Community-Based Interventions as Opportunities to Increase HIV Self-Testing and Linkage to Care Among Men Who Have Sex With Men – Lessons From Ghana, West Africa

Abstract

MSM in Ghana encounter challenges in accessing HIV services and may experience barriers to HIV self-testing due to multiple forms of stigma present in health care settings. We worked with community-based organization partners to implement three interventions that successfully engaged and retained MSM which provides an opportunity for linkage to self-testing and medical care. These interventions were (1) Many Men Many Voices (3MV) a locally-led culturally grounded group-level HIV prevention program, (2) Auntie's Corner: a mobile-app based connecting MSM to health monitoring by a registered nurse and (3) HIV Education, Empathy, & Empowerment (HIVE3): a mobile-app based peer support intervention for MSM living with HIV. The 3MV intervention may be effective in improving HIV self-testing due to its effectiveness in engaging MSM, increasing HIV testing, and improving MSM understanding of the need for HIV testing. The utilization of apps like Auntie's Corner could positively impact HIV self-testing among MSM because it increases contact with nurses and reporting of symptoms. In HIVE3, participants expressed appreciation of the security and privacy that protects their identities as MSM and the peer mentors' abilities to make referrals to the nurses in Auntie's Corners. The confidentiality component has proven key among MSM and connecting MSM to self-testing through apps to report their process and receive care could increase utilization. Together, we show the efficacy of using the community-engaged process in reaching and engaging highly stigmatized populations like Ghana and sub-Saharan Africa, and its potential in increasing HIV self-testing and linkage to HIV care.

HIV Education, Empathy, and Empowerment (HIVE3): A Peer Support Intervention for Reducing Intersectional Stigma as a Barrier to HIV Testing among Men Who Have Sex with Men in Ghana

“…In this paper, we describe the intervention and the adaptation process to serve as a guide for scholars and program implementers with interest in adapting interventions that will employ culturally relevant techniques and communication strategies to provide secured peer support targeted at improving HIV prevention and care among key populations in highly stigmatized environments. Our team created the currently adapted intervention to link people living with HIV with their peers, who can relate to their experiences living with HIV, and support them via effective information sharing, emotional connection, and linkage to nurses via a mobile platform [ 1 ].…”

“…In Ghana, men who have sex with men (MSM) experience multilevel stigma due to intersecting marginalized identities (e.g., sexual orientation, gender identity, HIV status) that contribute to adverse health outcomes [ 1 , 2 ]. In Ghana, same-gender sexual behavior may be punishable by up to three years of imprisonment [ 3 ].…”

“…For the current study, we employed a health promotion approach to collaborate with community partners in using the ADAPT-ITT model to adapt HIV Education, Empathy, and Empowerment (HIVE 3 ) Intervention to train MSM in Ghana to facilitate effective sexual health communication through peer mentoring and support. We specifically aimed to use peer support to address intersectional stigma, and improve HIV health-seeking behaviors among MSM, including HIV testing, and linkage to care using a mobile platform and effective communication strategies [ 1 ]. We used the Dennis Peer Support Model to develop the peer support components (emotional, informational, and appraisal support) to increase peer social support, decrease social isolation, and minimize intersectional stigma effects on HIV-related healthcare-seeking behaviors [ 17 , 18 ].…”

Perspectives of Policymakers on the Introduction and Scale-Up of HIV Self-Testing and Implication for National HIV Programming in Ghana

“…However, to conduct more active follow-up, obtaining contact information and unique personal identifiers (including biometrics) of clients is key to facilitate counseling text-messaging (along with specific locations of HIV clinics) and phone-based follow-up ( 10 ). In Ghana, a few strategies using community-based platforms have been piloted with success among the MSM population ( 36 ). These pilot interventions showed that virtual community-based platforms through mobile and digital technology could be used to link MSM to HIV care providers.…”

“…These pilot interventions showed that virtual community-based platforms through mobile and digital technology could be used to link MSM to HIV care providers. One intervention provided access to peers via an online app for peer support and referral to the providers (36). Toll-free telephone hotlines, online counseling, and automated text messaging may also be considered for counseling and facilitating linkage to care (8,10,19,(37)(38)(39)(40).…”