Community-led study of access to antiretroviral therapy and viral load testing.

Access to antiretroviral therapy (ART) has expanded in sub-Saharan Africa, yet sustained retention and viral-load testing remain fragile. In Ghana, sexual and gender minority (SGM) populations including men who have sex with men (MSM) and transgender women (TGW) experience intersecting vulnerabilities: the biomedical demands of living with HIV alongside stigma, criminalisation, and social exclusion. Despite global commitments to equity, existing research in West Africa has largely prioritised biomedical indicators and rarely centres SGM lived experience or participatory approaches, limiting understanding of how treatment is assessed, negotiated, and sustained within constrained health systems. This study examined how SGM living with HIV in Ghana experience, engage with, and sustain ART and viral load testing, how social determinants and participatory structures shape access, and how service delivery might be reimagined for greater equity and person-centredness. A co-produced hermeneutic phenomenological design, informed by Gadamer's philosophy of interpretation was implemented. Participatory governance was embedded through a Community and Research Advisory Groups, together forming a Public Scrutiny Panel. Eighteen participants (17 MSM and one TGW), purposively sampled to reflect diversity in age, geography, and service pathways, took part in semi-structured interviews co-developed and piloted with community partners. Analysis followed a six-stage hermeneutic interpretive cycle integrating Reflexive Thematic Analysis and the Framework Method, supported by reflexive journaling, member validation, and collaborative sense-making. Interpretation was further informed by Self-Determination Theory, intersectionality, and the Dahlgren and Whitehead model of social determinants. Two preparatory JBI-guided reviews - a scoping review and a methodological Study Within a Review - contextualised the primary study and informed its participatory and analytic design. Five interrelated themes structured the results: 1) Navigating Identity and Health; 2) The ART Experience; 3) Contextual Factors (influencing access); 4) The Viral load Testing Experience; and 5) Mindsets and Strategies of Access. ART engagement was experienced as a socially negotiated and structurally situated process. Diagnosis initiated a psychosocial transition in which "being MSM" and "being HIV-positive" intersected through stigma, disclosure, and contemplation. Empathetic counselling and trustful provider relationships anchored adherence, while empathy emerged as infrastructure sustaining care within fragile systems. Healthcare seekers actively constructed safety amid punitive legal environments, food insecurity, victim-blame, and service disruptions, drawing on community-based organisation (CBO) support and peer solidarity. Viral-load testing functioned simultaneously as empowerment and surveillance: timely results reinforced motivation and agency, whereas delays generated anxiety and speculation. ART engagement was therefore experienced as both life-sustaining and precarious, sustained through resilience, relational care, and adaptive strategies. This study advances a participatory hermeneutic paradigm for HIV health services research. Conceptually, it operationalises Gadamerian hermeneutics through participatory governance, democratising interpretation. Methodologically, it integrates Reflexive Thematic Analysis and the Framework Method with theory-informed, co-produced analytic structures that strengthen epistemic justice. Empirically, it reframes empathy and relatedness as central determinants of sustained ART engagement. Practically, it highlights the protective role of CBOs and proposes co-produced, pharmacy-linked, and digitally supported ART models embedding confidentiality, trust, and person-reported experience measures (PREMs). Together, these contributions reimagine HIV care as a rights-based, participatory, and context-responsive system.

Grantor dc:publisher.institution

Robert Gordon University

Year dc:date.issued

2025

Author dc:creator

• Konadu, Kwadjo

Advisor dc:contributor.advisor

• Swinton, P., Douglas, F. and Whitcombe, A.

• HIV care, Hermeneutic phenomenology
• Antiretroviral therapy (ART)
• Participatory research
• Reflexive thematic analysis
• Gay men

Language dc:language

en

Identifier

oai:rgu-repository.worktribe.com:3316014
https://doi.org/10.48526/rgu-wt-3316014

Author Identifier

0000-0003-0053-7505

OAI identifier oai:identifier

oai:rgu-repository.worktribe.com:3316014