“I think it\u27s male privilege”: a qualitative study of personal, behavioral, and socio-environmental factors influencing high risk sexual behavior and HIV transmission among heterosexual adult males In Ghana.

There are roughly 340,000 adults and children living with HIV. Despite the progress in the global response and the lowing of infections, HIV rates in Ghana remain stable. Cultural and societal norms that exist at a given time and place influence masculine socialization and behavior. These norms promote heterosexual men’s engagement in high-risk sexual behaviors which result in HIV infections. Factors such as HIV knowledge, risk perception, male condom use, HIV testing, and counseling which minimize the risk of HIV, are also influenced by these norms. Men have been identified as assets and advocates for behavior change and social responsibility in reducing the spread of HIV infection. Despite this, few studies have examined male behaviors and their association to the risk of HIV infection. This study utilized individual interviews to examine socio-environmental, behavioral, and personal factors influencing high risk sexual behaviors and HIV prevention among 15 heterosexual adult males in Ghana. Data analysis of the qualitative data was done using techniques from Interpretive Phenomenological Analysis (IPA). Findings from this study suggest formative experiences of masculinity are influenced by factors, which include family, friends, media, and socio-cultural practices. Findings also reveal that peer norms and expectations surrounding men’s sex drive, sexual competitions to prove masculinity, men’s capacity to perform sexually and gendered media influence HIV high-risk sexual behaviors in Ghanaian men. Study findings also suggest that HIV knowledge and risk perception influence decision-making regarding risky sexual behavior. Lack of sexual satisfaction, peer pressure, price of condoms, stigma from purchasing, religious reasons, unplanned sex, substance use and mistrust as well as perception of infidelity by women were associated with non or inconsistent use of condom. Logistics of testing, fear, and healthcare provider stigma were barriers to HIV testing and counseling. This is the first known study to explore the influence of masculine socialization and socio-environmental factors on high risk sexual behavior inclusive of factors informing sexual decision making and barriers to uptake of HIV prevention efforts amongst heterosexual adult men in Ghana. This study has also shown that factors such as gender and societal norm, power, and social relations have profoundly influenced the spread of the HIV epidemic. This study provides evidence that contextual and cultural factors have an impact on not only sustaining HIV risky behavior but have also hindering the efficacy of HIV prevention interventions among men. Study findings also reinforces the integrated nature of factors that influence HIV prevention behavior. In an effort to reach near zero cases for HIV in Ghana by 2030 per the sustainable development goals, this study highlights the need for more attention to engaging men in HIV prevention efforts. Lastly, This study justifies the need of more male centered research in public health