From Belief to Behaviour: Why Condom Use Attitudes Alone Fail to Predict Use Among Men Who Have Sex with Men in Ghana's Western and Central Regions. A Cross-Sectional Study

Background There are disproportionate HIV/AIDS infections among men who have sex with men (MSM) in Ghana compared to the general population, despite the implementation of condom utilisation campaigns. Attitudes towards the use of condoms are culturally dependent, but most condom use attitude studies ignore culture. Aim The study aimed to assess the determinants of condom use attitudes among MSM in two regions of Ghana. Methods From May 2025 to July 2025, a regional-based cross-sectional study was carried out using a snowball sampling approach to select 1000 MSM from two regions of Ghana. The study utilised the University of Chicago Los Angeles Multidimensional Condom Attitudes Scale (UCLA-MCAS) for data collection. Condom use attitudes were evaluated based on the mean scores of the five subscales of the UCLA-MCAS. Multivariable logistic regression established associations between dependent and independent variables. Outcome variables with a p -value < .05 were deemed statistically significant. The odds ratio with a 95% confidence interval was computed to determine the strength of an association. Results More than half of the respondents had poor condom use attitudes ( n = 513; 50.6%). The Western Region had higher perceived embarrassment associated with condom negotiation and use (2.84 ± 1.64), compared to counterparts in the Central Region (4.34 ± 1.35) in their response. Respondents who reported sexual involvement with women “always” had 56% lower odds of having a favourable condom use attitude compared to counterparts whose sexual preferences were men only (0.44, 95% CI: 0.25–0.76). Participants in the Western Region had 3.54 times higher odds of having a favourable condom use attitude as compared to participants in the Central Region of Ghana (95% CI: 2.57–4.89). Conclusion Being resident in the Central Region of Ghana, being affiliated with Pentecostal Christianity, being a Receptive MSM partner, engaging “always”, “sometimes or “rarely” in sexual activity with women, and anticipating condom use “rarely” in the future determined condom use attitude. The Central Region had negative condom use attitudes. In contrast, counterparts in the Western Region had positive condom use attitudes. Implementing an education strategy that not only focuses on promoting condom use attitudes of individuals but also on the context of the sexual encounter is encouraged.