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

ABSTRACT

LGBTQ populations experience human rights abuses worldwide; data need to document the health impact of these experiences in Africa. In Ghana, we measured events of sexuality-based stigma, discrimination, and violence among men who have sex with men (MSM) and the impact on HIV testing behavior. Data are from respondent-driven sampling surveillance surveys in Accra/Tema, Kumasi, Cape Coast/Takoradi, and Koforidua. Discrimination was common among MSM: 6.2%–30.6% were refused services, 29.0%–48.9% experienced verbal/symbolic violence, 2.8%–12.8% experienced physical violence, 12.3%-30.0% experienced sexual violence due to their sexuality in the preceding year. MSM who experienced sexual violence in their first male sexual encounter were less likely to ever test for HIV in Accra/Tema and Cape Coast/Takoradi. Further studies are needed to examine the impact of stigma and violence on MSM's HIV health-seeking behavior in Ghana. Structural interventions are needed to mitigate the consequences of stigma and discrimination on MSM health and well-being.

KEYWORDS:

• HIV/AIDS
• stigma/discrimination
• violence
• MSM
• Africa

Acknowledgements

We would like to thank the following. The Ghana AIDS Commission (GAC) for leading the charge for this important work. The Regional Institute for Population Studies (RIPS) and the Noguchi Memorial Institute for Medical Research (NMIMR), both affiliated with the University of Ghana, Legon, for partnering with the GAC in carrying out the survey. The West Africa Project to Combat AIDS and STIs (WAPCAS), Maritime Life Precious Foundation (MARITIME), Centre for Popular Education and Human Rights, Ghana (CEPEHRG) and MICDAK for their support provided for community entry and mobilization. This research has been supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC) Ghana Country Office under the terms of Cooperative Agreement Number 5U2GPS001469-03. Dr. Gyamerah was supported by the National Institutes of Health (T32 MH19105).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Funding

This research was supported by the U.S.President Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) Ghana Country Office under the terms of Cooperative Agreement Number 5U2GPS001469-03. The first author was supported by the National Institute of Mental Health (T32 MH19105).