1. Abuse Among Kayayo(o) in
Accra, Ghana
MICHELLE FLETCHER
SCHOLAR, SUMMER HIV/AIDS RESEARCH PROGRAM 2016
CENTER FOR PUBLIC HEALTH RESEARCH & UCSF GLOBAL HEALTH SCIENCES
SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH
7. Study Overview
Kayayo(o) a Key/Priority population?
◦ President’s Emergency Plan for AIDS Relief (PEPFAR) and gender based violence (GBV) funds
to support programs for Kayayo(o) if at risk
To assess
◦ Prevalence of HIV, HSV-2 (herpes type 2) , and pregnancy among Kayayo(o) in Accra and
their associated risk behaviors
◦ STI history and treatment-seeking behavior
◦ Willingness of Kayayo(o) to use HIV, STI, and sexual and reproductive health services and
identify components of a minimum package of services that can be offered to Kayayo(o)
8. Methods
Cross-sectional bio-behavioral study conducted in 2012 in Accra, Ghana
N=300
Face-to-face risk questionnaire in 10 markets in Accra
◦ Demographic, mobility, HIV/STI knowledge, risk behaviors, history of treatment-
seeking behaviors, GBV experience
132 question behavioral questionnaire
◦ Conducted by locally trained investigators
Blood Collection
◦ HIV, other STI, pregnancy
9. Research Question
In the population of Kayayo(o) in Accra, Ghana, is
there an association between age and education
and abuse by relationship?
10. Results: Interesting Overall Study Findings
Less than 1% (3 out of 300) HIV prevalence among
Kayayo(o) v. 1.3% HIV prevalence in Ghana
1 unknown pregnancy; 4 pregnancies in total
11. Results: Demographic Findings
Age
◦ ~ 45% of women between 18-21
◦ ~ 43% of women older than 22
Education
◦ More than half (~54%) never went to school
◦ Less than 1% have any education beyond high school
Marital Status
◦ ~ 40% are married
◦ ~ 48% are single
Most spoken languages
◦ ~ 82% identify with Akan language (Central Ghana)
◦ ~ 46% identify with Mampruli language (Northern Ghana)
12. Types of Abuse
Verbal Abuse: insults, sworn at, or threatened
Moderate Physical Abuse: slapped, pushed, shoved, or had something
thrown that can hurt
Severe Physical Abuse: hit, kicked, beaten up, choked, burned, threated
with a weapon (gun, knife)
Sexual Abuse: physically forced to have sex or had sex when did not want
to
13. 91
38
2
9
84
0
10
20
30
40
50
60
70
80
90
100
By Husband By Boyfriend By Other Sex
Partner
By
Gatekeeper
By Other
Person
#ofWomen
Type of Relationship
Figure 1. Number of Kayayo(o) v. Abuse by relationship in past 12 months. Accra,
Ghana. N=224
15. 2 2
0 0
10
6
2 2
16
6
3 3
18
13
5
3
0
5
10
15
20
25
30
35
40
45
50
Verbal Moderate Severe Forced Sex
AgeofWomen
Type of Abuse
Figure 3. Age demographic of Kayayo(o) v. Abuse by Husband in past 12 months.
Accra, Ghana. N=91
16-17
18-21
22-25
26-35
16. 33
9
2 2
0
19
6
2
0 0
8
1 1 0 0
5
1 2
0 0
0
5
10
15
20
25
30
35
40
45
50
No School School w/o
Completion
Primary School JSS/JHS/Middle
School
SS/SHS/Secondary
School
#ofWomen
Education Level
Figure 4. Education demographic of Kayayo(o) v. Abuse by Husband in past 12
months. Accra, Ghana. N=91
Verbal
Moderate
Severe
Forced Sex
17. Limitations
Social Desirability Bias
◦ Underreported information
Does not represent entire Kayayoo population in Ghana
No data collected for Kayayoo under age 16 (age 16 age of emancipation
for kayayoo)
19. Acknowledgements
Mentors:
◦ Drs. Kelly Taylor & Willi McFarland
City & County of San Francisco
San Francisco Department of Pubic Health
◦ Center for Learning and Innovation
◦ Summer HIV/AIDS Research Program (SHARP)
◦ Jonathan Fuchs & Aminta Kouyate
National Institute of Mental Health
◦ Grant #5R25MH097591-02
Editor's Notes
Hello, my name is Michelle Fletcher and I will be entering my final year at California State University, East Bay this fall. I will be graduating next spring with a degree in Health Science with an emphasis in Community Health. Today I will going into detail about my project about a women’s group in Ghana.
http://www.commisceo-global.com/country-guides/ghana-guide
Country in West Africa
More than 100 ethnic groups; English is the official language; there are 9 recognized languages by the government, however, there are many that are spoken outside of the 9
Hierarchical society: respect via age, wealth, life experience, etc
Family values: good reputation is important; one bad thing that one person does poorly reflects on the entire family
Prideful: professional etiquette is important (speaking well, dressing well, eating properly)
Kayayoo are female head porters who work in the market or for a family in exchange for money, shelter, or food. They carry goods for people shopping in the market to their vehicles and/or other destinations.
Hidden population – not much is known about them
Variety of ages
Because they come to the city poor most do not have a place to live so they live in the market, on the street, in kiosks, with others in their situation
Because many leave from a poor home or a home where they may have faced abuse, coming to a big city like Accra leaves them vulnerable to faced even more violence
This study was created to determine health related problems Kayayoo encounter including HIV, access to care, and experience of GBV. The Centers for Disease Control Ghana wanted to determine if Kayayoo are a key or priority population at risk of HIV, and if so develop a plan of action. When conducting the study it became apparent that within this sample size there was less than 1% HIV prevalence and a higher prevalence for violence which is why I will be exploring more in depth various demographic characteristics and the link to social abuse & violence among this population.
Before I present the data on the types of abuse and violence these women faced I want to provide context on the terminology I will be referring to throughout the rest of the presentation. (Explain the types of abuse)
