Autonomy-Supportive Healthcare Climate and HIV-Related Stigma Predict Linkage to HIV Care in Men Who Have Sex With Men in Ghana, West Africa

J Int Assoc Provid AIDS Care. 2021 Jan-Dec:20:2325958220978113. doi: 10.1177/2325958220978113.


In Ghana, the HIV prevalence among MSM is more than 10 times greater than the general population of adults, and rates of engagement in HIV medical care are low among MSM diagnosed with HIV. Using structured surveys, we investigated the impact of HIV-related stigma, same-sex behavior stigma, and gender nonconformity stigma on linkage to HIV care (LTC) in MSM (N = 225) living with HIV in Ghana. Autonomy-supportive healthcare climate (OR = 1.63, p < .01), vicarious HIV stigma (OR = 2.73, p < .01), and age (OR = 1.06, p < .004) predicted LTC. Conversely, felt normative HIV stigma negatively predicted LTC (OR = 0.65, p < .05). Finally, we identified regional disparities, with MSM from Takoradi being 4 times and 5 times more likely to be LTC compared to Kumasi and Accra, respectively. Our findings highlight the nuanced roles of stigmas in shaping the HIV care continuum among MSM living with HIV, while revealing potential gaps in current measures of HIV-related stigma.

Keywords: HIV/AIDS; MSM; Stigma; autonomy support; self-determination theory.

MeSH terms

  • Adult
  • Continuity of Patient Care
  • Cross-Sectional Studies
  • Delivery of Health Care*
  • Female
  • Ghana
  • HIV Infections / drug therapy
  • HIV Infections / psychology*
  • Homosexuality, Male / psychology*
  • Humans
  • Male
  • Sexual Behavior
  • Sexual and Gender Minorities
  • Social Stigma*