Self-Disclosure of HIV-Status: Perception and Experiences of Ghanaian Men Who Have Sex with Men (MSM) Living with HIV

Background: Disclosure of HIV status may help reduce risk of transmission and facilitate social support for people living with HIV. However, the stigma and discrimination associated with HIV might deter status disclosure. To date, no studies have explored factors that influence HIV status disclosure and non-disclosure among Ghanaian men who have sex with men (MSM) living with HIV. Consequently, we conducted a qualitative study to investigate factors surrounding HIV disclosure among Ghanaian MSM.

Methods: Between May and July 2015, 30 Ghanaian MSM living with HIV were interviewed in Accra, Ghana. Participants were recruited through referral from three key informants and snowball sampling. Participants were probed on disclosure of HIV-status to family, friends, and sexual partners. Interviews were audio recorded and transcribed verbatim.  Data was analyzed using an open and axial coding approach with qualitative data analysis software (NVIVO 10). 

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. Overall, participants described disclosing HIV status to close friends and sexual partners and non-disclosure to family members. Disclosure mostly occurred a few weeks after diagnosis. Reasons for status disclosure include: perceived confidentiality and trust, concern for sexual partner’s health, and social and/or financial support. Anxiety, anticipated stigma, concern of confidentiality, and comfort in keeping status a secret were reasons for non-disclosure.

Conclusions: This study offered insight into issues surrounding comfort with HIV status disclosure in Ghanaian MSM: why it comes easy to some and others have a difficult time in dealing with it. It appears status disclosure to family may be more arduous than disclosure to friends and sexual partners. This may be due to HIV and same-sex attraction being highly stigmatized in Ghana.  Healthcare providers may help counsel patients around strategies for disclosing status to family, friends, and sexual partners, as appropriate.