In Ghana, men who have sex with men often fail to access critical HIV information and services due to deep-rooted fear of social stigma. The Ghana Men’s Study, conducted in 2011,1 revealed a high level of HIV prevalence among men who have sex with men in five sites in Ghana (17.5 percent), with the highest rates in the Greater Accra and Ashanti regions: 34.4 percent and 13.6 percent respectively. This study also found that less than half of the men who have sex with men population surveyed had been reached with HIV prevention services.
Since 2010 year, the Strengthening HIV/AIDS Response Partnership with Evidenced-Based Results (SHARPER) project, funded by the U.S. Agency for International Development and implemented by FHI 360, has worked to reduce HIV transmission among men who have sex with men and other most-at-risk groups. The project operates in 30 districts with high HIV prevalence, with the goal of reaching 178,000 individuals with health behavior messages and improved access to health services by June 2014.
Before 2012, SHARPER relied on peer education alone to reach this key population. We found, however, that less than 10 percent of the men in this group referred by peer educators for HIV testing were positive. Clearly, new strategies were needed to identify those most at risk of HIV and link them with prevention and care services.
We tested two new approaches. The first involved social media. We partnered with men who have sex with men in Accra and Kumasi who were at the center of social networks not well accessed by peer educators. Over the past year, these individuals have reached almost 13,000 men who have sex with men through social media (Facebook, Badoo and ten other platforms) — more than twice as many contacted by peer educators. As many as 63 percent (Kumasi) to 82 percent (Accra) of this group had never been reached before by a peer educator. Men contacted through social media were significantly older, were better educated, were members of much larger networks of men who have sex with men and were more likely to have been tested for HIV in the past year.
The second strategy we used is called “social networks testing.” We partnered with HIV counselors to ask high-risk men who have sex with men (those testing HIV positive or frequently having unprotected sex) in Accra and Kumasi to invite peers within their networks to get tested. In a three-month period, 166 individuals were referred by our initial network of 13 individuals and accessed HIV testing. Through this approach, 33 percent of men who have sex with men tested HIV positive, and 91 percent were enrolled in care. We found that HIV-positive men who have sex with men who were not previously reached by peer educators were significantly more likely to refer men who have sex with men with HIV. These positive results have important implications for HIV programming.
Face-to-face peer education continues to be a critical component of HIV services among this key population in Ghana, but the success of social media and social networks testing are proving to be effective and powerful tools for reaching high-risk men who have sex with men and other key populations not yet connected to HIV prevention services.
1 U.S. Centers for Disease Control and Prevention Ghana and the Ghana AIDS Commission: Preliminary findings 2012.