Using qualitative data gathered through in-depth interviews with women in Accra, Ghana, this paper explores narratives of masculinity and femininity and sexual risk negotiation practices among women. While women framed 'proper' masculinity in terms of stereotypical reproductive norms, they also acknowledged the fluidity and multiplicity of masculinities. Femininity was more uniformly characterised in terms of physical attractiveness and beauty, responsibility and reproduction. These features, especially those related to adherence to morally and socially appropriate sexual norms (e.g., menstrual and bodily hygiene, unplanned pregnancy etc.), influenced women's approach to sexual negotiation. Work aiming to support women to negotiate sex safely needs to pay attention to their notions of gender and practices of sexual negotiation.

BackgroundTimely and enduring access to antiretroviral therapy (ART) by HIV-infected individuals has been shown to substantially reduce HIV transmission risk, HIV-related morbidity and mortality. However, there is evidence that in addition to limited supply of antiretrovirals (ARVs) and linkage to ART in many low-income countries, HIV+ persons often encounter barriers in accessing ART-related services even in contexts where these services are freely available. In Ghana, limited research evidence exists regarding the barriers HIV+ persons already linked to ART face. This paper explores ART access–related barriers that HIV+ persons linked to care in southern Ghana face.MethodsA mixed method study design, involving a cross-sectional survey and qualitative in-depth interviews, was conducted to collect data from four healthcare providers and a total of 540 adult HIV+ persons receiving ART at four treatment centres in Ghana. We used univariate analysis to generate descriptive tabulations for key variables from the survey. Data from qualitative in-depth interviews were thematically analysed. Results from the survey and in-depth interviews were brought together to illuminate the challenges of the HIV+ persons.ResultsAll (100%) the HIV+ persons interviewed were ARV-exposed and linked to ART. Reasons for taking ARVs ranged from beliefs that they will suppress the HIV virus, desire to maintain good health and prolong life, and desire to prevent infection in unborn children, desire both to avoid death and to become good therapeutic citizens (abide by doctors’ advice). Despite this, more than half of the study participants (63.3%) reported seven major factors as barriers hindering access to ART. These were high financial costs associated with accessing and receiving ART (26%), delays associated with receiving care from treatment centres (24%), shortage of drugs and other commodities (23%), stigma (8.8%), fear of side effects of taking ARVs (7.9%), job insecurity arising from regular leave of absence to receive ART (5.3%), and long distance to treatment centres (4.9%).ConclusionsThe results in this study suggest that efforts to provide and scale-up ART to all HIV+ persons must be accompanied by interventions that address structural and individual level access barriers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2075-0) contains supplementary material, which is available to authorized users.

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Although sexual intercourse is an important aspect of women's sexuality, there is little knowledge on how women experience sexual pleasure in Ghana. In this paper we explore how women and men express sexual pleasure and highlight women's experience of sexual pleasure based on the narratives of 20 women and 16 men. Specifically, we focus on describing how women and men understand sexual pleasure, the factors that stimulate sexual pleasure, and show how women experience it. The interviewee's expressions of sexual pleasure were symbolic and had both direct and indirect manifestation. Ejaculation was reported to indicate a direct manifestation of sexual pleasure. Screams, facial and other expressions were reported to indicate indirect experiences of sexual pleasure, and were seen to be associated with female sexuality more than male sexuality. Women and men expressed sexual pleasure in a variety of ways (e.g., ejaculation, screaming, "good pain", treating a partner nicely after sex, asking rhetoric questions during sex, and prolonged sex intercourse) and there were no differences in the meanings both women and men ascribed to sexual pleasure, regardless of their demographic profiles. Women reported experiencing sexual pleasure as their male partners did based on meanings they attach to erotic sensuality as expressed in romance, foreplay, and physical attractiveness. If sex is sexually stimulating (e.g., due to a partner's agreeable personal hygiene), women would engage in it. Well-intentioned sexuality programmes emphasizing partners' touching each other for pleasure, as well as educating partners to maintain erotic sensuality is compelling for inducing sexual pleasure.

While women present themselves and their sexuality through dress and their deportment, there are areas of their sexual lives that are not so public and are less easy to research, such as intimate sexual relations. In this study, the authors report findings from interviews with men and women about a topic not often reported on – choice of sexual positions. The focus on sexual positions raises questions about sexual agency – who chooses, what do they choose, and why? It also raises issues of gender power and inequality between consenting (heterosexual) adults. In this study from urban Ghana, the authors show that women exercise sexual agency in the ‘bedroom’ but do so in ways that reflect emotional and relational security and, in turn, reflect men’s power. However, the article’s argument is not just about the power of men to seek and obtain pleasure. Women seek and obtain pleasure too.