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
Authors: Abdulai Ratif , Phalane Edith , Atuahene Kyeremeh , Kwao Isaiah Doe , Afriyie Rita , Shiferaw Yegnanew A , Phaswana-Mafuya Refilwe Nancy 
Published: January 2025

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. Educational campaigns on HIV prevention, dissemination of HIV prevention tools such as condoms and lubricants, and scientific research are also mainly focused on the general population, and this approach overlooks the specific needs and vulnerabilities of MSM. Currently, there is no published record on the prevalence and associated factors of consistent condom use with lubricants among the MSM population in Ghana. 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 4,095 MSM aged 18 years and above. De-identified data was imported into STATA (College Station, TX, USA, software version 17) for data cleaning and processing. Before the analysis, the data was treated for missing information and outliers. Descriptive analysis was performed to describe relevant characteristics of the study population, such as socio-demographic/socio-economic variables, behavioral practices, and condom use behavior. Bivariate analysis was conducted to determine the relationship between consistent condom use with lubricants and the study variables. Multivariable logistic regression analysis was then 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&lt;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. More than half of MSM (55.1%) used lubricants consistently during anal sex. 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: 3.42; 95% CI: 1.38-8.46, p=0.008), bought 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), moderate drinkers (AOR: 0.48; 95% CI: 0.30-0.78, p=0.003), and 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: 0.56; 95% CI: 0 .45-0.71, p˂0.001), low income (AOR: 0.62; 95% CI: 0.49-0.78, 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.