Barriers to and Facilitators of Engagement in HIV Care Among Adult Ghanaian Men Who Have Sex with Men (MSM) Living with HIV

Background: Approximately 18% of men who have sex with men (MSM) in Ghana are living with HIV. However, there is a gap in the literature on the clinical experiences of this subgroup. Consequently, we carried out a qualitative study to explore barriers and facilitators to engagement in HIV care among adult Ghanaian MSM living with HIV. 

Methods: Semi-structured, in-depth qualitative interviews were conducted with 30 MSM in Accra, Ghana between May and July 2015. Participants were recruited through referral from key informants and snowball sampling.  The interviews were conducted in a private office at a local NGO that provides HIV prevention services to vulnerable populations.  Using qualitative software (NVIVO 10), an inductive content analysis approach was used to identify barriers to and facilitators to engagement in HIV care.  

Results:  The average age of participants was 29.1 years (S.D. = 7.7) and more than half (N=16, 53%) self-identified as gay/homosexual. Major barriers to engagement in HIV care included high cost of medication and other related health services, employment and personal time conflicts, far distance of health facility, fear of being seen at hospital, and concern over confidentiality of HIV status. Key facilitators of being engaged in HIV care included being enrolled in the national health insurance scheme, shorter hospital waiting time, privacy in the clinical setting, familiarity with clinical staff, and support from other HIV-positive individuals. 

Conclusions: This study identified major barriers and facilitators to engagement in HIV care among HIV-positive MSM in Ghana. It is important to explore interventions such as subsidizing medication costs and other medical services for Ghanaian MSM living with HIV. Devising strategies to increase social and emotional support for Ghanaian MSM might increase likelihood of engagement and retention in HIV care.  More research is needed to identify best practices to increase outcomes on the HIV care continuum for this population.