The MWP has engaged in numerous research projects in sub-Saharan Africa and other low and middle income countries examining co-occurring health and mental health issues. While the MWP engages in program design, we will continue to use rigorous research methods to evaluate our programs and engage in ongoing adaptive management. Check out our work below! For publications that are not open access, we are happy to provide you with the full article if you contact us directly.
A Systematic Review of HIV Risk Behaviors and Trauma Among Forced and Unforced Migrant Populations from Low and Middle-Income Countries (LMIC): State of the Literature and Future Directions
The review of the literature significantly advanced the field indicating a relationship between trauma and HIV risk behaviors among migrant populations in LMIC, specifically with sexual violence and sexual risk behavior. This is a critical finding as current HIV prevention interventions lack a trauma-focus among migrant populations globally. Findings from the review also highlight the need for additional research using more rigorous methods to understand the nature of the relationship among HIV risks and trauma experienced by migrants from LMIC.
A qualitative study of migrant-related stressors, psychosocial outcomes and HIV risk behavior among truck drivers in Zambia
In collaboration with the International Organization of Migration, Zambia we utilized qualitative in-depth interviews to examine the relationship between migration, trauma and HIV risk behaviors among truck drivers along the Copperbelt route in Zambia. In the study we found that truck drivers experience multiple stressors and potentially traumatic incidences, including delays and long waiting hours at borders, exposure to crime and violence, poverty, stress related to resisting temptation of sexual interactions with sex workers or migrant women, and job-related safety concerns. Multiple psychosocial problems such as intimate partner violence, loneliness, anxiety and depression-like symptoms were also noted to be related to HIV sexual risk. Inconsistent condom use, especially with transactional sex was identified as HIV sexual risk behaviors. These findings significantly advance the field and suggest the critical need to develop HIV prevention interventions which account for mobility, potentially traumatic events, psychosocial problems, and the extreme fear of HIV testing among this key population in a country which is heavily burdened by HIV.
“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
In collaboration with the Ministry of Community Development and Maternal and Child Health, University of Zambia School of Social Development, Findings from the interviews (N=20) and focus group discussion (N=12) indicated that fish traders in Zambia are exposed to multiple and ongoing potentially traumatic experiences (e.g. sexual violence, river accidents, intimate partner violence, AIDS-related deaths), trauma symptoms resembling PTSD, complicated grief, depression and local idioms of distress (e.g. nightmares, thinking too much, hatred in the heart, troubles in the heart, lack of peace, intrusive thoughts), and HIV risk behaviors (multiple partners, transactional sex for fish, etc.).The results suggest a relationship between trauma and HIV sexual risk behavior, indicating the importance of addressing both the mental health problems and HIV sexual risk among this vulnerable population. This study is an important contribution to the field as it is the first to examine trauma, mental health problems and the relationship with HIV risk among an extremely vulnerable and under-served population at high risk for HIV.
In collaboration with Johns Hopkins University, we conducted a systematic review of peer-reviewed qualitative studies which identified global symptoms of post-traumatic stress that may not be identified in current assessment tools. This innovative systemic approach, where data was extracted from open-ended studies, allowed us to determine if there are symptoms that are important in other parts of the world but are not emphasized or even included in western conceptualizations. The search (total N=392 studies) indicated a number of symptoms that frequently occurred across regions globally that are not included in the DSM-5 post-traumatic stress disorder diagnosis, such as constant sense of fear, sadness, physical pain, fatigue, headaches and thinking too much. There was considerable overlap with symptoms of depression, complex post traumatic stress disorder, and somatization, highlighting the need to account for these symptoms among trauma-affected populations globally. Also of large significance, the study indicated a number of symptoms which are not accounted for in western assessment tools, but were indicated among trauma-affected populations from western contexts, suggesting the limitations of current models of mental health. Through a weighted analysis across regions, we found a total of 85 psychosocial and mental health symptoms that were indicated in all regions globally. These symptoms have formed the Global Post Trauma Symptom Bank which has been refined, reduced and validated in Zambia, Uganda, and South Africa. Please stay tuned for more studies utilizing this scale!
Additional studies from our team that have informed our work:
"We always live in fear of being attacked by thugs or even ordinary South Africans because they always say that foreigners have come to our country to get what belongs to us. And some of my friends got attacked and injured quite badly.”
- Zambian truck driver