title: Predictors of condom use among peer social networks of men who have sex with men in Ghana, West Africa.
abstract: Ghanaian men who have sex with men (MSM) have high rates of HIV infection. A first step in designing culturally relevant prevention interventions for MSM in Ghana is to understand the influence that peer social networks have on their attitudes and behaviors. We aimed to examine whether, in a sample of Ghanaian MSM, mean scores on psychosocial variables theorized to influence HIV/STI risk differed between peer social networks and to examine whether these variables were associated with condom use. We conducted a formative, cross-sectional survey with 22 peer social networks of MSM (n = 137) in Ghana. We assessed basic psychological-needs satisfaction, HIV/STI knowledge, sense of community, HIV and gender non-conformity stigmas, gender equitable norms, sexual behavior and condom use. Data were analyzed using analysis of variance, generalized estimating equations, and Wilcoxon two sample tests. All models were adjusted for age and income, ethnicity, education, housing and community of residence. Mean scores for all psychosocial variables differed significantly by social network. Men who reported experiencing more autonomy support by their healthcare providers had higher odds of condom use for anal (AOR = 3.29, p<0.01), oral (AOR = 5.06, p<0.01) and vaginal (AOR = 1.8, p<0.05) sex. Those with a stronger sense of community also had higher odds of condom use for anal sex (AOR = 1.26, p<0.001). Compared to networks with low prevalence of consistent condom users, networks with higher prevalence of consistent condom users had higher STD and HIV knowledge, had norms that were more supportive of gender equity, and experienced more autonomy support in their healthcare encounters. Healthcare providers and peer social networks can have an important influence on safer-sex behaviors in Ghanaian MSM. More research with Ghanaian MSM is needed that considers knowledge, attitudes, and norms of their social networks in the development and implementation of culturally relevant HIV/STI prevention intervention strategies.
authors: School of Nursing, University of Rochester, Rochester, NY, United States of America; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
authors: LaRon E
authors: LE
authors: Nelson
authors: State University of New York at Binghamton, College of Community and Public Affairs, Department of Human Development, Binghamton, NY, United States of America; Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa.
authors: Leo
authors: L
authors: Wilton
authors: Ghana Health Services, Ashanti Region Health Directorate, Kumasi, Ghana.
authors: Thomas
authors: T
authors: Agyarko-Poku
authors: Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, OH, United States of America.
authors: Nanhua
authors: N
authors: Zhang
authors: Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, OH, United States of America.
authors: Yuanshu
authors: Y
authors: Zou
authors: University of South Florida, College of Nursing, Tampa, FL, United States of America.
authors: Marilyn
authors: M
authors: Aluoch
authors: Department of Genitourinary Medicine, Barts & the Royal London Hospital, London, United Kingdom.
authors: Vanessa
authors: V
authors: Apea
authors: Centre for Popular Education & Human Rights Ghana, Accra, Ghana.
authors: Samuel Owiredu
authors: SO
authors: Hanson
authors: Kwame Nkrumah University of Science & Technology, School of Medical Sciences, Kumasi, Ghana.
authors: Yaw
authors: Y
authors: Adu-Sarkodie
mesh_terms: D000293:Adolescent; D000328:Adult; D000354:Africa, Western; D017280:Condoms; D005869:Ghana; D006678:HIV / Q000472:pathogenicity*; D015658:HIV Infections / Q000503:physiopathology / Q000635:transmission* / Q000821:virology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D012725:Sexual Behavior; D060756:Social Networking
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