, quest to hide HIV status and death of a cohabiting partner. Our findings suggest policy makers should pay attention to the deplorable and poor housing conditions of PLWHAs in Ghana.

Housing, psychosocial and adherence counseling among HIV+ persons in Ghana.

As part of providing comprehensive HIV/AIDS services, the Ghana National AIDS Control Programme (NACP) and Ministry of Health recommend that Persons Living with HIV/AIDS (PLWHAs) receive psychosocial support and follow-up visits that ensure medical and drug adherence assistance. The successful implementation of these support services requires patients to have stable and quality housing, yet studies that examine associations between housing, psychosocial support, and adherence counseling among PLWHAs in Ghana and sub-Saharan Africa are limited. Data were collected from 605 PLWHAs attending check-up and receiving Anti-Retroviral Therapy (ART) from both Atua Government Hospital and St. Martin's de Porres Hospital, located in the Manya Krobo district. Results show significant relationships between housing and access to psychosocial counseling and support. Specifically, respondents with stable homes and quality housing were significantly more likely to receive psychosocial counseling and support, compared to those without stable and quality housing. It is important for policy makers to consider housing as an important element of psychosocial counseling and care.

Managing HIV-positive sero-status in Ghana's most HIV concentrated district: self-perceived explanations and theoretical discourse.

As of December 2015 there were 37 million persons living with HIV/AIDS (PLWHAs), 70% of whom are in sub-Saharan Africa. Ghana, which contributes a relatively small number to Africa's HIV burden, has a generalised HIV epidemic. The current national prevalence is 1.47%. Agormanya, one of the HIV sentinel sites in the county and where this study was conducted, has current prevalence of 11.6%. This makes it critical to explore how persons infected with HIV manage their lives, especially in the midst of entrenched stigma and discrimination. However, available information on how PLWHAs in sub-Saharan Africa handle their day-to-day lives mostly dwell on food and nutrition. Thus, there is dearth of information on how PLWHAs in Ghana particularly handle the circumstances of their daily lives which are mostly coloured by their HIV-positive statuses, given their stigmatised identity. We explore how PLWHAs respond to the experiences and challenges of living with HIV/AIDS in Lower Manya Krobo, consistently most HIV-infected district in Ghana. Data were collected from 38 combined purposive and randomly selected HIV-positive persons in two leading hospitals (St Martins Depores Agormanya and Atua Government hospitals which provide specialised HIV care in the district. Using in-depth interviews, we studied how PLWHAs managed their routine livelihoods in the midst of extreme stigma. We combined the social capital and resilience theoretical frameworks to show that our respondents were mostly resilient and strategically mostly drew upon extended family social support to cope with their livelihood challenges. We recommend that community opinion leaders and other stakeholders sensitise community members in Lower Manya Krobo to better understand the mode of HIV infection and encourage/strengthen family and community cohesion and social support.

" he always slaps me on my ears": the health consequences of intimate partner violence among a group of patrilineal women in Ghana.

Intimate partner violence has implications for women's health globally. Patrilineal women have been shown to have increased risk of experiencing intimate partner violence, yet, the health consequences of intimate partner violence in patrilineal women have not been thoroughly explored or documented. This study used qualitative in-depth interviews to explore the health effects of intimate partner violence among 15 ever-partnered Ghanaian patrilineal women. Participants attributed violence to several factors including gendered domestic relations, cultural and marital rites and alcohol use, among other factors. Abused women reported health problems such as feelings of worthlessness, sleeplessness, suicidal ideation, eye injuries, bodily weakness, hypertension, genital sores and the premature termination of pregnancy. Policy makers should pay particular attention to intimate partner violence-related health consequences in designing health interventions for abused women.

Intimate Partner Violence and Health Outcomes Among Women Living With HIV/AIDS in Ghana: A Cross-Sectional Study.

Intimate partner violence (IPV) is known to have negative health consequences for victims. For women living with HIV/AIDS, whose health may be compromised, exposure to IPV can be devastating. Yet few (if any) studies have explored the health implications of exposure to IPV among HIV-positive women. We begin to fill this gap by examining the effects of various dimensions of IPV (physical, sexual, psychological/emotional, and economic) on the cardiovascular, psychosocial, and sexual reproductive health outcomes of HIV-positive women in Ghana. Data were collected from a cross-section of 538 HIV-positive women aged 18 years and older in the Lower Manya Krobo District in the Eastern Region. We used logit models to explore relationships between IPV and health. The findings indicate high prevalence of IPV in our sample: physical violence (61%), sexual violence (50.9%), emotional/psychological violence (79.6%), and economic violence (66.8%). Generally, participants with experiences of IPV reported cardiovascular health problems, unwanted pregnancies and pregnancy loss, and poor psychosocial health. Our findings suggest the importance of screening for IPV as part of HIV care in Ghana.

Intimate Partner Violence (IPV) Against HIV-Positive Women in Sub-Saharan Africa: A Mixed-Method Systematic Review and Meta-Analysis.

OBJECTIVES: To systematically analyze and summarize the literature on intimate partner violence (IPV) against HIV-positive women in sub-Saharan Africa (SSA) and to identify their risk factors for IPV. METHOD: A comprehensive review of the literature using the Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) and Meta-Analyses of Observational Studies in Epidemiology (MOOSE) yielded 1,879 articles (PubMed = 1,251, Embase = 491, Web of Science = 132, and identified additional records = 5). Twenty were selected for quantitative and qualitative assessment and synthesis. We employed a random effects model with generic inverse variance method and estimated the odds ratios. FINDINGS: Results indicated a high prevalence of physical, sexual, and emotional violence against women living with HIV/AIDS in SSA. Educational background, alcohol use, marital status, previous experiences with IPV, and employment status were identified as significant risk factors. We also assessed the methodological quality of the articles by examining publication bias and some heterogeneity statistics. CONCLUSION: There is limited research on IPV against HIV-positive women in SSA. However, the few existing studies agree on the importance of targeting HIV-positive women with specific interventions given their vulnerability to IPV and to address factors exacerbating these risks and vulnerabilities.

Does Economic Abuse Affect the Health Outcomes of Women in Ghana?

Although academically underexplored, economic abuse is common in most societies. Using data collected from 2,289 ever-married Ghanaian women, this study employed regression techniques to examine dimensions of economic abuse (employment sabotage, economic exploitation, and economic deprivation) on the cardiovascular, psychosocial, and overall general health of respondents. Results showed respondents with experiences of economic sabotage had poor psychosocial health. Meanwhile, compared with those with no such experiences, respondents with experiences of economic exploitation not only reported poor psychosocial health but were also more likely to live with cardiovascular diseases. Women with experiences of economic deprivation reported poor psychosocial health, were more likely to live with cardiovascular diseases, and more likely to report poor or good than very good health. Our findings suggest the need to screen for economic abuse as a correlate of poor health among women in Ghana.

A life course understanding of domestic and intimate partner violence in Ghana.

Previous studies demonstrate the long term effects of childhood violence on future victimization and perpetration of intimate partner violence (IPV). With a few exceptions from Asia, however, this literature is largely limited to North America and Europe. To date, contributions from sub-Saharan Africa remain scant. We began to fill this gap by applying the life course theory to retrospective data collected from 2289 women in Ghana. Specifically, we examined if women's childhood experiences of family violence were associated with their later victimization and/or their perpetration of IPV. We also explored the effect of the timing and continuity of family violence over the life course. Generally, we found that women with childhood experiences of violence were more likely to be victims and perpetrators of IPV than those with no such experiences. However, the effect and significance of the violence was more pronounced if it continued from early childhood (before age 15) to adulthood (after age 15). Violence experienced after age 15 was more significant than violence experienced before age 15, and women who perpetrated IPV were significantly more likely to be victimized themselves. To improve domestic violence interventions in Ghana, it is necessary to pay attention to victims' early childhood experiences.

Kinship and Intimate Partner Violence Against Married Women in Ghana: A Qualitative Exploration.

In African societies, kinship ties determine how women are socialized, their access to power and wealth, as well as custody of children, often considered important factors in married women's experience of intimate partner violence (IPV). Yet studies that examine how kinship norms influence IPV are scant. Using in-depth interviews collected from women identifying with both matrilineal and patrilineal descent systems, we explored differences in Ghanaian women's experiences of IPV in both kin groups. Results show that while IPV occurs across matrilineal and patrilineal societies, all women in patrilineal societies narrated continuous pattern of emotional, physical, and sexual assault, and their retaliation to any type of violence almost always culminated in more experience of violent attacks and abandonment. In matrilineal societies, however, more than half of the women recounted frequent experiences of emotional violence, and physical violence occurred as isolated events resulting from common couple disagreements. Sexual violence against matrilineal women occurred as consented but unwanted sexual acts, but patrilineal women narrated experiencing violent emotional and physical attack with aggressive unconsented sexual intercourse. Contextualizing these findings within existing literature on IPV against women suggests that policies aimed at addressing widespread IPV in Ghanaian communities should appreciate the dynamics of kinship norms.

Housing and Health Outcomes of persons living with HIV/AIDS (PLWHAs) in the Lower Manya Krobo District, Ghana.

OBJECTIVE: Although emerging in Western industrialized societies, limited research exists on the links between housing and health outcomes for persons living with HIV/AIDS (PLWHAs) in sub-Saharan Africa (SSA). METHODS: Using survey data collected from 605 PLWHAs in the Lower Manya Krobo district of Ghana, this paper examined the effects of housing structure, arrangements, accessibility and conditions on the physical and psychological/emotional health of respondents. RESULTS: Results indicate that housing variables have independent effects on health outcomes, controlling for socio-economic and demographic variables. Respondents living in poor housing structures and deplorable housing conditions had poorer physical and psychological health scores. CONCLUSION: The findings suggest that it is relevant to think about houses occupied by PLWHAs as important sources of health inequality.

Examining HIV-related stigma and discrimination in Ghana: what are the major contributors?

BACKGROUND: Although AIDS-related stigma and discrimination are considered detrimental to HIV prevention activities, not many studies have attempted to understand stigma and discrimination in sub-Saharan Africa, particularly Ghana. METHODS: Using the 2008 Ghana Demographic and Health Survey and applying the ordinary least-squares technique, this study examined what influences AIDS-related stigma and discrimination among men and women in Ghana. RESULTS: The results indicate that Ghanaian men and women with relatively high knowledge about HIV/AIDS had low stigmatising and discriminatory attitudes (b=-0.097, P<0.01; b=-0.083, P<0.01), respectively. On the other hand, respondents who endorsed more myths about HIV transmission had high stigma and discriminatory attitudes. Women who had ever tested for their HIV serostatus reported significantly lower levels of stigma and discrimination (b=-0.085, P<0.01) compared with those who had not tested for HIV. Individuals who are highly educated, employed and in wealthy households all reported significantly lower levels of stigma and discrimination compared with those who are uneducated, unemployed and in poorer households. CONCLUSION: AIDS-related stigma and discrimination can be reduced by encouraging HIV testing, and ensuring that Ghanaians understand and have factual knowledge regarding the transmission of the disease.