The Association Between Alcohol Use and Consistent Condom Use Among Men Who Have Sex with Men in Ghana

Abstract

Introduction: MSM have an elevated risk of HIV infection. Although there have been some interventions for MSM in Ghana over the years, the prevalence of HIV rose from 18 % in 2017 to 26 % in 2023, surpassing the HIV prevalence rate of 1.53% in the general population. Alcohol use has been identified as a potential factor influencing the consistent use of condoms. It is therefore crucial to determine how alcohol use influences consistent condom use among this population in Ghana to guide future policies and interventions. Objective: To examine the relationship between alcohol use and consistent condom use among men who have Sex with Men in Ghana. Methods: Data was analyzed from the Integrated Biological and Behavioral Surveillance Survey (IBBSS), conducted in 2023 among MSM in Ghana using the Pearson Chi-Square to test the association between alcohol consumption, sociodemographic factors and consistent use of condom. Logistic regression models were used to assess the extent to which alcohol and sociodemographic factors influence consistent condom use. Results: There was no association between alcohol and consistent condom use among MSM in Ghana and across different partner types (regular partners: χ² =1.96, p = 0.161, non–regular partners: χ² =0.62, p = 0.430, and paying partners: χ² =0.27, p = 0.610). The study also found that educational level ( regular partners: χ² = 22.16, p<0.001, non–regular partners: χ² =19.57, p<0.001, paying partners: χ² =15.49, p = 0.008), age ( regular partners: χ² = 11.95, p=0.008, non–regular partners: χ² =12.04, p=0.007, paying partners: χ² =11.03, p = 0.012), religious beliefs (regular partners: χ² = 14.32, p=0.006, non–regular partners: χ² =11.88, p=0.018, paying partners: χ² =11.72, p=0.020), occupation (regular partners: χ² = 41.16, p<0.001, non–regular partners: χ² =61.36, p<0.001, paying partners: χ² =30.59,p=0.015), and geographical region (regular partners: χ²=145.63, p<0.001, non-regular partners :χ²=88.49, p<0.001, paying partners: χ²=28.98, p<0.001) were significantly associated with consistent condom use among regular, non-regular, and paying partners. The findings showed that MSM with higher educational levels are twice as likely to use condoms consistently with their non-regular partners (aOR: 2.22; 95% CI: 0.98–5.07). Another notable finding was that MSM who worked as peer educators were 4 times more likely to use condoms with their non- regular partners (aOR: 4.11; 95% CI: 2.24 - 7.53; p-value < 0.001). Conclusion: The study found no significant association between alcohol use and consistent condom use among MSM in Ghana across all partner types. However, educational level, religious belief, occupation, and geographical region were significantly associated with condom use. MSM with higher education were twice as likely to use condoms consistently with non-regular partners, and those working as peer educators were four times more likely to do so. These findings highlight the importance of socio-demographic factors in shaping safer sexual practices among MSM.