Barriers and facilitators to HIV prevention services among key populations in Biakoye District, Ghana

Abstract Background Key populations such as sex workers, men who have sex with men (MSM), women who have sex with women (WSW), and people who inject drugs (PWID) bear a disproportionately high burden of HIV infection. Despite the availability of HIV prevention services in Ghana, access and utilization remain limited, particularly in rural settings. Methods A cross-sectional study was conducted in April 2025 among 43 key population members in the Biakoye District of Ghana. Participants were recruited using snowball sampling. Data were collected through a structured questionnaire and analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression to identify factors associated with HIV prevention service utilization. Results The mean age of participants was 25.2 years (SD = 4.9). Most participants were female (65.1%) and sex workers (72.1%). Although 93.0% had heard of HIV prevention methods, only 62.8% had ever used prevention services. Common barriers included lack of awareness (48.8%), fear of stigma or discrimination (48.8%), long waiting times (36.1%), transportation challenges (29.5%), and concerns about confidentiality (34.9%). In the adjusted analysis, participants with secondary or tertiary education were more likely to utilize HIV prevention services compared to those with no formal or primary education (aOR = 3.84, 95% CI: 1.02–14.5, p = 0.046). Similarly, knowledge of where to access HIV prevention services was significantly associated with utilization (aOR = 4.96, 95% CI: 1.21–20.3, p = 0.026). Conclusion Despite high awareness of HIV prevention methods, utilization remains suboptimal among key populations in Biakoye District due to persistent structural and social barriers. Improving access to services, enhancing community-based interventions, and reducing stigma are critical to increasing uptake of HIV prevention services in rural settings.