"I told myself, be bold and go and test": Motivators and barriers to HIV testing among gay, bisexual, and other cis-gender men who have sex with men in Ghana ‒ West Africa

Abstract

Despite a disproportionately high burden of HIV, GBMSM in Ghana and sub-Saharan Africa often delay testing until the point of illness. However, limited studies examine factors that affect their participation in testing. We used qualitative in-depth interviews (IDIs) and focus group discussions (FGDs) to collect insights into experiences, motivators, and barriers to HIV testing among GBMSM. Two community-based organizations used snowball and convenience sampling to recruit 10 GBMSM for IDIs and 8 to 12 for FGDs. We transcribed, coded, identified, and analyzed the relationship and commonalities between the participants’ responses. Under experiences with testing, 1) fear of HIV infection created a stressful HIV testing experience, and 2) a friendly and supportive healthcare environment facilitated a positive experience in healthcare facilities. Motivators or facilitators of testing include 1) the perception or belief that HIV testing is an HIV prevention strategy; 2) encouragement from friends and peers; 3) understanding risk associated with certain sexual behaviors; 4) education or information on HIV; 5) access to free testing and incentives; 6) early symptoms and provider recommendation. Barriers to HIV testing include 1) negative community perceptions of HIV; 2) individual-level low-risk perception or indifference about HIV infection; 3) health system issues; 5) Perceived stigma at healthcare facilities. The findings point to the need to address critical issues around stigma, education, peer support, and healthcare resources through interventions and research to improve HIV testing among GBMSM in the country.

“It’s a Lot of Closets to Come Out of in This Life”: Experiences of Brazilian Gay Men Living with Human Immunodeficiency Virus at the Time of Diagnosis and Its Biopsychosocial Impacts

“…Studies indicate that both serophobia and homophobia, whether internalized or perceived in the community, increase the likelihood of gay men engaging in high-risk sexual behaviors for HIV exposure [40,41]. They also decrease the likelihood of individuals undergoing regular testing [42,43] and adhering to treatment among those already diagnosed [44,45]. These three effects of stigma, in their various forms, partially explain the disproportionate increase in the incidence and prevalence of HIV among gay men in Brazil [3][4][5][6], including among those diagnosed late.…”

Qualitative description of interpersonal HIV stigma and motivations for HIV testing among gays, bisexuals, and men who have sex with men in Ghana’s slums—BSGH-005

“…Research assistants (EYZ, OWS) engaged in data collection had prior and extensive research training from working with these populations in the past. We also utilized the expertise of these researchers in our past studies, with similar populations, hence, the familiarity and experience engaging our participants [23,24,[40][41][42][43][44]. The research assistants also read the consent forms out loud and provided extra explanations to ensure everything was understood.…”

A qualitative description of HIV testing and healthcare experiences among trans women in Ghanaian urban slums BSGH-011

“…Trans women in these areas are likely to have low HIV testing rates due to poor access to services, low HIV risk perception, lower education levels, and poverty [50][51][52][53] .Additionally, in low-resource settings, the impact of stigma on healthcare access is even more pronounced, presenting a signi cant barrier to service utilization compared to other contexts 54 . Healthcare-related stigma not only leads to avoidance of healthcare services but also adds discomfort and stress, adversely affecting health outcomes [55][56][57] . For instance, in Ghana, intersectional stigma and discrimination experienced by key populations not only deters them from seeking healthcare services, resulting in delayed diagnosis and treatment of physical health conditions, but also contributes to increased rates of depression, anxiety, and other mental health issues, as well as social exclusion and isolation 7,8,34,39,58 .…”