Consistency of Condom Use with Lubricants and Associated Factors Among Men Who Have Sex with Men in Ghana: Evidence from Integrated Bio-Behavioral Surveillance Survey.

Abstract

Several studies conducted worldwide have reported on the effectiveness of consistent condom use with lubricants in preventing HIV transmission and acquisition; however, men who have sex with men (MSM) in Ghana continue to be disproportionately affected by the HIV burden. They are stigmatized, discriminated against, and criminalized, leading to social isolation, reduced access to health care, and inadequate targeted interventions. The dissemination of HIV prevention tools such as condoms and lubricants is also mainly focused on the general population, and this approach overlooks the specific needs and vulnerabilities of MSM. This study aimed to determine the prevalence and associated factors of consistent condom use with lubricants among MSM in Ghana. We analyzed cross-sectional data from the Ghana Men's Study II dataset involving 4095 MSM aged 18 years and above. De-identified data were imported into STATA (College Station, TX, USA, software version 17) for data analysis. Descriptive analysis was performed to describe relevant characteristics of the study population. Multivariable logistic regression analysis was performed for significant variables in bivariate analysis to determine the associated factors of consistent condom use with lubricants. All the statistical analyses were performed at a 95% confidence interval, with significant differences at p < 0.05. The prevalence of consistent condom use with lubricants during penetrative anal sex was highest with male partners (44.9%), followed by female partners (40.0%), and all sexual partners (38.9%), respectively. In multivariable logistic regression analysis, having a senior high school education (AOR: 1.76; 95% CI: 0.88-3.12, p = 0.039), tertiary education or higher (AOR: 2.24; 95% CI: 0.86-3.23, p = 0.041), being an insertive sex partner (AOR: 1.26; 95% CI: 1.02-1.56, p = 0.029), being a sex worker (AOR: 1.41; 95% CI: 1.00-1.98, p = 0.048), buying sex from other males (AOR: 1.32; 95% CI: 1.03-1.70, p = 0.027), being a light drinker (AOR: 0.54; 95% CI: 0.42-0.68, p < 0.001), being a moderate drinker (AOR: 0.48; 95% CI: 0.30-0.78, p = 0.003), and possessing good HIV knowledge (AOR: 1.79; 95% CI: 1.46-2.20, p < 0.001) had higher odds of consistent condom use with lubricants. Being Islamic (AOR: 0.65; 95% CI: 0.49-0.87, p = 0.004), having a low income (AOR: 0.57; 95% CI: 0.42-0.77, p < 0.001), and easy access (AOR: 0.52; 95% CI: 0.37-0.72, p < 0.001) to condoms were positively associated with consistent condom use. This study found a low prevalence of consistent condom use with lubricants among the MSM population in Ghana. The study also found a range of socio-demographic, behavioral, and structural factors associated with consistent condom use with lubricants. This calls for very specific and unique public health interventions, such as developing a predictive model to identify and mitigate barriers to consistent condom use with lubricants.