Research Article

Exploring the Barriers to Clinic-based Screening for Sexually Transmitted Infections (STIs) among Men in Ghana: A Qualitative Study

Joseph Kuufaakang Kuunibe, Felix Apiribu, Timothy Tienbia Laari*, Gideon Awenabisa Atanuriba, Veronica Millicent Dzomeku, Victoria Bubunyo Bam, Abigail Kusi-Amponsah Diji, Adwoa Bemah Boamah Mensah, Philemon Adoliwine Amooba, Rumana Saeed Mohammed and E

Published: 16 April, 2024 | Volume 5 - Issue 1 | Pages: 044-051

The burden of sexually transmitted infections (STIs) continues to increase with over one million curable STIs occurring daily worldwide. Sex disparity in the rates of testing for STIs can compromise the efforts to reduce the incidence of STIs. The study aimed to explore the barriers to facility-based screening for STIs among men in Ghana. A qualitative exploratory design was employed in this study. Using a semi-structured interview guide, individual in-depth interviews were conducted among purposively sampled men from November 2019 to January 2020. Data saturation was achieved at the ninth participant. Audio-recorded interviews were transcribed verbatim and analysed thematically through Braun and Clarke’s approach. Four themes emerged from the analyses: (1) lack of privacy from healthcare providers, (2) mistrust of healthcare providers, (3) the burden of handling thoughts of positive status, and (4) fear of stigmatisation. These barriers deterred men from seeking clinic-based screening for STIs. The barriers were multi-factorial and a major hindrance to ensuring that people are aware of their STI status through screening and diagnosis. It is imperative to consider these barriers when designing STI screening interventions and policies to help promote facility-based screening for STIs among men in Ghana.

Read Full Article HTML DOI: 10.29328/journal.jcmhs.1001046 Cite this Article Read Full Article PDF


Barriers; Sexually transmitted infections; Screening; Men


  1. Mutaru A-M, Asumah M, Ibrahim M, Sumaila I, Hallidu M, Mbemah J. Knowledge on Sexually Transmitted Infections (STIs) and sexual practices among Nursing Trainees in Yendi Municipality, Northern Region of Ghana. European Journal of Health Sciences. 2021; 6(4):33–47.
  2. Dela H, Attram N, Behene E, Kumordjie S, Addo KK, Nyarko EO, Kyei NNA, Carroll JNA, Kwakye C, Duplessis CA, Adams N, Garges E, Letizia AG. Risk factors associated with gonorrhea and chlamydia transmission in selected health facilities in Ghana. BMC Infect Dis. 2019 May 16;19(1):425. doi: 10.1186/s12879-019-4035-y. PMID: 31096920; PMCID: PMC6524331.
  3. Abdurahman C, Oljira L, Hailu S, Mengesha MM. Sexual and reproductive health services utilization and associated factors among adolescents attending secondary schools. Reprod Health. 2022 Jul 15;19(1):161. doi: 10.1186/s12978-022-01468-w. PMID: 35840973; PMCID: PMC9287868.
  4. Risenga PR, Davhana-Maselesele M. A concept analysis of young adults; Perception of HIV Counselling and Testing. Health SA Gesondheid. 2017; 22:213-20.
  5. Ramjee G, Abbai NS, Naidoo S. Women and Sexually Transmitted Infections in Africa. Open Journal of Obstetrics and Gynecology. 2015; 5(July):385–99.
  6. Kassie BA, Yenus H, Berhe R, Kassahun EA. Prevalence of sexually transmitted infections and associated factors among the University of Gondar students, Northwest Ethiopia: a cross-sectional study. Reprod Health. 2019 Nov 8;16(1):163. doi: 10.1186/s12978-019-0815-5. PMID: 31703688; PMCID: PMC6842222.
  7. Veronese V, van Gemert C, Bulu S, Kwarteng T, Bergeri I, Badman S, Vella A, Stoové M. Sexually transmitted infections among transgender people and men who have sex with men in Port Vila, Vanuatu. Western Pac Surveill Response J. 2015 Mar 5;6(1):55-9. doi: 10.2471/WPSAR.2014.5.1.001. PMID: 25960923; PMCID: PMC4410108.
  8. Lubega GN, Musinguzi B, Omiel P, Tumuhe JL. Determinants of health seeking behaviour among men in Luwero District. Journal of Educational Research and Behavioural Sciences. 2015; 4(2):37–54.
  9. Su JY, Belton S, Ryder N. Why are men less tested for sexually transmitted infections in remote Australian Indigenous communities? A mixed-methods study. Cult Health Sex. 2016 Oct;18(10):1150-64. doi: 10.1080/13691058.2016.1175028. Epub 2016 May 4. PMID: 27142316.
  10. World Health Organization. Report on global sexually transmitted infection surveillance [Internet]. Geneva, Switzerland; 2018. https://apps.who.int/iris/rest/bitstreams/1170799/retrieve
  11. Seidu AA, Agbaglo E, Dadzie LK, Tetteh JK, Ahinkorah BO. Self-reported sexually transmitted infections among sexually active men in Ghana. BMC Public Health. 2021 May 26;21(1):993. doi: 10.1186/s12889-021-11030-1. PMID: 34039317; PMCID: PMC8157633.
  12. Seidu AA, Ahinkorah BO, Dadzie LK, Tetteh JK, Agbaglo E, Okyere J, Salihu T, Oteng KF, Bugase E, Osei SA, Hagan JE Jr, Schack T. A multi-country cross-sectional study of self-reported sexually transmitted infections among sexually active men in sub-Saharan Africa. BMC Public Health. 2020 Dec 7;20(1):1884. doi: 10.1186/s12889-020-09996-5. PMID: 33287785; PMCID: PMC7722450.
  13. Azu MN, Richter S, Aniteye P. Ghanaian Men Living with Sexual Transmitted Infections: Knowledge and Impact on Treatment Seeking Behaviour- A Qualitative Study. Afr J Reprod Health. 2018 Sep;22(3):24-32. doi: 10.29063/ajrh2018/v22i3.3. PMID: 30381929.
  14. Gilbert M, Thomson K, Salway T, Haag D, Grennan T, Fairley CK, Buchner C, Krajden M, Kendall P, Shoveller J, Ogilvie G. Differences in experiences of barriers to STI testing between clients of the internet-based diagnostic testing service GetCheckedOnline.com and an STI clinic in Vancouver, Canada. Sex Transm Infect. 2019 Mar;95(2):151-156. doi: 10.1136/sextrans-2017-053325. Epub 2018 Feb 7. PMID: 29437984; PMCID: PMC6580770.
  15. Barbee LA, Dhanireddy S, Tat SA, Marrazzo JM. Barriers to Bacterial Sexually Transmitted Infection Testing of HIV-Infected Men Who Have Sex With Men Engaged in HIV Primary Care. Sex Transm Dis. 2015 Oct;42(10):590-4. doi: 10.1097/OLQ.0000000000000320. PMID: 26372931; PMCID: PMC4576720.
  16. Bell S, Aggleton P, Ward J, Murray W, Silver B, Lockyer A, Ferguson T, Fairley CK, Whiley D, Ryder N, Donovan B, Guy R, Kaldor J, Maher L. Young Aboriginal people's engagement with STI testing in the Northern Territory, Australia. BMC Public Health. 2020 Apr 6;20(1):459. doi: 10.1186/s12889-020-08565-0. PMID: 32252712; PMCID: PMC7137447.
  17. Avuvika E, Masese LN, Wanje G, Wanyonyi J, Nyaribo B, Omoni G, Baghazal A, McClelland RS. Barriers and Facilitators of Screening for Sexually Transmitted Infections in Adolescent Girls and Young Women in Mombasa, Kenya: A Qualitative Study. PLoS One. 2017 Jan 3;12(1):e0169388. doi: 10.1371/journal.pone.0169388. PMID: 28046104; PMCID: PMC5207488.
  18. Mapp F, Wellings K, Hickson F, Mercer CH. Understanding sexual healthcare seeking behaviour: why a broader research perspective is needed. BMC Health Serv Res. 2017 Jul 6;17(1):462. doi: 10.1186/s12913-017-2420-z. PMID: 28683744; PMCID: PMC5501268.
  19. Nyarko C, Unson C, Koduah M, Nyarko P, Galley J. Risk Factors Of Sexually-Transmitted Infections (STIs) Among Men And Women In A Mining Community In Western Ghana : A Study Of Lifetime Occurrence. International Journal of Scientific & Technology Research. 2014; 3(12).
  20. Ghana AIDS Commission. National HIV and AIDS, STI Policy [Internet]. Accra, Ghana; 2013. https://www.healthpolicyproject.com/pubs/153_Policyfinal.pdf
  21. Ali Abdulai M, Baiden F, Afari-Asiedu S, Gyabaa-Febir L, Adjei KK, Mahama E, Tawiah-Agyemang C, Newton SK, Asante KP, Owusu-Agyei S. The Risk of Sexually Transmitted Infection and Its Influence on Condom Use among Pregnant Women in the Kintampo North Municipality of Ghana. J Sex Transm Dis. 2017;2017:8642685. doi: 10.1155/2017/8642685. Epub 2017 Jan 26. PMID: 28246570; PMCID: PMC5299183.
  22. Standard protocol to assess the prevalence of gonorrhoea and chlamydia among pregnant women in antenatal care clinics. Geneva, Switzerland; 2018.
  23. Yilmaz K. Comparison of Quantitative and Qualitative Research Traditions : epistemological, theoretical, and methodological differences. European Journal of Education. 2013; 48(2):311–25.
  24. Mitchell ML, Jolley JM. Research Design Explained. 7th ed. USA: Wadsworth, Cengage Learning; 2010.
  25. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007 Dec;19(6):349-57. doi: 10.1093/intqhc/mzm042. Epub 2007 Sep 14. PMID: 17872937.
  26. Ghana Statistical Service. Ghana 2021 Population and Housing Census: Population of Regions and Districts [Internet]. Accra, Ghana; 2021. www.statsghana.gov.gh
  27. Ofosu W. Upper West Regional Health Services: 2016 Annual Report. Wa; 2017.
  28. Yahaya A. Transportation Network in the Sissala East District of Ghana : A Bane to Maternal Health. 2014.
  29. Ghana Districts. A repository of all Local Assemblies in Ghana: Sisala East. 2022. 1–9. https://ghanadistricts.com/Home/LinkDataDistrict/2508
  30. Ingham-Broomfield R. A Guide to Qualitative Research. Australian Journal of Advanced Nursing. 2015; 32(3):34–40.
  31. Teo CH, Ng CJ, Booth A, White A. Barriers and facilitators to health screening in men: A systematic review. Soc Sci Med. 2016 Sep;165:168-176. doi: 10.1016/j.socscimed.2016.07.023. Epub 2016 Aug 1. PMID: 27511617.
  32. Denison HJ, Bromhead C, Grainger R, Dennison EM, Jutel A. Barriers to sexually transmitted infection testing in New Zealand: a qualitative study. Aust N Z J Public Health. 2017 Aug;41(4):432-437. doi: 10.1111/1753-6405.12680. Epub 2017 Jun 29. PMID: 28664644; PMCID: PMC5564490.
  33. Mapp F, Hickson F, Mercer CH, Wellings K. How social representations of sexually transmitted infections influence experiences of genito-urinary symptoms and care-seeking in Britain: mixed methods study protocol. BMC Public Health. 2016 Jul 11;16:548. doi: 10.1186/s12889-016-3261-0. PMID: 27400780; PMCID: PMC4940703.
  34. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology [Internet]. 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa
  35. Lincoln YS, Guba EG. Naturalistic Inquiry. Newbury Park: SAGE Publications, Inc.; 1985.
  36. Squires A, Dorsen C. Qualitative Research in Nursing and Health Professions Regulation. Journal of Nursing Regulation [Internet]. 2018;9(3):15–26. https://doi.org/10.1016/S2155-8256(18)30150-9
  37. Polit DF, Beck CT. Nursing Research: Principles and Methods. 7th ed. New York: Lippincott Williams & Wilkins; 2003. 301.
  38. Denison HJ. Healthcare-seeking behaviour for sexually transmitted infection testing in New Zealand : A mixed methods study. Victoria University of Wellington; 2017.
  39. Jayapalan S. Healthcare-seeking preferences of patients with sexually transmitted infection attending a tertiary care center in South Kerala. Indian J Sex Transm Dis AIDS. 2016 Jul-Dec;37(2):157-161. doi: 10.4103/0253-7184.188483. PMID: 27890950; PMCID: PMC5111301.
  40. Nyalela M. Healh Seeking Behaviour in Men Presenting with Sexually Transmitted Infections at Prince Mshiyeni Gateway Clinic and KwaMashu Community Health Centre in 2015. University of KwaZulu-Natal; 2015.
  41. Lichtenstein B. Stigma as a barrier to treatment of sexually transmitted infection in the American deep south: issues of race, gender and poverty. Soc Sci Med. 2003 Dec;57(12):2435-45. doi: 10.1016/j.socscimed.2003.08.002. PMID: 14572849.
  42. Medved Kendrick H. Are religion and spirituality barriers or facilitators to treatment for HIV: a systematic review of the literature. AIDS Care. 2017 Jan;29(1):1-13. doi: 10.1080/09540121.2016.1201196. Epub 2016 Jul 13. PMID: 27410058; PMCID: PMC9670680.
  43. Nyalela M, Dlungwane T, Taylor M, Nkwanyana N. Health seeking and sexual behaviour of men presenting with sexually transmitted infections in two primary health care clinics in Durban. Southern African Journal of Infectious Diseases. 2018; 0(0):1–6.
  44. Nagarkar A, Mhaskar P. A systematic review on the prevalence and utilization of health care services for reproductive tract infections/sexually transmitted infections: Evidence from India. Indian J Sex Transm Dis AIDS. 2015 Jan-Jun;36(1):18-25. doi: 10.4103/0253-7184.156690. PMID: 26392649; PMCID: PMC4555893.
  45. Hengel B, Guy R, Garton L, Ward J, Rumbold A, Taylor-Thomson D, Silver B, McGregor S, Dyda A, Knox J, Kaldor J, Maher L. Barriers and facilitators of sexually transmissible infection testing in remote Australian Aboriginal communities: results from the Sexually Transmitted Infections in Remote Communities, Improved and Enhanced Primary Health Care (STRIVE) Study. Sex Health. 2015 Mar;12(1):4-12. doi: 10.1071/SH14080. PMID: 25426563.
  46. Morris JL, Lippman SA, Philip S, Bernstein K, Neilands TB, Lightfoot M. Sexually transmitted infection related stigma and shame among African American male youth: implications for testing practices, partner notification, and treatment. AIDS Patient Care STDS. 2014 Sep;28(9):499-506. doi: 10.1089/apc.2013.0316. PMID: 25133501; PMCID: PMC4135319.


Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?