“Too Much Sex and Alcohol”: Beliefs, Attitudes, and Behaviors of Male Adolescents and Young Men Who have Sex with Men in Ghana

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.

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

“…In this paper, we describe the use of the ADAPT-ITT model in the adoption and adaptation of the 3MV with MSM in Ghana. Despite the existing disproportionate infection rates of HIV among MSM and its association with existing structural factors (such as criminalization and stigma against MSM), and individual-level factors (such as sex without a condom, and transactional sex) in Ghana and other sub-Saharan African countries, only a few scholars consider intervention as an approach to reducing HIV and STI risk among MSM in the country (Koblin et al, 2006;Baral et al, 2011;Cloete et al, 2013;Logie et al, 2012;Park et al, 2013;Sabin et al, 2018). As such, in collaboration with community partners, we engaged MSM through the use of the ADAPT-ITT model (Table 1) to adapt the 3MV (Table 2) to address HIV and STD risk factors and contribute to reducing HIV infections (Abubakari et al, 2020).…”

Multi-level intersectional stigma reduction intervention to increase HIV testing among men who have sex with men in Ghana: Protocol for a cluster randomized controlled trial

“…The presence of HIV stigma in Sub-Saharan Africa leads to guarded disclosures which are disruptive to HIV testing and early linkage to care [ 21 , 24 ]. Qualitative studies in Ghana found same-sex stigma undermines HIV testing for MSM [ 7 ] and was a barrier to seeking general health and HIV testing services [ 25 ]. Within HCFs, negative interactions with staff can discourage MSM from seeking HIV testing or disrupt linkage to care [ 25 ].…”

“…Qualitative studies in Ghana found same-sex stigma undermines HIV testing for MSM [ 7 ] and was a barrier to seeking general health and HIV testing services [ 25 ]. Within HCFs, negative interactions with staff can discourage MSM from seeking HIV testing or disrupt linkage to care [ 25 ]. At the interpersonal and individual levels, perceived stigma can lead MSM to avoid health care services due to fear that someone will discover they have sex with men [ 21 ].…”

Social capital and chemsex initiation in young gay, bisexual, and other men who have sex with men: the pink carpet Y cohort study

“…Reasons for heavy alcohol use reported by GBMSM in general may include life histories of traumatic experiences such as sexual orientation-based discrimination and childhood sexual abuse [ 38 , 39 ], while YMSM specifically reported social drinking motivations as a main reason for engaging in heavy alcohol use [ 40 ]. As for the use of alcohol during sex among GBMSM, reasons included more situational or contextual factors such as the facilitation of cognitive ‘escape’ for the awareness of HIV risk, or the enhancement of sexual pleasure [ 41 , 42 ].…”