Regional and cultural determinants of condom use attitudes among HIV seropositive heterosexuals in Ghana: A cross-sectional study.

Background: There is a growing number of new Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome infections in Ghana despite the implementation of condom utilisation campaigns. Attitudes toward the use of condoms are culturally dependent, but most condom use attitude studies ignore this. Obstacles such as embarrassment to purchase or inability to negotiate use are due to Ghana's strong adversarial cultural norms against condom use.

Method: From February 2025 to April 2025, an institution-based cross-sectional study was carried out using a systematic sampling approach to select 1748 seropositive heterosexual participants from four regions of Ghana. The study utilised the University of Chicago Los Angeles Multidimensional Condom Attitudes Scale as the instrument for data collection. Condom use attitudes were evaluated based on the mean scores of the five psychometric properties of the scale. Multivariable logistic regression established the associations between dependent and independent variables. Outcome variables with a p-value < 0.05 were deemed statistically significant. The odds ratio with a 95% confidence interval was computed to determine the strength of an association.

Results: Despite more than half of the respondents having positive condom use attitudes (n = 884; 50.6%), the majority (n = 1171; 67%) of respondents engaged in unprotected sex. While few participants in the Ashanti Region (n = 120; 27.1%) and Bono Region (n = 150; 34.4%) had a positive condom use attitude, the majority of participants in the Volta Region (n = 336; 77.6%) and Central Regions (n = 278; 63.3%) had a positive condom use attitude. Based on the means, perceived embarrassment about condom negotiation and use was high in the Ashanti Region (4.87 ± 1.12), Bono Region (4.68 ± 1.18), Central Region (4.41 ± 1.64), except the Volta Region (3.98 ± 1.38). Perceived embarrassment about condom purchase was high in the Ashanti Region (4.43 ± 1.10), Bono Region (4.19 ± 1.01), but low among counterparts in the Central (3.71 ± 1.35) and Volta (3.17 ± 1.89) Regions based on the means. Compared to participants in Ashanti Region, counterparts in the Bono Region (aOR = 0.64, 95% CI = 0.45-0.91), Central Region (aOR = 0.17, 95% CI = 0.12-0.25), and Volta Regions (aOR = 0.11, 95% CI = 0.08-0.17) had a lower likelihood of consistent condom use. Relative to participants who were sexually inactive, those who were sexually active had lower odds of using condoms (aOR = 0.74, 95% CI = 0.57-0.97).

Conclusion: Regions from which antiretroviral medications were obtained, engaging in sexual activity and frequency of condom use in the previous year, and the likelihood of condom use in the future were the determinants of condom use attitude. The Ashanti and Bono Regions had a negative condom use attitude due to high perceived sexual health stigma, high perceived embarrassment associated with condom with condom purchase purchases and negotiations, and use. In contrast, counterparts in the Volta and Central Regions had positive condom use attitudes due to a low perceived sexual health stigma, low perceived embarrassment associated with condom negotiation and use, as well as low perceived embarrassment associated with condom purchases. Human Immunodeficiency Virus-positive populations in the Volta and Central Region are more likely to use condoms consistently and implement Human Immunodeficiency Virus preventive strategies due to the positive condom use attitudes compared to their counterparts in the Ashanti and Bono Regions. Implementing a condom use education campaign focused on addressing the negative cultural norms against condom use attitudes and emphasising the need for consistent condom use among the seropositive population is encouraged.