Filling a critical gap: a qualitative study of HIV prevention needs and vulnerability among older sexual minority men in Ghana

Abstract

Abstract Background Ghana’s HIV prevalence in the general population is relatively low at 1.7%, but concentrated at much higher levels among key populations, particularly sexual minority men. Vulnerability will likely increase if a popular bill discriminating against sexual minorities is signed into law. Men over age 30 are at greater risk for HIV compared to their younger counterparts, yet little is known about their prevention needs. We describe a qualitative study that explored protective behaviors and vulnerabilities among older sexual minority men in Kumasi. Methods We used snowball sampling to recruit sexual minority men aged 30 and older for in-depth interviews and focus group discussions. Semi-structured guides posed questions about HIV knowledge, condom use, alcohol and substance use, access to health services, and experiences of stigma and discrimination. Results Forty-four men aged 30 to 48 years participated: 20 in in-depth interviews and 24 in 4 focus group discussions. Most respondents described engaging in protective behaviors, including condom use and HIV testing. Many also revealed vulnerabilities such as HIV knowledge gaps and inconsistent condom use. Stigma and discrimination were persistent challenges. Conclusion This qualitative study helps fill a critical knowledge gap related to the experiences and challenges faced by older sexual minority men. The Promotion of Proper Human Sexual Rights and Ghanaian Family Values Bill threatens sexual minorities and health services focused on meeting their needs, and will undo years of HIV prevention and treatment programming. We suggest future avenues for providing health care that meets the specific needs of sexual minority men.

Keywords

• HIV
• Sexual minority men
• Men who have sex with men
• Key populations
• Ghana
• Qualitative research