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Ghana is experiencing high rates of HIV transmission and women have been identified as a group with increased vulnerability to infection. Women's vulnerability may be influenced by factors such as gender, unequal power relationships and poverty. Research was undertaken in Ghana from January to May 1999 to examine the experiences of HIV sero-positive women. Thirty-one women were interviewed to explore the broad context of disease transmission and to identify factors that mediated women's ability to protect themselves from infection. The poverty experienced by many of the women during their childhood years, coupled with a societal belief that favored the education of males, restricted the participants' educational and vocational opportunities. With limited education and few vocational skills, many of the women took boyfriends to assist them with the purchase of food, clothing and shelter, as a strategy for survival. For most women, the use of condoms with sexual partners was restricted by the high value placed on fertility, the negative association of condoms with prostitution, and the women's limited ability to influence decision-making in this area. The women's narratives provide a compelling description of the context of HIV transmission in Ghana. Strategies to expand and intensify the response to HIV prevention are presented and critiqued. [c] 2002 Elsevier Science Ltd. All rights reserved. Keywords: Ghana; HIV; Women; Risk environment

Human trafficking is a crime that is often shaped by violence, particularly for women who are trafficked. Additionally, trafficking survivors often report severe psychological distress, though research on the causes of this psychological distress is lacking, as there is little longitudinal data available on trafficking survivors. Informed by past literature on the links between violence and mental health among other traumatized groups of women, we investigate how experiences of violence influence posttraumatic stress, depression, and suicide ideation among a unique longitudinal sample of 116 labor-trafficked women in Ghana. We find that experiencing sexual violence while being trafficked is associated with higher levels of both depression and posttraumatic stress years after the trafficking period ended. This indicates both the long-term effects of stress and the enduring nature of psychological distress among the women in this study. Our analytic account of how violent experiences while trafficked impact mental health over the period of reintegration contributes to the general literature on violence and mental health among women, as well as to literature on the health implications of human trafficking., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.