Project Summary
Young sexual minority men (YSMM) make up 63% of the HIV prevalence (18%) among sexual minority men in
Ghana, which has a 2% national prevalence rate. Our previous studies that included YSMM in Ghana show that
internalized and interpersonal intersectional (HIV, sexual minority, gender expression) stigma and insufficient
HIV knowledge impedes HIV testing among SMM. For those in slums, the social and economic barriers in slum
communities can intertwine with intersectional stigma to exacerbate the risk of HIV infections and discourage
HIV testing among YSMM. HIV self-testing (HIVST) has the efficacy of increasing testing, providing privacy and
convenience. Yet its uptake among YSMM remains daunting due to insufficient expertise and intersectional
stigma. We propose to adapt the Many Men, Many Voices (3MV) to a modified version dubbed LAFIYA (local
word meaning wellness) to address intersectional stigma and increase HIVST among YSMM. Whereas 3MV has
the efficacy to increase HIV testing among SMM, adaptation for YSMM in slums will show its applicability to
young adults and YSMM in a different geographic and socioeconomic context in Ghana and SSA. LAFIYA will
also extend 3MV’s utility for HIV prevention by utilizing scientific advancements around intersectional stigma and
HIVST options, which came after the original version. Guided by the eight steps of the ADAPTT-IT model, we
will implement the following aims. 1) Assess intersectional stigma and options for HIVST implementation among
YSMM, 2) Adapt 3MV to LAFIYA to address intersectional stigma and HIVST among YSMM, and 3) Test
acceptance, feasibility, appropriateness, and preliminary efficacy of LAFIYA to address intersectional stigma and
increase HIVST uptake. In Aim 1, we will conduct in-depth interviews with YSMM (n= 20), providers (n=20);
clinics=10, and community-based organizations (=10) that work with YSMM to evaluate experiences of
intersectional stigma and options for implementing HIV self-testing among YSMM. In Aim 2, we will conduct a
summative analysis to interpret findings from AIM1 to identify fit and modifications to tailor 3MV to the realities
of YSMM in Ghanaian slums. In AIM 3, we will test the acceptability, feasibility, appropriateness, and preliminary
efficacy of LAFIYA through a pilot pre-post intervention among YSMM (n=60). The YSMM will receive the LAFIYA
intervention and have the option to pick up HIVST and contact of ART providers for support if they test positive.
We will assess primary outcomes (acceptability, feasibility, appropriateness) and secondary outcomes
(preliminary efficacy) using baseline, immediate, and 3-month post-intervention surveys. The study will inform
the preparation of a clustered randomized control trial to measure LAFIYA’s efficacy in increasing HIVST among
YSMM. The findings will inform intersectional stigma reduction and HIVST implementation strategies among
YSMM, slums, SSA, and other high-risk populations in different settings.
