“Too Much Sex and Alcohol”: Beliefs, Attitudes, and Behaviors of Male Adolescents and Young Men Who have Sex with Men in Ghana

Lora L. Sabin1, *, Jennifer Beard1, Thomas Agyarko-Poku2, Mary DeSilva3, Paul Ashigbie1, Tami Segal4, Michael Esang5, Mabel Kissiwah Asafo6, Peter Wondergem7, Kimberly Green8, Samuel Wambugu9, Yaw Adu-Sarkodie6
1 Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd Floor, Boston, MA, 02118, USA
2 Ghana Health Service, Private Mail Bag, Ministries, Accra, Ghana
3 University of New England, 716 Stevens Avenue, Portland, ME, 04103, USA
4 Athenahealth, 311 Arsenal Street, Watertown, MA, 02118, USA
5 Department of Psychiatry & Behavioral Sciences, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, USA
6 School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, KNUST, Kumasi, Ghana
7 Independent Health Consultant, D 102 Michael Addy Street, Accra, Ghana
8 PATH, R11.01, 11th Floor, Hanoi Towers, 49 Hai Ba Trung, Hoan Kiem District, Hanoi, Vietnam
9 MEASURE Evaluation, 123 West Franklin Street, Suite 330, Chapel Hill, NC, 27516, USA

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© 2018 Sabin et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, Boston, MA 02118, USA: Tel: 617-414-1272; E-mail:



Research suggests that men who have sex with men (MSM) often engage in high-risk sex and use illicit substances.


To increase understanding of HIV knowledge and vulnerability among adolescent and young adult MSM, with a focus on alcohol and drug use and transactional sex.


We conducted in-depth interviews and Focus Group Discussions (FGDs) with adolescent (aged 15-17 years) and young adult (aged 18-29 years) MSM in Kumasi, Ghana. MSM who reported recent alcohol and/or substance use or engagement in transactional sex were eligible. Questions covered HIV-related knowledge, experiences with substance-use and transactional sex, and attitudes regarding sexual risk-taking and HIV-related services. Data were analyzed thematically using NVivo 10.0 software.


Ninety-nine MSM participated in 44 interviews and 8 FGDs. Most were attending or had completed secondary school. HIV knowledge was high, but with major gaps. Most consumed alcohol; one-fourth used drugs. Alcohol and substances were consumed to enhance pleasure during sex with another man. Transactional sex was common and positively viewed. Half of the participants used condoms inconsistently or never, and self-perceived HIV risk was high. Nearly half faced stigma-related barriers to accessing HIV-related services.


As Ghana strives to achieve the UNAIDS’s 90-90-90 global targets (90% of people living with HIV know their status, 90% who know their status are on sustained treatment, and 90% of those on treatment are virally suppressed), we recommend enhancing MSM-targeted prevention programs, improving care options, and increasing use of critical clinical HIV-services by ensuring that MSM receive unbiased, confidential care.

Keywords: HIV/AIDS, HIV prevention, Ghana, men who have sex with men (MSM), substance use, transactional sex, qualitative research.