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Article ; Online: Impact of COVID-19 on people living with HIV and HIV care: A qualitative study in the Volta Region of Ghana.

Asakitogum, David Ayangba / Nutor, Jerry John / Thompson, Rachel G A / Alhassan, Robert K / Gyamerah, Akua O

PLOS global public health

2024 Volume 4, Issue 3, Page(s) e0003017

Abstract: The COVID-19 pandemic caused significant social changes and challenges globally, including economic slowdown and limitation of essential services. Our study explored the impact of the COVID-19 pandemic on the HIV treatment experiences and lives of people ...

Abstract	The COVID-19 pandemic caused significant social changes and challenges globally, including economic slowdown and limitation of essential services. Our study explored the impact of the COVID-19 pandemic on the HIV treatment experiences and lives of people living with HIV in Ghana. Between October 2021 and January 2022, we conducted four focus group discussions with 24 people living with HIV and six in-depth interviews with healthcare providers to understand the impact of the COVID-19 epidemic on their lives and HIV treatment and care. Transcribed interviews were analyzed using thematic analysis. The COVID-19 pandemic most impacted people living with HIV economically and psychosocially. Economic challenges included loss of income/economic support, financial hardship, and material insecurities. The psychosocial impact included fear of the health impact of COVID-19 on people living with HIV and social isolation. The pandemic also impacted participants' HIV treatment and care services including change in their site of care and non-adherence to antiretroviral therapy. Clinics in particular modified HIV care services to maintain treatment and care during the pandemic. Healthcare providers also implemented direct antiretroviral therapy service delivery to clients, which reduced patient overcrowding but increased providers' workload and expenses. The COVID-19 pandemic caused economic hardship, social isolation, and changes in HIV treatment and care services for people living with HIV. It also imposed a work and financial burden on healthcare providers. However, service changes made by providers helped sustain HIV care and treatment for clients and should inform future pandemic responses in HIV services.
Language	English
Publishing date	2024-03-15
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0003017
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Article ; Online: The association of HIV-related stigma and psychosocial factors and HIV treatment outcomes among people living with HIV in the Volta region of Ghana: A mixed-methods study.

Nutor, Jerry John / Gyamerah, Akua O / Duah, Henry Ofori / Asakitogum, David Ayangba / Thompson, Rachel G A / Alhassan, Robert Kaba / Hamilton, Alison

PLOS global public health

2024 Volume 4, Issue 2, Page(s) e0002994

Abstract: Stigma and discrimination have been identified as significant barriers to HIV treatment among people living with HIV (PLWH). HIV stigma affects decision to seek HIV testing and early treatment. Evidence shows that HIV stigma undermines antiretroviral ... ...

Abstract	Stigma and discrimination have been identified as significant barriers to HIV treatment among people living with HIV (PLWH). HIV stigma affects decision to seek HIV testing and early treatment. Evidence shows that HIV stigma undermines antiretroviral therapy (ART) adherence by affecting the psychological process such as adjusting and coping with social support. In Ghana, stigma toward PLWH occurs in many ways including rejection by their communities and family members, ostracism, and refusal to engage in social interactions such as eating, sharing a bed, or shaking hands. Therefore. we examined PLWH's experiences with different forms of HIV-related stigma and the impact on HIV treatment outcome in the Volta region of Ghana. We employed a convergent mixed-method approach consisting of a survey with 181 PLWH, four focus group discussions with 24 survey respondents, and in-depth interviews with six providers. We performed independent samples t-test, ANOVA, and chi-square test to test associations in bivariate analysis and analyzed qualitative data using thematic analysis. In all, 49% of survey respondents reported experiencing high internalized stigma, which was associated with high social support and depression (p<0.001). In qualitative interviews, anticipated stigma was the most salient concern of PLWH, followed by internalized and enacted stigma, which all negatively impacted HIV treatment and care. Stigma was experienced on multiple levels and affected psychosocial and treatment outcomes. Findings suggest urgent need for HIV-stigma reduction intervention among PLWH and their family, providers, and community members.
Language	English
Publishing date	2024-02-29
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0002994
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Article ; Online: PrEP knowledge, acceptability, and implementation in Ghana: Perspectives of HIV service providers and MSM, trans women, and gender diverse individuals living with HIV.

Gyamerah, Akua O / Kinzer, Ezra / Aidoo-Frimpong, Gloria / Sorensen, Guro / Mensah, Matilda D / Taylor, Kelly D / Vanderpuye, Naa Ashiley / Lippman, Sheri A

PLOS global public health

2023 Volume 3, Issue 6, Page(s) e0001956

Abstract: Pre-exposure prophylaxis (PrEP) could help reduce HIV incidence among cis men, trans women, and gender diverse individuals assigned male at birth who have sex with men (MSM, trans women, and GDSM) in Ghana, a group that bears a high HIV burden. Our study ...

Abstract	Pre-exposure prophylaxis (PrEP) could help reduce HIV incidence among cis men, trans women, and gender diverse individuals assigned male at birth who have sex with men (MSM, trans women, and GDSM) in Ghana, a group that bears a high HIV burden. Our study examined PrEP knowledge and acceptability, and barriers and facilitators to its uptake and implementation through qualitative interviews with 32 MSM, trans women, and GDSM clients living with HIV, 14 service providers (SPs), and four key informants (KIs) in Accra, Ghana. We interviewed participants about their PrEP knowledge, whether MSM would take PrEP, and what factors would make it easy/difficult to uptake or implement PrEP. Interview transcripts were analyzed using thematic analysis. There was high acceptability of PrEP use and implementation among MSM, trans women, GDSM, and SPs/KIs in Ghana. MSM, trans women, and GDSM interest in, access to, and use of PrEP were shaped by intersectional HIV and anti-gay stigma; PrEP affordability, acceptability, and ease of use (e.g., consumption and side effects); sexual preferences (e.g., condomless sex vs. condom use), and HIV risk perception. Concerns raised about barriers and facilitators of PrEP use and implementation ranged from medical concerns (e.g., STIs; drug resistance); social behavioral concerns (e.g., stigma, risk compensation, adherence issues); and structural barriers (e.g., cost/affordability, govern commitment, monitoring systems, policy guidance). Targeted education on PrEP and proper use of it is needed to generate demand and dispel worries of side effects among MSM, trans women, and GDSM. Free, confidential, and easy access to PrEP must be supported by health systems strengthening, clear prescription guidelines, and anti-stigma training for providers.
Language	English
Publishing date	2023-06-07
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0001956
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Article ; Online: Mental Distress and Use of Stimulants: Analysis of a Longitudinal Cohort of Transgender Women.

Baguso, Glenda N / Santiago-Rodriguez, Edda / Gyamerah, Akua O / Wilson, Erin C / Chung, Cecilia / McFarland, Willi / Wesson, Paul

LGBT health

2022 Volume 10, Issue 3, Page(s) 228–236

Abstract: Purpose: ...

Abstract	Purpose:
MeSH term(s)	Humans ; Female ; Transgender Persons ; Crime ; Methamphetamine ; Mental Health ; Cocaine
Chemical Substances	Methamphetamine (44RAL3456C) ; Cocaine (I5Y540LHVR)
Language	English
Publishing date	2022-10-26
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2727303-9
ISSN	2325-8306 ; 2325-8292
ISSN (online)	2325-8306
ISSN	2325-8292
DOI	10.1089/lgbt.2021.0192
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Article ; Online: Sexuality Disclosure Among Black South African MSM and Responses by Family.

Gyamerah, Akua O / Collier, Kate L / Reddy, Vasu / Sandfort, Theo G M

Journal of sex research

2019 Volume 56, Issue 9, Page(s) 1203–1218

Abstract: Although South Africa protects sexual orientation in its Constitution, homosexuality is socioculturally contested and unaccepted. This lack of acceptance may impact the coming-out process of men who have sex with men (MSM). This study explored diverse ... ...

Abstract	Although South Africa protects sexual orientation in its Constitution, homosexuality is socioculturally contested and unaccepted. This lack of acceptance may impact the coming-out process of men who have sex with men (MSM). This study explored diverse factors that influenced whether Black South African MSM disclosed their sexual practices and identities to their families, how their families responded, and how family responses affected them. In-depth interviews were conducted with 81 Black MSM from four Tshwane townships about their sexual and gender identities, sexual practices, social networks, and familial relationships. Interview transcripts were analyzed with ATLAS.ti using a priori codes and inductive coding. Most participants disclosed their sexual identities to at least one person in their families or assumed their families knew despite no explicit disclosure about their sexual identity; a significant minority had not disclosed. Families of those who disclosed were either supportive, in denial, confused, or unsupportive in their responses. Whether or not family was supportive, silence around the participants' same-sex sexualities was prevalent within families. Family responses affected how participants perceived their sexuality and their confidence. Further studies are required to better understand the underlying processes of coming out for Black South African MSM and how these processes impact health outcomes and social well-being.
MeSH term(s)	African Continental Ancestry Group/ethnology ; Bisexuality/ethnology ; Family/ethnology ; Homosexuality, Male/ethnology ; Humans ; Male ; Qualitative Research ; Self Disclosure ; Social Support ; South Africa/ethnology
Language	English
Publishing date	2019-01-11
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	220889-1
ISSN	1559-8519 ; 0022-4499
ISSN (online)	1559-8519
ISSN	0022-4499
DOI	10.1080/00224499.2018.1559917
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Article ; Online: Influence of depression and interpersonal support on adherence to antiretroviral therapy among people living with HIV.

Nutor, Jerry John / Gyamerah, Akua O / Alhassan, Robert Kaba / Duah, Henry Ofori / Thompson, Rachel G A / Wilson, Natalie / Harris, Orlando / Gutierrez, Jose / Hoffmann, Thomas J / Getahun, Monica / Santos, Glenn-Milo

AIDS research and therapy

2023 Volume 20, Issue 1, Page(s) 42

Abstract: Background: Poor adherence and under-utilization of antiretroviral therapy (ART) services have been major setbacks to achieving 95-95-95 policy goals in Sub-Saharan Africa. Social support and mental health challenges may serve as barriers to accessing ... ...

Abstract	Background: Poor adherence and under-utilization of antiretroviral therapy (ART) services have been major setbacks to achieving 95-95-95 policy goals in Sub-Saharan Africa. Social support and mental health challenges may serve as barriers to accessing and adhering to ART but are under-studied in low-income countries. The purpose of this study was to examine the association of interpersonal support and depression scores with adherence to ART among persons living with HIV (PLWH) in the Volta region of Ghana. Methods: We conducted a cross-sectional survey among 181 PLWH 18 years or older who receive care at an ART clinic between November 2021 and March 2022. The questionnaire included a 6-item simplified ART adherence scale, the 20-item Center for Epidemiologic Studies Depression Scale (CES-D), and the 12-item Interpersonal Support Evaluation List-12 (ISEL-12). We first used a chi-squared or Fisher's exact test to assess the association between these and additional demographic variables with ART adherence status. We then built a stepwise multivariable logistic regression model to explain ART adherence. Results: ART adherence was 34%. The threshold for depression was met by 23% of participants, but it was not significantly associated with adherence in multivariate analysis(p = 0.25). High social support was reported by 48.1%, and associated with adherence (p = 0.033, aOR = 3.45, 95% CI = 1.09-5.88). Other factors associated with adherence included in the multivariable model included not disclosing HIV status (p = 0.044, aOR = 2.17, 95% CI = 1.03-4.54) and not living in an urban area (p = 0.00037, aOR = 0.24, 95% CI = 0.11-0.52). Conclusion: Interpersonal support, rural residence, and not disclosing HIV status were independent predictors of adherence to ART in the study area.
MeSH term(s)	Humans ; Cross-Sectional Studies ; Depression/epidemiology ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Ambulatory Care Facilities ; Anti-Retroviral Agents ; Social Support
Chemical Substances	Anti-Retroviral Agents
Language	English
Publishing date	2023-06-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2173450-1
ISSN	1742-6405 ; 1742-6405
ISSN (online)	1742-6405
ISSN	1742-6405
DOI	10.1186/s12981-023-00538-8
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Article ; Online: Inadequate preparedness for response to COVID-19 is associated with stress and burnout among healthcare workers in Ghana.

Afulani, Patience A / Gyamerah, Akua O / Nutor, Jerry J / Laar, Amos / Aborigo, Raymond A / Malechi, Hawa / Sterling, Mona / Awoonor-Williams, John K

PloS one

2021 Volume 16, Issue 4, Page(s) e0250294

Abstract: Introduction: The COVID-19 pandemic has compounded the global crisis of stress and burnout among healthcare workers. But few studies have empirically examined the factors driving these outcomes in Africa. Our study examined associations between ... ...

Abstract	Introduction: The COVID-19 pandemic has compounded the global crisis of stress and burnout among healthcare workers. But few studies have empirically examined the factors driving these outcomes in Africa. Our study examined associations between perceived preparedness to respond to the COVID-19 pandemic and healthcare worker stress and burnout and identified potential mediating factors among healthcare workers in Ghana. Methods: Healthcare workers in Ghana completed a cross-sectional self-administered online survey from April to May 2020; 414 and 409 completed stress and burnout questions, respectively. Perceived preparedness, stress, and burnout were measured using validated psychosocial scales. We assessed associations using linear regressions with robust standard errors. Results: The average score for preparedness was 24 (SD = 8.8), 16.3 (SD = 5.9) for stress, and 37.4 (SD = 15.5) for burnout. In multivariate analysis, healthcare workers who felt somewhat prepared and prepared had lower stress (β = -1.89, 95% CI: -3.49 to -0.30 and β = -2.66, 95% CI: -4.48 to -0.84) and burnout (β = -7.74, 95% CI: -11.8 to -3.64 and β = -9.25, 95% CI: -14.1 to -4.41) scores than those who did not feel prepared. Appreciation from management and family support were associated with lower stress and burnout, while fear of infection was associated with higher stress and burnout. Fear of infection partially mediated the relationship between perceived preparedness and stress/burnout, accounting for about 16 to 17% of the effect. Conclusions: Low perceived preparedness to respond to COVID-19 increases stress and burnout, and this is partly through fear of infection. Interventions, incentives, and health systemic changes to increase healthcare workers' morale and capacity to respond to the pandemic are needed.
MeSH term(s)	Anxiety/psychology ; Burnout, Professional/psychology ; Burnout, Psychological ; COVID-19/epidemiology ; COVID-19/psychology ; COVID-19/therapy ; Cross-Sectional Studies ; Depression/psychology ; Fear ; Female ; Ghana/epidemiology ; Health Personnel/psychology ; Humans ; Male ; Pandemics ; SARS-CoV-2/isolation & purification ; Stress, Psychological/psychology ; Surveys and Questionnaires
Language	English
Publishing date	2021-04-16
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0250294
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Article ; Online: Social and Behavioral Correlates of Sexually Transmitted Infections among Men who Have Sex with Men who Use Alcohol in the San Francisco Bay Area.

Jain, Jennifer P / Gyamerah, Akua O / Baguso, Glenda N / Dawson-Rose, Carol / Ikeda, Janet / Santos, Glenn-Milo

American journal of men's health

2021 Volume 15, Issue 3, Page(s) 15579883211026830

Abstract: The risk of acquiring sexually transmitted infections (STIs) among men who have sex with men (MSM) is driven by various socio-behavioral factors. From 2015-2017, 247 MSM ≥ 18 years-old who reported alcohol use in the past year, were recruited into a ... ...

Abstract	The risk of acquiring sexually transmitted infections (STIs) among men who have sex with men (MSM) is driven by various socio-behavioral factors. From 2015-2017, 247 MSM ≥ 18 years-old who reported alcohol use in the past year, were recruited into a cross-sectional study in San Francisco. Participants completed a survey assessing socio-demographics, substance use and treatment, sexual behaviors, HIV status and self-reported STI diagnosis in the past 6 months. Multivariable logistic regression models stratified by HIV status were used to identify the correlates of STIs. Of 247 MSM, the prevalence of bacterial STIs were: gonorrhea (12.9%), chlamydia (9.3%) and syphilis (6.0%). Among 177 MSM living without HIV, factors significantly associated with recent STI diagnosis were: current pre-exposure prophylaxis (PrEP) use (aOR = 3.53, 95% CI: 1.42-8.75,
MeSH term(s)	Adolescent ; Cross-Sectional Studies ; HIV Infections/diagnosis ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; Homosexuality, Male ; Humans ; Male ; Prevalence ; San Francisco/epidemiology ; Sexual Behavior ; Sexual and Gender Minorities ; Sexually Transmitted Diseases/diagnosis ; Sexually Transmitted Diseases/epidemiology
Language	English
Publishing date	2021-06-16
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2275106-3
ISSN	1557-9891 ; 1557-9883
ISSN (online)	1557-9891
ISSN	1557-9883
DOI	10.1177/15579883211026830
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Article ; Online: Stigma, discrimination, violence, and HIV testing among men who have sex with men in four major cities in Ghana.

Gyamerah, Akua O / Taylor, Kelly D / Atuahene, Kyeremeh / Anarfi, John K / Fletcher, Michelle / Raymond, Henry F / McFarland, Willi / Dodoo, F Nii-Amoo

AIDS care

2020 Volume 32, Issue 8, Page(s) 1036–1044

Abstract: LGBTQ populations experience human rights abuses worldwide; data need to document the health impact of these experiences in Africa. In Ghana, we measured events of sexuality-based stigma, discrimination, and violence among men who have sex with men (MSM) ...

Abstract	LGBTQ populations experience human rights abuses worldwide; data need to document the health impact of these experiences in Africa. In Ghana, we measured events of sexuality-based stigma, discrimination, and violence among men who have sex with men (MSM) and the impact on HIV testing behavior. Data are from respondent-driven sampling surveillance surveys in Accra/Tema, Kumasi, Cape Coast/Takoradi, and Koforidua. Discrimination was common among MSM: 6.2%-30.6% were refused services, 29.0%-48.9% experienced verbal/symbolic violence, 2.8%-12.8% experienced physical violence, 12.3%-30.0% experienced sexual violence due to their sexuality in the preceding year. MSM who experienced sexual violence in their first male sexual encounter were less likely to ever test for HIV in Accra/Tema and Cape Coast/Takoradi. Further studies are needed to examine the impact of stigma and violence on MSM's HIV health-seeking behavior in Ghana. Structural interventions are needed to mitigate the consequences of stigma and discrimination on MSM health and well-being.
MeSH term(s)	Adult ; Cities ; Cross-Sectional Studies ; Discrimination, Psychological ; Female ; Ghana/epidemiology ; HIV Infections/diagnosis ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; HIV Infections/psychology ; Health Behavior/ethnology ; Homosexuality, Male/psychology ; Humans ; Male ; Middle Aged ; Sexual Behavior ; Sexual and Gender Minorities ; Social Stigma ; Violence/psychology ; Violence/statistics & numerical data
Language	English
Publishing date	2020-05-04
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1012651-x
ISSN	1360-0451 ; 0954-0121
ISSN (online)	1360-0451
ISSN	0954-0121
DOI	10.1080/09540121.2020.1757020
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Article ; Online: Experiences and factors associated with transphobic hate crimes among transgender women in the San Francisco Bay Area: comparisons across race.

Gyamerah, Akua O / Baguso, Glenda / Santiago-Rodriguez, Edda / Sa'id, Aria / Arayasirikul, Sean / Lin, Jess / Turner, Caitlin M / Taylor, Kelly D / McFarland, Willi / Wilson, Erin C / Wesson, Paul

BMC public health

2021 Volume 21, Issue 1, Page(s) 1053

Abstract: Background: Trans women experience high rates of gender-based violence (GBV)-a risk factor for adverse health outcomes. Transphobic hate crimes are one such form of GBV that affect trans women. However, little is understood about factors that shape ... ...

Abstract	Background: Trans women experience high rates of gender-based violence (GBV)-a risk factor for adverse health outcomes. Transphobic hate crimes are one such form of GBV that affect trans women. However, little is understood about factors that shape transphobic hate crimes and racial/ethnic variation in these experiences. To contextualize GBV risk and police reporting, we examined self-reported types and correlates of transphobic hate crimes by racial/ethnic group of trans women in the San Francisco Bay Area. Methods: From 2016 to 2018, trans women participated in a longitudinal cohort study of HIV. Secondary data analyses (N = 629) examined self-reported experiences of transphobic hate crimes (i.e., robbery, physical assault, sexual assault, and battery with weapon) by race/ethnicity, and whether hate crimes were reported to the police. Chi-square tests and simple logistic regression examined demographic, sociocultural, and gender identity factors associated with transphobic violence experiences and police reporting. Results: About half (45.8%) of participants reported ever experiencing a transphobic hate crime; only 51.1% of these were reported to the police. Among those who reported a hate crime experience, Black (47.9%) and Latina (49.0%) trans women reported a higher prevalence of battery with a weapon; White (26.7%) and trans women of "other" race/ethnicities (25.0%) reported a higher prevalence of sexual assault (p = 0.001). Having one's gender questioned, history of sex work, homelessness as a child and adult, and a history incarceration were associated with higher odds of experiencing a transphobic hate crime. Trans women who felt their gender identity questioned had lower odds of reporting a hate crime to the police compared to those did not feel questioned. Conclusions: A high proportion of trans women experienced a transphobic hate crime, with significant socio-structural risk factors and racial differences by crime type. However, crimes were underreported to the police. Interventions that address structural factors, especially among trans women of color, can yield violence prevention benefits.
MeSH term(s)	Adult ; Child ; Crime ; Crime Victims ; Female ; Gender Identity ; Hate ; Humans ; Longitudinal Studies ; Male ; San Francisco/epidemiology ; Transgender Persons
Language	English
Publishing date	2021-06-02
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-021-11107-x
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