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Background <p>Men who have sex with men (MSM) in Ghana continue to face a disproportionately high HIV burden, with an estimated prevalence of 18.1% far exceeding the national average of 1.7%. Transactional sex (TS), defined as the exchange of sex for money, goods, or services, is a key behavioral risk factor for HIV acquisition. However, nationally representative data on its prevalence, correlates, and health consequences among MSM in Ghana remain scarce. This study aimed to identify sociodemographic and behavioral predictors of TS and assess its association with laboratory-confirmed HIV and syphilis.</p> Methods <p>We conducted a cross-sectional bio-behavioral survey using respondent-driven sampling (RDS) among 3,448 MSM aged ≥ 18&#xa0;years across Ghana’s ten traditional regions (August 2022–July 2023). Weighted descriptive statistics and multivariable logistic regression models were used to analyze correlates of TS and its association with HIV/syphilis. HIV and syphilis were diagnosed on-site using a rapid dual HIV–syphilis serological test, followed by confirmatory HIV testing with OraQuick and SD Bioline per Ghana’s national HIV testing guidelines.</p> Results <p>Nearly half (44.8%) of participants reported engaging in TS. TS Prevalence was highest among adolescents (18–19&#xa0;years: 50.8%), those with basic education (52.9%), and MSM in Greater Accra (63.9%). Older age (≥ 35&#xa0;years) was associated with 63% lower odds of TS (aOR: 0.37, 95% CI 0.21–0.68, <i>p</i> = 0.001), while tertiary education was protective (aOR: 0.52, 95% CI 0.32–0.86, <i>p</i> = 0.010). TS odds increased significantly with multiple sexual partners, high alcohol use, forced sex, and poor HIV knowledge. Although TS was not independently associated with HIV (aOR: 1.16, 95% CI 0.92–1.47) or syphilis (aOR: 1.12, 95% CI 0.83–1.52), it co-occurred with other established factors.</p> Conclusion <p>TS is prevalent among MSM in Ghana, driven by structural and behavioral factors such as young age (18–19), low education, urban residence, alcohol use, stigma, and sexual role. While not directly linked to HIV/syphilis risk in this study, TS serves as a significant indicator of vulnerability due to its clustering with other risks. Targeted interventions addressing these social and structural drivers, especially education and urban-focused outreach, are critical to reducing HIV transmission in this population.</p>

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Transactional sex, HIV, and STIs among men who have sex with men in Ghana: an MSM bio-behavioral study

  • 期刊论文

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  • 发表日期：

    2025年10月22日

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  • Chris Guure,
  • Irene Animah Acheampong,
  • Marian Abedua Harrision,
  • Amos Apreku,
  • Samuel Dery,
  • Alhassan Yakubu,
  • Gamji Rabiu Abu-Ba’are,
  • Stephen Ayisi Addo,
  • Kwasi Torpey

摘要

Background

Men who have sex with men (MSM) in Ghana continue to face a disproportionately high HIV burden, with an estimated prevalence of 18.1% far exceeding the national average of 1.7%. Transactional sex (TS), defined as the exchange of sex for money, goods, or services, is a key behavioral risk factor for HIV acquisition. However, nationally representative data on its prevalence, correlates, and health consequences among MSM in Ghana remain scarce. This study aimed to identify sociodemographic and behavioral predictors of TS and assess its association with laboratory-confirmed HIV and syphilis.

Methods

We conducted a cross-sectional bio-behavioral survey using respondent-driven sampling (RDS) among 3,448 MSM aged ≥ 18 years across Ghana’s ten traditional regions (August 2022–July 2023). Weighted descriptive statistics and multivariable logistic regression models were used to analyze correlates of TS and its association with HIV/syphilis. HIV and syphilis were diagnosed on-site using a rapid dual HIV–syphilis serological test, followed by confirmatory HIV testing with OraQuick and SD Bioline per Ghana’s national HIV testing guidelines.

Results

Nearly half (44.8%) of participants reported engaging in TS. TS Prevalence was highest among adolescents (18–19 years: 50.8%), those with basic education (52.9%), and MSM in Greater Accra (63.9%). Older age (≥ 35 years) was associated with 63% lower odds of TS (aOR: 0.37, 95% CI 0.21–0.68, p = 0.001), while tertiary education was protective (aOR: 0.52, 95% CI 0.32–0.86, p = 0.010). TS odds increased significantly with multiple sexual partners, high alcohol use, forced sex, and poor HIV knowledge. Although TS was not independently associated with HIV (aOR: 1.16, 95% CI 0.92–1.47) or syphilis (aOR: 1.12, 95% CI 0.83–1.52), it co-occurred with other established factors.

Conclusion

TS is prevalent among MSM in Ghana, driven by structural and behavioral factors such as young age (18–19), low education, urban residence, alcohol use, stigma, and sexual role. While not directly linked to HIV/syphilis risk in this study, TS serves as a significant indicator of vulnerability due to its clustering with other risks. Targeted interventions addressing these social and structural drivers, especially education and urban-focused outreach, are critical to reducing HIV transmission in this population.