Adaptation and feasibility of Many Men Many Voices (3MV), an HIV prevention intervention to reduce intersectional stigma and increase HIVST among YSMM residing in Ghanaian slums – A clustered pre-post pilot trial protocol.
Authors: Abu-Ba’are Gamji Rabiu , Torpey Kwasi , Nelson LaRon , Conserve Donaldson , Jeon Sangchoon , McMahon James , Manu Adom , Zigah Edem Yaw , Shamrock Osman Wumpini , Apreku Amos , Dakpui Delali Henry , Agbemedu George Rudolph , Adjaka Gideon 
Published: April 2024

Background
Young sexual minority men (YSMM) living in slums face high risks of contracting HIV due to poverty and limited healthcare access. Certain areas in Accra's slums have much higher HIV rates than the national average, around 7% compared to 2%. YSMM in these areas struggle to access services, have lower perceptions of HIV risk, less education, and face poverty, leading to low rates of HIV testing. These YSMM also encounter increased stigma because of where they live, like in the slum area known as "Old Fadama" or "Sodom and Gomorrah." This stigma affects their willingness to get tested for HIV and adds to other stigmas related to their sexuality and gender expression. Ghana's efforts to improve HIV testing for YSMM face challenges such as stigma, low-risk perception, and concerns about confidentiality. Introducing HIV self-testing (HIVST) offers hope to increase testing among YSMM by allowing them to test in private. However, there are challenges with implementing HIVST in Ghana, including limited knowledge and fears of stigma. Advocates suggest integrating HIVST with existing testing methods to improve access and inclusivity for YSMM in Ghana.
Methods
The study adapts the 3MV approach into a modified version called LAFIYA to combat intersectional stigma and enhance HIVST among young cis-gender men who have sex with men (YSMM) in Ghana. Using the ADAPTT-IT framework, the study plans to implement three aims, refining the adapted intervention, creating a manual for LAFIYA, and conducting a pilot test to assess acceptance, feasibility, appropriateness, and preliminary efficacy in reducing stigma and increasing HIVST among YSMM. Conducted within urban slum communities in Accra, the research intends to recruit 20 YSMM and 20 providers, stratified into nurses and community organization providers. The study employs a starfish sampling to recruit YSMM and purposive sampling techniques for providers. Eligibility criteria for YSMM include specific age, lack of experience with unassisted HIVST kits, identification as cis-gender men, recent engagement in sex with another man, and residency in the Greater Accra Metropolitan area within a slum community. Providers must have at least one year of experience in sexual health services and working with YSMM on HIV prevention and care within the same geographical area.
Discussion
The adaptation of the 3MV approach into LAFIYA aimed to tackle intersectional stigma and improve HIVST among YSMM in Ghana. The study's primary objective focused on assessing the acceptance and feasibility of this modified method in reducing stigma and increasing HIVST uptake among YSMM. Organized into three core objectives, the research evaluated the presence of stigma, transformed 3MV into LAFIYA, and rigorously examined LAFIYA's effectiveness in reducing stigma and boosting HIVST uptake among YSMM. Following the ADAPTT-IT framework, the study systematically progressed through different stages to produce a comprehensive manual for the LAFIYA intervention. This foundational study set the groundwork for a larger-scale trial intended to assess LAFIYA's effectiveness in reducing stigma and enhancing HIVST among YSMM.
Trail registration
This study is registered on clinicalTrail.gov, with identifier number NCT06238323 on 02/02/2024
https://clinicaltrials.gov/study/NCT06238323?locStr=Ghana&country=Ghana&cond=HIV&aggFilters=status:not%20rec&rank=4