Stigma, discrimination, violence, and HIV testing among men who have sex with men in four major cities in Ghana

Int Health Trends & Persp

Turner

Nelson

et al. 2021

Despite constituting only about 1% of Ghana’s population, men who have sex with men (MSM) carry a disproportionate burden of HIV infections, constituting 18% of the population of people living with HIV in the country. Scholars have associated the disproportionate infection rates of HIV among MSM with existing structural factors (such as criminalization and stigma against MSM), and individual-level factors (such as sex without a condom, and transactional sex). Nonetheless, limited scholars consider intervention as an approach to reducing HIV and STI risk among MSM in the country. As such, in collaboration with community partners, we engaged MSM through the use of the ADAPT-ITT model to adapt the Many Men Many Voices (3MV) to address the needs of MSM. We addressed HIV/STD risk factors and ways to reduce HIV/STD infections. In this paper, we describe the use of the ADAPT-ITT model in the adoption and adaptation of the 3MV with MSM in Ghana. Whereas the 3MV was a good fit for our target population, we made modifications to fit the Ghanaian cultural setting by examining HIV and STD risk in the context of bisexuality, emphasizing on secrecy in location choice, and incorporating historical colonial setting in contextualizing sexuality and stigma in the Ghanaian sociocultural context. Our implementation process shows the efficacy of collaboration with community partners to implement culturally relevant interventions in HIV and STD prevention efforts in highly stigmatized environments.

Section: Discussionmentioning

confidence: 98%

An application of the ADAPT-ITT model to an evidence-based behavioral HIV prevention intervention for men who have sex with men in Ghana

Int Health Trends & Persp

Turner

Nelson

et al. 2021

“…MSM in Ghana remain disproportionately affected by the HIV epidemic, with an estimated prevalence of 18% compared to 2% for the general population [ 6 , 7 , 8 ]. Factors contributing to the increased risk of HIV transmission among MSM in Ghana include low rates of HIV testing, and stigma associated with HIV testing, insufficient knowledge of HIV pre-exposure prophylaxis (PrEP), and inconsistent condom use [ 2 , 9 , 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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

Owusu-Dampare

Ogunbajo

et al. 2021

IJERPH

Men who have sex with men (MSM) in Ghana remain at heightened risk of HIV infection, and face challenges in accessing HIV prevention and care services. Previous research in Ghana shows that MSM face intersectional stigma across ecological levels (family, peers, healthcare settings, and community level) and the criminalization of same-gender sexual behaviors in the country. To protect their wellbeing from exposure to stigma, many MSM avoid interactions with healthcare systems and services, which inadvertently inhibits their opportunities for early detection and treatment of HIV. Consequently, MSM in Ghana carry a disproportionate burden of HIV prevalence (18%) compared to the general population (2%), highlighting the need for culturally relevant processes in HIV/STI prevention, and care communication to optimize sexual health and wellness among MSM in Ghana. To this effect, we collaborated with community partners to use the Assessment, Decision, Adaptation, Production, Topical Experts, Training, Testing (ADAPT-ITT) model to modify a theory-driven smartphone-based peer support intervention to enhance its focus on intersectional stigma reduction, and improve HIV health-seeking behaviors among MSM, including HIV testing and linkage to care. 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. This paper shows the preliminary acceptability and effectiveness of employing culturally relevant techniques and communication strategies to provide secure peer support to improve HIV prevention and care among key populations in highly stigmatized environments.

“…Stigma (against MSM identity, gender expression, and HIV status) and misconceptions (e.g., low-risk perception) dissuade MSM from testing regularly (7)(8)(9). Many MSM express concerns of confidentiality, discrimination, and judgmental interactions with healthcare workers (6,7,10) and never tested for HIV or do not test regularly (11,12).…”

Section: Introductionmentioning

confidence: 99%

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

Turner

et al. 2021

Front. Public Health

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.