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Government implemented education access policies occupy a prominent place in the discourse on access to education. Education access issues have, thus, been examined almost exclusively from macro-level structural perspective. The micro-politics that take place behind the scenes after structural access issues have been resolved is minimally broached. Drawing on qualitative data from first generation educated women in Ghana and their mothers, this paper addresses the dark underbelly of girls' access to education, and the resistance activities undertaken by women to ensure that girls who become causalities of non-enrolment decisions are enrolled. Thus, the paper is guided by two questions. How do girls who become casualties of non-enrolment decisions go to school? How does the resistance activities women take against such non-enrolment decisions enable access for girls? In presenting the roles played by different actors such as mothers and kins, this paper makes an argument that, through women's resistance activities such as subverting the norms, covert diplomacy, and infractions of gendered rules in decision-making, women resist structural distribution of norms that exclude them from decision-making before girls can go to school unimpeded. [ABSTRACT FROM AUTHOR]

People with disabilities have an inviolable right to equitable access and participation in tertiary education and support systems are known to be indispensable in making this right a reality. This article presents the voices of students with disabilities regarding aspects that influence their successful access and participation in tertiary education in Ghana. A qualitative approach was adopted for the study with data collected through interviews with 12 students with disabilities in three public universities. From the perspective of these students, successful inclusion of people with disabilities in tertiary education in Ghana is influenced by enrolment practices, the built environment, teaching and learning approaches, and assessment provisions. The context influenced provisions and support provided. Attitudes of the university community and lack of knowledge of inclusive practices such as Universal Design play a role in students' access and participation. Comprehensive awareness-raising on disability and inclusive practices is recommended to address this issue. This paper explores inclusion practices in three Ghanaian public universities focussing on the combined voices of students with disabilities. The context of the three universities influences the provisions and support available for people with disabilities. The students with disabilities involved in the study reported that access to the university environment and support for academic engagement impact their university experience. The attitude of the university community is a factor in ensuring access, participation and success of people with disabilities in higher education. Creating awareness of disability issues within the university community is pivotal in building and sustaining inclusive culture. The application of universal design principles is essential to improving access and participation of people with disabilities in higher education institutions. [ABSTRACT FROM AUTHOR]

As an interface between health and education, comprehensive sexuality education (CSE) offers a potent tool among other interventions to accelerate healthy transition of adolescents into adulthood. With increasing interest in in-school CSE provision/delivery, young people in out-of-school contexts may be left behind. This study forms part of implementation research to understand if the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling them to engage a defined group of young people, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. This paper presents findings of mapping of out-of-school CSE interventions in Ghana, ongoing or completed between 2015 and 2020, and then discusses a needs assessment of two purposively selected groups of vulnerable out-of-school youth: young people living with HIV and AIDS (YPLHIV) and those living in detention (YPiD). We conducted 10 interviews with YPLHIV and three focus group discussions with YPiD in November 2020. Qualitative data were analysed thematically using both deductive and inductive approaches. The mapping yielded 29 interventions (18/62% were ongoing) focused extensively on the delivery of CSE-related knowledge and information; none were aimed at building facilitators' capacity and most targeted the northern regions. Among YPLHIV, living positively after diagnosis, disclosure skills and use of HIV/AIDS health services were critical. YpID sought clarification on personal hygiene, consent in sexual relationships, medium/channel to deliver CSE, and issues around same-sex sexual intercourse. Both groups sought skills in dealing with stigmatisation and discrimination. Implications of the findings for our own and other interventions are highlighted. [ABSTRACT FROM AUTHOR]

This study employs the therapeutic landscape theory to explore how online religious services during lockdown restrictions shape experiences of well-being and intergenerational learning. We used qualitative data from in depth interviews and focus groups with older adults and pastors in five churches in Ghana to explore how online religious places are conceptualized as therapeutic landscapes for sustaining wellbeing goals amidst a global pandemic. We identified multiple pathways of meaning through which online religious services shape the lives of people in a faith community to sustain the experience of well-being in a difficult time. In addition, this paper reflects on the broader implications of COVID-19 in shaping a paradigm shift in digital religion and intergenerational learning experiences through a changing religious landscape precipitated by lockdown restrictions that have drastically altered traditional religious places. [ABSTRACT FROM AUTHOR]

As an interface between health and education, comprehensive sexuality education (CSE) offers a potent tool among other interventions to accelerate healthy transition of adolescents into adulthood. With increasing interest in in-school CSE provision/delivery, young people in out-of-school contexts may be left behind. This study forms part of implementation research to understand if the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling them to engage a defined group of young people, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. This paper presents findings of mapping of out-of-school CSE interventions in Ghana, ongoing or completed between 2015 and 2020, and then discusses a needs assessment of two purposively selected groups of vulnerable out-of-school youth: young people living with HIV and AIDS (YPLHIV) and those living in detention (YPiD). We conducted 10 interviews with YPLHIV and three focus group discussions with YPiD in November 2020. Qualitative data were analysed thematically using both deductive and inductive approaches. The mapping yielded 29 interventions (18/62% were ongoing) focused extensively on the delivery of CSE-related knowledge and information; none were aimed at building facilitators' capacity and most targeted the northern regions. Among YPLHIV, living positively after diagnosis, disclosure skills and use of HIV/AIDS health services were critical. YpID sought clarification on personal hygiene, consent in sexual relationships, medium/channel to deliver CSE, and issues around same-sex sexual intercourse. Both groups sought skills in dealing with stigmatisation and discrimination. Implications of the findings for our own and other interventions are highlighted. [ABSTRACT FROM AUTHOR]

The health and wellbeing of older adults have taken center-stage in global policy agendas in recent times. In 2003, Ghana introduced an insurance exemption policy to eliminate financial barriers to healthcare for older adults and other vulnerable population groups. Embedded within the National Health Insurance Scheme (NHIS), this policy ostensibly guarantees free healthcare for older adults at publicly-funded facilities across the country. In this paper, we applied the implementation problem framework to identify gaps in the implementation of the exemptions policy and their impact on the healthcare experiences of older adults. Our data collection involved qualitative interviews with a purposive sample of community-residing older adults, health workers, community leaders, and policymakers. Our thematic data analysis identified resource, substantive, bureaucratic, political, and administrative constraints in the policy implementation process which, in turn, affected quality healthcare delivery. While most of these constraints are general challenges confronting the NHIS, they serve to undermine the intent of the scheme's exemptions policy. In particular, despite the exemptions, older adults continued to pay out-of-pocket for certain categories of treatments and medications, creating as yet financial barriers to healthcare. We present policy recommendations for addressing these implementation challenges, including suggestions to decentralize, depoliticize, and financially liberate the operations of the NHIS. Ghana's health insurance scheme has not eliminated financial barriers to healthcare for older adults. Older Ghanaians reported unmet healthcare needs, despite implementation of health insurance. Resource, substantive, bureaucratic, and political constraints impede the policy implementation process. Measures are needed to decentralize and depoliticize the NHIS implementation process. [ABSTRACT FROM AUTHOR]

Background: In psychiatric care, doctors depend on information from interactions with patients to arrive at the right diagnosis and appropriate therapy (Brisset C, Leanza Y, Rosenberg E, Vissandjée B, Kirmayer LJ, Muckle G, et al. language barriers in mental health care: a survey of primary care practitioners. J Immigr Minor Health. 2014;16(6):1238–46). This is a qualitative descriptive study which seeks to investigate language barriers faced by psychiatrists in their interactions with patients and the effectiveness of the strategies which are employed to deal with the barriers. Methods: Research questions are informed by Convergence (Giles H. Communication Accommodation Theory. In: Baxter LA, Braithewaite DO, editors. Engaging theories in interpersonal communication: multiple perspectives. Thousand Oaks (CA): Sage Publications; 2008. p. 161–73). Using semi-structured interviews, psychiatric doctors from the three state-owned psychiatric hospitals in Ghana report their experiences with convergence strategies they use, and offer suggestions that could inform future studies and policy formulation with regard to psychiatric care in Ghana. A qualitative conventional content analysis was applied whereby coding categories were derived straight from the text data. Results: The literature suggests that the study is novel with reference to Ghana. Similar studies (Lee E. Cross-cultural communication: therapeutic use of interpreters in mental health for professionals and clinicians. In: Lee E, editor. Working with Asian Americans: a guide for clinicians. New York (NY): The Guilford Press; 1997; Swartz L, Drennan G. Beyond Words: notes on the 'irrelevance' of language to mental health services in South Africa. Transcult Psychiatry. 2000;37(2):185–201; Jarvis GE, Ahmed R, Ryder A, Kirmayer LJ. Assessing language barriers to mental health services in a multiethnic population: preliminary findings. Presentation at Health care Access for Linguistic Minorities: Breaking the Barriers. Montreal, Quebec, Canada; 2014) corroborate this paper's findings that language barriers have the potential of causing misdiagnoses if psychiatrists do not employ effective communication strategies. Conclusions: The paper recommends areas for further research and improvement measures which carry policy implications. [ABSTRACT FROM AUTHOR]

Child Panels (CPs) are quasi-judicial bodies charged with administering alternative measures in accordance with the Juvenile Justice Act and the Children's Act in Ghana. This study set out to examine the functioning, relevance, efficiency, and sustainability of CPs. Drawing on qualitative research methods of observation, semi-structured interviews, and a case study, the major findings of this study include a lack of awareness of the concept and existence of CPs with only one functioning CP in 12 districts in the study area that were supposed to have them, and a general lack of training for members of the panel. Notwithstanding these findings, when researchers prodded, interviewees' responses pointed to tremendous support for the concept of CPs. The paper argues that implemented well, CPs have the potential to enhance access to justice for all children in the country considering their composition and requirement that they be formed by every municipal and district assembly in the country, which makes them more accessible to parents and their children everywhere in the country than other state agencies within the juvenile justice system. Hence, the paper recommends that CPs should be equipped to function efficiently. [ABSTRACT FROM AUTHOR]

This paper presents findings of a study that explored the challenges and coping strategies of parents of children with mental disorders. In-depth interviews were conducted with 35 parents of children with mental disorders at the Psychiatric Unit of the Komfo Anokye Teaching Hospital in Kumasi. Data were analyzed using thematic content analysis. Findings indicated that financial constraints, inability to secure permanent employment, and stigma were the challenges of the parents. Having faith in God and accepting their children's condition were the coping strategies adopted by the parents. However, lack of effective support system makes coping difficult for the parents. [ABSTRACT FROM AUTHOR]

Integrating consumers' experiences into quality mental health service assessment is relevant to improve service outcomes. Despite this, limited studies have attempted to explore consumers' experiences, particularly in developing countries, such as Ghana. This paper aims to explore consumers' subjective experiences of the quality of mental health services. A qualitative method involving in-depth interviews was used to collect data from 21 consumers of mental health services. Thematic analysis was used to analyse the data, which is discussed using a realistic evaluation approach. The study identifies four themes, 33 inductive codes and 594 references. The themes used to interpret the verbatim narratives are the available mental health services, therapeutic interaction with the professionals, competency and skills of the professionals, and the changes experienced in the consumers' lives. The study indicates that the mental health services aim to provide a range of treatments and medications as well as recovery-oriented services, using mechanisms such as ensuring an effective therapeutic relationship and improving technical competency and skills. The contextual factors and the mechanisms have helped to achieve some changes in the lives of consumers (increased satisfaction, reduced symptoms, improved functionality, feeling normal, improved living skills and self-care, work and capabilities, and social inclusion). The study concludes that policymakers and clinicians should integrate evidence-based recovery services, principles and values into the existing mental health services. The mechanisms used to promote quality of mental health services should be strengthened, through periodic monitoring and evaluation, using approaches such as sensor data capturing, to ensure good coordination and continuity. [ABSTRACT FROM AUTHOR]

This paper explores consumers' understanding and perception of the etiology of mental illness in community-based residential facilities in Ghana. Qualitative data involving in-depth interviews were used to collect data from 15 consumers of mental health services from two residential facilities. Thematic analysis was used to analyze the data. The study showed that mental illness is generally constructed within the medical and religious-cultural notion. The religious-cultural construction aligned mental illness to Ghanaian belief systems (supernatural forces, spirituality and traditional belief) and cultural practices (social norms and values) whilst the medical construction ascribed the etiology to biological, emotional and substance abuse issues. Although consumers had a positive perception of mental illness, they were doubtful about the presence of illness. The study concludes that the combination of medical, social and religious-cultural constructs and understanding of mental illness should be integrated into advocacy and awareness programmes to better educate consumers and clinicians. [ABSTRACT FROM AUTHOR]

The need to establish universal standards to protect children led to the development of the United Nations Convention on the Rights of the Child (UNCRC). I drew on literature exploring the UNCRC and children's rights to provision, protection, and participation. This paper aimed to ascertain challenges of enforcing children's rights to provision, protection, and participation in rural and urban Ghana drawing on the experiences and perceptions of 60 government officials, NGO representatives, and parents. Semistructured interviews were conducted with parents (10), stakeholders (10), focus groups (30); and participant observation techniques (10) were utilised to gather the required data and purposively sampled across rural and urban areas in Ghana. Interviews were recorded, and transcribed utilising a framework approach as the qualitative data analysis method. Acceptance of childhood as understood in the UNCRC is different from traditional child-rearing patterns in rural and urban Ghana. IMPLICATIONS Social workers' knowledge about dealing with dilemmas posed by rights to provision, protection, and participation for children may be enhanced. Social workers can improve their knowledge of factors that challenge the enforcement of children's rights for children engaged in child labour and the possible tension between children and parental rights in their everyday social work practice. Social workers can introduce culturally sensitive parenting programs and develop their own contribution towards monitoring and implementing the rights to provision, protection, and participation for children. [ABSTRACT FROM AUTHOR]

Child sexual abuse (CSA) is a prevalent problem in many societies across the globe. There have been several discussions of the subject and attempts have been made to explain its incidence and find ways to prevent and/or control it. However, despite these efforts, the problem seems to persist in developing countries like Ghana with dire consequences for the children and society at large. This paper sought to glean insights about the persistence of the problem by focusing on the discourse surrounding the subject. Using Focus Group Discussions with adult members in the Ga communities in Accra namely La, Teshie, and James Town where the phenomenon is relatively pervasive, the paper sought to understand the reasoning and the implications of accusing children who were sexually abused in the Ga community of seducing the perpetrators and engaging in sex for money. The paper posits that the labeling of victims of CSA as “gbɛkɛfɔŋs” (children of bad character) disempowers children and perpetuates the abuse of children. Thus, introducing and situating this notion of “gbɛkɛfɔŋs” in the center of the discourse largely results in a victimization of the victims and a vicious cycle of CSA. The conclusions from this study point to the need for a reorientation of parental and communal roles and an empowering of children to identify and resist sexual abuse. [ABSTRACT FROM AUTHOR]

Expanding access to sexual and reproductive health (SRH) services is one of the key targets of the Sustainable Development Goals. The extent to which sexual and reproductive health and rights (SRHR) targets will be achieved largely depends on how well they are integrated within Universal Health Coverage (UHC) initiatives. This paper examines challenges and facilitators to the effective provision of three SRHR services (maternal health, gender-based violence (GBV) and safe abortion/post-abortion care) in Ghana. The analysis triangulates evidence from document review with in-depth qualitative stakeholder interviews and adopts the Donabedian framework in evaluating provision of these services. Critical among the challenges identified are inadequate funding, non-inclusion of some SRHR services including family planning and abortion/post-abortion services within the health benefits package and hidden charges for maternal services. Other issues are poor supervision, maldistribution of logistics and health personnel, fragmentation of support services for GBV victims across agencies, and socio-cultural and religious beliefs and practices affecting service delivery and utilisation. Facilitators that hold promise for effective SRH service delivery include stakeholder collaboration and support, health system structure that supports continuum of care, availability of data for monitoring progress and setting priorities, and an effective process for sharing lessons and accountability through frequent review meetings. We propose the development of a national master plan for SRHR integration within UHC initiatives in the country. Addressing the financial, logistical and health worker shortages and maldistribution will go a long way to propel Ghana's efforts to expand population coverage, service coverage and financial risk protection in accessing essential SRH services. [ABSTRACT FROM AUTHOR]

Purpose: With the increasing number of assistance programs that target trafficking survivors around the globe, there is a need for documentation of evidence that can inform such programs. This paper examined and documented the post-intervention experiences of trafficked and vulnerable women who had received services at Lifeline, a residential care facility in Ghana, West Africa. Method: The study employed a secondary qualitative analysis of in-depth, face-to face interviews with n = 37 participants. Data analyzes were conducted using thematic analysis and themes and sub-themes were then extracted. Findings: Three major themes emerged from the study: major achievements after leaving Lifeline; challenges after leaving Lifeline; and family dynamics and relations after leaving Lifeline. Conclusion: Despite experiencing various social, psychological, and economic challenges after the intervention, participants reported that this particular agency had positively impacted their lives. [ABSTRACT FROM AUTHOR]

In Ghana, men who have sex with men (MSM) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is a biomedical intervention that reduces the risk of HIV infection but is not currently available in Ghana. This paper explores knowledge and acceptability of HIV PrEP among Ghanaian MSM. Qualitative content analysis was conducted on 22 focus group discussions (N = 137) conducted between March and June 2012 in Accra, Kumasi, and Manya Krobo. Overall, participants reported low knowledge of PrEP. However, once information about PrEP was provided, there was high acceptability. The primary reason for acceptability was that PrEP provided an extra level of protection against HIV. Acceptability of PrEP was conditioned on it having minimal side effects, being affordable and efficient in preventing HIV infection. No acceptability of PrEP was attributed to limited knowledge of side effects and perceived lack of effectiveness. The reasons provided to utilize PrEP and condoms were that condoms protect against other STIs, and sexual partner factors. This is the first known study to explore PrEP knowledge and acceptability among Ghanaian MSM. It is important that key stakeholders preemptively address potential barriers to PrEP acceptability, uptake, and adherence, especially among MSM, once PrEP becomes available in Ghana. [ABSTRACT FROM AUTHOR]

Background: Persons with disabilities have often been overlooked in the context of HIV and AIDS risk prevention and service provision. This paper explores access to and use of HIV information and services among persons with disabilities. Methods: We conducted a multi-country qualitative research study at urban and rural sites in Uganda, Zambia, and Ghana: three countries selected to exemplify different stages of the HIV response to persons with disabilities. We conducted key informant interviews with government officials and service providers, and focus group discussions with persons with disabilities and caregivers. Research methods were designed to promote active, meaningful participation from persons with disabilities, under the guidance of local stakeholder advisors. Results: Persons with disabilities emphatically challenged the common assumption that persons with disabilities are not sexually active, pointing out that this assumption denies their rights and – by denying their circumstances – leaves them vulnerable to abuse. Among persons with disabilities, knowledge about HIV was limited and attitudes towards HIV services were frequently based upon misinformation and stigmatising cultural beliefs; associated with illiteracy especially in rural areas, and rendering people with intellectual and developmental disability especially vulnerable. Multiple overlapping layers of stigma towards persons with disabilities (including internalised self-stigma and stigma associated with gender and abuse) have compounded each other to contribute to social isolation and impediments to accessing HIV information and services. Participants suggested approaches to HIV education outreach that emphasise the importance of sharing responsibility, promoting peer leadership, and increasing the active, visible participation of persons with disabilities in intervention activities, in order to make sure that accurate information reflecting the vulnerabilities of persons with disabilities is accessible to people of all levels of education. Fundamental change to improve the skills and attitudes of healthcare providers and raise their sensitivity towards persons with disabilities (including recognising multiple layers of stigma) will be critical to the ability of HIV service organisations to implement programs that are accessible to and inclusive of persons with disabilities. Discussion: We suggest practical steps towards improving HIV service accessibility and utilisation for persons with disabilities, particularly emphasising the power of community responsibility and support; including acknowledging compounded stigma, addressing attitudinal barriers, promoting participatory responses, building political will and generating high-quality evidence to drive the continuing response. Conclusions: HIV service providers and rehabilitation professionals alike must recognise the two-way relationship between HIV and disability, and their multiple overlapping vulnerabilities and stigmas. Persons with disabilities demand recognition through practical steps to improve HIV service accessibility and utilisation in a manner that recognises their vulnerability and facilitates retention in care and adherence to treatment. In order to promote lasting change, interventions must look beyond the service delivery context and take into account the living circumstances of individuals and communities affected by HIV and disability. Persons with disabilities are vulnerable to HIV infection but have historically been excluded from HIV and AIDS services, including prevention education, testing, treatment, care and support. Fundamental change is needed to address practical and attitudinal barriers to access, including provider training. Rehabilitation professionals and HIV service providers alike must acknowledge the two-way relationship between HIV and disability: people with disability are vulnerable to HIV infection; people with HIV are increasingly becoming disabled. Peer participation by persons with disabilities in the design and implementation of HIV services is crucial to increasing accessibility. Addressing political will (through the National Strategic Plan for HIV) is crucial to ensuring long-term sustainable change in recognizing and responding to the heightened vulnerability of people with disability to HIV. [ABSTRACT FROM AUTHOR]

The paper examines the hygiene practices and health risk perception of vegetable sellers in urban Ghana. Based on a qualitative in-depth study of vegetable sellers drawn from five purposively sampled markets in Kumasi Metropolis, the study found that the vegetable sellers have generally low risk perception. Consequently, the vegetable handling practices by these market women remain largely unsafe presenting potential health risks to consumers. Regular monitoring by relevant agencies and sustained public education are therefore key for reducing market contamination which is critical for maintaining a healthy population. [ABSTRACT FROM AUTHOR]

The need to improve the sexual and reproductive health (SRH) and rights of women with disabilities is increasingly acknowledged. Unfortunately, women with disabilities in low- and middle-income settings, including Ghana, face several barriers (including structural, financial, physical, social and attitudinal) to accessing SRH services and care. This paper explores the enablers and barriers to accessing SRH services and care among visually impaired women in the Ashanti and Brong Ahafo Regions of Ghana. Qualitative data from in-depth interviews and focus group discussions were collected from 21 visually impaired women, selected through purposive and snowballing sampling techniques. Thematic analysis was used to develop codes, and data were further grouped into emerging themes. The barriers to accessing SRH services and care were financial difficulties and lack of preferential treatment. The enablers which facilitated access to SRH services and care were the support provided by caregivers and friendly relationships with health providers. To address these challenges and promote access, SRH related policies, services and programmes should be inclusive of the needs of visually impaired women, and measures to remove financial challenges to service utilisation and foster positive relationships with health workers, church and community members should be adopted. [ABSTRACT FROM AUTHOR]

Mistreatment of women during childbirth at health facilities violates their human rights and autonomy and may be associated with preventable maternal and newborn mortality and morbidity. In this paper, we explore women’s perspectives on mistreatment during facility-based childbirth as part of a bigger World Health Organization (WHO) multi-country study for developing consensus definitions, and validating indicators and tools for measuring the burden of the phenomenon. Focus group discussions (FGDs) and in-depth interviews (IDIs) were used to explore experiences of mistreatment from women who have ever given birth in a health facility in Koforidua and Nsawam, Ghana. Interviews were audio-recorded, transcribed and thematic analysis conducted. A total of 39 IDIs and 10 FGDs involving 110 women in total were conducted. The major types of mistreatment identified were: verbal abuse (shouting, insults, and derogatory remarks), physical abuse (pinching, slapping) and abandonment and lack of support. Mistreatment was commonly experienced during the second stage of labour, especially amongst adolescents. Inability to push well during the second stage, disobedience to instructions from birth attendants, and not bringing prescribed items for childbirth (mama kit) often preceded mistreatment. Most women indicated that slapping and pinching were acceptable means to “correct” disobedient behaviours and encourage pushing. Women may avoid giving birth in health facilities in the future because of their own experiences of mistreatment, or hearing about another woman’s experience of mistreatment. Consensus definitions, validated indicators and tools for measuring mistreatment are needed to measure prevalence and identify drivers and potential entry points to minimise the phenomenon and improve respectful care during childbirth. [ABSTRACT FROM AUTHOR]

This paper examines Ghanaian young people's perceptions of the determinants of HIV- and AIDS-related stigma and discrimination, and how these perceptions may influence the de-stigmatisation process. Drawing on findings from an in-depth, multi-method qualitative study involving 104 school and street young people aged between 14 and 19 years, the paper presents young people's accounts of HIV and AIDS. The paper provokes discussion on how language and images associated with existing educational programmes on HIV and AIDS place young people in a dilemma. It also argues that fear and secrecy associated with the disease not only consolidate stigmatisation and discrimination, but also create the desire for retribution. It concludes by challenging health educators to pay particular attention to the language and images used in future educational programmes. [ABSTRACT FROM AUTHOR]

Many people living with HIV in Ghana make use of spiritual therapy, however complex. This paper describes the complexities of these therapies in the context of increasing access to antiretroviral (ARV) drugs and high levels of HIV stigma. The study took place in Kumasi and Offinso, both in the Ashanti Region of Ghana (the most populated region, with around 4.5 million people), and is the result of 15 months of anthropological and ethnographic research utilising observations and in-depth interviews with 48 HIV-positive persons, their families, and other significant people in the lives. The article describes the participants' experience of their HIV infection as a 'spiritual challenge,' which thereby formulated a personal need to 'heal body and soul.' The findings illustrate how crossing religious and denominational boundaries is an important element in people's search for healing and wellbeing. The article argues that, especially in the context of high levels of HIV stigma in Ghana, spiritual therapy is one pragmatic option available to people living with HIV as it helps them to find meaning to their predicament or extends their coping mechanisms. [ABSTRACT FROM AUTHOR]

This paper explores the use of informal credit as a strategy for managing risks by market women in northern Ghana. A broad concept of the costs of risk management strategies is introduced and encompasses both a time and monetary dimension. Based on qualitative data, the analysis reveals that market women invest a considerable amount of time in maintaining complex networks of informal credit providers to ensure their access to credit once a shock occurs. Informal credit involves high transaction costs and prevents market women from growing out of poverty in the long term. [ABSTRACT FROM AUTHOR]