Abstract
Background:Research suggests that men who have sex with men (MSM) often engage in high-risk sex and use illicit substances.Objective:To increase understanding of HIV knowledge and vulnerability among adolescent and young adult MSM, with a focus on alcohol and drug use and transactional sex.Methods:We conducted in-depth interviews and Focus Group Discussions (FGDs) with adolescent (aged 15-17 years) and young adult (aged 18-29 years) MSM in Kumasi, Ghana. MSM who reported recent alcohol and/or substance use or engagement in transactional sex were eligible. Questions covered HIV-related knowledge, experiences with substance-use and transactional sex, and attitudes regarding sexual risk-taking and HIV-related services. Data were analyzed thematically using NVivo 10.0 software.Results:Ninety-nine MSM participated in 44 interviews and 8 FGDs. Most were attending or had completed secondary school. HIV knowledge was high, but with major gaps. Most consumed alcohol; one-fourth used drugs. Alcohol and substances were consumed to enhance pleasure during sex with another man. Transactional sex was common and positively viewed. Half of the participants used condoms inconsistently or never, and self-perceived HIV risk was high. Nearly half faced stigma-related barriers to accessing HIV-related services.Conclusion:As Ghana strives to achieve the UNAIDS’s 90-90-90 global targets (90% of people living with HIV know their status, 90% who know their status are on sustained treatment, and 90% of those on treatment are virally suppressed), we recommend enhancing MSM-targeted prevention programs, improving care options, and increasing use of critical clinical HIV-services by ensuring that MSM receive unbiased, confidential care.
Highlights
More than three decades have passed since HIV was first characterized among men who have sex with men (MSM) in North America [1]
This study was designed to illuminate beliefs and behaviors contributing to vulnerability to HIV infection faced by young men who have sex with men in Ghana, those engaging in transactional sex and alcohol or drug use
We found that accessing needed health services is a substantial challenge for many MSM in Ghana due to the fear of discrimination by providers
Summary
More than three decades have passed since HIV was first characterized among men who have sex with men (MSM) in North America [1]. While HIV prevalence has declined globally, MSM continue to be disproportionately affected, in low resource settings [2]. There are signs of intensifying HIV epidemics among MSM—both in generalized epidemics and where MSM are considered to be at high risk of infection [3]. In sub-Saharan Africa, where the HIV burden is greatest, overall adult prevalence is 4.4%, but typically much higher among MSM [4]. Nowhere is this difference more striking than in West Africa. Research suggests that men who have sex with men (MSM) often engage in high-risk sex and use illicit substances
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