Attitudes and behaviors among older MSM in Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.Men who have sex with men (MSM) are a particularly stigmatized group in Ghana. Male-tomale sex is viewed as “unnatural” and therefore illegal. MSM are a critical, though difficult, population to reach with HIV-related services. Preventing HIV among key populations is a goal of the National AIDS Control Program (NACP) and the Ghana AIDS Commission (GAC).1 Until recently, specific data on MSM in the country were limited. The Ghana Men’s Study (GMS), which collected information from 1,302 MSM in five regions in 2011, provides detailed data on HIV and sexually transmitted infection (STI) prevalence and risk behaviors among MSM. Whereas adult HIV prevalence in Ghana has been estimated 1.31% in 2013,2 the GMS documented a nationwide average prevalence in 2011 of 17.5% among MSM, with the rate in Accra estimated at 34.3% and 13.7% in Kumasi.3 Boston University’s Center for Global Health and Development (BU CGHD) and the Kwame Nkrumah University of Science and Technology (KNUST), in collaboration with the GAC and FHI 360, conducted a qualitative study to examine HIV vulnerability among “older” MSM in Kumasi, Ghana’s second largest urban area. It is the second of two studies focusing on MSM in Ghana undertaken by CGHD/KNUST. The first, “Exploring the beliefs, attitudes, and behaviors of MSM engaged in substance use and transactional sex in Ghana,”4 focused on adolescent and young adult MSM aged 15 to 29 years. This companion study included MSM aged 30 years and above. The research is designed to complement and supplement information on MSM obtained by the GMS. The study’s goal was to collect and analyze data to improve the outreach and effectiveness of local programs that aim to reach older MSM with important HIV prevention and treatment information and with services appropriate to their needs. In-depth interviews (IDIs) and focus group discussions (FGDs) were used to collect data from two MSM groups: those aged 30 to 39 years and those aged forty and older. A total of 44 MSM participated in the study, 22 in each age group.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201