Adaptation and feasibility of Many Men Many Voices (3MV), an HIV prevention intervention to reduce intersectional stigma and increase HIVST among YSMM residing in Ghanaian slums - 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.
