A Cross-National Study of Ghanaian and African American Women and MSM Experiences of HIV Stigma, Coping and Behavior

Purpose: HIV prevalence rates of U.S. blacks, in some cities, rival those of Ghana, which has one of the lower prevalence rates in sub-Saharan Africa. This raises questions about the extent to which African Americans and Africans living with HIV/AIDS are similar in coping characteristics, especially given the high rates of stigma these two groups face. Our study examined similarities and differences in stigma, homophobia, internalized racism, HIV transmission behavior and coping across African-American and Ghanaian persons living with HIV/AIDS to further the global HIV/AIDS discourse and inform prevention and intervention strategies in both countries. Additionally, we sought to examine the extent to which African American men who have sex with men (MSM) and Ghanaian MSM living with HIV/AIDS face similar challenges in coping with HIV stigma, especially given the heightened socio-cultural stigma for Black MSM in U.S. and Ghanaian MSM in Ghana where homosexuality is a criminal act.   

Methods: This mixed-methods research used a cross-sectional design with quantitative analysis and a qualitative component to examine the role of multiple stigmas, HIV/AIDS knowledge and perceptions and other demographic factors on risk behavior and coping among women and MSM living with HIV/AIDS in two locations: US and Ghana.  Data was collected from 63 study participants: Ghana (n=33) and US (n=30). A 140 item composite questionnaire was used to assess general demographics, health-related behaviors and the nature and extent of participant’s attitudes and actions toward their HIV status, well-being and risk behavior. Measures in the composite questionnaire included The Internalized Stigma Scale, HIV/AIDS Transmission and Prevention Knowledge Scale, HIV transmission risk behavior questionnaire, Attitudes about Homosexuality Scale, Internalized and Externalized homophobia, Internalized racism, and Violence and Discrimination experience.

Findings. African American MSM and Ghanaian MSM experienced similar levels of internalized homophobia and internalized stigma.  Internalized racism was prevalent across both women and MSM in both countries. Women in both countries identified similar coping behavior and identified social support and HIV education delivered in a group setting as the primary useful coping strategy.  Men and women in both countries were similar in transmission risk behavior.

Implications: Findings of internalized stigma, internalized homophobia and internalized racism point to the need for increased attention to these variables in increasing coping and health promotion among both African American and Ghanaian persons living with HIV. There is evidence that HIV/AIDS  stigma is associated with avoidance of HIV/STD testing, delayed seeking of HIV/STD medical care, reluctance to disclose HIV status to others, non-adherence to HIV treatment, and poorer self-assessed mental and physical health.  These finding have implications related to the future development and transferability of transmission prevention interventions in both countries for men and women.  Moreover, there are international social work and social justice implications regarding the human rights issues facing Ghanaian MSM who face criminal sanctions against consensual same-sex sexual acts.  Finally, this presentation will increase awareness about HIV health disparities among African descent people globally and foster a discussion about the social work response with culturally-grounded solutions.