Knowledge and experience of a cohort of HIV-positive and HIV-negative Ghanaian women after undergoing human papillomavirus and cervical cancer screening.

BACKGROUND: Cervical cancer is the most common cancer in women in Ghana, but knowledge and experience of women who have had cervical screening is under-evaluated. This study examined knowledge and understanding of HPV and cervical cancer and evaluated experiences of screening in a cohort of women of mixed HIV status. METHODS: This was a mixed methods study using questionnaires and focus group discussions, with a knowledge score constructed from the questionnaire. HIV-positive and HIV-negative women were recruited from a larger cervical screening study in Ghana and were interviewed 6 months after receiving screening. Quantitative data was analyzed and triangulated with qualitative data following thematic analysis using the framework approach. RESULTS: A total of 131 women were included (HIV-positive, n = 60). Over 80% of participants had a knowledge score deemed adequate. There was no difference between HIV-status groups in overall knowledge scores (p = 0.1), but variation was seen in individual knowledge items. HIV-positive women were more likely to correctly identify HPV as being sexually-transmitted (p = 0.05), and HIV negative women to correctly identify the stages in developing cervical cancer (p = < 0.0001). HIV-positive women mostly described acquisition of HPV in stigmatising terms. The early asymptomatic phase of cervical cancer made it difficult for women to define "what" cancer was versus "what" HPV infection was. All women expressed that they found it difficult waiting for their screening results but that receiving information and counselling from health workers alleviated anxiety. CONCLUSIONS: Knowledge of women who had participated in a cervical screening study was good, but specific misconceptions existed. HIV-positive women had similar levels of knowledge to HIV-negative, but different misconceptions. Women expressed generally positive views about screening, but did experience distress. A standardized education tool explaining cervical screening and relevance specifically of HPV-DNA results in Ghana should be developed, taking into consideration the different needs of HIV-positive women

Does labour matter in reforms? Indications from Ghana’s environmental sanitation policy: Does labour matter in reforms? Indications from Ghana’s environmental sanitation policy

Recent policy debates point to public service privatisation as a solution to the problems of state indebtedness, non-performance, and inefciency of the public sector. This privatisation agenda has raised concerns about the implications for jobs and working conditions. In developing countries like Ghana, where markets are weak or exhibit signs of failure, state policy becomes a vital avenue for securing decent working conditions for workers. Using an appraisal of Ghana’s Environmental Sanitation Policy and through the lens of institutional theory, the paper argues that the extent to which employment rights are framed, even at the policy stage, signals how labour rights will be impacted within privatised employment spaces. The analysis shows that the environmental sanitation policy ignores the interests of labour. The paper, therefore, recommends the need for inputs of labour market institutions such as trade unions at the policy stage. This is because trade unions remain the most credible source of response to the unrestrained exploitative tendencies of capital at the expense of labour

Informal operators in waste management in Accra, Ghana: From neglect to recognition? Informal operators in waste management in Accra, Ghana: From neglect to recognition?

Informal waste collectors play an essentialrole in urban solid waste management; however,in many developing countries, they are neglectedin the waste management policy framework. Thispaper explored the policy regime of informal waste operators in waste management in Accra, Ghana.Drawing on qualitative data from in-depth interviews and focus group discussions with informal waste collectors, private waste companies and officials of Accra Metropolitan Assembly, the paper shows that formal waste contractors with concession rights underserve low-class areas due to operational difficulties. The informal waste collectors fill this gap by providing services to these underserved communities though they have no legal entitlement to the concessions. The formal waste contractors and the municipal authorities recognize this gap filling role of informal waste collectors in waste management in Accra yet fail to provide the official recognition to legitimise their participation in solid waste management. The lack of official recognition, even in formal policy documents, undermines the development of informal waste management services as a viable employment option. It also denies a substantial section of the residents in poorer neighbourhoods in the national capital access to affordable and efficient waste management services