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. 2017 Oct 3;17(1):770.
doi: 10.1186/s12889-017-4799-1.

"But the moment they find out that you are MSM…": a qualitative investigation of HIV prevention experiences among men who have sex with men (MSM) in Ghana's health care system

Sameer Kushwaha  1 , Yasmin Lalani  2 , Geoffrey Maina  3 , Adedotun Ogunbajo  4 , Leo Wilton  5   6 , Thomas Agyarko-Poku  7 , Yaw Adu-Sarkodie  7 , Francis Boakye  8 , Nanhua Zhang  9 , LaRon E Nelson  1   2   10
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"But the moment they find out that you are MSM…": a qualitative investigation of HIV prevention experiences among men who have sex with men (MSM) in Ghana's health care system

Sameer Kushwaha et al. BMC Public Health. .

Abstract

Background: The prevalence of HIV in Ghana is 1.3%, compared to 17% among men who have sex with men (MSM). There is limited empirical data on the current health care climate and its impact on HIV prevention services for Ghanaian MSM. The purposes of this study were to investigate (1) MSM's experiences using HIV prevention resources, (2) what factors, including health care climate factors, influenced MSM's use of prevention resources and (3) MSM self-identified strategies for improving HIV/sexually transmitted infection (STI) prevention among MSM in Ghanaian communities.

Methods: We conducted 22 focus groups (n = 137) with peer social networks of MSM drawn from three geographic communities in Ghana (Accra, Kumasi, Manya Krobo). The data were examined using qualitative content analysis. Interviews with individual health care providers were also conducted to supplement the analysis of focus group findings to provide more nuanced illuminations of the experiences reported by MSM.

Results: There were four major findings related to MSM experiences using HIV prevention resources: (1) condom quality is low, condom access is poor, and condom use is disruptive, (2) inaccurate information undermines HIV testing (3), stigma undermines HIV testing, and (4) positive attitudes towards HIV prevention exist among MSM. The main healthcare climate factors that affected prevention were that MSM were not free to be themselves, MSM were not understood by healthcare providers, and that MSM did not feel that healthcare providers cared about them. To improve HIV prevention MSM suggested increased education tailored to MSM should be provided to enable self-advocacy and that education and awareness are needed to protect human rights of MSM in Ghana.

Conclusion: MSM in Ghana are exposed to negative health care climates. Health care spaces that are unsupportive of MSM's autonomy undermine the uptake of prevention measures such as condoms, HIV testing, and accurate sexual health education. These findings contribute to knowledge to inform development of HIV prevention interventions for MSM in Ghana, such as culturally appropriate sexual health education, and digital technology to connect individuals with resources supportive of MSM.

Keywords: Ghana; HIV prevention; Health care climate; Health care providers; Men who have sex with men (MSM); Self-determination theory; Sexual health; Stigma.

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Conflict of interest statement

Ethics approval and consent to participate

The Kwame Nkrumah University of Science and Technology Committee on Human Research, Publication, and Ethics and the University of Toronto Research Ethics Board approved all study protocols. All participants have given written informed consent for unidentified data from focus groups and interviews to be published.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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