“Life at the River is a Living Hell:” a qualitative study of trauma, mental health, substance use and HIV risk behavior among female fish traders from the Kafue Flatlands in Zambia

Abstract

BackgroundIn Western settings, the relationship between trauma history, posttraumatic stress disorder, substance use, and HIV risk behavior, is well established. Although female fish traders in Zambia are affected by HIV at rates estimated to be 4–14 times higher than the national prevalence, no studies have examined the co-occurring issues of trauma, substance use and HIV risk behavior among this vulnerable population. The current study examined: 1) trauma history, trauma symptoms and HIV risk behaviors and 2) the relationship between these co-occurring issues among female fish traders from the Kafue Flatlands in Zambia.MethodsTwenty individual semi-structured qualitative interviews and a focus group discussion (n = 12 participants) were conducted with female fish traders in the Kafue Flatlands of Zambia. Template analysis was used to examine the data.ResultsThe findings indicate that female fish traders in Zambia are at risk of multiple and ongoing traumatic events and daily stressors, severe mental health symptoms (including western conceptualizations of disorders such as anxiety, depression, post-traumatic stress disorder (PTSD) and complicated grief, as well as local idioms of distress), substance abuse, and HIV sexual risk behaviors. The results suggest a relationship between trauma and HIV sexual risk behavior in this population.ConclusionsThe indication of these co-occurring issues demonstrates the need for HIV prevention intervention efforts, which account for trauma, mobility, and psychosocial outcomes in order to reduce HIV sexual risk behavior among female fish traders in Zambia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12905-017-0369-z) contains supplementary material, which is available to authorized users.

Sexual risk behaviors, mental health outcomes and attitudes supportive of wife-beating associated with childhood transactional sex among adolescent girls and young women: Findings from the Uganda Violence Against Children Survey

“…As the results from this study demonstrate, childhood transactional sex is associated with self-harm in Uganda. Studies focused on transactional sex in adult populations have similarly documented high levels of trauma [ 67 ]. HIV prevention programming with AGYW may also benefit from a trauma-informed approach and mental health services for AGYW who have or are still engaging in transactional sex may be an important service.…”

Transactional Sex and HIV Risk among Adolescent School Girls in Ethiopia: Mixed Method Study

“…Thus the fact that they frequently cooccur does not necessarily mean that substance use causes TS; the causal direction could be the opposite. Students could be using substances as a coping mechanism in response to experiencing TS [53]. Meaning, substance use could be associated with TS both as a risk and coping mechanism.…”

Sexual and reproductive health in riverine communities: integrative review

“…As for the contents (Figure 2), after reading and organizing the information from the studies selected, it was possible to group them into four thematic categories: 1) Sexual component; 2) Reproductive component; 3) Environmental component; and 4) Sociocultural component. -Gender determinations on sexual and reproductive knowledge (17,(22)(23) -Gender-based violence (16,22) -Sexual aggression at the river and at home (16) -Child sexual abuse (16) -Forced marriage (16) Risk/vulnerabilities to STIs -Urogenital schistosomiasis (17) -Genital lesions (17) -Extramarital relationships (16) -Prostitution (Transactional sex) (16) -Unprotected sex, including the first sexual intercourse (16)(17)21,24) -Cutting tools shared between family members (razors, nail pliers) (21) -Low vaccination coverage for hepatitis B (21) -Alcohol abuse (16) -Multiple sexual partners (16) Prevention of STIs -Use of condoms as a prevention method (16,24) -Difficulties in the use of condoms as prevention (16,24) Perceptions of the STIs/HIV -HIV as a health problem (16) -HIV/STI: stigma and shame (16) Family planning/fertility control -Unplanned/undesired pregnancy (18) -High birth rates (18,23) -Decreased age of menarche (23) -Association between age of menarche and number of children (23) Perceptions and atitudes on abortion -Midwives and abortion (20) -Abortion (20,22) x Donation/adoption (20) -Recurrence of abortion (20) Problems...…”

“…The scientific evidence of the sexual component is related to the risks/vulnerabilities to STIs, the means of prevention and the perceptions of the riverine population on STIs, as verified in four studies (16)(17)21,24) .…”

“…In addition, there are also factors such as extramarital relationships and prostitution, which is part of the fish trade and is defined in the study by the term transactional sex, as sexual practice is used by riverine women to facilitate purchase/sale negotiations (16) . These practices commonly include unprotected sex, that is, no condom is used since the first sexual intercourse (16)(17)21,24) . However, in two studies, riverine inhabitants demonstrated knowledge about the risks of this practice (16,24) .…”