JMIR Publications

ABSTRACT

Background:

Young sexual minority men (YSMM) living in slums face high risks of contracting HIV due to poverty and limited healthcare access. Certain areas in Accra's slums have much higher HIV rates than the national average, around 7% compared to 2%. YSMM in these areas struggle to access services, have lower perceptions of HIV risk, less education, and face poverty, leading to low rates of HIV testing. These YSMM also encounter increased stigma because of where they live, like in the slum area known as "Old Fadama" or "Sodom and Gomorrah." This stigma affects their willingness to get tested for HIV and adds to other stigmas related to their sexuality and gender expression. Ghana's efforts to improve HIV testing for YSMM face challenges such as stigma, low-risk perception, and concerns about confidentiality. Introducing HIV self-testing (HIVST) offers hope to increase testing among YSMM by allowing them to test in private. However, there are challenges with implementing HIVST in Ghana, including limited knowledge and fears of stigma. Advocates suggest integrating HIVST with existing testing methods to improve access and inclusivity for YSMM in Ghana.

Objective:

This pilot project aims to adapt the Many Men Many Voices intervention into a new version called LAFIYA to reduce intersectional stigma and increase capacity and uptake of HIV self-testing among young sexual minority men in Ghanaian slums. The study seeks to assess the acceptability, feasibility, appropriateness, and preliminary efficacy of the intervention.

Methods:

The study adapts the 3MV approach into a modified version called LAFIYA to combat intersectional stigma and enhance HIVST among young cis-gender men who have sex with men (YSMM) in Ghana. Using the ADAPTT-IT framework, the study plans to implement three aims, refining the adapted intervention, creating a manual for LAFIYA, and conducting a pilot test to assess acceptance, feasibility, appropriateness, and preliminary efficacy in reducing stigma and increasing HIVST among YSMM. Conducted within urban slum communities in Accra, the research intends to recruit 20 YSMM and 20 providers, stratified into nurses and community organization providers. The study employs a starfish sampling to recruit YSMM and purposive sampling techniques for providers. Eligibility criteria for YSMM include specific age, lack of experience with unassisted HIVST kits, identification as cis-gender men, recent engagement in sex with another man, and residency in the Greater Accra Metropolitan area within a slum community. Providers must have at least one year of experience in sexual health services and working with YSMM on HIV prevention and care within the same geographical area.

Results:

This trial will generate findings on how acceptable and feasible the adapted LAFIYA intervention is for young sexual minority men in slums. Preliminary outcomes will explore changes in internalized and interpersonal stigma, HIV self-testing initiation, and willingness to seek confirmatory testing or care. The results will guide refinement of the intervention and provide effect size estimates for a future randomized trial.

Conclusions:

Addressing intersectional stigma while building self-testing skills has the potential to improve HIV prevention among young sexual minority men in Ghana. If LAFIYA proves acceptable and feasible, it will serve as an important next step toward a fully powered efficacy trial and broader implementation in similar high-risk communities. Clinical Trial: ClinicalTrials.gov: NCT06238323