title: "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.
abstract: In Western settings, the relationship between trauma history, posttraumatic stress disorder, substance use, and HIV risk behavior, is well established. Although female fish traders in Zambia are affected by HIV at rates estimated to be 4-14 times higher than the national prevalence, no studies have examined the co-occurring issues of trauma, substance use and HIV risk behavior among this vulnerable population. The current study examined: 1) trauma history, trauma symptoms and HIV risk behaviors and 2) the relationship between these co-occurring issues among female fish traders from the Kafue Flatlands in Zambia.
  
  
  
  Twenty individual semi-structured qualitative interviews and a focus group discussion (n = 12 participants) were conducted with female fish traders in the Kafue Flatlands of Zambia. Template analysis was used to examine the data.
  
  
  
  The findings indicate that female fish traders in Zambia are at risk of multiple and ongoing traumatic events and daily stressors, severe mental health symptoms (including western conceptualizations of disorders such as anxiety, depression, post-traumatic stress disorder (PTSD) and complicated grief, as well as local idioms of distress), substance abuse, and HIV sexual risk behaviors. The results suggest a relationship between trauma and HIV sexual risk behavior in this population.
  
  
  
  The indication of these co-occurring issues demonstrates the need for HIV prevention intervention efforts, which account for trauma, mobility, and psychosocial outcomes in order to reduce HIV sexual risk behavior among female fish traders in Zambia.
authors.affiliation: Columbia University School of Social Work, Social Intervention Group, Global Health and Mental Health Unit, 1255 Amsterdam Avenue, Room 804, Mail Code 4600, New York, NY, 10027, USA. lm2996@columbia.edu.
authors.forename: Lynn T Murphy
authors.initials: LT
authors.lastname: Michalopoulos
authors.affiliation: University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, North Carolina, USA.
authors.forename: Stefani N
authors.initials: SN
authors.lastname: Baca-Atlas
authors.affiliation: Department of Social Development Studies, University of Zambia, School of Humanities and Social Sciences, Lusaka, Zambia.
authors.forename: Simona J
authors.initials: SJ
authors.lastname: Simona
authors.affiliation: University of Michigan, Curtis Center, School of Social Work, 1080 South University, Ann Arbor, 48109-1106, Michigan, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Jiwatram-Negrón
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Zambia, Lusaka, Zambia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ncube
authors.affiliation: Columbia University School of Social Work, New York, NY, 10027, USA.
authors.forename: Melanie B
authors.initials: MB
authors.lastname: Chery
mesh_terms: D000328:Adult; D005260:Female; D005398:Fisheries; D017144:Focus Groups; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D000066511:Intimate Partner Violence / Q000523:psychology; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D015995:Prevalence; D036301:Qualitative Research; D012309:Risk-Taking; D045483:Rivers; D012742:Sex Offenses / Q000523:psychology; D012725:Sexual Behavior / Q000523:psychology; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D000078329:Workforce; D015024:Zambia / Q000453:epidemiology
keywords: Female fish traders; HIV sexual risk; Mental health; Qualitative methods; Transactional sex; Trauma; Zambia