Exploring the Sexual and Reproductive Health Experiences of Young Women and Girls Living with HIV in the Lower Manya Krobo Municipality of Ghana: A Multi-Methods Qualitative Study

Abstract

Despite carrying the disproportionate burden of Human Immunodeficiency Virus (HIV) and poor sexual reproductive health outcomes in sub-Saharan Africa, young women and girls' experiences and the system level influences shaping their experiences receive little attention in research. In Ghana, young women account for 83% of new HIV infections among people aged 18-24. The Lower Manya Krobo Municipality (LMK) is one of the top places with high HIV prevalence in the country. With a prevalence rate three times higher than the national average yet little known about the sexual reproductive health experiences of young women in this community.

Using a qualitative photovoice design, twenty-one young women and girls living with HIV, aged 15-24 (inclusive) in LMK documented their sexual and reproductive health experiences. We also conducted 15 key informant interviews with health providers, health system managers and community leaders to further understand their perspective on services and barriers available to these young women. Our findings show that young women's sexual reproductive health and HIV care management were shaped by interconnected structural barriers including poverty, food insecurity, stigma, gendered power relations, pronatalist expectations and an inadequate health system. These shaped their reproductive health decisions including safe sex, abortion, and remaining in continuous care. Despite many challenges of the healthcare system including stigma, provider attitude and confidentiality breaches, the system provides several meaningful adaptations including youth clinic days, trusted provider relationships, peer counselors, multi-month antiretroviral dispensing of drugs and PrEP for harm reduction.

For Ghana to improve sexual reproductive health outcomes and achieve the UNAIDS 95-95-95 targets, it must shift from the single focus HIV programming that focuses on sexual risk to a comprehensive well-being approach. This will mean considering economic security, reproductive autonomy, and confidentiality as interconnected priorities backed by a well-funded sustainable policy implementation system.