Michael Perry Kweku Okyerefo

Constructions of masculinity and femininity and sexual risk negotiation practices among women in urban Ghana

Using qualitative data gathered through in-depth interviews with women in Accra, Ghana, this paper explores narratives of masculinity and femininity and sexual risk negotiation practices among women. While women framed ‘proper’ masculinity in terms of stereotypical reproductive norms, they also acknowledged the fluidity and multiplicity of masculinities. Femininity was more uniformly characterised in terms of physical attractiveness and beauty, responsibility and reproduction. These features, especially those related to adherence to morally and socially appropriate sexual norms (e.g., menstrual and bodily hygiene, unplanned pregnancy etc.), influenced womens approach to sexual negotiation. Work aiming to support women to negotiate sex safely needs to pay attention to their notions of gender and practices of sexual negotiation.

Prayer and health-seeking beliefs in Ghana: understanding the ‘religious space’ of the urban forest

ABSTRACT Few studies have examined the relationship between religiosity and health-seeking belief outcomes in Ghana. Drawing on in-depth interviews and group discussions with informal prayer group members and leaders in Accra, Ghana, the study explores participants’ conceptions of illnesses and the significance of the forest as a place of gathering and healing. There are several reasons why prayer group members in this study make their way to the forest, including finding a serene sacred space in a crowded city to confront the vicissitudes of life. Disease, for the prayer group members, is seen to hold both spiritual and physical origins, inspiring them to seek both biomedical and spiritual forms of care. Interviewees believed hospitals could help with physical diseases, but saw spiritual diseases as requiring spiritual solutions. There was a salient differentiation expressed between treatment and healing, however: doctors can treat certain conditions, but only God heals. While there is a need for public health practitioners to better engage spiritual/religious leaders and their followers with mainstream biomedicine, and to challenge some of their misconceptions and mistrust, attending to and understanding the role of religious beliefs, and religious spaces, in everyday conceptions of health, would strengthen the promotion of both men’s and women’s health in this context.

Use of Non-Prescription Remedies by Ghanaian Human Immunodeficiency Virus-Positive Persons on Antiretroviral Therapy

Background Inappropriate use of non-prescription remedies by persons living with human immunodeficiency virus (PLHIV) may result in adverse events or potentiate non-adherence to prescribed medications. This study investigated the use of non-prescription remedies among PLHIV receiving antiretroviral therapy (ART) from four treatment centers in southern Ghana. Methods A mixed method design using quantitative and qualitative methods was used. This article focuses on the quantitative survey of 540 respondents. Univariate analysis was used to generate descriptive tabulations of key variables. Bivariate analysis and logistic regression modeling, respectively, produced unadjusted and adjusted associations between background attributes of PLHIV and the use of non-prescription remedies. A p-value of < 0.05 was considered statistically significant. All analyses were performed using IBM SPSS Statistics for Windows, Version 20.0. Results One out of three respondents reported the use of non-prescription remedies at least once within 3 months of the survey. Most of these were locally made and included “Angel natural bitters, concoctions from the Christian prayer centers, garlic, and mahogany syrups.” These remedies were used concomitantly with antiretroviral medications (ARVs)—46% or administered with ARVs but at different times during the day (43%). Some of the remedies were reportedly prescribed by health workers, or self-initiated during periods of ARVs shortage. Others took them based on their perception of their efficacy. Bivariate level analysis identified ART clinic site, place of residence, and ARV adherence monitoring to be significantly associated with the use of non-prescription remedies (p < 0.05). Multiple logistic regression analysis controlling for covariates confirmed the location of ART clinic as the only predictor of the use of non-prescription remedies. Compared to clients at the large urban teaching hospital (Korle-Bu Fevers Unit ART center), those at the district level (Atua ART center) were ninefold more likely to use non-prescription remedies [adjusted odds ratio (AOR) = 8.84; 95% confidence interval (CI) 2.83–33.72]. Those from a district level mission hospital (St. Martin’s ART center) were threefold as likely to use these remedies (AOR = 2.610; 95% CI 1.074–9.120). Conclusion The use of non-prescription remedies by PLHIV on ART is common in southern Ghana. Usage is mostly self-initiated because of perceived efficacy of remedy, and was more common among clients attending rural ART clinics.

ART access-related barriers faced by HIV-positive persons linked to care in southern Ghana: a mixed method study.

BackgroundTimely and enduring access to antiretroviral therapy (ART) by HIV-infected individuals has been shown to substantially reduce HIV transmission risk, HIV-related morbidity and mortality. However, there is evidence that in addition to limited supply of antiretrovirals (ARVs) and linkage to ART in many low-income countries, HIV+ persons often encounter barriers in accessing ART-related services even in contexts where these services are freely available. In Ghana, limited research evidence exists regarding the barriers HIV+ persons already linked to ART face. This paper explores ART access–related barriers that HIV+ persons linked to care in southern Ghana face.MethodsA mixed method study design, involving a cross-sectional survey and qualitative in-depth interviews, was conducted to collect data from four healthcare providers and a total of 540 adult HIV+ persons receiving ART at four treatment centres in Ghana. We used univariate analysis to generate descriptive tabulations for key variables from the survey. Data from qualitative in-depth interviews were thematically analysed. Results from the survey and in-depth interviews were brought together to illuminate the challenges of the HIV+ persons.ResultsAll (100%) the HIV+ persons interviewed were ARV-exposed and linked to ART. Reasons for taking ARVs ranged from beliefs that they will suppress the HIV virus, desire to maintain good health and prolong life, and desire to prevent infection in unborn children, desire both to avoid death and to become good therapeutic citizens (abide by doctors’ advice). Despite this, more than half of the study participants (63.3%) reported seven major factors as barriers hindering access to ART. These were high financial costs associated with accessing and receiving ART (26%), delays associated with receiving care from treatment centres (24%), shortage of drugs and other commodities (23%), stigma (8.8%), fear of side effects of taking ARVs (7.9%), job insecurity arising from regular leave of absence to receive ART (5.3%), and long distance to treatment centres (4.9%).ConclusionsThe results in this study suggest that efforts to provide and scale-up ART to all HIV+ persons must be accompanied by interventions that address structural and individual level access barriers.