A Performance Evaluation of the National HIV Prevention 
Program for FSW and MSM in Ghana 
This research has been supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. 
Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement 
GHA-A-00-08-00003-00, which is implemented by the Carolina Population Center at the University of North 
Carolina at Chapel Hill, with Futures Group, ICF International, John Snow, Inc., Management Sciences for Health, 
and Tulane University. The views expressed in this publication do not necessarily reflect the views of PEPFAR, 
USAID, or the United States government. 
July 2014 TR-14-97
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana ii
ACRONYMS
ADRA Adventist Development Relief Agency
ART Antiretroviral therapy 
eTWG Expanded Technical Working Group
FGD Focus group discussion
FSW Female sex worker
GAC Ghana AIDS Commission
IBBSS Integrated Biological and Behavioral Surveillance Survey
IEC Information, education, communication
PWID People who inject drugs
IRB Institutional review board
KII Key informant interviews
M&E Monitoring and evaluation
MARP Most-at-risk population
MSM Men who have sex with men
NACP National AIDS/STI Control Programme
NGO Nongovernmental organization
NSP Ghana National Strategic Plan
OCA Organizational capacity assessment
PE Peer educator
PLWHA People living with HIV/AIDs
PMTCT Prevention of mother-to-child transmission of HIV
SPA Service provision assessment
STI Sexually transmitted infection
TWG Technical Working Group
UIC Unique identifier codes 
UNAIDS Joint United Nations Programme on HIV/AIDS
USAID U.S. Agency for International Development
VCT Voluntary counseling and testing
WAPCAS West Africa Project to Combat AIDS and STI, Ghana 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana iii
Table of Contents
Acronyms ................................................................................................................................................................. ii
Executive Summary.............................................................................................................................................vi
Background and Study Aims ......................................................................................................................vi
Methodology.....................................................................................................................................................vi
Findings.............................................................................................................................................................vii
Conclusions and Recommendations .................................................................................................... viii
1. Introduction........................................................................................................................................................ 1
1.1. Background, Rationale, and Contest ............................................................................................ 1
1.2. Specific Aims and Objectives of the Evaluation....................................................................... 3
1.3. Overview of Report............................................................................................................................. 3
2. Evaluation Methodology................................................................................................................................ 5
2.1. Study Design.............................................................................................................................................. 5
2.2. Sensitization of Study Community.................................................................................................... 5
2.3. Evaluation Areas and Components .................................................................................................. 5
2.3.1. Survey Interviews with MSM and FSW................................................................................... 6
2.3.2. Focus Groups with FSW................................................................................................................ 7
2.3.3. Service Provision Assessment and Peer Educator Interviews....................................... 8
2.3.4. Organizational Capacity Assessment....................................................................................... 9
2.3.5. Key Informant Interviews with Stakeholders ...................................................................... 9
2.4. Data Handling, Management, and Storage.................................................................................. 10
2.5. Quantitative Data Management, Processing and Analysis ................................................... 10
2.6. Qualitative Data Management, Processing, and Analysis ..................................................... 10
2.7. Ethical Considerations........................................................................................................................ 10
2.7.1. Informed Consent and Minimization of Risks to Participants .................................... 11
2.8. Data Collectors Training.................................................................................................................... 11
3. Study Findings ................................................................................................................................................ 13
3.1. Provider Demographics ..................................................................................................................... 13
3.1.1. Organizational Capacity Assessment with Local Nongovernment
Organizations ................................................................................................................................. 13
3.1.2. Service Delivery Points ............................................................................................................... 13
3.1.3. Peer Educators ............................................................................................................................... 13
3.2. Services .................................................................................................................................................... 14
3.2.1. Services Provided.......................................................................................................................... 14
3.2.2. Client Demographics.................................................................................................................... 16
3.2.3. Service Uptake as Measure of Coverage: Peer Educators.............................................. 18
3.2.4. Service Uptake as Measure of Coverage: Drop-in Centers............................................ 20
3.2.5. Service Uptake as Measure of Coverage: Mobile Outreach........................................... 22
3.3. Measurement......................................................................................................................................... 24
3.3.1. Describing Coverage .................................................................................................................... 24
3.3.2. Reporting, Training, and Supervision ................................................................................... 25
3.3.3. Other Service Providers.............................................................................................................. 27
3.4. Progress Toward 80% Coverage.................................................................................................... 27
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana iv
3.5. Quality....................................................................................................................................................... 28
3.5.1. Defining Quality ............................................................................................................................. 28
3.5.2.Quality: Adherence and Availability ....................................................................................... 29
3.5.3.Quality: Accessibility of Services.............................................................................................. 29
3.5.4. Quality: Acceptability of Services............................................................................................ 33
3.5.5. Quality: Attitudes of Providers and Clients......................................................................... 35
4. Barriers and Facilitators to Accessing Health Services by MSM and FSW.............................. 39
4.1. Potential Barriers and Opportunities for FSW.......................................................................... 39
4.2. Potential Barriers and Opportunities for MSM......................................................................... 44
4.3. Potential Barriers and Opportunities: Perspectives of Service Providers..................... 48
4.3.1. Providers’ (Peer Educators and SDPs Providers) Perspectives.................................. 48
4.3.2. Providers’ Views on How to Improve Key Population Services.................................. 49
5. Organizational Profiles, Service Provision, Challenges, and Opportunities ........................... 51
5.1. Organizational Profiles....................................................................................................................... 51
5.2. Services Provided................................................................................................................................. 52
5.3. Service Provision Challenges and Opportunities..................................................................... 53
5.4. Involvement of Community in Decision Making and Program
Standard Operating Procedures................................................................................................. 54
6. Stakeholder and Organizational Coordination and Social, Cultural, Religious, Political, 
and Legal Barriers to HIV Prevention Efforts among FSWs and MSM ........................ 61
6.1. Status of National Key Populations Program ............................................................................ 61
6.2. Stakeholder and Organizational Coordination Efforts .......................................................... 62
6.3. Barriers to HIV Prevention Efforts for Key Populations....................................................... 63
6.4. Way Forward for Programs and Policies .................................................................................... 64
7. Conclusions and Recommendations ...................................................................................................... 67
7.1. Coverage .................................................................................................................................................. 67
7.2. Quality and Access ............................................................................................................................... 68
7.3. Organizational Capacity..................................................................................................................... 69
7.4. National Socio-politico-legal Environment................................................................................ 70
7.5. Strengths and Limitations................................................................................................................. 71
7.6. Way Forward ......................................................................................................................................... 71
Acknowledgements........................................................................................................................................... 72
References ............................................................................................................................................................ 73
Appendix 1. Service Uptake ........................................................................................................................... 75
Appendix 2. Evaluation Tools........................................................................................................................ 81
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana v 
List of Tables 
Table 1. Distribution of FGD Participants by City and Type of FSW................................................. 8
Table 2. Percent of Services Provided by Peer Educators, Separated by Population Most 
Served................................................................................................................................................... 15
Table 3. Percent of Services Provided by Service Delivery Points................................................. 16
Table 4. Demographic Information for Client Populations............................................................... 17
Table 5. Percent of Service Uptake for Clients of Peer Educators.................................................. 19
Table 6. Percent of Service Uptake for Service Users at Drop-in Centers ................................... 21
Table 7. Percent of Service Uptake by MSM and FSWs at Mobile Outreach Centers .............. 23
Table 8. Demographic Information – FSW & MSM Service Users and Non-users.................... 31
Table 9. Percent of Repeated Service Uptake by Clients by Place of Contact, including 
Number of Times Clients Who Sought Care in 12-Month Period.................................. 34
Table 10. Percent of Clients with Positive Feelings about Services from Peer Educators .... 37
Table 11. Percent of Clients with Positive Feelings about Services with Drop-in Center
 Providers ........................................................................................................................................... 37
Table 12. Percent of Clients with Positive Feelings about Services from Mobile Outreach
 Centers ............................................................................................................................................... 38
Table 13. mHealth Opportunities and Experiences of FSWs ........................................................... 40
Table 14. mHealth Opportunities and Experiences of MSM.............................................................. 45
Table 15. Twelve Independent Organizations Involved in OCA Component of Evaluation.. 51
Table 16. Services Rendered by Organizations to Target Populations......................................... 52
Table 17. Community Participation and Program Standard Operating Procedures ............... 55
Table 18. Functional Supervision Mechanisms...................................................................................... 56
Table 19. Functional Monitoring and Evaluation Systems ................................................................ 57
Table 20. Administration, Management, and Planning Capacity..................................................... 59
Table 21. Participants of Key Informant Interviews ............................................................................ 61
Table A1. Percent of Service Uptake by Clients from Peer Educators by Ecological Zone.... 75
Table A2. Percent of Service Uptake by Clients from Peer Educators by City............................ 76
Table A3. Percent of Service Uptake for Clients at Drop-in Centers by Ecological Zone ....... 77
Table A4. Percent of Service Uptake for Clients at Drop-in Centers by City............................... 78
Table A5. Percent of Service Uptake for Clients at Mobile Outreach Centers
 by Ecological Zone ......................................................................................................................... 79
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana vi
EXECUTIVE SUMMARY
BACKGROUND AND STUDY AIMS
The Ghana AIDS Commission (GAC) estimates that 1.5% of the general population in Ghana 
is HIV positive; however, analyses have shown that the epidemic disproportionately affects 
certain marginalized groups, including female sex workers (FSW) and men who have sex 
with men (MSM). In response to these findings, the Ghana National Strategic Plan (NSP) for 
HIV and AIDS 2011-2015 places a strong emphasis on expanding access to HIV services for 
key populations at greatest risk of acquiring and transmitting HIV. By concentrating efforts 
on at-risk groups and their partners, the NSP seeks to attenuate the epidemic among key 
populations while reducing the risk of new infections in the general population. 
More specifically, the NSP aims to reach 80% of all key populations by 2015 with a 
comprehensive package of HIV services, including prevention, treatment, and support. 
Under the strategy, a number of evidence-based services have been rolled out to key 
populations nationwide by GAC and implementing partners. This evaluation, therefore, was 
conducted as a mid-point assessment by MEASURE Evaluation and the University of Ghana 
School of Public Health, with USAID support and in collaboration with GAC, in order to 
describe the achievements and challenges of the ongoing implementation of the National 
HIV Prevention Program for FSW and MSM in Ghana.
This performance evaluation employed a mixed-methods approach in order to assess the 
following key study aims:
• describe how services are being delivered;
• document barriers and facilitators to accessing health services for MSM and FSW as 
well as the larger structural influences on sexual and health seeking behaviors such 
as stigma and discrimination;
• assess whether organizations directly providing services to FSW and MSM have 
standard operating procedures, functional supervision mechanisms, monitoring and 
reporting systems, and administrative, management, and planning capacity; and
• document efforts to increase stakeholder and organizational coordination and to 
address social, cultural, religious, political, and legal barriers to HIV prevention 
efforts among FSW and MSM.
METHODOLOGY
The evaluation was conducted as a post-test only non-experimental design using 
quantitative and qualitative methods. A mixed-methods approach was best suited to 
evaluate the above mentioned strategic objectives. The evaluation included seven distinct 
yet complementary components:
1. survey interviews with FSW and MSM who utilized National HIV Prevention 
Program services
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana vii
2. survey interviews with FSW and MSM non-users of services provided as part of the 
National HIV Prevention Program
3. qualitative focus group discussions with FSW (both service users and non-service 
users) 
4. assessment of fixed service delivery points
5. survey interviews with peer educators
6. organizational capacity assessment
7. key informant interviews with stakeholders and policy makers involved in program 
planning and implementation
Descriptions of study populations, recruitment processes, sample sizes, and data collection 
techniques are provided in detail in Section 2 of this report.
FINDINGS
Service delivery, quality, accessibility, and acceptability: Peer educators, drop-in centers, and 
mobile outreach provide a wide variety of services, including HIV testing, condoms and 
lubricant, HIV prevention and treatment information, and referrals for related services. 
FSW service users sought out services from peer educators (96.2% of all FSW who had 
used services) more often than drop-in centers (62.1%) and mobile outreach (38.6%). 
However, considering the hard-to-reach nature of these groups, all three service providers 
offer unique opportunities for FSW and MSM to seek care. In terms of quality, service users 
were overwhelmingly satisfied with the services they received from program providers. In 
fact, more than 90% of MSM and FSW had repeat encounters with peer educators, for 
example, which may be a strong indicator of service acceptability. However, the challenge 
remains to engage non-users of services and help familiarize them with the providers and 
services available. Furthermore, continued education of both providers and service users 
will help ensure appropriate messaging is communicated among at-risk groups as well as 
the general population at large.
Barriers and facilitators to accessing health services: Several barriers and facilitators to 
accessing services were identified from service users and non-service users surveys, FSW 
focus groups, and peer educator interviews. Peer educators felt that the mobility of FSW 
and the privacy required by both groups served as significant barriers to providing 
services. The ubiquity of cell phone use among FSW and MSM is therefore considered an 
important opportunity for communicating information to these hard-to-reach populations. 
FSW and MSM can receive prevention and treatment information and support from the 
relative privacy of their mobile telephones. Services such as the Text me! Flash me! Call Me! 
Helpline, a service in Ghana that uses cell phones to provide counseling and other services 
to key populations, have great potential but need wider advertising campaigns, particularly 
among non-users of services. Related to the need for privacy, fear of stigma and 
discrimination keep MSM and FSW from accessing services. The establishment of more 
MSM-friendly facilities as well as public education campaigns to de-stigmatize these groups 
might be important program facilitators.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana viii
Organizational opportunities and challenges: The organizational capacity assessment was 
conducted to determine the extent to which implementing organizations established and 
adhered to standard operating procedures, supervision mechanisms, monitoring and 
reporting systems, and capacity building efforts. In absolute terms, implementers reported 
reaching significant numbers of FSW and MSM; however, definitions of “program reach” 
varied considerably across organizations. Procedures for measuring reach and handling 
double counting were not standardized. Despite the need to streamline certain procedures, 
implementers generally achieved high marks for incorporating the community in decision￾making processes. Furthermore, most had written work plans and operating procedures, as 
well as functional supervision mechanisms and reporting systems.
Stakeholder and organizational coordination: Key informant interviews with stakeholders 
involved in the planning and oversight of the NSP offered important insight into the social, 
cultural, and political barriers associated with program implementation. Although more 
than half of key informants felt the NSP offers a comprehensive package that is capable of 
achieving program goals, other stakeholders were dubious that 80% of key populations 
would be reached by 2015. Pervasive social stigma, discrimination, and the law that 
criminalizes sex work and homosexuality were cited as significant barriers to reaching 
FSW and MSM. Additionally, some stakeholders noted that implementing organizations 
should operate under a common definition of coverage in order to better describe and 
standardize measurement and reporting of program coverage. Addressing such issues will 
require concerted and coordinated efforts by implementing partners with strong 
leadership from the expanded Technical Working Group (TWG) of GAC.
CONCLUSIONS AND RECOMMENDATIONS
Study findings suggest that leadership provided by the GAC and the TWG are strong, and 
while some greater capacity building and standardization could improve data collection 
and reporting and standardize service availability, organizations are striving to adhere to 
the service package and to provide a high quality product. This effort has resulted in high 
demand for services and a positive reputation for respectful treatment and confidentiality 
among FSW and MSM. Overall, recommendations focus on the ways in which the program 
can continue to be strengthened and expanded to better meet demand for services without 
sacrificing the reputation for service quality upon which that demand is predicated.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 1 
1. INTRODUCTION
1.1. BACKGROUND, RATIONALE, AND CONTEST
The HIV epidemic in Ghana is characterized as a generalized epidemic with data from the 
recent HIV Sentinel Surveillance Report indicating a national prevalence of 1.3% (NACP, 
2012). Among some groups, however, the prevalence is much higher. For example, the 
2011 Integrated Biological and Behavioural Surveillance Survey (IBBSS) reported that 
11.1% (Roamers [6.6%], Seaters [21.4%]) of female sex workers (FSW) were living with 
HIV (Ghana IBBSS, 2011). A multi-country analysis done in March 2010 by the Joint United 
Nations Programme on HIV/AIDS (UNAIDS) and the World Bank covering the West African 
sub-region indicated that 38% of new HIV infections in Ghana were attributed to these 
groups and their partners (UNAIDS & World Bank, 2010). A much earlier policy paper by 
the UNAIDS underscored the need to link these high risk and marginalized populations 
with services in order to address the concentrated nature of the epidemic in Ghana 
(UNAIDS, 2005).
In line with this effort, a major focus of the Ghana National Strategic Plan (NSP) for HIV and 
AIDS covering the period 2011-2015 is to deliver HIV services to key populations at highest 
risk for HIV acquisition and transmission, including FSW, MSM, people who inject drugs, 
and prisoners. With the recognition that increasing access to appropriate interventions for 
these groups and their partners can reduce the number of new infections in the general 
population, the Ghana AIDS Commission (GAC) in August 2011 came out with the first NSP 
focusing on these key populations (previously referred to as most-at-risk population 
[MARP]). Seeking to provide a framework for the implementation of a comprehensive 
package of services for these subgroups, the strategy’s target is to reach 80% of all 
identified key populations by 2015 with a comprehensive package of HIV prevention, 
protection, treatment, care, and support services that are evidence-based, accessible, and 
acceptable to the groups mentioned. A reading of the NSP reveals a number of such 
evidence-based services including: advocacy strategies designed to address specific 
vulnerabilities of the key population subgroups; interventions to reduce stigma and 
discrimination toward key population subgroups by generating greater awareness from 
within the general population; improving mapping, surveillance, and other social research 
among key population subgroups; and ensuring the meaningful engagement of key 
population subgroups in the implementation, monitoring, and evaluation of the key 
population strategy.
This performance evaluation was well timed as it will enable the GAC and stakeholders to 
glean relevant and useful information on the challenges and successes in the ongoing 
implementation of the strategy. Data from the evaluation will, among other things, advise 
the GAC on the course of the program in relation to its goals and objectives. Information on 
the quality of care being provided, constraints, and opportunities are needed to better 
tailor the program. Per the objectives and deliverables outlined in the scope of work for 
this call, the specific information this evaluation will provide to the GAC and its partners 
will include the level of coverage, quality, and uptake of program interventions targeting 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 2 
FSW and MSM. It also includes whether the real-world implementation of the program is 
keeping Ghana on track to meet its target of reaching 80% of all key populations by 2015. 
In addition, findings of this performance evaluation will benefit the international public 
health community by helping to build the evidence base for effective programming 
targeting most-at-risk populations with HIV prevention services. Finally, as an adjunct to 
the Operational Plan and Strategic Plan for HIV Prevention among Key Populations (GAC, 
2010), the Technical Working Group (TWG) for HIV Prevention among Key Populations 
and GAC have also adopted an impact evaluation plan for the National HIV Prevention 
Program for Key Populations (MEASURE Evaluation & GAC, 2013). This impact evaluation 
plan relies on a plausibility design that draws on the complete body of evidence around HIV 
prevention programming for these populations, including this performance evaluation. 
Therefore, this performance evaluation not only contributes to a mid-term evaluation of 
the national HIV prevention program but also to a future understanding of the impact of 
this programming.
Implementation of the National HIV prevention program for FSW and MSM is being carried 
out nationwide by a network of service provision organizations. A total of 12 organizations 
were identified as providing services to FSW and MSM in Ghana at the time of data 
collection (July-October 2013). Further, an additional two organizations (FHI 360 and West 
Africa Project to Combat AIDS and STI [WAPCAS]) were identified as providing program 
level support and coordination among partner organizations to provide services to FSW 
and MSM. All organizations providing HIV prevention services to FSW and MSM are 
considered part of the national HIV prevention response for these key populations, and 
their work is expected to align with the National Strategic Plan for Most-at-Risk (or Key) 
Populations. Representatives of these organizations and other stakeholder representatives 
sit on the national TWG for Key Populations and contribute to strategic and operational 
planning affecting these populations under the auspices of the GAC.
Within this implementation context, this evaluation employed a mixed-method quantitative 
and qualitative data collection approach to gather the information needed to address the 
four key study aims and the related objectives (outlined below). The study was 
implemented by MEASURE Evaluation and the University of Ghana School of Public Health 
in collaboration with the GAC and with support from the U.S. Agency for International 
Development (USAID). Quantitative methods included service provision assessments 
(SPA), organizational capacity assessments (OCA) of partners implementing Ghana’s key 
populations HIV prevention services, structured interviews with FSW and MSM accessing 
HIV prevention services, structured interviews with FSW and MSM not accessing services, 
and structured interviews with peer educators providing HIV prevention services to key 
groups. Qualitative methods were used to elicit important contextual information, 
including focus group discussions (FGDs) with FSW and key informant interviews (KIIs) 
with relevant stakeholders and decision-makers of Ghana’s key populations HIV prevention 
programming.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 3 
1.2. SPECIFIC AIMS AND OBJECTIVES OF THE EVALUATION
The overarching goal of this performance evaluation was to determine whether and to 
what extent current program activities and interventions are being conducted; it assessed 
the level of quality, coverage, and uptake of a wide range of services outlined in the NSP. In 
particular, it evaluated progress toward reaching 80% of MSM and FSW with relevant 
services in Ghana by 2015 per the NSP. This overall goal was achieved by addressing the 
following specific objectives:
1. To describe how services are being delivered: 
a. measure the coverage and quality of those services; and
b. determine acceptability and accessibility of those services to service users and 
staff.
2. To document barriers and facilitators to accessing health services for MSM and FSW 
as well as the larger structural influences on sexual and health seeking behaviors 
such as stigma and discrimination.
3. To assess whether organizations directly providing services to FSW and MSM have:
a. program standard operating procedures;
b. functional supervision mechanisms; 
c. functional monitoring and reporting systems; and
d. assess organizational administration, management, and planning capacity.
4. To document efforts to increase stakeholder and organizational coordination and to 
address social, cultural, religious, political, and legal barriers to HIV prevention 
efforts among FSW and MSM.
1.3. OVERVIEW OF REPORT
This report provides a detailed description of the methods and data collection activities 
(found in section 2) used to address the four specific objectives described above. The main 
findings of the study as they pertain to each of the four specific objectives are then outlined 
in sections 3 through 6. Finally, in section 7, a discussion and synthesis of the results is 
provided in section, with specific recommendations and next steps presented on the basis 
of this evaluation.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 4 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 5 
2. EVALUATION METHODOLOGY
2.1. STUDY DESIGN 
We employed a post-test only non-experimental evaluation design using quantitative and 
qualitative methods. This mixed-method study design is best suited to address the 
evaluation objectives stated in section 1.2. The study sites and size estimation of FSW and 
MSM were based on data from previous local studies as well as data obtained from service 
providers. Data collection was stratified by Ghana’s three ecological zones: the savannah, 
forest, and coastal zones. Within each stratum, a city center was purposively selected for 
data collection. Tamale and Kumasi were selected for the savannah and forest zones, 
respectively. The cities of Accra-Tema, Koforidua, and Takoradi were selected to represent 
the coastal belt. These cities are known “hotspots” or areas with concentrated populations 
of FSW and MSM in Ghana based on the 2012 Integrated Biological and Behavioral 
Surveillance Survey (IBBSS) studies of FSW and MSM. FSW and MSM self-identified as such. 
FSW were further defined as “roamers” (those FSW who go out to recruit clients) and 
“seaters” (home- or brothel-based FSW). Further, all FSW and MSM for this study were 
determined to be “service users” or “non-users of services”. 
2.2. SENSITIZATION OF STUDY COMMUNITY
Sensitive entry into study communities was required given the stigma and vulnerabilities 
associated with our study population. Prior to the launch of the study, informational 
meetings were held with relevant stakeholders, including the expanded TWG (eTWG) of 
the GAC, to describe the study objectives and protocol. The goals, hopes, and expectations 
for participation were also discussed at the meeting. Members of the eTWG and local 
nongovernmental organizations (NGOs) in attendance were then asked to relay the news of 
the proposed study to their constituents. Peer educators played a key role by advertising 
the study to the FSW and MSM communities. Peer educators were also instrumental in 
recruiting both FSW and MSM receiving services as well as MSM non-users of services. The 
pre-implementation meetings were co-facilitated by the GAC, the USAID Ghana/SHARPER 
Project, and the University of Ghana School of Public Health (UG-SPH). The GAC solely 
facilitated the study team’s interaction with the MARP TWG, whose members contributed 
to the stakeholder key informant interviews.
2.3. EVALUATION AREAS AND COMPONENTS 
To achieve the study’s stated objectives, quantitative and qualitative data were collected 
using the following methods:
• survey interviews with FSW and MSM service users 
• survey interviews with FSW and MSM non-users of services
• qualitative focus group discussions (FGDs) with FSW 
• a service delivery assessment of fixed service delivery points 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 6 
• survey interviews of peer educators
• an implementer capacity assessment 
• key informant interviews with stakeholders and policy makers involved in program 
planning and implementation
Details on the data collection techniques, study populations, and recruitment processes are 
presented below. To facilitate a nuanced understanding of these processes, a brief 
background on the FSW and MSM HIV prevention program and how it is being delivered in 
Ghana is provided. The national HIV prevention program for FSW and MSM is coordinated 
by the GAC with the participation of the MARP TWG which consists of stakeholders from 
various organizations, groups, and sectors. All HIV prevention services are carried out 
through implementing partners, all of whom offer services to MSM and FSW through 
trained peer educators and a national information helpline (Text me! Flash me! Call Me! 
Helpline). Many implementers also offer services at discrete locations where FSW and MSM 
can interact confidentially with service providers. All implementing partners offer 
condoms, lubricants, HIV testing, and HIV prevention education. Some provide additional 
services including community outreach, social opportunities, online peer education, STI 
screening and treatment, referrals to MARP-friendly community resources, and political 
advocacy. Implementers are responsible for collecting, organizing, and reporting routine 
program data and can expect support and capacity building for that effort through larger 
program partners, such as FHI 360. 
2.3.1. SURVEY INTERVIEWS WITH MSM AND FSW
2.3.1.1. Sampling of MSM and FSW
This evaluation surveyed FSW and MSM service users and non-users of services in order to 
assess coverage of services for key populations, including quality of services and access to 
services. The analysis was powered on client satisfaction, which was chosen as the main 
client indicator because client satisfaction and word of mouth are the primary ways 
through which the HIV prevention program reaches key populations in Ghana. A service 
user’s sense of safety and perceived protection of privacy were also included as part of the 
satisfaction criteria because safety and confidentiality have been named as top priorities 
for both clients and providers of services to key populations in Ghana (MSA, 2012). Taken 
together, these critical elements ensure that services are of adequate quality and 
appropriate reach. Thirty percent was chosen as the proportion to estimate because it was 
felt that this was a high goal for services to achieve. While client satisfaction reports among 
FSW are generally high (Morin et al. 2008), levels of internalized stigma and discrimination 
among MARPS are likewise high, and might compromise feelings of safety and privacy 
(Smith, 2009). 
In order to estimate a proportion of 30% of MSM and FSW service users who report being 
satisfied or very satisfied overall with the MARP HIV services received, feeling safe or very 
safe while receiving services, and that client privacy was respected at all times, with a two￾sided 95% confidence interval and a distance from proportion to limit of 0.6, a minimum 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 7 
sample size of 600 service users (360 FSW and 240 MSM) was required. In addition to the 
600, 400 non-clients were estimated as a minimum sample size (240 FSW and 160 MSM). 
This sample was deemed large enough to allow for estimation of a proportion of 0.6 or 60% 
FSW and MSM non-clients (with a two sided confidence interval of 95% and 80% power) 
who report being aware of HIV prevention services for key populations in their 
communities. This variable was chosen as the main non-client indicator because awareness 
of the service is a first step in service utilization while word of mouth is the main means of 
recruitment in these vulnerable populations. In all, 1,140 MSM and FSW were interviewed 
(298 MSM service users, 362 FSW service users, 153 MSM non-users of services, and 327 
FSW non-users of services).
2.3.1.2. Survey Procedures
Service users were recruited via peer educators, while non-users were recruited through a 
place-based methodology that employs various sampling techniques such as snowballing. 
We relied on sampling frame of “hotspots” for MSM and FSW created by previous studies in 
Ghana. This sampling frame was used to create population proportional to size sampling 
targets for MSM and FSW in the three geographical zones. The survey interviewers that 
conducted fieldwork were street-savvy personnel with past experience with key 
population surveys. Both seaters and roamers were interviewed the day they were 
identified, with the exact place and timing of the interview agreed upon mutually. All 
interviews were recorded with paper and pencil by the trained data collectors. Consent 
was oral so as to not collect any identifiers that might link an individual to the personal 
information on health service utilization and HIV risk addressed in the study. Each FSW or 
MSM who successfully completed the interview was given compensation worth 20 Ghana 
Cedis to cover transportation costs. It typically took about one hour to complete a survey 
interview. 
In addition to asking about awareness of and satisfaction with services (for non-users and 
service users, respectively), all MSM and FSW surveyed responded to questions covering a 
range of topics, including: barriers to accessing services; HIV risk behaviors (including 
trans-generational sex, substance use, condom use, and partner history); HIV related 
testing and treatment; HIV knowledge, attitudes, and practices; and experience with 
stigma, discrimination, and violence. Finally, respondents were asked to provide 
recommendations for how to improve HIV services for key populations. Survey 
questionnaires were predominantly quantitative in nature but also included some open￾ended questions. 
2.3.2. FOCUS GROUPS WITH FSW
Qualitative focus group discussions were held with FSW to help understand barriers and 
facilitators to accessing health services for FSW as well as the larger structural influences 
on sexual and health seeking behaviors such as stigma and discrimination. A total of eight
FGDs were held with FSW (table 1). 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 8 
Table 1. Distribution of FGD Participants by City and Type of FSW 
City
Seaters Roamers Number of 
FGD Service 
users
Non-users of 
services 
Service 
users
Non-users of 
services 
Accra-Tema, Kofridua 1 0 1 0 2 
Kumasi 1 0 1 0 2 
Takoradi 0 1 1 1 3 
Tamale 0 0 0 1 1 
Total 2 1 3 2 8 
Participants were selected through convenience sampling. Each group discussion was 
comprised of eight to 12 participants. FSW service users were recruited by peer educators 
in the same manner, as part of the same process, and with the same eligibility criteria as 
service users are recruited for the FSW service user and non-user of services survey 
interviews. FGDs, which lasted about an hour each, were held in confidential locations. 
Trained facilitators moderated the discussions using a study-specific FGD guide. Focus 
group participants referred to each other by aliases that each person chose for herself. All 
focus group participants gave oral informed consent to participate in the study. 
Compensation for focus group participation was equal to that given to survey participants. 
All interviews were recorded with a digital audio recorder and later transcribed for 
analysis. All but two of the discussions were done in English; the two conducted in Kumasi 
were done in the local language (Twi) and later translated into English during the 
transcription stage. No FGDs were held with MSM as the extreme stigma against MSM 
poses high risks for conducting such data collection with this population.
2.3.3. SERVICE PROVISION ASSESSMENT AND PEER EDUCATOR INTERVIEWS
The service provision assessment consisted of a series of structured quantitative study 
instruments. These included a fixed service delivery point (SDP) questionnaire and a peer 
educator survey. The assessment was designed to describe how services are being 
delivered, measure the quality of those services, and understand the acceptability and 
accessibility of those services to staff. Peer educators served as the primary sampling unit 
for this assessment and included peer educators that work predominantly with one of 
three groups: roamers, seaters, and MSM. A minimum sample of 145 peer educators was 
required in order to determine, for each of these three main types of peer educators, if 40% 
of them report accurate HIV prevention knowledge with a 95% confidence in a two-sided 
interval and with a distance of proportion to limit of 0.08. 
The design effect present in this study (wherein peer educators are clustered among 
implementing organizations and service users are clustered among peer educators) was 
compensated for by multiplying the original sample estimate by 1.2 to achieve a final 
sample size of 174 peer educators. This number was rounded up to a total sample size of 
180. The expected frequency of 40% was chosen as the proportion to power based on a 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 9 
Demographic Health Survey comparative report of comprehensive HIV knowledge by men 
and women in sub-Saharan Africa (Mishra et al, 2009). This report cited figures between 
25% and 45% of men and women with comprehensive HIV knowledge and lower 
proportions of such knowledge among those in West Africa than in East and Southern 
Africa. In this study, 40% was chosen with the expectation that trained peer educators in 
West Africa would demonstrate HIV knowledge scores on the higher end of what is found 
in the general population. Since the total number of peer educators identified in the study 
area was fewer than the 180 sample size calculated for the study, all 174 peer educators 
aged 18 years or older were interviewed, resulting in a census rather than a sample of peer 
educators. All of them participated in survey interviews about training, attitudes towards 
key populations, and services provided. 
All fixed SDP locations where the 174 peer educators are based were assessed, including 
drop-in centers and field offices. The service delivery site coordinator or other 
implementing organization designee was interviewed. These interviews described the 
services offered, training and availability of staff, resources and commodities available for 
service delivery, staff perceptions of service quality, accessibility as well as barriers, and 
opportunities for service delivery. Interviews were about one hour in duration. 
2.3.4. ORGANIZATIONAL CAPACITY ASSESSMENT 
The OCA sought to identify the key elements that enable organizations to implement 
programs as planned and to conduct procedures to report and monitor the uptake and 
quality of program services. The assessments were conducted with the universe of FSW 
and MSM HIV prevention implementers in Ghana. It consisted of a structured interview 
conducted with a representative selected by each organization. This capacity assessment 
focused primarily on areas believed to pose challenges to program implementation, 
including making and following up on referrals and difficulties in systematic collection and 
reporting of program monitoring data. The OCA assessed the extent to which organizations 
have standard operating procedures, functional supervision mechanisms, functional 
monitoring and reporting systems, and organizational administration, management, and 
planning capacity. 
2.3.5. KEY INFORMANT INTERVIEWS WITH STAKEHOLDERS
Qualitative KIIs were conducted with stakeholders utilizing a semi-structured interview 
guide. This aimed to gather the information needed to document efforts to increase 
stakeholder and organizational coordination and to address social, cultural, religious, 
political, and legal barriers to HIV prevention efforts among FSW and MSM. Fourteen of the 
24-member Key population TWG consented to participate in the KIIs on HIV prevention for 
key populations. Only positions and titles were recorded. Interviews lasted for about 30 to 
45 minutes, and no compensation was offered. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 10
2.4. DATA HANDLING, MANAGEMENT, AND STORAGE
Fieldwork was conducted by 36 support staff (supervisors and field data collectors). One 
field supervisor oversaw the data collection process in each ecological zone. Data collectors 
reviewed all completed data collection forms and corrected any errors or inconsistencies 
before hand-delivering them, along with their accompanying consent forms, to field 
supervisors. Supervisors also reviewed the forms for accuracy, consistency, and 
completion. Once the data collection forms were considered complete, they were securely 
delivered to the in-country principal investigator’s office where they were kept in locked 
filing cabinets. Completed instruments will be stored for five years following the study, at 
which point they will be destroyed. All quantitative survey data were doubly entered into 
pre-programed data screens. Qualitative interviews and discussions were transcribed in 
English. All electronic data files were transmitted to MEASURE Evaluation for data analysis 
through a secure server. 
2.5. QUANTITATIVE DATA MANAGEMENT, PROCESSING AND ANALYSIS
The screens for data entry were designed in CSPro and doubly entered at a centralized 
location at UG-SPH. Data were exported to IBM SPSS Statistics, version 20, and to Stata, 
version 11, for consistency checks and validation. Cleaned and validated data sets were 
analyzed using SPSS and Stata. Analyses were descriptive; we examined distributions and 
proportions of key variables for which the study was powered as well as secondary 
outcomes of interest. These included variables related to service coverage, accessibility, 
quality, and the logistics of service provision. 
2.6. QUALITATIVE DATA MANAGEMENT, PROCESSING, AND ANALYSIS
The recorded KIIs and FGDs were transcribed verbatim and translated as necessary (all 
KIIs were done in English and two of the eight FGDs were translated into English). 
Transcriptions were augmented with moderators’ field notes. All qualitative data were 
transcribed and translated as necessary. Preliminary analysis was conducted in Microsoft 
for Windows 7 software, including Microsoft Word and Microsoft Excel. Thematic analysis 
was performed using QSR International’s NVivo 10 for Windows. 
2.7. ETHICAL CONSIDERATIONS 
This study protocol was reviewed by two institutional review boards (IRBs) to ensure that 
the study adhered to both local and international standards for protecting the rights and 
safety of human subjects in research. The IRB of the Noguchi Memorial Institute for Medical 
Research at the University of Ghana and an IRB at the University of North Carolina at 
Chapel Hill reviewed and approved the study before initiating data collection activities. The 
specific measures put in place to ensure the ethical conduct of this research are detailed 
below. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 11
2.7.1. INFORMED CONSENT AND MINIMIZATION OF RISKS TO PARTICIPANTS
FSW and MSM survey and focus group participants provided oral informed consent. This 
was deemed necessary to minimize the risk of individual study participants being 
identified as members of a vulnerable and stigmatized group. All other participants, 
including peer educators, provided written informed consent. Informed consent forms are 
included in this report (appendix 2). The consent form described the purpose of the 
research, the risks and benefits of their participation in the study, their rights as study 
participants (e.g., the ability to stop the interview at any time), and any details regarding 
compensation, how their information would be safeguarded, and how any risks to 
participation would be minimized. The consent form also provided contact information in 
case a participant had questions or wished to follow up with researchers. 
Risks to participants in this study vary dependent on whether the participant was a service 
user (FSW or MSM), a peer educator, a designee of the implementing organization, or a key 
informant interviewee. The major risk to any participant in this study is a breach of 
confidentiality. While this is a minimal risk for key informants and program implementers 
who are professionals publicly serving key populations, this is a more serious risk for 
members of the FSW and MSM communities who risk stigma and discrimination should 
their status be widely revealed. Organization designees and key informants were asked 
about the programs being implemented and not for any personal information of a sensitive 
nature. The risk of breach of confidentiality for all participants was minimized by arranging 
to conduct all data collection in a secure location at a mutually agreed time, not recording 
names and contact information or other identifiers, and by keeping all informed consents 
separate from data collection forms (both physically separate and in electronic data files) 
and interview recordings (for key informant interviews and focus groups). 
For FSW and MSM, risks were minimized by asking for oral rather than written informed 
consent. All participants were assigned a participant number; no identifying information 
was recorded. No participant will be identified in presentations or publications, including 
this evaluation report. All participants in the study were 18 years of age or older.
2.8. DATA COLLECTORS TRAINING 
Data collectors and supervisors were trained over a period of four days. They were trained 
on procedures for collecting qualitative and quantitative data, ethics and community entry, 
maintaining confidentiality of data, and appropriate handling and storage of data. Training 
included extensive discussion of the research instruments as well as practicing with mock 
interviews. Tools and techniques were pretested on the third and fourth days of the 
training. Pretested tools were discussed and adjustments were made to the finalized tools. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 12
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 13
3. STUDY FINDINGS
Through the NSP for 2011-2015, the GAC seeks to provide evidence-based prevention, 
treatment, and support service to 80% of key populations by 2015. As a key part of this 
performance evaluation, insights into how coverage is being tracked and what progress is 
being made by programs in reaching target populations was assessed. This evaluation also 
sought to describe the management, resources, and technical capacity of providers to meet 
the needs of the key populations that they serve.
3.1. PROVIDER DEMOGRAPHICS
3.1.1. ORGANIZATIONAL CAPACITY ASSESSMENT WITH LOCAL NONGOVERNMENT 
ORGANIZATIONS
The OCA was conducted with 14 local NGOs that were implementing HIV prevention 
programs for key populations. Of these 14 NGOs, 13 were officially registered with a 
government organization, such as the Department of Social Welfare or the Registrar 
General Department. Roughly 43% of these NGOs provided services for MSM over a 12-
month period, whereas 64% provided services for FSW. Each organization was managed by 
a board of directors, ranging from four to nine members, and had an average of 24 full-time 
paid employees. Additionally, all NGOs had the capacity to support peer educators, a type of 
case worker that networks directly with FSW and MSM to provide HIV prevention, testing, 
counseling, and related services, and all were doing so at the time of this study. On average, 
each NGO supported 57 peer educators.
3.1.2. SERVICE DELIVERY POINTS
A site visit and key informant survey were conducted for a sample of 17 SDPs that offer 
services to MSM and FSW at fixed locations (see the previous chapter for additional details 
regarding sampling). More than two-thirds of SDPs were drop-in centers where FSW and 
MSM go for services without scheduling an appointment in advance. Other SDPs included 
field offices and project offices. The average SDP had been operating at its current location 
for 5.4 years and employed a range of staff members, including nurses, counselors, and 
program officers. On average, each SDP had 14 peer educators on staff.
3.1.3. PEER EDUCATORS
A peer educator survey was conducted with 174 peer educators, including four
supervisors, in order to better understand the types of services provided by peer educators
to FSW and MSM. About 68% of peer educators were female and had an average age of 26 
years; and ranged from 18 -56 years. Although eighty percent of all peer educators had 
never been married, 53.5% reported having at least one child. About 91% of all peer 
educators had received at least a junior high school education, and roughly 65% had 
occupations outside of their role as a peer educator. In terms of populations served, 31% of 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 14
peer educators provided services primarily to MSM. A combined 62% reported working 
mainly with FSW; however, 51% and 11% worked with roamer FSW and seater FSW, 
respectively. An additional 6% worked specifically with partners of FSW. Approximately 
42% of peer educators were from the Greater Accra region (Accra-Tema), 23.6% from the 
Eastern region (Koforidua and Krobo Odumase), 25.9% from Ashanti region (Kumasi), 
2.9% from the Northern region (Tamale), and 5.8% from the Western region (Sekondi￾Takoradi, Tarkwa). 
3.2. SERVICES
The NSP recommends that critical steps be taken to scale up the response to at risk 
populations. This may include defining service packages and tailoring specific services to 
better meet the needs of key populations. This section outlines the services being provided 
by NGOs, SDPs, and peer educators, as well as the uptake of these services by client FSW 
and MSM.
3.2.1. SERVICES PROVIDED
Peer educators offer a wide array of prevention, treatment, and wellness services to key 
populations. As shown in table 2, the top services provided by peer educators were 
condoms and lubricant. On average, 94.4% of peer educators provided this service to their 
primary key population. A majority of peer educators also reported providing assessments 
of HIV risk, referrals for sexually transmitted infection (STI) services, and referrals for HIV 
testing. Across the board, peer educators reported offering information on correct and 
consistent condom use almost half as often as they provided condoms and lubricant. 
Services that were offered least often included pregnancy tests, referrals for prevention of 
mother-to-child transmission, and referrals for mental health services. These were offered 
by fewer than 5% of all peer educators. 
In general, peer educators offered similar services regardless of the primary population 
they served. However, there are some key differences. Peer educators serving MSM, for 
example, offered information via mobile device more often than other peer educators. Peer 
educators serving MSM reported providing information on the Text me! Flash me! Call Me! 
Helpline, mHealth information, and referrals for mFriend services more often than other 
peer educators. Another key difference was between peer educators serving roamer FSW 
and seater FSW populations; 16.9% of peer educators of roamer FSW offered a variety of 
contraceptive methods outside of condoms and emergency contraception in comparison 
with just 5.3% of peer educators serving seater FSW. The variation in services provided by 
peer educators is indicative of the differences in the specific populations that they serve. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 15
Table 2. Percent of Services Provided by Peer Educators, Separated by Population Most 
Served
Service MSM Roamer FSW Seater FSW Partners of FSW
Condoms and lubricant 98.2 97.8 100.0 81.8
Assessment of HIV Risk 77.8 67.4 63.2 100.0
Referrals for STI services 59.3 62.9 73.7 45.5
Information about correct and 
consistent condom use 53.7 51.7 42.1 81.8
Referrals for HIV Testing 53.7 53.9 63.2 45.5
Emergency contraception 7.4 2.3 5.3 100.0
Other in-person HIV prevention 20.4 18.0 26.3 18.2
Information on the Text me! Flash 
me! Call Me! Helpline 18.5 14.6 10.5 18.2
Contraceptive methods other than 
condoms and EC 7.4 16.9 5.3 27.3
Text (mHealth) information 13.0 3.4 10.5 9.1
Rape counseling 9.3 10.1 15.8 0.0
Referrals for Mfriend services 14.8 4.5 5.3 0.0
Pregnancy tests 0.0 5.6 0.0 9.1
Referrals for PMTCT 3.7 2.3 5.3 0.0
Referrals for mental health services 1.9 1.1 0.0 0.0
Number of Observations (PEs) 54 89 19 11
While peer educators tended to work with one specific population, SDPs often worked with 
multiple groups. Among all SDPs, 41.2% served MSM, 70.6% served roamer FSW, 58.5% 
served seater FSW, and 58.8% also served partners of FSW. As shown in Table 3 below, 
SDPs offered comparable services to those provided by peer educators. Specifically, all 
SDPs provided condoms and lubricant, HIV counseling and testing, and STI screening and 
referral. More than 90% of all SDPs also offered referrals for HIV treatment and mFriend 
services. Several SDPs also offer additional services, including group events that focus on 
education and health promotion.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 16
Table 3. Percent of Services Provided by Service Delivery Points
Service Provided by SDP* Percent Offering Service to any Key Population
HIV counseling and testing 100.0
HIV risk assessment 82.4
Condoms & lubrication 100.0
Emergency Contraception 23.5
Regular contraception other than condoms 11.8
Pregnancy tests 23.5
STI screening and referral 100.0
Rape counselling 52.9
Mental health referral 11.8
mFriend referral 94.1
Referral for HIV treatment 94.1
Referral for PMTCT 35.3
Other referral 17.7
Text me! Flash me! Call Me! Helpline 82.4
MARP specific IEC materials 88.2
Delivery of mHealth messages 64.7
Mobile outreach 94.1
Group events (education and promotion) 88.2
Internet access 17.7
Safe physical space for MARP 41.2
Number of Observations (SDPs) 17
* Among all SDPs, 41.2% served MSM, 70.6% served roamer FSW, 58.8% served seater FSW, and 58.8% served partners of FSW.
3.2.2. CLIENT DEMOGRAPHICS
Outlining the breadth of services provided by peer educators and SDPs is an important step 
to understanding coverage; however, we must also link these services to reported client 
uptake in order to generate a more comprehensive picture of program reach. FSW and 
MSM clients of peer educators were interviewed about their service utilization, knowledge 
and beliefs regarding HIV/AIDS, and barriers and opportunities for improving quality and 
access to services in their areas.
Table 4 describes the demographic characteristics of the FSW and MSM service users. On 
average, seater FSW were older than roamer FSW and MSM. Ghanaians represented the 
vast majority of respondents, although seater FSW also had a large Nigerian representation 
at 13.8%. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 17
Table 4. Demographic Information for Client Populations
MSM Roamer FSW Seater FSW Average
Average Age (Years) 25.82 25.45 30.34 27.20
Nationality
Ghanaian 95.6% 94.5% 84.8% 91.6%
Nigerian 3.4% 2.8% 13.8% 6.6%
Other 1.0% 2.8% 1.4% 1.7%
City
Accra 27.9% 40.1% 27.6% 31.8%
Tamale 0.0% 11.1% 5.5% 5.5%
Koforidua 8.4% 14.3% 4.8% 9.2%
Sekondi/Takoradi 40.3% 16.1% 31.0% 29.1%
Kumasi 22.8% 18.4% 31.0% 24.1%
Tema 0.7% 0.0% 0.0% 0.2%
Marital status
Never married 83.9% 72.4% 49.0% 68.4%
Divorced/separated 9.7% 16.1% 39.3% 21.7%
Widowed 0.3% 3.2% 6.2% 3.3%
Currently married/
living with spouse 6.0% 3.2% 0.0% 3.1%
Religion
Christian 85.9% 76.5% 86.2% 82.9%
Muslim 9.1% 21.7% 11.0% 13.9%
Other 5.0% 1.8% 2.8% 3.2%
Highest level of education
Never Attended 3.0% 6.9% 15.9% 8.6%
Primary 4.4% 21.2% 28.3% 17.9%
Middle/Secondary 20.8% 42.4% 34.5% 32.6%
SHS/technical/vocational 51.0% 26.7% 19.3% 32.4%
Higher 20.8% 2.8% 2.1% 8.5%
Mean No. of children 0.3 1.0 1.5 0.9
Number of observations 289 217 145
MSM and FSW respondents were sampled from various cities across the country, including 
Accra, Tamale in the north, and the Sekondi/Takoradi area in the coastal west. Forty 
percent of MSM respondents were from Sekondi/Takoradi. Forty percent of roamer FSW 
were from Accra, while 31% of seater FSW were located in both Sekondi/Takoradi and 
Kumasi. Few respondents were married or living with spouses at the time of the interview. 
For example, 83.9% of MSM were never married in comparison with 49.0% of seater FSW 
and 72.4% of roamer FSW. On average, seater FSW seem to have more relationship 
experience, with 39.3% being separated or divorced and 6.2% being widowed. 
Furthermore, seater FSW had more children on average than roamer FSW or MSM. In 
terms of average education, MSM were higher achievers than FSW with 51% having 
completed technical or vocational school. Seater FSW and roamer FSW were similar in that 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 18
the majority of each population completed at least middle school; however, 15.9% of seater 
FSW had never attended school, in comparison with 6.9% of roamer FSW.
3.2.3. SERVICE UPTAKE AS MEASURE OF COVERAGE: PEER EDUCATORS
This evaluation asked service users about the services they received from peer educators, 
drop-in centers, and mobile outreach clinics. The vast majority of service users across all 
three groups reported having contact with peer educators in the last 12 months. Table 5 
details the percent of FSWs and MSM utilizing specific peer educator services of those who 
reported having contact with peer educators in the past 12 months. Service users reported 
receiving HIV risk reduction counseling from peer educators more often than any other 
service, although FSW received such counseling more often than MSM (98.6% of seater 
FSW compared with 89.6% of MSM). Service users also cited HIV testing and screening for 
STI as commonly received services from peer educators. In general, FSW and MSM 
reported similar rates of service uptake across the board; however, on average, MSM 
received HIV tests from peer educators more often than FSWs (94.2% and 82.1%, 
respectively). Additionally, 16.2% of MSM reported being referred by peer educators for 
antiretroviral therapy (ART), whereas 9.0% of FSW reported receiving ART referrals from 
peer educators. Finally, peer educators provided 13.0% of MSM with referrals for mental 
health services in comparison with 8.8% of FSW. Seater and roamer FSW tended to receive 
similar services except for a few notable differences. For example, roughly twice as many 
seater FSW reported receiving referrals for mental health services than roamer FSW. 
Similarly, 20.3% of seater FSW were referred for drug and alcohol abuse services, whereas 
10.0% of roamer FSW reported receiving this type of referral. On average, these referral 
rates may be indicative of larger social issues impacting these groups. Tables providing a 
breakdown of service uptake for clients of peer educators by ecological zone and by city are 
provided in appendix 1.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 19
Table 5. Percent of Service Uptake for Clients of Peer Educators
MSM Roamer 
FSW
Seater 
FSW Average
Has been in contact with peer educator in past 12 
months 93.3 96.8 98.6 96.2
Number of observations 289 217 145
Services among those in contact with peer educator in past 12 months:
HIV risk reduction counseling 89.6 97.6 98.6 95.3
HIV counseling and testing 94.2 82.4 81.8 86.1
Screening for STI 77.0 87.1 83.9 82.7
Referral for treatment of STI 52.5 56.2 54.6 54.4
Emergency contraception or referral for EC -- 20.5 21.0 20.7
Contraceptive methods other than condoms or referral -- 19.5 24.5 22.0
Pregnancy test or referral for pregnancy test -- 20.0 28.7 24.3
Referral for primary health care 37.8 32.4 40.6 36.9
Referral for mental health services 13.0 5.7 11.9 10.2
Referral for drug/alcohol addiction 14.0 10.0 20.3 14.8
Referral for legal assistance 14.4 4.3 13.3 10.7
Referral for clinical careclinical care 16.2 4.8 13.3 11.4
Referral for PMTCT -- 7.6 14.0 10.8
Sexual assault/rape crisis services or referral 12.6 10.5 13.3 12.1
Condoms 95.7 95.2 93.7 94.9
Lubricant 95.0 88.1 88.1 90.4
Information about reducing risk of HIV 91.4 95.7 90.9 92.7
Number of observations 278 210 143
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 20
3.2.4. SERVICE UPTAKE AS MEASURE OF COVERAGE: DROP-IN CENTERS
Across all three groups, fewer service users reported receiving services at drop-in centers 
than from peer educators. Just 49.0% of seater FSWs received any service at a drop-in 
center over a 12 month recall period as compared with 71.4% of roamer FSW and 65.8% of 
MSM. As shown in table 6, of those who did receive services, utilization rates were similar to 
those receiving services from peer educators. For example, as with peer educators, service
users reported receiving HIV risk reduction counseling, HIV testing, and STI screening most 
often from drop-in centers. However, there was less between group variation for HIV risk 
reduction counseling and HIV testing at drop-in centers. 
Although service uptake between the two types of providers was largely the same, there 
were some notable differences. For instance, more service users across the three groups 
reported receiving referrals for legal assistance at drop-in centers than from peer 
educators. Pregnancy tests or referrals for pregnancy test, on the other hand, were offered 
less often at drop-in centers, with 19.0% of all FSW receiving one compared with 24.3% of 
FSW with peer educators. Finally, service users received condoms and lubricant more often 
from peer educators than drop-in centers. On average, 90.3% of service users received 
condoms from drop-in centers compared with 94.9% from peer educators. Roamer and 
seater FSWs continued to report markedly different utilization rates for certain services. 
For example, more than twice as many seater FSWs received referrals for prevention of 
mother-to-child transmission of HIV (PMTCT) than did roamer FSW at drop-in centers 
(18.3% and 7.1%, respectively). The variation was relatively consistent for drop-in centers 
and peer educators, which likely indicates an inherent difference in roamer and seater 
FSW. Tables providing a breakdown of service uptake of FSWs and MSM at drop-in centers 
by ecological zone and by city are provided in appendix 1.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 21
Table 6. Percent of Service Uptake for Service Users at Drop-in Centers
MSM Roamer 
FSW
Seater 
FSW Average
Has been to a drop-in center in past 12 months 65.8 71.4 49.0 62.1
Number of Observations 289 217 145
Of those who have been to a drop-in center in past 12 months:
HIV risk reduction counseling 96.4 97.4 95.8 96.5
HIV counseling and testing 94.4 96.8 94.4 95.2
Screening for STI 80.1 93.6 87.3 87.0
Referral for treatment of STI 55.6 53.6 45.5 51.5
Emergency contraception or referral for EC -- 15.5 23.9 19.7
Contraceptive methods other than condoms or 
referral
-- 23.9 25.4 24.6
Pregnancy test or referral for pregnancy test -- 16.8 21.1 19.0
Referral for primary health care 39.8 34.2 31.0 35.0
Referral for mental health services 14.8 7.1 15.5 12.5
Referral for drug/alcohol addiction 15.8 10.3 18.3 14.8
Referral for legal assistance 18.4 7.1 16.9 14.1
Referral for clinical care 18.4 7.1 9.9 11.8
Referral for PMTCT -- 7.1 18.3 12.7
Sexual assault/rape crisis services or referral 15.8 9.7 14.1 13.2
Condoms 92.4 91.0 87.3 90.2
Lubricant 88.3 85.8 80.3 84.8
Information about reducing risk of HIV 90.3 91.0 91.6 90.9
Number of observations 196 155 71
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 22
3.2.5. SERVICE UPTAKE AS MEASURE OF COVERAGE: MOBILE OUTREACH
Mobile outreach services were utilized least often by service users. On average, just 38.6% 
of service users sought out services from mobile outreach clinics over a 12 month recall 
period. FSW received services from mobile outreach far more often than MSM, with fewer 
than one-quarter of MSM accessing these services. As with peer educators and drop-in 
centers, HIV risk reduction counseling, HIV testing, and STI screening were the 
predominate services utilized by key populations. However, as shown in table 7, service 
uptake for FSW and MSM who did access mobile outreach services varied considerably by 
group. For example, of MSM accessing mobile outreach services, 94.3% received HIV 
counseling and testing, whereas just 64.1% of all FSW accessing mobile outreach received 
this service. Furthermore, 67.1% of MSM were referred for STI screening and treatment, 
yet just 38.2% of all FSW received this type of referral. Moreover, considerably fewer FSW 
received condoms and lubricant at mobile outreach clinics than with peer educators or at 
drop-in centers, while rates of service uptake for MSM remained relatively constant.
In general, service uptake by roamer and seater FSW was much lower at mobile outreach 
clinics for the majority of services offered, including HIV testing and STI screening. 
Furthermore, 19.4% of roamer FSW were referred for primary health care, in comparison 
with 32.4% and 34.2% of roamer FSW at peer educator and drop-in centers, respectively. 
On the other hand, greater percentages of MSM accessing mobile outreach reported 
receiving referrals for mental health, drug and alcohol abuse, legal, and sexual assault
services (31.4%, 34.3%, 34.3%, and 34.3% respectively). Additionally, more than one-third 
of all MSM accessing mobile outreach services reported receiving a Referral for clinical 
careclinical care. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 23
Table 7. Percent of Service Uptake by MSM and FSWs at Mobile Outreach Centers
MSM Roamer 
FSW
Seater 
FSW Average
Has received services from mobile outreach center 
in past 12 months 23.5 47.5 44.8 38.6
Number of Observations 289 217 145
Of those who have received services from mobile outreach center in past 12 months:
HIV risk reduction counseling 95.7 82.5 89.2 89.2
HIV counseling and testing 94.3 62.1 66.2 74.2
Screening for STI 85.7 61.2 76.9 74.6
Referral for treatment of STI 67.1 37.9 38.5 47.8
Emergency contraception or referral for EC -- 11.7 26.2 18.9
Contraceptive methods other than condoms or 
referral -- 13.6 21.5 17.6
Pregnancy test or referral for pregnancy test -- 10.7 20.0 15.3
Referral for primary health care 55.7 19.4 27.7 25.7
Referral for mental health services 31.4 4.9 15.4 17.2
Referral for drug/alcohol addiction 34.3 5.8 18.5 19.5
Referral for legal assistance 34.3 5.8 13.9 18.0
Referral for clinical careclinical care 35.7 6.8 10.8 17.8
Referral for PMTCT -- 7.8 16.9 12.3
Sexual assault/rape crisis services or referral 34.3 6.8 12.3 17.8
Condoms 95.7 68.0 72.3 78.7
Lubricant 94.5 64.1 60.0 72.9
Information about reducing risk of HIV 95.7 70.9 72.3 79.6
Number of observations 70 103 65
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 24
3.3. MEASUREMENT
Specific local NGOs providing HIV prevention services to FSW and MSM across the country
are outlined in this section, as well as the types of services being offered to and accessed by 
FSW and MSM. Implementers’ strategies for measuring program reach are provided in this 
section in order to more clearly understand the extent of program coverage in Ghana.
3.3.1. DESCRIBING COVERAGE 
The NSP prevention strategy is carried out largely by the peer educators, SDPs, and local 
NGOs that work directly with key populations of interest. While each provides essential 
programs to MSM and FSW, they also provide analogous services to potentially overlapping 
groups. Peer educators reported working with an average of 16 new service users and 23 
repeat service users over a 30-day recall period. SDPs, on the other hand, estimated that 
they came into contact with an average of 70 new FSW service users within the 30 days. 
They also reported working with an average of 193 repeat FSW service users during the 
same time period. SDPs saw far fewer MSM service users; averaging about 23 new contacts 
and 19 repeat service users in 30 days. 
SDPs were able to provide specific estimates of new and repeat service users per month; 
however, it is unclear whether SDPs are reaching appropriate numbers of service users
given the ambiguity surrounding the size of key population groups within SDP catchment 
areas. On average, SDP interviewees were unable to provide estimated group sizes. When 
asked about the size of FSW groups, 52.9% of SDPs were not able to provide an estimate. Of 
the SDPs that could approximate the size of the FSW group they serve, estimates ranged 
from 300 to 15,000 FSW. Similarly, the estimated size of MSM groups within catchment 
areas ranged from 150 to 250,350 men, and 76.5% of SDPs were unable to provide any 
estimate. Just one SDP reported figures from an IBBSS study, and two others reported 
estimates based on other studies. The remaining SDPs provided estimates based on expert 
opinion or peer educator reports. 
Local NGOs also reported estimates of the FSW and MSM reached over a 12 month period. 
There were eight organizations that did not serve MSM; however, those that did reported 
reaching an estimated 2,597 MSM in one year. There were also five organizations that did 
not serve FSW, yet those that did reported reaching an estimated 4,596 FSW over 12 
months. The size estimates reported by local NGOs ranged considerably. Although this may 
reflect differences in the size or capacity of organizations, it is more likely a result of the 
lack of clarity surrounding how program reach is defined. For example, one respondent 
defined program reach as specifically “when a client has been provided with at least three
services of the HIV package.” Another respondent’s criteria were much broader, including 
“people reached by HIV prevention messages.” Yet another respondent acknowledged a 
two-part process for reaching key populations that involved providing information and 
referring clients to the care they need, described as “number of [people] reached with 
information on HIV, STIs, condoms, and then referred to services.” This lack of clarity 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 25
provides a source of measurement error, making it difficult to compare and interpret the 
results of this evaluation.
3.3.2. REPORTING, TRAINING, AND SUPERVISION
3.3.2.1. Implementer Reporting Procedures for Measuring Coverage
The NSP seeks to implement a package of high quality, accessible, and acceptable HIV 
prevention services. Data collection and reporting mechanisms can help facilitate this 
process by generating evidence to monitor progress and guide decision making. Peer 
educators and employees of SDPs are trained on the client data reporting processes that 
should be followed. Although not all SDPs follow the same procedures, the mechanisms for 
reporting seem to be more streamlined for fixed drop-in centers. However, the procedures 
continue to differ considerably between individual peer educators.
There was sizeable variation in the type and richness of information collected for each new 
contact by peer educators. Although the vast majority of peer educators collected client 
data, 9.2% of peer educators reported that they do not take down any basic client contact 
information. The range of new client data collected is as follows: 89.7% reported asking for 
a new client’s name, 44.3% asked for a new client’s address, and just 17.8% recorded the 
service provided to the client. Of the peer educators that did record client data, 69.0% 
recorded this information in a notebook, while 25.3% used a standardized client register. 
SDPs, on the other hand, tended to collect more detailed information on new service users. 
Although only 82.35% of all SDPs reported collecting basic contact information, 94.1% 
collected names of new service users, 76.5% collected addresses, and 82.5% recorded the 
service that the client received. All SDPs reported recording this information in a 
standardized client ledger or chart. Finally, 56.9% of peer educators said they reported 
client data to a supervisor on a weekly basis. An additional 28.7% reported back every 
month. More than two-thirds of SDPs (64.7%) reported their data to supervisors or 
program officers on a monthly basis, while an additional 23.5% reported data on a weekly 
basis. 
Double counting is a potential limitation and source of measurement error when recording 
and reporting client data. Double counting could take place both within and between 
providers. For example, if a peer educator reports providing services to a single client 
twice, the peer educator overestimates the number of FSW or MSM he or she has reached
in that reporting period. Additionally, if a SDP and peer educator report providing services 
to the same MSM and FSWs, together they will overestimate the total population served. 
For this reason, providers must be very clear in their reporting mechanisms and check in 
with partner organizations so as to eliminate double counting to the extent possible. 
Unique identifier codes (UIC) are numbers given to each new contact to help identify that 
person as a service user while keeping their contact information private. Client identifiers 
are also meant to help providers manage their client list and avoid double counting. Slightly 
more than half of peer educators (51.1%) assigned service users unique identifier 
numbers. While a significant portion of peer educators reported using UICs, only 8.0% of 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 26
peer educators mentioned using UIC in a free response question about how to define a 
client contact for reporting purposes. By comparison, 100% of SDPs reported using UIC to 
identify their clients.
When asked if there was a way of knowing for sure whether or not a client had seen 
another peer educator or drop-in center, 87.4% of peer educators and 100% of SDPs 
confirmed that they did have a method. However, the responses for how one could tell 
were less convincing. The vast majority of peer educators responded that they could tell if a 
client had been in contact with another peer educator by asking the client directly. Of 
course, recall bias is a significant concern with this strategy. Just one peer educator 
reported that he or she would cross-check his or her records with the local health facility, 
and two others mentioned checking records with peer educator colleagues. Roughly 41% 
of SDPs, on the other hand, mentioned the use of UICs to determine whether or not a client 
had seen another provider. However, asking clients directly was still a prominent response 
among SDPs. Of local NGOs, 57.1% said that double counting was never a problem for their 
organizations; however, 28.6% reported that it is a problem at times. The level of 
uncertainty surrounding double counting suggests that program reach may indeed be 
overestimated by certain providers.
3.3.2.2. Training for Program Implementers
SDPs provide formal training to peer educators on standard operating protocol as well as
procedures for reporting client data. Of peer educators, 97.7% reported attending an 
orientation when they first became a peer educator. Senior peer educator mentors, 
supervisors, or the director of local NGOs were the primary providers of these trainings, 
which typically cover a range of topics including: client data collection, data reporting, HIV 
knowledge and attitudes, client confidentiality, and mHealth. Similarly, 100% of local NGOs 
reported having a standard training that all peer educators are required to attend. 
Furthermore, 100% of local NGOs provide equipment and materials to peer educators, 
including uniforms, notebooks, condoms, and models for demonstrations. 
However, of all peer educators, 87.9% reported ever receiving formal training on reporting 
mechanism with 69.3% being trained by their supervisor. Of the peer educators that 
received training in the 12-month period prior to the interview, just 52.9% and 47.7% 
received training on client data collection and data reporting, respectively. Despite that 
roughly half of peer educators received data reporting training during the previous year, 
97.1% reported feeling very confident in their ability to appropriately record and report 
client related data. 
All SDPs employ and train at least one staff member to collate and report client data on a 
regular basis. Monitoring and evaluation coordinators at local NGOs or donor organizations 
were most often responsible for training employees. Of those with this position at SDPs, 
94.1% felt very confident in their reporting abilities, and the remaining 5.9% felt somewhat 
confident.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 27
3.3.2.3. Supervision and Support for Program Implementers
Supervising and providing sufficient support to peer educators and staff ensures that 
providers have the relevant skills to make them more efficient in their roles. About 99% of 
peer educators receive support and supervision. All peer educators are encouraged to meet 
with supervisors on a regular basis; however, meetings range in frequency from daily to 
twice per year. Roughly one-quarter of peer educators met with their supervisor on a daily 
basis, while 27.8% met with their supervisor every week. These meetings are an 
opportunity for peer educators to report client data and ask questions. The peer educator￾supervisor relationship appears strong with 80.5% referring to supervisors when they are 
unsure how to answer a client’s question. Others typically ask fellow peer educators in the 
field.
Not all supervisors provide peer educators with the same materials. For example, 80.5% of 
peer educators received a written description of their roles and responsibilities. 
Furthermore, 74.1% received a written supervision checklist with an equal percentage 
receiving written performance evaluation objectives. Similarly, 70.1% of peer educators 
received a performance appraisal from their supervisor in the past year, which is an 
important aspect of improving the services they provide. All local NGOs employed peer 
educator supervisors. Although 71.4% of local NGOs had one supervisor, others had up to 
four at the time of interview. Of all local NGOs, 92.9% provided supervisors with specific 
training and 78.6% provided supervisory checklists. 
3.3.3. OTHER SERVICE PROVIDERS
Another important aspect of coverage is overlap between organizations within the same 
service area. It may be effective having multiple organizations in a given area providing 
complementary services, particularly if they are serving a large, complex client base. 
However, the challenge lies in working together to reach all potential clients instead of 
competing for the same clients and offering duplicative services. More than half of SDPs 
(52.9%) reported that there are organizations other than the Ghana Health Service 
providing HIV prevention programs to key populations in their catchment area. Another 
11.8% were unsure of any potential overlap. Most SDPs felt these other organizations 
provided complementary services, particularly to the general population, and did not feel 
that overlap was an issue. 
3.4. PROGRESS TOWARD 80% COVERAGE
As previously mentioned, the NSP’s main goal is to “reach 80% of all identified key 
populations by 2015 with a comprehensive and evidence-based package of HIV prevention, 
protection, treatment, care, and support services.” This evaluation has found that a sizeable 
portion of the population is indeed being reached, as evidenced in part by the percentage of 
service users accessing services from peer educators, drop-in centers, and mobile outreach 
clinics. However, the exact reach of the key population program is unclear given the 
measurement error in how providers define coverage and determine double counting.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 28
In order to assess the reach of the program, providers must operate under a clear and 
common definition of coverage. As mentioned above, local NGOs defined program reach in 
various ways. Some considered a client had been reached when they received three or 
more prevention services, whereas others felt any FSW or MSM receiving HIV prevention 
messages could be included per their definition. This variation introduces measurement 
error into the evaluation and makes the numbers reported here not directly comparable. At 
the time of this writing, the GAC TWG for Key Populations had already identified this as a 
potential problem and had initiated conversations to define program reach for reporting 
purposes. 
Double counting is another source of measurement error that limits our ability to 
determine the full extent of program reach. Providers do not have a clear mechanism for 
concluding whether or not two providers served the same client during a specific reporting 
period. Simply asking a client about his or her service uptake is not a reliable method to 
determine double counting since a client may forget or decline to disclose the information. 
Some organizations have implemented UICs in an effort to reduce double counting; 
however, this may not be as effective across organizations without collaboration and cross 
checking.
Defining coverage and establishing mechanisms to manage double counting represent two 
strong limitations of using routine program data to measure program success. An 
alternative for successfully measuring reach might be to use a representative population￾based survey such as IBBSS. GAC will need to collaborate with partners to eliminate these 
issues in order to determine whether or not 80% of the population is reached by 2015.
3.5. QUALITY
Under the NSP’s first objective, “to develop and implement evidence-based, comprehensive 
HIV prevention, protection, treatment care, and support services for MARPs,” GAC has 
included several strategies that aim to update and implement a package of services that are 
acceptable, accessible, and of high quality. If clients and staff do not perceive services to be 
of high quality, it is unlikely the program will achieve a strong, sustainable impact that 
reaches its goal of at least 80% of the population. This section addresses the evaluation’s 
second priority question: To what extent are planned MSM and FSW program activities 
realized and implemented with improved quality? To answer this question, quality and its 
associated dimensions must first be defined, and the resulting framework must then be 
related to the key population program.
3.5.1. DEFINING QUALITY
Measuring quality in health care is a complex undertaking because the term quality can 
take on different meanings for different people and in different contexts. For the purposes 
of this study, quality is defined in terms of the way FSW and MSM are treated by providers 
of HIV prevention programs. Quality is also defined in terms of provider perceptions of 
how care is being received by the population of interest. This study uses a multi-
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 29 
component definition provided by the Operational Guidelines or Monitoring and Evaluation 
of HIV Programmes for Sex Workers, Men who have Sex with Man, and Transgender People
and adapted by Andrudh K. Jain (1989). The definition of quality in this study explores the 
five A’s of quality, which are adherence to national standards, availability of services, 
accessibility of services, acceptability of services, and attitudes of service delivery 
providers towards users are positive. This study also used Jain’s definition to inform and 
modify the five A’s. For example, the study includes Jain’s appropriate constellation of care, 
which ensures that services are appropriate, convenient, and acceptable to the population 
they are intended to serve, under the fourth A of acceptability. The fifth A, attitudes of 
services delivery providers towards users are positive, was adjusted so that it would be bi￾directional, allowing an evaluation of positive attitudes of both providers and clients. Jain’s 
elements of provider competence and a strong client/provider relationship were also 
included in defining quality for this study. 
3.5.2. QUALITY: ADHERENCE AND AVAILABILITY
The first of the five A’s, adherence to national standards, was addressed in that all services 
offered by the local NGOs and reported by FSW and MSM service users are part of the 
service package detailed in the Operationalization Plan for Key Populations. As evidenced 
by discussion in sections 3.3 and 3.4, mechanisms for reporting and supervision may need 
to be nationally standardized in order to continue to improve service provision across the 
country. 
The second A, availability of services, was discussed in detail in section 3.2. In general, 
implementers are providing a comprehensive package of services that covers education, 
prevention, and referrals for treatment and care. These services are made available 
through several providers, including peer educators, drop-in centers, mobile outreach 
clinics, and a number of mobile and internet-based platforms. However, not all services are 
presently available from all program implementers.
3.5.3. QUALITY: ACCESSIBILITY OF SERVICES
One way to determine accessibility is to understand the characteristics of those who are 
not currently accessing services and to tailor services to better meet their needs. This 
evaluation does so by evaluating the perceptions of FSW and MSM non-users of services. 
Further discussion of access is contained in section 4.
3.5.3.1. Non-client Demographics
This evaluation included a survey of 327 FSW and 153 MSM non-users of services that 
were used as comparison groups by which the impact of program exposure can be 
measured. Non-users of services, or ‘non-clients’, are defined as FSW or MSM who were not 
receiving peer educator services at the time of the interview. As shown in table 8, service 
users and non-users of services have similar demographic backgrounds. For example, mean 
age and mean number of children were similar for all non-user groups in comparison with 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 30
their service user counterparts. MSM, in particular, exhibit similar baseline characteristics 
between the two groups with the exception of education. MSM service users were more 
educated than non-users of services, with 20.8% of service users and 5.9% of non-users
having completed programs higher than vocational school. 
Demographics tended to vary more for FSW. For instance, a higher portion of the roamer 
FSW service user population was Ghanaian compared with the non-user group. More 
notably, greater percentages of roamer FSW ‘non-clients’ reported having no education and
higher education than their client counterparts. More specifically, 12.2% of non-user
roamers had no education compared with 6.9% of service users, and 6.3% of non-users of 
services had completed programs higher than vocational school compared with 2.8% of 
service users. Seater FSW ‘non-clients’ were also different from their client counterparts in 
terms of education. While both groups had high percentages of women never attending 
school (15.9% of service users and 16.7% of ‘non-clients’), the variation in those 
completing primary and secondary school was much greater. More than half of seater non￾users of services finished secondary school compared with little more than one-third of 
seater service uses. Finally, seater ‘non-clients’ reported being never married more often 
than users of services, 58.3% and 49%, respectively.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 31
Table 8. Demographic Information – FSW & MSM Service Users and Non-users 
Service Users Non-users
MSM Roamer FSW Seater FSW MSM Roamer 
FSW
Seater 
FSW
Average age in years 
(range)
25.8
(18-48)
25.4
(18-60)
30.3
(18-65)
25.4
(18-65 )
25.4
(18-51)
27.2
(18-43)
Nationality
Ghanaian 95.6% 94.5% 84.8% 98.0% 87.1% 83.3%
Nigerian 3.4% 2.8% 13.8% 0.7% 7.6% 12.5%
Other 1.0% 2.8% 1.4% 1.3% 5.3% 4.2%
City
Accra 27.9% 40.1% 27.6% 54.9% 39.6% 33.3%
Tamale 0.0% 11.1% 5.5% 10.5% 10.6% 25.0%
Koforidua 8.4% 14.3% 4.8% 2.0% 9.9% 4.2%
Sekondi/Takradi 40.3% 16.1% 31.0% 15.0% 20.1% 4.2%
Kumasi 22.8% 18.4% 31.0% 17.7% 11.2% 33.3%
Tema 0.7% 0.0% 0.0% 8.6%
Marital status
Never married 83.9% 72.4% 49.0% 78.4% 66.0% 58.3%
Divorced/separated 9.7% 16.1% 39.3% 10.5% 23.1% 20.8%
Widowed 0.3% 3.2% 6.2% 2.0% 2.0% 0.0%
Currently 
married/living with 
Spouse
6.0% 3.2% 0.0% 9.2% 5.3% 0.0%
Refused 3.6% 20.8%
Religion
Christian 85.9% 76.5% 86.2% 84.3% 79.2% 54.2%
Muslim 9.1% 21.7% 11.0% 11.1% 14.9% 29.2%
Other 5.0% 1.8% 2.8% 4.6% 5.9% 16.7%
Highest level of 
education
Never Attended 3.0% 6.9% 15.9% 2.6% 12.2% 16.7%
Primary 4.4% 21.2% 28.3% 8.6% 14.9% 4.2%
Middle/Secondary 20.8% 42.4% 34.5% 38.1% 39.3% 54.2%
SHS/Technical/ 
Vocational 51.0% 26.7% 19.3% 44.7% 27.4% 20.8%
Higher 20.8% 2.8% 2.1% 5.9% 6.3% 0.0%
Don't Know 4.2%
Mean # of children 0.31 1.03 1.54 0.36 1.03 1.08
Observations 289 217 145 153 303 24
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 32
3.5.5.2 Service uptake by non-users of services
Peer educators: Fewer than half of FSW non-users of services had heard of peer educators 
at the time of interview, which includes 42.9% of roamer ‘non-clients’ and 37.5% of seater 
‘non-clients’. More MSM ‘non-clients’ had heard of peer educators, though this only 
represents 60.1% of all MSM non-users. These figures suggest that peer educators and 
associated organizations could better advertise their services to their population of 
interest. Fortunately, of those had heard of peer educators, the majority reported hearing 
positive opinions of peer educators and the services provided, including 89.2% of roamer, 
88.9% of seaters, and 93.8% of MSM non-users of services. When asked what types of 
services they had heard peer educators provided, FSW and MSM ‘non-clients’ mentioned 
several relevant topics such as education, HIV prevention, and condom distribution. 
The ‘non-clients’ that had heard of peer educators indeed demonstrated an understanding 
of the peer educator mission. Nevertheless, they did not access peer educators services for 
a number of reasons. Of the FSW non-users of services who had heard of peer educators, 
19.2% and 11.1% of roamers and seaters, respectively, said they did not know how to find 
a peer educator. An additional 10.9% of MSM reported not knowing how to contact one. 
Twenty percent of roamer ‘non-clients’ and 11.1% of seaters said they were afraid others 
would discover they were FSWs. Interestingly, lack of confidentiality was a concern for 
15.4% of roamers but not at all for seaters. MSM were more concerned with confidentiality, 
with 19.57% reporting it as a barrier to contacting a peer educator. Some ‘non-clients’
simply did not have the time, including the 23.3% of roamers, 22.2% of seaters, and 28.3% 
of MSM that reported being too busy to access services. Finally, 16.9% of roamers, 11.1% of 
seaters, and 16.3% of MSM reported that they did not require peer educator services.
Mobile outreach: Far fewer FSW and MSM non-users of services had heard of mobile 
outreach services than peer educators at the time of the survey, including 28.4% of all FSW 
‘non-clients’ and 29.4% of MSM ‘non-clients’. Slightly more than one-third of all roamer 
FSW non-users had heard of mobile outreach services compared with 20.8% of seaters. 
The 15-percentage point difference may be due to the limited mobility of seaters and lack 
of advertising on behalf of the mobile outreach provider. Similar to those who had actually 
heard of peer educators, ‘non-clients’ reported hearing positive feedback and comments 
about mobile outreach services, including 100% of MSM, 95.4% of roamer FSW, and 100% 
of seater FSW ‘non-clients’. Non-users of services were also able to correctly name 
education, prevention, and condom distribution as key services provided by mobile 
outreach.
Non-users of services who had heard of but had not used mobile outreach services 
provided important insight as to why services were not accessed. Not having sufficient time 
to seek services was a common response for MSM and FSW (28.9% and 25.6%, 
respectively). Additionally, some ‘non-clients’ felt the hours of operation were too 
inconvenient. Others, including MSM and roamer FSW, had concerns about privacy and 
avoided mobile outreach so others would not learn that they were involved in sex work. 
Lack of transportation did not appear to be a barrier for any of the non-client groups.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 33
Text me! Flash me! Call Me! Helpline: Non-users of services were also asked about their 
experience with the Text me! Flash me! Call Me! Helpline, an HIV prevention service that 
provides information on reducing risks and accessing services to targeted populations. 
Mobile phone access was widespread in ‘non-client’ populations; 96.7% of MSM ‘non￾clients’ and 94.5% of FSW ‘non-clients’ either owned or had access to a cell phone. Mobile 
phone usage, however, was slightly lower in both populations with 92.2% of MSM ‘non￾clients’ and 85.0% of FSW ‘non-clients’ reporting that they always used a cell phone. 
Despite the ubiquity of mobile phones, few ‘non-clients’ had heard of the Text me! Flash 
me! Call Me! Helpline. Less than one-quarter (23.3%) of MSM ‘non-clients’ had heard of the 
helpline, and only 19.4% of those who had heard of it took advantage of its services. By 
contrast, 19.9% of FSW ‘non-clients’ had heard of the Text me! Flash me! Call Me! Helpline, 
but 38.5% of those who had heard of it went on to utilize its services. Both FSW and MSM 
‘non-clients’ that used the helpline were pleased with the services they received. 
Furthermore, those who had not actually used the helpline reported hearing positive 
comments about the service offered, including 92.7% of FSW ‘non-clients’ and 86.2% of 
MSM ‘non-clients’. The fact that a greater portion of FSW ‘non-clients’ that had heard of the 
helpline actually used the services suggests that this method for disseminating HIV 
prevention information may be more appealing, more accessible, or more acceptable to 
FSW than MSM ‘non-clients’. Alternatively, FSW ‘non-clients’ reported hearing more 
favorable feedback, which may have impacted FSW ‘non-clients’ decision to utilize this 
service more often than MSM ‘non-clients’. 
3.5.4. QUALITY: ACCEPTABILITY OF SERVICES
3.5.4.1. Appropriate Constellation of Care
Constructing and ensuring an appropriate constellation of care requires that providers 
offer appropriate and convenient services that are acceptable to the target population as 
well as the surrounding community. This evaluation assessed community awareness of SDP 
services as one measure of appropriateness. Although some SDPs were unsure if their 
community knew about the services provided by their organization, 58.8% of SDPs 
reported that their community was indeed aware. One SDP reported that the surrounding 
community was somewhat intolerant of their organization; however, 82.4% of SDPs 
reported receiving community support. All SDPs felt their physical location was accessible 
to their target population, although 41.2% reported most service users accessed their 
location by taxi. Only 11.8% reported clients most often accessed the location by walking. 
Having a location within walking distance would certainly help reduce ancillary costs of 
receiving care; however, qualitative evidence suggests that some clients actually prefer 
locations to be outside of town for privacy reasons.
Privacy is also a key measure of service acceptability. Providers are required to follow 
standards for ensuring that the privacy of clients is maintained. Of all SDPs, 76.5% reported 
having a confidential room available for HIV counseling and testing. Also, 94.1% of SDPs 
have a lockable filing cabinet for storing patient information. Privacy and safety was 
evaluated at drop-in centers for clients. Overall, 94.4% of MSM and 98.6% of all FSW that 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 34
accessed services at drop-in centers felt safe while at the facility. Furthermore, 93.4% of 
MSM, 92.9% of roamer, and 100% of seater FSW felt their privacy was maintained at all 
times during their appointment.
3.5.4.2. Repeated Service Uptake
Service uptake by clients can be a strong indicator of how acceptable services are to the 
population of interest. However, the descriptive statistics provided in the coverage chapter 
are somewhat limiting; perhaps a stronger indicator of service acceptability and usability is 
the number of times clients return to a specific provider for HIV prevention services. For 
example, as shown in table 9, a large percentage of clients utilize peer educator services. Of 
those who were in contact with a peer educator, only 8.6% of MSM and 7.9% of all FSW had 
one encounter with a peer educator. All others reported having more than one, and 
sometimes quarterly, interactions with peer educators. Smaller percentages of the overall 
client population sought care at drop-in centers and mobile outreach. Nevertheless, clients 
who received care tended to return for additional services within a 12-month period. 
Mobile outreach services had the lowest rates of return for clients who received services. 
These findings suggest that once a client is exposed to a particular provider or service, they 
find the services to be of acceptable quality and are interested in receiving services again. 
Peer educators may have a high rate of repeat clients since they more actively reach out to 
those on their client lists. Mobile outreach, on the other hand, might consider addressing 
some of the barriers to care expressed by clients and ‘non-clients’ in order to encourage 
clients to return. 
Table 9. Percent of Repeated Service Uptake by Clients by Place of Contact, including 
Number of Times Clients Who Sought Care in 12-Month Period
MSM Roamer FSW Seater FSW
Peer Educators
Has been in contact with peer educator in past 12 months 93.3 96.8 98.6
Once* 8.6 8.1 7.7
More than once* 91.4 91.9 92.3
Drop-in Centers
Visited a drop in center in the past 12 months 65.8 71.4 49.0
Once* 9.2 12.3 9.9
More than once* 86.7 87.7 85.9
Mobile Outreach
Received services from mobile outreach in past 12 months 23.5 47.5 44.8
Once* 11.4 35.9 30.8
More than once* 88.6 64.1 69.2
* Note: “once” and “more than once” are only for those who did have contact with provider
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 35
3.5.5. QUALITY: ATTITUDES OF PROVIDERS AND CLIENTS
3.5.5.1. Knowledge and Attitudes of Peer Educators
The knowledge and attitudes of peer educators can also be used as an indicator of service 
quality. After all, one cannot expect clients to be well educated in HIV prevention and 
treatment options if providers themselves are not sharing good quality information. 
Measuring peer educator attitudes and knowledge is also an important tool to help inform 
the content of future trainings and refresher courses. Overall, peer educators were quite 
knowledgeable on the causes and modes of HIV transmission. Peer educators answered 
90.5% of questions correctly in a module assessing HIV prevention knowledge. Almost all 
peer educators knew men can give HIV to women and women can give HIV to men, with 
98.3% of peer educators correctly answering each question. In addition, 96.6% of peer 
educators knew that HIV is virus that causes AIDS.
Although the overall average seems high, responses to some questions might suggest that 
peer educators require additional training and information. For example, one-third of peer 
educators incorrectly responded that a person must have many different partners in order 
to contract HIV. This is concerning given that their clients engage in sex with multiple 
partners on a regular basis. Another example is that 15.5% of peer educators responded 
that there is a cure for HIV and another 2.9% responded that they did not know. Peer 
educators must clearly understand that, although treatment exists to alleviate the 
symptoms of HIV/AIDS, this is not the same as a cure.
Having a positive attitude toward people living with HIV/AIDS (PLWHA), including but not 
limited to potential clients, is an important aspect of the peer educator position. Measuring 
peer educator knowledge ensures that clients are receiving appropriate information, 
whereas peer educator attitude gives insight into prevailing social norms. Overall, peer 
educators had an encouraging attitude toward HIV. One module in the survey asked 
whether or not peer educators disagreed with a statement about HIV; for example, “People 
who have HIV are like everybody else”. In general, peer educators had a positive response 
83.8% of the time. However, these responses varied considerably. For example, 97.1% of 
peer educators disagreed that people who have HIV must have done something wrong and 
deserve to be punished. Yet 44.3% of peer educators felt that people with HIV should feel 
guilty, which seems to imply that they should feel they have done something wrong. 
Another interesting point is that 95.4% of peer educators agreed that getting tested for HIV 
helps people feel better. At the same time, 29.3% of peer educators agreed that those who 
test positive should hide it from others. Furthermore, 50.3% of peer educators agreed that 
people in their lives would leave them if they knew they were HIV positive. These 
conflicted attitudes toward PLWHA suggest that stigma and discrimination are widespread 
and even affect a knowledgeable, supportive group of individuals who are committed to 
working with those most at risk.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 36
3.5.5.2. Knowledge and Attitudes of Clients
We also measured the knowledge and attitudes of clients to better understand the extent of 
information sharing between patients and providers, as well as the key messages that are 
being conveyed to the target population. Clients were asked to name ways to reduce their 
risk of contracting HIV, and the results indicate that condom usage is promoted as a 
prevention method far more often than any other method. Condoms were mentioned by 
96.7% of FSW and 87.9% of MSM. By comparison, being faithful to one partner was 
mentioned as a HIV prevention strategy by 48.1% and 53.4% of FSW and MSM, 
respectively. FSW mentioned avoiding contaminated needles more often than MSM (62.4% 
and 43.3%). FSW also mentioned avoiding casual sex more often than MSM (44.2% and 
28.5%). Overall, roamers and seaters shared similar responses, and FSW mentioned more 
methods than MSM. 
FSW and MSM generally had an encouraging attitude toward PLWHA, though MSM 
attitudes were slightly more positive. MSM responded positively 86.7% of the time to 
statements about how those with HIV should be treated, and FSW responded positively 
79.4% of the time by comparison. MSM and FSW agreed that people living with HIV 
deserve equal treatment from healers (91.9% and 91.7%, respectively). However, 80.4% of 
FSW agreed that people living with HIV should be allowed to participate in social events in 
the community compared with 94.6% of MSM. In general, FSW had less positive attitudes 
toward inclusion and allowing people with HIV to work and participate in the community. 
Furthermore, 44.2% of FSW said they would feel ashamed if someone in their family had 
HIV compared with 36.9% of MSM. 
The attitudes of non-users of services followed a similar pattern. MSM ‘non-clients’
responded positively 81.4% of the time while FSW ‘non-clients’ reported an encouraging 
attitude 75.7% of the time. The attitudes of on-users of services were slightly lower for 
most questions than their client counterparts. One exception was that slightly more MSM 
‘non-clients’ thought those with HIV should be treated the same by healers (93.5% 
compared with 91.9% of MSM service users above). Also, slightly more FSW ‘non-clients’
agreed that people with HIV should participate in social events in their community than 
their client counterparts. However, 54.7% of FSW ‘non-clients’ and 43.1% of MSM ‘non￾clients’ said they would be ashamed if someone in their family had HIV, which are greater 
proportions than both service user groups by comparison.
3.5.5.3. Client/Provider Relations
Peer educators: Of the service users who saw peer educators over a 12-month period, the 
vast majority reported feeling satisfied with the services they received, including 98.6% of 
MSM, 97.1% of roamers, and 97.9% of seaters. As shown in table 10, service users felt very 
positively about peer educators and reported that they were attentive, responsive to client 
needs, and friendly. In line with these findings, 98.9% of MSM, 96.2% of roamers, and 
96.5% of seaters said they would be interested in receiving services again from a peer 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 37
educator. Furthermore, 99.2% of MSM, 96.2% of roamers, 96.5% of seaters would 
recommend peer educator services to a friend. 
Table 10. Percent of Clients with Positive Feelings about Services from Peer Educators
Clients Reporting that Peer Educators Were: MSM Roamer FSW Seater FSW
Attentive 98.9 98.1 97.9
Responsive 99.2 98.5 97.2
Friendly 99.6 99.1 98.6
Drop-in centers: Service users also reported feeling satisfied by the services they received 
at drop-in centers. Of those that visited drop-in centers, 98.7% of roamer and 97.2% of 
seater FSW as well as 94.4% of MSM felt satisfied with the services provided. As shown in 
table 11, MSM and FSW generally rated drop-in center with high marks for attentiveness, 
responsiveness, and friendliness. However, MSM felt less positively about these 
characteristics than either roamer or seater FSW. Drop-in center staff were considered 
professional and respectful; however, 25.5% of MSM, 20% of roamer FSW, and 32.4% of 
seater FSW reported feeling judged by staff members. Feeling judged did not directly 
translate into being treated unfairly, yet almost one-quarter of MSM as well as 9% of 
roamer and 12.7% of seater FSW felt they received unfair treatment at drop-in centers. 
MSM reported being less likely than FSW to receive services at drop-in centers again, 
although 94.4% of MSM and 97.6% of all FSW reported they would recommend drop-in 
center services to a friend.
Table 11. Percent of Clients with Positive Feelings about Services with Drop-in Center 
Providers
Clients Reported Drop-in Center Staff Were: MSM Roamer FSW Seater FSW
Attentive 94.4 100.0 97.2
Responsive 94.4 99.4 97.2
Friendly 94.4 100.0 97.2
Felt welcomed 94.4 100.0 97.2
Treated unfairly 23.5 9.0 12.7
Respectful 93.9 100.0 95.8
Professional 94.4 99.4 97.2
Knowledgeable about resources 97.4 100.0 97.2
Maintained privacy 93.4 92.9 100.0
Serviced helped reduce risk (a lot) 85.2 91.0 87.3
Staff listened to concerns (a lot) 86.7 86.5 85.9
Staff judged you? (a lot) 25.5 20.0 32.4
Felt Safety 94.4 98.7 98.6
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 38
Mobile outreach: Clients reported feeling less satisfied with mobile outreach than peer 
educators or drop-in centers. However, satisfaction was still quite high as evidenced by the 
98.6% of MSM, 91.3% of roamers, and 92.3% of seaters reporting that they felt satisfied 
with mobile outreach services. Table 12 shows the percentages of service users who felt 
staff members at outreach centers were attentive, responsive, and friendly. MSM scored 
outreach staff higher across all three categories than roamers or seaters. All FSW, but 
roamers in particular, felt that staff members at outreach centers were less attentive, 
responsive, and friendly than those at drop-in centers or peer educators. Reflective of these 
findings, 98.6% of MSM, 89.3% of roamers, and 87.7% of seaters reported that they would 
receive services at mobile outreach centers in the future. Slightly fewer in each category, 
however, would recommend these services to a friend: 97.3% of MSM, 90.3% of roamers, 
and 89.2% of seaters. 
Table 12. Percent of Clients with Positive Feelings about Services from Mobile Outreach 
Centers
Clients Reporting that Mobile Outreach Staff Were: MSM Roamer FSW Seater FSW
Attentive 98.6 88.4 92.3
Responsive 97.3 90.3 92.3
Friendly 98.6 91.3 92.3
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 39
4. BARRIERS AND FACILITATORS TO ACCESSING HEALTH SERVICES 
BY MSM AND FSW 
This section presents both the potential and real barriers and opportunities for key 
populations with regards to access to health services from program implementers. The 
chapter draws heavily on the qualitative data collected through open-ended questions in
the FSW, MSM, and service provider questionnaires (peer educator and SDP) as well as
focus group discussions held with FSW. Quantitative survey data from the FSW and MSM 
questionnaires are used to address specific barriers and opportunities relating to mobile 
and Internet technologies.
4.1. POTENTIAL BARRIERS AND OPPORTUNITIES FOR FSW
Table 13 presents some opportunities as well as potential barriers that prevent FSW
service users from accessing health services from program implementers. One such 
opportunity is the ubiquity of mobile phone use among FSW clients; more than 80% of FSW 
have and always use a mobile phone. Unfortunately, only about 40% of FSW had heard of 
the Text me! Flash me! Call Me! Helpline and, of those who had heard of it, nearly 60% had 
not used it.
Similarly, Internet use among FSW was very low. Eighty percent of FSW indicated that in 
the past 12 months they had not used the Internet to get information about HIV prevention 
specifically intended for FSW. Most FSW would like services such as periodic HIV 
information through peer educators (90%) and TV/radio (56.9%). Channels of mHealth 
such as text messaging, Facebook, Twitter, WhatsApp, email, or the Web were not popular. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 40
Table 13. mHealth Opportunities and Experiences of FSWs 
Opportunity or Barrier FSW Service 
Users (%)
FSW Non-Users of 
Services (%)
Has a cell phone 82.3 85.6
Cell phone usage frequency 
Always 80.9 85.0
Sometimes 10.8 10.4
Rarely 5.8 4.0
Never 2.5 6.6
FSW has heard of the Text me! Flash me! Call Me! Helpline 43.6 19.9
Ever used the Text me! Flash me! Call Me! Helpline
No 57.0 61.5
Yes, one time 14.6 26.2
Yes, more than once 28.5 12.3
Satisfaction with the Text me! Flash me! Call Me! Helpline
Very Satisfied 86.8 72.0
Somewhat satisfied 11.8 20.0
Don't Know 1.5 4.0
Impressions based on things heard about Text me! Flash me! 
Call Me! Helpline
Very positive 44.4 0
Somewhat positive 44.4 92.7
Very negative 1.1 4.9
Don't Know 6.7 85.6
Never used the Internet to get information about HIV 
prevention specifically for FSW in the past 12months 79.8 74.3
Willingness to use a service that allows FSW to send text 
message and request for HIV information 69.3
Willing to use a service that provides periodic HIV 
information through various channels
Peer educators 90.1 37.6
Drop-in Centers 45.3 20.5
Mobile Outreach 27.9 39.8
TV/radio 56.9 66.7
Text Messaging 23.5 35.5
Facebook 6.9 14.7
Twitter 1.9 5.8
WhatsApp 5.8 11.3
Email 2.5 5.8
Web Portal 0.3 0.6
Number of Observations 362 327
Barriers to receiving HIV testing or attending referrals are echoed in the FGDs conducted 
among FSW. FSW who use and do not use services, both roamers and seaters, were 
interviewed in FGDs. However, the FGDs did not largely differ in their content on the basis 
of these divisions. Both service users and non-users emphasized the role of social stigma in 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 41
influencing their use of services. FSW reported a reluctance to use services unless they can 
be assured of respectful treatment and confidentiality. For example, one FSW reported:
They said nurses came around to undertake HIV testing for us but we suggest the 
nurses to come to our community in order for us to have a convincing issue of 
confidentiality. We can create a conducive place for the nurse to operate. We don’t 
want just anybody to come and talk to us or test us when we don’t know the person. 
Since somebody can pretend to come from the hospital and get to gather information 
from us.
Tema seater FSW
This comment illustrates the importance of trust and confidentiality to FSW. Another FSW 
FGD participant said the following: 
Sometimes the looks and treatment/care or handlings you would receive after 
disclosing your identity [as a sex worker] puts you off from visiting the clinic or 
hospital and therefore buy a drug at the pharmacy and cure yourself.
Accra roamer FSW 
This comment illustrates the FGD finding that FSW will avoid formal health services if they 
believe they would be exposed as an FSW and would suffer mistreatment as a result. One 
FGD participant, a user of program services, explained her preference for FSW specific 
program services, by saying the following: 
This work has a lot of risk which when I go to the doctor, he educates me and tells me 
more about STI prevention.
Kumasi service user seater FSW
The study also surveyed FSW not receiving services from program implementers. FSW 
non-users of program services were also included in FGDs, as reported above. These FSW, 
like their counterparts using program services, cite fear of exposure, social stigma, 
confidentiality, and privacy as key considerations when choosing whether to use services 
and where to seek care. 
Access to mobile phone and use could be said to be an opportunity for service delivery both 
for FSW users and non-users of services. Eighty-five percent of non-users of services 
indicated having and using a mobile phone. Unfortunately, only 11.9% of FSW non-users of 
services received health information on their mobile phone about how to reduce their risk 
of HIV infection 12 months preceding the survey. More than 80% of those who got the 
message espoused its relevance to our survey staff. When quizzed about Text me! Flash 
me! Call Me! Helpline, 65 of the 327 (19.9%) surveyed indicated that they had heard of the 
Helpline. Of those who had heard of it, 17 (26.2%) had used it once, and eight (12.3%) had 
used it more than once in the past 12months. Internet use among FSW was very low; 85.6% 
had not used the Internet to get information about HIV prevention specifically for FSW in 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 42
the past 12 months. Likewise, most (74.3%) had not used the Internet to get information 
about HIV prevention and risk reduction.
The survey also explored FSW access to HIV prevention commodities such as condoms, 
lubricants, or information about how to use them (tables 5 through 7). Given the survey’s 
screening questions, and also their self-identification as non-recipients of services from 
organizations rendering services to key populations, it was not unexpected that 50% of 
them had not received these commodities from a health facility or related service. Most of 
those who did access these commodities cited a government health facility or mobile 
outreach staff as their sources. Overall, the staff providing these services was adjudged by 
the respondents to be very professional (73.8%) or somewhat professional (22.6%). Only 
one of the 164 FSW who responded to the question on staff professionalism characterized 
the staff as very unprofessional. 
In addition to the questionnaire items with fixed answer choices, open-ended questions 
were also included to ask respondents about where FSW go to receive services and about 
barriers FSW experience in accessing care. Further, FSW FGDs provided important 
information on FSW care seeking behavior. These qualitative data were analyzed 
thematically, to further explore potential barriers and opportunities for serving these 
populations with targeted health services. FSW did not significantly differ in their 
responses regardless of status (roamer vs. seater), geography, or use of FSW prevention 
services. Therefore, results are presented collectively for FSW in the study. 
Several themes were identified by FSW as barriers to accessing treatment. However, the 
main theme that dominated FSW’s choice to seek health care, where, and under what 
circumstances are tied to past interactions with specific providers and service locations. 
FSW in the study reiterated that positive interactions with specific health care workers 
guided FSW decision making around health care seeking. For example, past interactions 
would determine where an FSW would seek care. One respondent summed up this view, 
saying such things as: 
Sometime the questions they ask you puts you off and don’t even go to the hospital for 
check up again. 
Koforidua roamer FSW
The nurse in charge takes proper care and attention for FSWs. There is a cordial 
relationship there with the FSWs. 
Tema seater FSW
The value placed on previous interactions was tied in part, as demonstrated above, to 
respectful treatment and lack of stigma against sex work. It was also examined specifically 
relating to concerns regarding confidentiality. For example, one respondent commented: 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 43
I do test but when they finish and they go back to their office they discuss those of us 
the FSW who are infected. Even they disclose your status in front of all the people they 
tested, so now we have been avoiding them when they come here by telling them to 
wait we are doing something else. 
Takoradi FSW
FSW in this study also raised concerns regarding the cost of services and the fear of 
learning negative health diagnoses as reasons FSW avoid seeking services relating to health 
concerns. For example, one participant stated: 
Sometimes the drugs the doctors prescribe for us are too expensive and the money we 
get from our business is not even enough to buy the drug. 
Tamale roamer FSW
Another, participant mentioned cost by saying: 
We have to be testing for our HIV status at least every month. We pay some money at 
the hospital during checkups, so if you don’t have money then you don’t go for 
checkups. 
Tema seater FSW
A fear of receiving a negative diagnosis, particularly learning of a positive HIV status, was 
also commonly mentioned by FSW in this study. Here are two examples of focus group 
respondents raising the issue of fear of diagnosis in this study.
It depends on the kind of sickness. If simple sickness, that is fine but if a serious on then 
they might fear that HIV test would be done for them and the fear of knowing their HIV 
status. 
Koforidua roamer FSW
Some people are afraid they will be told she have a sickness, that’s why they do not go 
to the clinic/hospital. So they will intentionally not visit the clinic for want of fear of 
being told the disease they have. 
Kumasi seater FSW
In addition to discussing barriers to seeking health services and factors that guide choice of 
health care provider, FSW also were asked about the services that are most important for 
FSW and recommendations they have for programmers thinking of offering services to 
FSW. Several services were named, most of which are already included in the HIV 
prevention Program Service Package for Key Populations. The recommended services
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 44
include HIV testing, HIV education, condoms and lube, and referrals to “mFriends” in the 
community. 
However, FSW also specifically mentioned services that are desirable for FSW but are 
currently not offered frequently or by all program implementers. These include services for 
the children of FSW, services to assist FSW in obtaining other work and opportunities such 
as vocational training and microcredit programs, and additional health services for family 
planning and STI treatment (and not just referrals for these services). These services were 
also mentioned by service providers as services they would like to see included in the 
comprehensive care package for FSW (see section 4.3 below). 
4.2. POTENTIAL BARRIERS AND OPPORTUNITIES FOR MSM 
As shown in table 14, mHealth services were popular among MSM service users. Most 
mHealth service users attested that the information they received was very useful. This 
was facilitated by the fact that the majority of them owned or had access to mobile phones. 
The availability of mobile phones is an opportunity that can be further explored to reach 
more MSM as not all had received information through this medium. Additionally, 
accessibility to the Internet and social media (Facebook, Twitter, etc.) are avenues that can 
be used to reach the target groups. Most of the respondents affirmed their willingness to 
assess services through such channels. Despite the potential for using information 
technology to reach more MSM, peer educators and drop-in centers remain the most 
prevalent method for providing services to MSM. Participants mentioned they generally 
seek health care from a private facility or drop-in center where staff is friendly. MSM also
said they would feel comfortable disclosing their sexual orientation if the doctor was also
MSM or was non-judgmental, confidentiality was assured, and if their health condition was 
so serious that there was no other option than to do so.
Although there are several facilitators to help MSM access care, there are also a number of 
barriers that prevent MSM from seeking services. Stigma and discrimination were
prominent reasons listed for not visiting a facility for health care, including for HIV testing 
and treatment services. Other reasons for not honoring referrals or seeking HIV testing or 
treatment were lack of confidentiality, fear of knowing one’s status, inconvenient 
scheduling, and transportation costs. Respondents recommended that any future 
interventions aimed at getting more MSM to access HIV prevention services should 
consider providing more MSM-friendly drop-in centers in private areas, educating health 
professionals against stigma and discrimination, providing free HIV testing, and supplying 
adequate condoms and lubricants. They also mentioned respect for privacy and 
confidentiality of service users and collaborating with mobile phone service providers to 
send regular HIV prevention messages to the youth as ways to improving health care 
access. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 45
Table 14. mHealth Opportunities and Experiences of MSM 
Barrier or Facilitator Service 
Users (%)
Non-users 
(%)
MSM has a cell phone 97.7 92.2
Cell phone usage frequency
Always 96.0 92.2
Sometimes/rarely 4.0 7.2
Ever received information about how to reduce your risk of HIV infection 
over the phone in the past 12 months:
No 45.6 78.4
Yes, one time 17.1 8.5
Yes, more than once 37.2 13.1
Health information received by text message is very useful 85.2 75.8
MSM has heard of the Text me! Flash me! Call Me! Helpline 60.7 23.5
Used the internet to get information about HIV prevention specifically for 
MSM in the past 12months 48.3 22.9
Would use a service that allows MSM to send text message and request 
for HIV information 89.3 70.6
Preferred information delivery channels
Peer educators 82.6 42.5
Drop-in Centers 59.4 26.1
Mobile Outreach 31.5 22.9
TV/Radio 36.9 65.4
Text Messaging 44.3 45.1
Facebook 25.8 27.5
Twitter 9.1 14.4
WhatsApp 16.8 19.0
Email 12.4 11.8
Web Portal 1.0 .7
Number of Observations 298 153
FGDs were not conducted with MSM as part of this study. It was feared that MSM were so 
highly stigmatized that MSM would not be willing to take part in a group discussion. 
However, community engagement, the success of key populations programs to gain trust in 
the MSM community, and the successful recruitment of MSM for the survey questionnaires 
has led us to recommend that FGDs with MSM be considered for future studies of this kind.
In lieu of FGDs, we aimed to gain the insights and recommendations of MSM by including 
open-ended questions in the individual survey questionnaires about health care seeking by 
MSM and soliciting opinions and recommendations for health programmers who wished to 
better serve the MSM community. These open-ended responses of the MSM are 
summarized here. 
MSM in this study were asked about where MSM go for health care. There were largely 
three different responses to this question. One category of responses suggested that MSM 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 46
do not seek health care because of their fears of discrimination and stigma. This view is 
captured in the following two quotations from the open-ended questionnaire:
Those who may not go to the hospital feel shy and afraid. 
Most of them will not go because they are afraid of discrimination. 
Other MSM expressed the view that MSM will go to providers who they know personally or 
to MSM specific providers at drop-in centers and other specialized facilities. This was the 
most common response and is reflected in the following quotations from MSM:
We go to DICs [drop-in centers] because we feel at home. Very safe and confidential.
We go to a particular private hospital because they have a doctor who understands 
and is friendly.
Most people visit private clinics or doctors because they feel it is safer.
I go to doctors I know.
The best is to go to DIC [drop-in center] for referral.
Open-ended question responses also described MSM not seeking out specialized or 
preferred services but instead seeking services wherever they are most convenient. MSM 
might also seek services wherever they are available in areas with limited options. With 
few MSM-friendly options available, some MSM felt the need to lie to providers about their 
status. Examples of these perspectives are captured in the following quotations from MSM 
in our study:
[MSM go to] central hospital because there is no other place.
For me, I go to the hospital and try to lie.
[I will go to] any hospital near my residence.
To understand better how MSM decide whether or not to offer information about their 
sexual preferences to providers, we asked MSM whether they would tell a provider about 
his status. MSM reported three different responses: yes, no, and it depends. Examples of 
these responses are presented below. 
Examples of those answering yes: 
This can easily be told. Our health is most important. 
I would easily tell the doctor to receive the best care. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 47
Examples of those answering no: 
The doctor will report him to the police. 
We can’t tell because we cannot know his mind. 
Examples of those answering that, most commonly, depends on illness or provider: 
MSM will only do that if he thinks he is safe. 
If the doctor frowns on Gayism, they won’t tell him. 
It depends on the trust of the doctor.
Would not tell the doctor unless illness was linked.
From these responses, we can determine that the decision to tell a specific provider about 
his sexual orientation is a very weighty matter for many MSM and may not be automatic. 
Trust in a provider and confidentiality is very important to the MSM in our study. 
When asked about ways in which services could be improved for MSM or what 
recommendations MSM would have for health programmers interested in better meeting 
their needs, MSM raised many issues. The most common response was a request for a 
regular supply of high quality condoms and lubricants. These responses suggested that 
stock outs and quality have been perceived as problematic issues with the program to date. 
Below are four of the responses that raised the issue of supply and quality of condoms and 
lubricant, which serve to illustrate the high importance of these issues to the respondents 
in our study.
Should have a regular supply of high quality condoms. 
Should provide us with quality condoms. 
Improve the quality of condoms and lubes. 
Enough condoms and lubricants.
Other recommendations to programmers and providers included an emphasis on security 
and confidentiality. For example, MSM made the following statements in regard to the 
security of drop-in centers and other service delivery points: 
I would like it to be solely for MSM. 
Should be at a strategic place known to MSM. 
The location should not be in an open place where a lot of people stay or reside.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 48
The following quotations are presented to demonstrate the emphasis that respondents 
placed on respectful treatment and confidentiality of interactions with providers by our 
MSM respondents: 
Educate the doctors and nurses to accept MSM. 
Confidentiality should be the main priority. 
4.3. POTENTIAL BARRIERS AND OPPORTUNITIES: PERSPECTIVES OF SERVICE 
PROVIDERS 
4.3.1. PROVIDERS’(PEER EDUCATORS AND SDPS PROVIDERS) PERSPECTIVES
Of 174 peer educators, more than 75% felt that some key populations were harder to reach 
than others. MSM were a challenging group to reach for many reasons. Stigma and 
discrimination are significant barriers that keep MSM from accessing care. MSM often fear 
exposure, either of HIV or MSM status, and some do not trust that health professionals will 
keep their information confidential. As a result, some peer educators noted that they had 
received false information from MSM, making them even more challenging to track down 
for a second contact. The busy schedules of some MSM also pose a challenge to reaching 
them. Furthermore, some MSM do not like to be approached in person. Referred to as the 
“VIP MSM” or “high class” or highly educated older MSM, they prefer to be contacted via 
calls or text messages. This presents both a barrier and an opportunity. It is an opportunity 
given that most MSM (98% of service users; and 92% of non-users of services) owned and 
always use a cell phone (table 14). The challenge, however, is reaching the few MSM who 
do not have cell phones. Another barrier noted by the peer educators is the “lack of 
stability” with regard to an appropriate meeting place for MSM. Peer educators noted that 
venues constantly change and there is little opportunity for MSM to meet safely and 
regularly in a particular setting and engage with other MSM. Because of this instability, 
transportation is often a barrier for MSM.
Peer educators suggested a few opportunities for engaging these men. First, peer educators 
noted that it would be important to provide access to phone credit for all MSM. Peer 
educators can have frequent engagement via phone with MSM, which is preferred to 
meeting in-person for many of them. Second, although the use of social media platforms 
such as Facebook, Twitter and Whatsapp was somewhat low (table 14), many peer 
educators suggested social media as an important opportunity for accessing this group.
FSW were challenging to reach for different reasons. Unlike the MSM, privacy and stigma 
were not the main difficulties when working with FSW. Roamers were particularly hard to 
work with because of their mobile lifestyle. Many peer educators commented that roamers 
are constantly on the move and provide several home addresses. Even if peer educators 
can make a first contact with this group, there seem to be significant problems with 
providing follow-up or secondary services. Peer educators found it challenging to work 
with FSW even when they stayed in one place. The working hours for FSW are long and 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 49
unstructured. Typically, if peer educators want to meet with FSW, they need to find them 
when they are out at night instead of while they are asleep during the day. However, many 
FSW do not like to be observed or bothered while they are working. An overwhelming 
number of peer educators commented on FSW being too busy to make the time for their 
services. One commented:
They have little confidence in peer educators so they play hide and seek with them.
According to peer educators, the way forward with FSW is through strengthening 
relationships. Overall, there is a sense that FSW do not recognize the valuable services the 
peer educators provide. Perhaps they do not feel they are at risk or the opportunity cost of 
seeking services is too high (i.e., miss customers and lose money while meeting with peer 
educators). Several peer educators noted a need to establish strong relationships with FSW 
and good rapport. A trusting relationship between FSW and peer educators would help 
convince FSW of the importance of peer educators’ messages. Some peer educators also 
commented that FSW need incentives. If peer educators could provide more condoms or 
even pay FSW for their time, they would have more success with this group. For those that 
are challenging to reach, peer educators suggest a friendly first contact followed by 
exchange of contact information. Then peer educators can schedule calls or have FSW call 
them at their own convenience.
Like the peer educators, almost all SDPs reported that some client groups are more 
challenging to reach than others. Roamer FSW are a particularly challenging population to 
reach because they do not work from one location. It is not always possible to track down 
and work with this highly mobile group on a regular basis. Respondents thought that 
seeking out roamer FSW at times when they are least busy or finding them at condom 
activation spots were promising approaches for expanding coverage. Furthermore, two 
respondents thought collaborating with hotels and facilities with which FSW work could 
facilitate greater contact with this hard to reach group.
While some respondents commented that MSM in general are challenging to reach due to 
stigma, three SDPs commented specifically on their difficulty reaching older, “elite” or “VIP” 
MSM. This group of men also faces the fear and discrimination shared by their younger 
counterparts; however, business executives or other high power MSM tend to be less likely 
to identify as MSM. This may be due to fear of exposure and the impact this could have on 
their job or social standing. These MSM could better be reached by addressing the issues of 
stigma and education in the general population. One respondent also suggested recruiting
older peer educators who can identify with the older cohort of MSM.
4.3.2. PROVIDERS’ VIEWS ON HOW TO IMPROVE KEY POPULATION SERVICES
Peer educators provided many ideas that might improve services for key populations. The 
more common thoughts were around ensuring condoms and materials were always 
available; outreach and education; and more training for peer educators. Not only are 
condoms an important tool in the fight against HIV, but peer educators also find that key 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 50
populations are more interested in their services when condoms and supplies are available. 
A steady supply of condoms, lubricants, HIV test kits, ART, and education materials are 
important for peer educators to provide better services for their clients. Beyond supplies, 
peer educators felt greater education and outreach were necessary to reach all key 
populations. Advertisements, social media, and rallies could help raise awareness of 
available services while meaningfully reduce stigma and discrimination in the population 
at large. Peer educators also commented that they need more training and capacity 
building, particularly with how to engage with individuals who are uninterested in their 
services or who do not trust them. More training for existing peer educators and other 
health professionals as well as a larger workforce would help improve services delivered to 
key populations. 
To improve the quality of their services, peer educators suggested consistent and regular 
follow up to clients. Peer educators noted that MSM need their own hospital and MSM 
friendly doctors. Other suggested ways to improve MARP friendly services included 
frequent trainings and keeping information confidential. Others felts that organizing events 
like roamer get-togethers and providing them with health insurance could help improve 
services. 
SDPs suggested three main ideas as to how key population services could be improved. 
First, designating more facilities as friendly to key populations and having a welcoming and 
well-trained staff may make hard-to-reach groups more willing to seek care. Second, 
respondents suggested there be increased efforts to educate the general population and 
reduce stigma and discrimination against these groups through awareness campaigns. 
Third, several respondents supported the idea of service providers being more active in 
seeking out these hard-to-reach groups. Suggestions to “take services to the door steps”, 
intensify mobile outreach, and recruit more peer educators to go out and educate key 
populations support this idea.
Apart from reaching more key populations, service quality must also be improved. SDP 
respondents again pointed to the need for key population friendly workers who are better 
trained in issues of confidentiality. Periodic capacity building of service providers could 
reinforce a MARP-friendly approach. At least two respondents also noted that more and 
better-trained peer educators could help improve service quality. Finally, some 
respondents commented on the need to improve drop-in centers. More funding and better 
equipment, along with a more welcoming environment (i.e., games or a café), might elevate 
the quality of services provided and entice more key populations to access these facilities.
Two respondents commented that FSW and MSM should be involved in decision making 
that affect their communities. By incorporating representatives of these groups in 
discussions, GAC and program implementers may be more successful in improving service 
quality, reaching key populations, and meeting strategic goals. Another respondent 
commented that while the service delivery for key populations has improved, stigma and 
discrimination persist, making key populations hesitant to seek services. Greater education 
and awareness campaigns for the broader population could help improve the health care 
experience for key populations. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 51
5. ORGANIZATIONAL PROFILES, SERVICE PROVISION, CHALLENGES, 
AND OPPORTUNITIES 
5.1. ORGANIZATIONAL PROFILES 
The OCA component of the evaluation involved 12 independent organizations (table 15). 
Table 15. Twelve Independent Organizations Involved in OCA Component of Evaluation 
All organizations were either registered with a government agency (i.e., the Department of 
Social Welfare or the Registrar General Department), or were umbrella organizations, such 
as Ghana Coalition of NGOs for Health or GHANET. Some organizations were also affiliated 
with religious groups, political entities, or trade unions. Eleven of the 12 organizations 
reported receiving funding from an international donor or NGO. The main donors 
mentioned included the USAID Ghana/SHARPER Project, Johns Hopkins University (JHU), 
Global Fund, Heartland Alliance International, the Red Cross, and USAID. 
All organizations were overseen by a board of directors, though the period of time served 
by board members varied by organization. Most organizations held elections on an annual 
or biannual basis; however, two organizations were unable to provide information on the 
frequency with which their board members were elected. These boards are considered 
important decision-making and oversight entities that help manage a variety of full-time 
and part-time employees, as well as volunteers. The number of paid full-time employees 
(not including peer educators or Ghana Health Service Nurses) ranged from five to 50, with 
11 being the modal number. 
Name Headquarters
4-H Ghana Koforidua
Center for Population Education and Human Rights Accra
Ghana Red Cross Society Accra
Hope for All Foundation Tarkwa
Interfaith Family Network Techiman
Maritime Life Precious Foundation Takoradi
Micdak Charity Foundation Kumasi
Philip Foundation Programme Accra
Prolink Accra
West Africa Programme to Combat AIDS/STIs (WAPCAS) Accra
Worldwide International Youth Organization Tema-Ashiama
Youngsters Peer Education Project Accra
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 52
5.2. SERVICES PROVIDED
As described in table 16, all organizations were responsible for offering a variety of HIV 
prevention services to key populations; 100% of organizations reported providing 
condoms and lubricants, STI screening and referral, and mFriend (service providers in the 
community with sensitivity training and a willingness to work with key populations)
referral services to their clients. HIV treatment referral and voluntary counseling and 
testing (VCT) were also common services provided by nearly 93% of all organization. In 
addition to the mFriend services, 85.7% of organizations offered the Text me! Flash me! 
Call Me! Helpline. Other services, however, were not as widely available. For example, less 
than half (42.9%) of organizations provided PMTCT referral services and none provided 
pregnancy testing.
Table 16. Services Rendered by Organizations to Target Populations
Services Number of Organizations
Condoms/lubricant 12
Emergency contraception 3
Regular contraceptive methods other than condoms 3
Pregnancy tests 0
Mobile outreach 12
VCT 12
HIV risk assessment 12
Rape counseling 8
STI screening and referral 12
Mental health referral 4
Mfriend referral 12
HIV treatment referral 12
PMTCT referral 6
Other Referral 4
Text me! Flash me! Call Me! Helpline 12
Mhealth information by text 5
Follow-up visits to defaulters 1
Number of Observations 12
Understanding the reach of a program is as important as knowing the types and quality of 
services provided. According to the OCA, a total of 15,584 MSM were reached by six 
organizations in the last 12 months. The highest number reached by any organization was 
7,125 MSM and the lowest number reached was 291. Furthermore, nine organizations 
reported reaching 41,368 FSW, ranging from a total of 108 to 11,714 FSW. 
The absolute numbers provided by organizations are substantial; however, it is difficult to 
understand the true reach of the NSP given that organizations operate under disparate 
definitions of program reach. Some definitions of program reach that were mentioned by 
the organizations are as follows:
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 53
The contact we make with the people and the service provided. 
When target population receive our services such as HIV testing and counseling, GBV. 
MARPs who received message and a change in knowledge, attitudes and practices. 
Number of target population reached with information on HIV, STI, condoms and 
referred with those services. 
People reached with the HIV prevention messages. 
Program reach is when our target group receives all the services that we provide, such 
as lubes, condoms, GBV, IEC, materials, referrals, etc. 
The target population has been reached with programs and activities. 
When a client has been provided with at least three of the HIV prevention package. 
As discussed earlier, providers deal with double counting in different ways. As a result of 
the OCA, eight organizations reported that they did not have any problems with double
counting, four affirmed they sometimes encountered difficulties, and one said this problem 
was rare. Organizations often have policies to avoid double counting that include the use of 
client unique identifier codes (UICs), by clearly demarcating areas of operation for each 
peer educator, dividing clients into new, reached, and multiple contacts using the template 
provided by GAC, FHI 360, and Johns Hopkins University and through monitoring and 
supervision (tracking of old and new contacts). The extent to which these strategies are 
appropriately implemented and reported is addressed in section 2.
5.3. SERVICE PROVISION CHALLENGES AND OPPORTUNITIES. 
There were a number of obstacles that prevented organizations from reaching FSW and 
MSM with quality HIV prevention services. High societal stigma and discrimination against 
the target populations was the main obstacle reported, while other barriers identified 
included intermittent shortage of commodities, police swoops, poor road networks to the 
community, lack of employment, inadequate funding for program activities, media attacks, 
and demand for financial reward by community leaders. Respondents also commented that 
the legal framework in Ghana, which criminalizes sex work and homosexuality, makes it 
extremely difficult to reach key populations. The desire to protect one’s privacy often 
makes potential clients reluctant to access drop-in centers or other services. 
Despite these challenges, certain opportunities can be explored to help improve access to 
and quality of HIV services for key populations. OCA respondents mentioned the following 
as potential opportunities: availability of friendly, non-discriminatory health facilities; 
support from community and mFriends; the target populations’ interest and willingness to 
change behavior and access interventions; exposure to safe sex practices; the availability of 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 54
commodities like lubricant and condoms; and the formation of a Key Populations TWG. The 
exemplary leadership of the GAC, planned education and capacity building activities 
targeting key populations, the capture of issues relating to key populations in the NSP 
2011-15, the establishment of drop-in centers, and gradual acceptance of key populations 
by the general population were also mentioned as opportunities worth exploring.
5.4. INVOLVEMENT OF COMMUNITY IN DECISION MAKING AND PROGRAM STANDARD 
OPERATING PROCEDURES
One of the objectives of this evaluation was to assess whether or not organizations involved 
their community in decision making and if they have standard program operating 
procedures. As indicated in table 17, all 12 organizations reported that they involve the 
community in their decision-making process through consultations with community 
leaders and the use of field staff in mobilizing community members. Consultation with 
community members was another popular method; others use groups or community 
committees. Nine of the 12 organizations have representations of the communities on their 
boards. 
Table 17 also shows that all organizations had written statements of their overall goals, had 
a written set of objectives, and maintained a written calendar of activities to guide their 
work. Many also had written organizational development plans and a written work plan 
that covers the current year. In general, an organization’s work plan is approved by the 
donor, executive director, governing board, and finally the implementing agency or 
organization’s management team. 
Progress on the work plan is monitored primarily through each organization’s monitoring 
and evaluation systems. Some organizations reported having daily, weekly, monthly, or 
quarterly checks to ensure the work plan is on track. Others monitored the activities of 
project coordinators while some set up targets in line with the plan. In spite of the work 
plans and other procedures in place, less than two-thirds of organizations had a written list 
or description of all geographic/catchment areas in which their FSW and MSM services are
located. However, a higher proportion (71%) had a manual that establishes standards for 
managing the needs of FSW and/or MSM clients by organization staff. In order to better 
reach their target populations, all the organizations have a team of peer educators, ranging 
from 12 to 254; and all but one had written criteria for choosing peer educators.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 55
Table 17. Community Participation and Program Standard Operating Procedures 
Method of Community Participation Number of 
Organizations
Consultation with community leaders 12
Consultation with community members 12
Consultation with community leaders 12
Field workers that mobilize community 12
User groups or community committees 12
Representation on NGO board 9
Other methods 7
Organization has received mentoring/coaching from an outside organization in 
strengthening organizational capacity 12 
Respondent has personally participated in a community practice for MSM or FSW 
service providers in the last 12 months 12 
Standard operating procedures that are in a:
written statement of the over-all goal of the organization 12
written organizational development plan 12
written work plan that covers the current year 12
written set of objectives for the organization 12
There is a written calendar of activities for the organization 12
Organization has a written list or descriptions of all geographic/catchment areas in 
which FSW and MSM services are provided 9 
There is a written organizational chart for the organization 12
Every employee is given a written copy of his or her job description 12
Organization has a personnel manual 10
Organization has an orientation program for all new staff 12
There is a manual that establishes standards for managing the needs of FSW 
and/or MSM clients 10
Organization has written criteria that are used in choosing peer educators 12
Number of Observations 12
One objective of the study was to determine if organizations had capacity reflecting 
effective supervision mechanisms. As shown in table 18, most organizations had annual 
written performance objectives established for each of their employees. All respondents 
reported conducting annual evaluations of their staff using a well-written performance 
appraisal form. The organizations generally had a list of all their current employees as well 
as staff training plans. All but one of the organizations offered special supervision training 
for their peer educator supervisors. Furthermore, 11 of the 12 organizations provided 
supervisors with checklists in order to facilitate effective supervision. Finally, all but one 
organization had their peer educators hold group meetings. Issues discussed at such 
meetings generally involved achievements, challenges, review of reports and targets, 
planning the way forward, and strategizing to meet set objectives. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 56
Table 18. Functional Supervision Mechanisms. 
Mechanism Number of 
Organizations
There is annual written performance objectives established for each employee 11*
Annual evaluations of staff are conducted 12
There is a written performance appraisal form used for evaluating employees 12
There is a written plan for staff training 10
There is a list of all current employees 12
Organization currently support peer educators 12
Each peer educator is given a written statement of his or her objectives for each year 12
There is a standard training that all peer educators attend 12
Provides equipment or materials to the peer educators 12
Peer educator supervisors have received special training in supervision 12
Supervisory checklist has been provided to supervisors of peer educators 11
There are group meetings of peer educators 12
Number of Observations 12
* One of the 11 was unable to provide a copy.
The evaluation also aimed to determine if organizations had effective monitoring and 
reporting systems in place. All organizations had indicators to assess the quantity or 
volume of services rendered to the target populations. Some common volume indicators
mentioned included the number of condoms and lubricants distributed to target 
population and number of FSW and MSM reached. Table 19 shows that 11 of the 12 
organizations reported having established impact indicators for their services. These 
impact indicators comprised “the number of MARP reached with services, number of 
referrals made, number of target population using condoms and lubricants, number of 4H 
clubs by in-schools and out-of- school youth, total number of commodities such as 
condoms/lubes sold, total number of IEC [information, education, communication] 
materials distributed”. Also, 10 of 12 organizations had indicators on the organization’s 
financial status. They identified their financial indicators to include the total amount of 
money for program activities, financial statements, funds for outreach activities, and funds 
for personnel and administration (i.e., staff salaries, allowances for peer educators and 
drop-in center nurses). 
Organizations collect data mainly through service statistics, surveys, and focus groups. 
Other data collection methods included specifically designed field outreach tools, one-on￾one interactions with key populations, and summary sheets. A report on the data collected 
is typically received on a weekly or monthly basis for review and evaluation. Only one 
organization receives reports on a daily basis. All participating organizations indicated 
reviewing quantity indicator reports with program staff. Eleven organizations indicated 
reviewing impact and financial indicator reports. Nearly all the organizations use the 
reports to adjust performance targets, help improve resource allocation, change service 
delivery strategies, initiate or improve quality of care interventions, and appraise staff. All 
of the organizations had held trainings on monitoring and evaluation for their staff or peer 
educators in the past 12 months. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 57
Organizations also reported facing challenges in collecting, analyzing, and utilizing data. 
Prominent among them were inaccurate and inadequate information by key population 
(e.g., some clients did not want to give personal information, or difficulty in taking pictures 
of clients). Mobility of key populations, high illiteracy among key groups, lack of transport 
and logistics, and appropriate software to assist in data analysis were other challenges 
mentioned. 
Table 19. Functional Monitoring and Evaluation Systems 
Monitoring and Evaluation Indicator Number of 
Organizations
Organization has established indicators regarding the quantity or volume of 
services provided to your target population 12 
Organization collects data on the quantity or volume of services provided to 
target population 12 
Methods of data collection:
Service statistics 7
Surveys 2
Focus groups 4
Other 5
Receipt frequency of reports on the quantity or volume of services provided:
Weekly 4
Monthly 9
Other 1
Organization reviews reports on volume of services with program staff 12
Organization has impact indicators of services provided on target population 9
Organization reviews reports on impact, with program staff 11
Organization has key indicators of its financial status 10
Organization reviews financial status reports with program staff 11
Data collected and reports generated are used in:
Adjusting performance targets 12
Resource allocation 12
Adjusting work loads 12
Changing service delivery strategies 12
Commodity procurement 12
Quality of care interventions 12
Staff appraisal 12
Organization provided staff or peer educators with training in M&E in the last 12 
months 12
Number of Observations 12
A series of questions was asked to assess organizational administration, management, and 
planning capacity. As indicated in table 20, the study found that 11 organizations had a 
written policy for procuring commodities (all but one provided copies of these policies) 
and nine had a policy for commodity forecasting requirements. Despite these commodity￾forecasting arrangements, shortages were recorded by nine organizations in the last six 
months. Condoms, HIV test kits, lubricants, and information, education, and communication
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 58
materials were the first through fourth most commonly stocked-out items, respectively. Six 
of the nine organizations that recorded these shortages responded by obtaining emergency 
supplies from an alternate source, two referred clients to the different provider, and one 
asked clients to return when the commodity was back in stock. Popular sources of 
commodity supply were Exp Social Marketing, regional and district health facilities, 
Adventist Development Relief Agency (ADRA), donors, GAC, National AIDS Control 
Programme, and the Ghana Health Service.
All of the organizations had a warehouse or storage facility; four of these organizations 
affirmed that their facility’s conditions were completely satisfactory. An audit had been 
carried out in the last three years on commodity management systems of 10 organizations. 
As far as financial management is concerned, all 12 organizations had budgets covering the 
current fiscal year; all had budget performance reports that compare actual to projected
expenditures. The budget performance reports are reviewed monthly, quarterly, half￾yearly, or annually as deemed appropriate by different organizations. Additionally, almost 
all the organizations reported having balance sheets, a register for recording receipt of cash 
and checks, and a fixed assets register. An external audit of the organizations’ finances had 
been done for all 12 organizations. Only one organization charged a fee to MARP for 
services (GH₵2 per box of condoms and 10 Ghana pesewas for lubricant). At the time of the 
study, a U.S. dollar (US $1) was equivalent to 1.4 Ghanaian cedis (GH₵1.4). 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 59
Table 20. Administration, Management, and Planning Capacity 
Administration, Management, and Planning Capacity Indicator Number of 
Organizations
Organization has a written policy for procuring the commodities 11
Organization has a warehouse or storage facility for commodities 12
Commodity storage facility is:
Completely satisfactory 4
Somewhat satisfactory 3
Somewhat unsatisfactory 5
Organization has a written policy for forecasting commodity requirements 9
There been an audit of commodity management system in the last three 
years
10
Organization has experienced stock out of commodities in the last 6 months 9
Condoms stock out 9
Lube stock out 4
IEC materials stock out 2
HIV test kits stock out 6
Respond to the stock out by:
Directing clients to return when commodity was back in stock 1
Obtaining emergency supply of commodity from an alternate source 6
Directing client to alternate source of commodity 2
Organization has a budget covering the current fiscal year 12
Organization has a budget performance report that compares actual to 
projected expenditures 12 
Budget performance report issuance frequency:
Every month 9
Every quarter 2
Every six months 1
Other [1 quarterly, 1 yearly] 2
Organization has a balance sheet 12
There has been an external audit of the organization’s finances 12
Organization has register for recording receipt of cash and checks 12
Organization has a fixed assets register 12
Organization did an inventory of fixed assets conducted in the last 12 months 12
Written bids are obtained for purchases above a fixed amount 11 
Organization has a register for accounts payable 12 
Organization currently charges fees for its MARP services 1
Number of Observations 12
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 60
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 61
6. STAKEHOLDER AND ORGANIZATIONAL COORDINATION AND 
SOCIAL, CULTURAL, RELIGIOUS, POLITICAL, AND LEGAL BARRIERS 
TO HIV PREVENTION EFFORTS AMONG FSWS AND MSM
This section of the report presents an evaluation of key population HIV prevention 
programs by 12 selected stakeholders who were involved in KIIs (table 21).. Participants 
for KIIs included chief executive officers, directors, program managers and coordinators, 
and technical advisors who had worked in their various positions for a period ranging 
between one and 11 years Emerging themes from the KIIs focus on: the status of the 
national program for key populations; stakeholder and organizational coordination efforts 
and gaps; barriers to HIV prevention efforts; and strategies for moving forward.
Table 21. Participants of Key Informant Interviews 
Organization Title/Position of KII Respondent
ADRA Technical supervisor
UNAIDS Social mobilization/partnership manager
Centre for Population Education on Human 
Rights, Ghana
Programs manager
Ghana Police AIDS Program Programs coordinator
PROLINK M&E coordinator
Young Women against Stigma Chief executive officer
Unite Nations Population Fund HIV program analyst
World Education, Ghana Programs Manager
National AIDS/STI Control Programme Deputy programs manager
FHI 360 Technical advisor
WAPCAS Project coordinator
GAC Director, technical service
6.1. STATUS OF NATIONAL KEY POPULATIONS PROGRAM
Key informants submitted split opinions about the current status of the national key 
populations HIV prevention program. Several participants (eight) believed the program is 
sufficient in scope, quality, and coverage to facilitate reach to 80% of MSM and FSW. 
Regarding scope, some stakeholders described the program as comprehensive, 
acknowledging the increased efforts to expand reach. They identified the effectiveness of 
programmatic structures, resource availability and keen involvement of key partners as 
factors that can facilitate progress toward achieving targeted goals of the national program. 
Below are some statements made by key informants to this effect:
Yes, the strategy is comprehensive and interventions are being scaled up for 
nationwide coverage. The human rights issues are being addressed. There is also 
political willingness to create a conducive environment for MARPs. More implementing 
partners are working hard to meet objectives.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 62
Yes, the program is on course. If the estimates used in setting the target is correct, then 
this is achievable due to the comprehensive nature of the strategy.
From data seen so far, the program is on course to meeting the set targets. The 
strategy is comprehensive.
On the other hand, some informants doubted the possibility of reaching 80% of FSW and 
MSM by 2015. They isolated the case of hard-to-reach FSW and MSM populations and 
locations where key populations are not effectively networked as problematic. Also, there 
are areas with limited availability of HIV services for key populations. Additionally, some 
informants believed the fragmented nature and focus of activities by implementing 
partners can limit the performance of the entire program. Moreover, some informants 
showed concerns that HIV prevention in key populations is no longer seen as a national 
priority, a situation that has led to limited availability of resources. These were illustrated 
by statements such as:
Meeting the target was based on availability of resources but this is limited now. Also 
MARP is not currently the top priority on the national agenda.
6.2. STAKEHOLDER AND ORGANIZATIONAL COORDINATION EFFORTS
In commenting on stakeholder and organizational coordination, informants highlighted the 
creation of the TWG for Key Populations and availability of various resources as efforts that 
facilitate the HIV prevention program. Several informants described the TWG as one of 
several structures established to effectively coordinate and drive the national HIV 
prevention efforts. Participants described it as a central organ, leading and mapping 
strategies for key population HIV prevention in the country. Its functions include 
formulation of policies and guidelines as well as coordinating and implementing the key 
populations strategy, programs, and activities. In this regard, the TWG creates an 
opportunity for members to share expertise. It also provides updates on strategies as well 
as technical and program information to stakeholders and donor partners. Following are 
some comments in this regard:
The TWG provides the platform to share technical and program information. It 
coordinates activities of implementing partners and provides donor partners 
information on allocation of resources. These roles are pivotal in meeting the targets 
set in the national MARP strategy.
The TWG plays a major role as it coordinates the program and shares expertise to 
maximize achievement of targets.
Additionally, key informants identified the availability of implementing partners and access 
to relevant information as crucial efforts that facilitate stakeholder organization and 
coordination. Key informants believed access to relevant information provides overall 
direction to implementing partners on the HIV program. It also provides details, updates, 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 63
and targets/milestones that need to be achieved. Information from IBBSS; a legal study; 
HIV prevalence data; coverage and reach estimates; periodic implementing partner
reports; mapping and size estimation data; key population strategic plan and standard 
operating procedures; the anti-discrimination, barrier to condom-use study; and men’s 
study are useful. These information sources give insights into behavioral patterns and 
utilization of services. 
The above-mentioned opportunities were not considered to be clear strengths by all. Key 
informants discussed gaps associated with stakeholder and organizational efforts, which 
included the somewhat dysfunctional nature of the TWG. Unfortunately, some informants 
believe the TWG does not have a clear agenda, which limits its effectiveness. Particularly, 
key informants were concerned about the TWG’s difficulty in organizing regular meetings, 
the centralized nature of the group, limited funds, as well as donor influence. Also, some 
informants were concerned about the lack of leadership by GAC as well as the ineffective 
vertical approach adopted for the HIV prevention strategy. Other informants found 
variability in capacity levels of implementing partners to be problematic. This is manifest in 
the statement of a stakeholder that “competence of IPs differs and so do their delivery. 
Some implementing partners are better able to reach MARP.” 
Moreover, informants showed concern about gaps related to resource availability and 
service provision. They isolated the shortage of HIV test kits; condoms; information, 
education and communication materials; and lubricants, as well as inadequate MSM￾friendly health facilities and limited treatment of STIs at the drop-in centers as gaps in the
range of services provided under the program. Some stakeholders also thought there is still 
inadequate information on the estimates of HIV prevalence among MSM, number of MSM 
reached with HIV services, full scope typology of the key population groups, data on 
progress of programs, and prisoners, including information on follow-up interventions, and 
some Global Fund interventions. Some informants believe such information is crucial since 
HIV trends among key populations keep changing with time. Despite these gaps, 
participants believed obstacles could be addressed if the TWG takes full advantage of 
existing opportunities including willingness on part of implementing partners to 
implement interventions and the diverse nature of the TWG to reach a wider population. 
6.3. BARRIERS TO HIV PREVENTION EFFORTS FOR KEY POPULATIONS
It is worth mentioning that the efforts to increase stakeholder and organizational 
coordination are currently saddled by social, legal, political, and cultural barriers. Key 
informants identified high levels of social stigma and discrimination against key 
populations as a prominent barrier to HIV prevention efforts among MSM and FSWs. Also, 
stakeholders thought the laws that criminalize sex work and MSM in the country was 
another clear obstacle. Relatedly, informants believed the non-compliant and 
uncooperative nature of key populations, as a result of stigma and laws, often serve as a 
barrier to the HIV prevention efforts. Unfortunately, key populations are sometimes 
reluctant to honor referrals to mainstream facilities. Other barriers to HIV prevention 
efforts include inability to serve hard to reach groups and accurately estimate the size of 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 64
the MSM population. Unfortunately, this makes it difficult for target setting. In addition, 
informants highlighted the lack of resources as a hindrance to HIV prevention efforts. The 
following comments highlight informants’ perspectives on identified barriers:
High levels of social stigma, target specific groups like health and legal practitioners 
for them to see the need to draw a line between their moral values and duty of care to 
all manner of people. 
The law that criminalizes sex work and homosexuality — not much can be done about 
this at the moment. It may take a lot more years before any change can be seen in this 
regard.
To help address these challenges, stakeholders suggested the need to change political will 
and modernize laws. They believed laws must be more flexible and aim to be rehabilitative 
instead of punitive. They also appealed to authorities to strengthen human rights laws and 
fast-track a draft proposal for better laws involving HIV/AIDS in Parliament. These are 
changes that can help key populations have confidence to access services. Other crucial 
changes in the social spheres to supplement services include integration of services in the 
health facility into general public health services instead of the drop-in center concept. 
Also, informants suggested that in some instances drop-in centers should be supported to 
offer STI treatment. Awareness should be raised on the need to focus on HIV prevention for 
key populations and to differentiate this goal from advocacy for the legalization of their 
activities. A stakeholder, for, example said:
Inadequate MARP-friendly health facilities means some MSM, especially, do not access 
treatment when referred to main-stream facilities, thereby making treatment and 
prevention more difficult among the group. 
6.4. WAY FORWARD FOR PROGRAMS AND POLICIES
Moving forward, the key populations program has several opportunities that can be 
explored to facilitate stakeholder coordination efforts. Informants identified key 
opportunities including potential collaborative opportunities, review of MARP programs, 
capacity building and strengthening, and creation of enabling environment. In order to 
effectively leverage collaboration, informants urged GAC to organize effectively and 
harmonize the resource base of implementing partners and donor partners to avoid 
duplication of efforts and resources and to ensure that capacity increases. Additionally, 
informants highlighted that the TWG should ensure multi-sectoral collaboration by 
ensuring dissemination of information and resources across various sectors. Furthermore, 
the availability of friendly NGOs, presence of human rights organizations, Commission for 
Human Rights and Administrative Justice, faith-based organizations, civil society 
organizations, and traditional leaders should be seen as opportunities for collaboration. 
Finally, informants identified the provision of MSM-friendly services as an opportunity for 
collaboration with key populations to help disseminate more information. The following 
statements by key informants highlight these issues:
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 65
Availability of MSM friendly NGOs. More MSM can be reached with HIV services and 
NGOs will sensitize and disseminate information on safer sexual practices and 
behavior change.
Availability of civil society organizations and implementing partners who are willing 
to reach out to MARP. There is the need to increase their capacity and harmonize their 
work to improve efficiency and avoid waste of resources.
In addition to increased collaboration, informants identified other potential opportunities 
to ensure proper management. Stakeholders proposed the adoption of a holistic approach 
for the national strategy. That is, interventions should also include psychosocial and 
financial support to ensure a level of independence for the key populations. For example, 
FSW and MSM should be trained on life management skills and self-esteem so they can 
engage in other income-generating activities. Furthermore, other aspects of the strategy, 
such as rehabilitation, should receive more emphasis. On capacity building and 
strengthening, informants emphasized the need to strengthen the capacity of implementing 
partners and embark on routine data collection. Additionally, healthcare providers should 
be trained so they do not stigmatize key populations. One key informant stated: 
The vertical approach of HIV prevention is not helping. A more holistic strategy is 
needed. Building the self-esteem of MARP and introducing alternative sources of 
income can help to a large extent, reduce risk of HIV.
In commenting on the creation of enabling environment through advocacy and education, 
informants urged the TWG to advocate for an environment that would ensure optimum 
monitoring of activities for key populations. Relatedly, opportunities to educate the public 
on self-esteem, gender and sexuality, alcohol and drug use, and overcoming stigma should 
be explored and utilized. Furthermore, education and public awareness among religious 
groups and opinion leaders should be intensified. Some informants claimed there is a good 
chance of sensitizing people to at least respect the rights of key populations (if not 
accepting their activities) through increased social education. On the other hand, key 
populations should be educated on self-esteem and the need to avoid self-stigma. This is 
critical since the cooperation of key populations is needed to maximize utilization of 
service. One informant commented: 
Legislation on FSWs and MSM should be modified. Awareness should be raised on the 
need to focus on HIV prevention for [key populations] and to differentiate this goal 
from advocacy for the legalization of their activities. Also MARP should be educated on 
self-esteem and the need to avoid self-stigma. Additionally, health care providers 
should be trained against stigmatizing MARPs.
Finally, key informants identified the potential of technology for facilitating stakeholder 
efforts and coordination. For instance, social media can be used to reach more people. This 
will be an innovative way to bridge the gap and engage the hard-to-reach MSM. Also, 
informants suggested the use of social media for data collection as well as monitoring and 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 66
evaluation purposes. Some also believed the drop-in center system should be integrated 
into the general public health system to ensure proper monitoring. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 67
7. CONCLUSIONS AND RECOMMENDATIONS
This study sought to document the implementation of the Ghana National HIV Prevention 
Program for FSW and MSM. To accomplish this aim, the study implemented data collection 
at all levels of program implementation including the national (through KII with TWG 
members), organizational (through OCA of implementing partners), service delivery 
(through interviews with staff at fixed SDPs and with peer educators), and the target 
population (through surveys and focus group discussions with FSW and MSM who both 
patronized and did not patronize program services). 
The results of this study yield interesting conclusions and suggest relevant 
recommendations for continued implementation of the program in Ghana. This section
summarizes the key findings and presents recommendations relating to the study 
objectives. Then, the strengths and limitations of the study will be discussed and the way 
forward outlined.
7.1. COVERAGE
The stated goal of the National Program for Key Populations is to reach 80% of the target 
populations with services. With this in mind, this study attempted to measure the coverage 
of services provided by national program implementers to FSW and MSM in the study 
areas. While we were able to ascertain that large numbers of FSW and MSM were 
considered by the programs to be “reached” by services, the exact number is difficult to 
determine. This task was complicated by widely differing definitions of program “reach” 
and the limited ability to correct for double counting of individuals. This issue of reach vs. 
exposure and the need for a standardized definition of reach for reporting to the national 
program has been acknowledged by the National TWG for Key Populations and is 
addressed in the National Evaluation Plan for the program, intended to outline the plans for 
an impact evaluation in 2015 (MEASURE Evaluation & Ghana AIDS Commission, 2013).
Until this standardization is implemented, however, it is difficult to measure progress in 
this indicator other than to note that programs are reporting “reaching” ever steady and 
even increasing numbers of FSW and MSM each quarter; and that the majority of service 
users interviewed indicating that they are “repeat service users”, indicating that service 
saturation has not been reached and that unmet demand for program services continues to 
exist in the target population.
Recommendation: Continue to work towards a common definition of program reach to be 
reported by implementing partners. Include this reach indicator in future planned 
representative surveys of FSW and MSM such as the IBBSS. In the meantime, implementers 
should continue to strive to attract and to meet the demand of new clients, while 
maintaining current clients.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 68
7.2. QUALITY AND ACCESS
Service quality and access are both multi-dimensional concepts that were measured in a 
variety of ways in this study. Service quality can be measured in part by demand for 
services. As mentioned above, demand for services does not seem to have yet been met. 
Looking at services offered and service uptake, we see that demand for various services is 
wide-ranging among clients of program services. Implementers are offering a wide range of 
health and social services, both directly and by referral, though organizations differ in the 
number of these services being offered, especially those offered by referral. FSW and MSM 
patronizing the program are reporting using this range of services to varying degrees. 
While the percentages of service users who are accessing some of these specialized 
services, such as referrals for mental health, legal support, and rape counseling are 
relatively low (5% to 10%) compared to the nearly 100% receiving information on HIV and 
condoms, these are the exact services that potentially are hardest to provide to vulnerable 
populations in a non-specialized program setting. Further, these are the exact services that 
are being offered by the smallest number of organizations providing program services. For 
example, only four of the 12 organizations providing program services offer mental health 
referrals. Understanding the range of services both offered and received is an important 
way of understanding program coverage and quality. 
Other important markers of program quality include client satisfaction with services and 
“felt safety” during contact with services. On this measure, the national program performed 
outstandingly, with a near 100% of clients reporting satisfaction with services. Service 
users also overwhelmingly report being willing to recommend the services to friends, and 
feeling “safe” receiving services, reporting respectful, professional treatment during 
contact with service providers. In addition, the majority of those FSW and MSM 
interviewed who had not accessed the services did report hearing of the services. 
Furthermore, of those who had heard of services, the overwhelming majority reported
hearing “good things”. This is an especially important finding given the overwhelming
responses from both FSW and MSM, triangulating across data collection activities, found 
that the most critical factor influencing service use among these populations is feeling as 
though their information and identity would be held confidential and that they were 
treated well by providers. One of the most frequently given reasons among ‘non-clients’ for 
not accessing services was a fear of breach of confidentiality. This work underscores the 
critical importance that the program’s reputation for quality, safety, and confidentiality has 
for making the services accessible by these key populations. Interviews with peer 
educators, service providers, and technical working group members all also emphasized 
the critical nature of confidentiality and trust in making program services accessible for 
key populations. It appears that on this critical point of quality and access, that service 
providers and their intended client-base are in sync. 
When asked about additional measures that could be taken to improve service accessibility 
for MSM and FSW, both key populations and service providers (including peer educators 
and TWG members) stressed expanding the current service package to increase coverage 
while maintaining high quality in terms of confidentiality and trust in the community. In 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 69
general, price, location of SDPs, available services, and modes of service provision were not 
cited as barriers to access. mHealth and Internet technologies were also cited as a possible 
means of expanding access to “virtual” services to FSW and MSM who were concerned 
about confidentiality. The wide use of cell phones and Internet among FSW and MSM in the 
study illustrate that this is a promising mode of service delivery to explore, although 
knowledge and use of such interventions as Text me! Flash me! Call Me! Helpline among 
program service users remains low compared to knowledge and use of in-person service 
delivery methods, such as peer educators and drop-in centers.
Recommendation: Programmers should give consideration to continuing to expand the 
national program by adding providers and locations and ensuring all service package 
services (such as referral for psychosocial services) are offered by all service providers, as 
demand for services continues to grow. Consideration should also continue to be given to 
alternative service delivery outlets that provide secure and confidential access to services 
such as the use of mHealth and the Internet. However, it is critical to place quality of the 
program, measured in terms of reputation among service users for satisfactory service 
provision, including respectful and confidential treatment, as paramount to any expansion 
plans. Study findings make it clear that respectful and confidential treatment (and the 
reputation for such) is the cornerstone of demand and uptake of services among FSW and 
MSM. 
7.3. ORGANIZATIONAL CAPACITY
The OCA was administered to all 12 local NGOs providing direct services nationwide to 
FSW and MSM in Ghana. Most, if not all, of these organizations receive direct capacity 
building support from other organizations or donors, as well as from the GAC. Since this 
capacity support is an integral (though perhaps under-emphasized) part of the national 
program meant to strengthen service provision and the monitoring and evaluation (M&E) 
of program implementation, it is important to understand how these organizations are 
performing on several aspects of organizational capacity. 
In general, there were several “core” services and capacities that virtually all organizations 
provided or possessed. Outside of these “core” services and capacities, however, the 
capacity was highly variable and differed by the size and scope of the organization’s key 
populations programs. In terms of services, while virtually all organizations provided HIV 
testing and counseling, condoms and lubricant, STI screening, and referral for treatment of 
HIV and STIs, far fewer (between three and eight of the 12 organizations) provide 
psychosocial services in the national package, including rape referrals and mental health 
referrals. Further, only three of the 12 organizations offer contraceptive methods other 
than condoms or emergency contraception, and none of the 12 organizations offer 
pregnancy tests. These latter services would certainly have the potential to provide some 
value to FSW service users and potentially increase demand among that population. 
However, a majority of organizations report commodities problems, and these concerns 
could prevent the enthusiastic adoption of additional commodity-based services.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 70
Similarly, there are “core” competencies among the organizations when it comes to human 
resources and training as well as M&E. All organizations report having written job 
requirements and required training for peer educators. But fewer have written training 
plans and provide supervisory checklists. Almost all regularly meet with community 
leaders, but fewer of these organizations report having representation from the community 
on their boards or having mapped their service areas. All report regularly reporting 
coverage data, but only about half report that data coming from routine service statistics 
with the others relying on “surveys, focus groups, or other” means of gathering this 
information. 
Recommendations: The local NGOs interviewed as part of this study varied widely in size 
and scope of the national program services that they were implementing. While all the 
organizations had a set of “core” competencies in breadth of services offered and depth of 
human resources, community engagement, and M&E responsibilities, the organization 
capacity assessment revealed a lack of depth in these areas. Many details of what services 
are offered, to whom, by whom, and how this is tracked varies between organizations. As 
the national program looks to the future, consideration may be given to how and what sorts 
of organizational capacities are to be considered the minimum among program 
implementers and to what degree certain organizational capacities (such as reporting and 
training of peer educators and other service providers) should be standardized. Further, 
commodities provision should also be considered going forward, and the degree of support 
that can be provided to support commodities procurement for program services should be 
assessed in order to respond to the frequent stock-outs experienced by service providers.
7.4. NATIONAL SOCIO-POLITICO-LEGAL ENVIRONMENT
Information on the socio-legal-political environment for key populations was derived from 
key informant interviews with 14 members of the TWG for Key Populations (formerly TWG 
for MARP) convened by the GAC. This technical working group provides the main forum for 
making recommendations for socio-legal-political change at the national level, which 
affects key populations. 
While group members were split on whether the comprehensive program could achieve 
their coverage targets by 2015 or was too fragmented and under-resourced to reach that 
target, the technical working group largely agreed on many other aspects of key 
populations programming in Ghana. The TWG members interviewed cited that national 
laws outlawing sex work and sex among MSMs were punitive and an obstacle to providing 
services. Further, the stigma and risks of exposure in general society were also a barrier 
that lead to fear among FSW and MSM that prevent many from accessing services or 
referrals. While admitting that social norms that give rise to stigma may be slow to change, 
advocating for less punitive laws and a greater emphasis on rehabilitation could begin to 
open the door for a less stigmatized approach to these populations. TWG members also felt 
that greater attention to psycho-social services in the national service package could also 
be beneficial in improving outcomes among key populations. All felt the TWG was a strong 
platform for discussion, coordination, and advocacy.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 71
Recommendations: The TWG for HIV Prevention among Key Populations should continue 
to convene, with greater effort to make these meetings regular and frequent. Interviewees 
also suggested that the TWG form a clearer plan of action, or agenda that would strengthen 
the effectiveness of the group to continue to monitor the needs of key populations, program 
implementers, and advocate for national socio-legal-political change.
7.5. STRENGTHS AND LIMITATIONS
This study has many strengths but also some limitations to be considered. Perhaps the 
greatest strength of the study is the collection of data at all levels of program planning and 
implementation, from the national (members of the TWG and GAC) to the 
organizational/service provider, to members of key populations themselves. This style of 
data collection allows for an understanding of where program planners and implementers 
are in sync (or not) with the populations that they are trying to serve. Another strength of 
this study is the comprehensive nature of the sampling. A census was taken of all 
organizations implementing services and all peer educators in the country. Also, samples 
were drawn from “hotspots” identified in prior research. There is no reason to think that 
the sampling was biased, although a respondent-driven sampling approach does not ensure 
that a representative sample of service users and non-users among FSW and MSM were 
drawn. Another limitation of the study is the one-time data collection approach, which 
relies heavily on self-report. This method of data collection among subjects means there is 
a possibility of a social desirability bias among respondents. Despite these limitations, 
however, the study fulfills its goals of providing a snapshot of program implementation and 
raises several points for consideration among program planners as the program continues 
to be implemented. 
7.6. WAY FORWARD
The Ghana National Program for HIV Prevention among Key Populations has several key 
structures in place to assure that the data in these reports are reviewed and acted on, as 
deemed appropriate. The program is overseen by the GAC in close cooperation with the 
TWG for HIV Prevention among Key Populations. This latter group is made up of many 
stakeholders, the majority of whom are represented in this study. This report summarizing 
the findings of this study will be reviewed and validated by these key study stakeholders 
and their input will be sought in refining the recommendations above. The TWG can then 
act to adopt, modify, or otherwise implement the recommendations as part of the 
continued development of the operationalization plan for the current program (which runs 
through 2015) or to take these recommendations under consideration for the next 
strategic and operational plan to follow. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 72
ACKNOWLEDGEMENTS
The authors would like to recognize the Ghana AIDS Commission and the Technical 
Working Group for HIV Prevention among Key Populations for their support of this work.
We would also like to acknowledge the hard work and generosity of the study team and 
study participants who made this work possible. 
This research has been supported by the U.S. President’s Emergency Plan for AIDS Relief 
(PEPFAR) through the U.S. Agency for International Development (USAID) under the terms 
of MEASURE Evaluation cooperative agreement GHA-A-00-08-00003-00, which is 
implemented by the Carolina Population Center at the University of North Carolina at 
Chapel Hill, with Futures Group, ICF International, John Snow, Inc., Management Sciences 
for Health, and Tulane University. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 73
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Central Africa: 2010. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 74
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 75
APPENDIX 1. SERVICE UPTAKE
Table A1. Percent of Service Uptake by Clients from Peer Educators by Ecological Zone
FSW MSM
Savannah Forest Coastal Average Forest Coastal Average
Has been in contact with 
peer educator in past 12 
months
100.0 96.5 97.6 98.0 97.1 92.2 94.6
Number of observations 32 85 245 68 230
Services among those in contact with peer educator in past 12 months:
HIV risk reduction 
counselling 100.0 97.6 97.9 98.5 97.0 87.3 92.2
HIV counseling and testing 87.5 80.5 82.0 83.3 97.0 93.4 95.2
Screening for STI 93.8 81.7 86.2 87.2 80.3 75.9 78.1
Referral for treatment of 
STI 56.3 39.0 61.1 52.1 53.0 52.4 52.7
Emergency contraception 
or referral for EC 21.9 11.0 23.9 18.9 -- -- --
Contraceptive methods 
other than condoms or 
referral
21.9 14.6 23.9 20.1 -- -- --
Pregnancy test or referral 
for pregnancy test 25.0 13.4 26.8 21.7 -- -- --
Referral for primary health 
care
40.6 22.0 39.8 34.1 31.8 39.6 35.7
Referral for mental health 
services
15.6 6.1 8.0 9.9 6.1 15.1 10.6
Referral for drug/alcohol 
addiction 21.9 12.2 13.8 16.0 10.6 15.1 12.9
Referral for legal 
assistance
9.4 7.3 8.0 8.2 10.6 15.6 13.1
Referral for clinical care 25.0 7.3 6.3 12.9 15.2 16.5 15.8
Referral for PMTCT 21.9 9.8 8.8 13.5
Sexual assault/rape crisis 
services or referral 18.8 12.2 10.5 13.8 10.6 13.2 11.9
Condoms 96.9 96.3 93.3 95.5 98.5 94.8 96.6
Lubricant 93.8 95.1 84.1 91.0 98.5 93.9 96.2
Information about 
reducing risk of HIV 90.6 96.3 93.3 93.4 93.9 90.6 92.3
Number of Observations 32 82 239 66 212
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 76
Table A2. Percent of Service Uptake by Clients from Peer Educators by City
FSW MSM
Accra Tamale Koforidua Sekondi/
Takoradi Kumasi Accra Koforidua Sekondi/
Takoradi Kumasi Tema
Contact with peer educator 
in past 12 months 96.1 100.0 100.0 98.8 96.5 95.2 92.0 90.0 97.1 100.0
Number of Observations 127 32 38 80 85 83 25 120 68 2
Services among those in contact with peer educator in past 12 months:
HIV risk reduction 
counseling 99.2 100.0 100.0 94.9 97.6 82.3 73.9 93.5 97.0 100.0
HIV counseling and testing 79.5 87.5 79.0 87.3 80.5 94.0 95.7 92.6 97.0 100.0
Screening for STI 86.9 93.8 89.5 83.5 81.7 77.2 69.6 75.9 80.3 100.0
Referral for STI treatment 68.9 56.3 65.8 46.8 39.0 60.8 43.5 47.2 53.0 100.0
Emergency contraception 
or referral for EC 18.0 21.9 31.6 29.1 11.0 -- -- -- -- --
Contraceptive methods 
other than condoms or 
referral
19.7 21.9 23.7 30.4 14.6 -- -- -- -- --
Pregnancy test or referral 
for pregnancy test 20.5 25.0 34.2 32.9 13.4 -- -- -- -- --
Referral for primary health 
care
37.7 40.6 44.7 40.5 22.0 46.8 34.8 36.1 31.8 100.0
Referral for mental health 
services 2.5 15.6 5.3 17.7 6.1 7.6 8.7 22.2 6.1 0.0
Referral for drug/alcohol 
addiction 8.2 21.9 15.8 21.5 12.2 7.6 4.4 23.2 10.6 0.0
Referral for legal 
assistance 2.5 9.4 10.5 15.2 7.3 11.4 8.7 20.4 10.6 0.0
Referral for clinical care 2.5 25.0 7.9 11.4 7.3 7.6 8.7 25.0 15.2 0.0
Referral for PMTCT 2.5 21.9 10.5 17.7 9.8
Sexual assault/rape crisis 
services or referral 5.7 18.8 10.5 17.7 12.2 5.1 0.0 22.2 10.6 0.0
Condoms 92.6 96.9 94.7 93.7 96.3 96.2 95.7 93.5 98.5 100.0
Lubricant 85.3 93.8 84.2 82.3 95.1 97.5 91.3 91.7 98.5 100.0
Information about 
reducing risk of HIV 96.7 90.6 97.4 84.8 96.3 93.7 95.7 87.0 93.9 100.0
Number of Observations 122 32 38 79 82 79 23 108 66 2
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 77
Table A3. Percent of Service Uptake for Clients at Drop-in Centers by Ecological Zone
FSW MSM
Savannah Forest Coastal Average Forest Coastal Average
Has been to a drop-in 
center in past 12 
months
62.5 55.3 64.9 60.9 73.5 63.5 68.5
Number of observations 32 85 245 68 230
Of those who have been to a drop-in center in past 12 months:
HIV risk reduction 
counselling
95.0 93.6 98.1 95.6 98.0 95.9 96.9
HIV counseling and 
testing
95.0 91.5 97.5 94.7 94.0 94.5 94.3
Screening for STI 85.0 85.1 94.3 88.2 72.0 82.9 77.4
Referral for treatment of 
STI
65.0 36.2 54.1 51.8 44.0 59.6 51.8
Emergency contraception 
or referral for EC
15.0 4.3 22.6 14.0 -- -- --
Contraceptive methods 
other than condoms or 
referral
25.0 21.3 25.2 23.8 -- -- --
Pregnancy test or referral 
for pregnancy test
15.0 6.2 22.0 14.4 -- -- --
Referral for primary 
health care
30.0 21.3 37.1 29.5 26.0 44.5 35.3
Referral for mental 
health services
10.0 6.4 10.7 9.0 4.0 18.5 11.2
Referral for drug/alcohol 
addiction
15.0 12.8 12.6 13.5 4.0 19.9 11.9
Referral for legal 
assistance
10.0 6.4 11.3 9.2 8.0 21.9 15.0
Referral for clinical care 10.0 8.5 7.6 8.7 10.0 21.2 15.6
Referral for PMTCT 10.0 8.5 11.3 9.9 -- -- --
Sexual assault/rape crisis 
services or referral
10.0 12.8 10.5 11.1 8.0 18.5 13.2
Condoms 90.0 85.1 91.2 88.8 90.0 93.2 91.6
Lubricant 90.0 80.9 84.3 85.0 92.0 87.0 89.5
Information about 
reducing risk of HIV
90.0 87.2 92.5 89.9 96.0 88.4 92.2
Number of Observations 20 47 159 50 146
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 78
Table A4. Percent of Service Uptake for Clients at Drop-in Centers by City
FSW MSM
Accra Tamale Koforidua Sekondi/
Takoradi Kumasi Accra Koforidua Sekondi/
Takoradi Kumasi Tema
Has been to a drop-in center 
in past 12 months 70.9 62.5 73.7 51.3 55.3 63.9 64.0 62.5 73.5 100.0
Number of Observations 127 32 38 80 85 83 25 120 68 2
Services among those who have been to a drop-in ccenter in past 12 months:
HIV risk reduction 
counseling 97.8 95.0 100.0 97.6 93.6 96.2 87.5 94.7 98.0 100.0
HIV counseling and testing 95.6 95.0 96.4 85.4 91.5 96.2 93.8 93.3 94.0 100.0
Screening for STI 93.3 85.0 92.9 97.6 85.1 86.8 75.0 81.3 72.0 100.0
Referral for STI treatment 56.7 65.0 71.4 36.6 36.2 66.0 43.8 57.3 44.0 100.0
Emergency contraception 
or referral for EC 13.3 15.0 35.7 34.2 4.3 -- -- -- -- --
Contraceptive methods 
other than condoms or 
referral
17.8 25.0 32.1 36.6 21.3 -- -- -- -- --
Pregnancy test or referral 
for pregnancy test
11.1 15.0 35.7 36.6 6.4 -- -- -- -- --
Referral for primary health 
care
33.3 30.0 46.4 39.0 21.3 39.6 37.5 50.7 26.0 0.0
Referral for mental health 
services 2.2 10.0 10.7 29.3 6.4 7.6 0.0 30.7 4.0 0.0
Referral for drug/alcohol 
addiction 2.2 15.0 14.3 34.2 12.8 9.4 6.3 30.7 4.0 0.0
Referral for legal 
assistance 3.3 10.0 17.9 24.4 6.4 15.1 6.3 30.7 8.0 0.0
Referral for clinical care 5.6 10.0 10.7 9.8 8.5 7.6 12.5 33.3 10.0 0.0
Referral for PMTCT 3.3 10.0 10.7 29.3 8.5 -- -- -- -- --
Sexual assault/rape crisis 
services or referral 3.3 10.0 14.3 24.4 12.8 9.4 0.0 29.3 8.0 0.0
Condoms 93.3 90.0 82.1 92.7 85.1 94.3 81.3 94.7 90.0 100.0
Lubricant 86.7 90.0 67.9 90.2 80.9 96.2 81.3 81.3 92.0 100.0
Information about 
reducing risk of HIV 97.8 90.0 82.1 87.8 87.2 94.3 87.5 84.0 96.0 100.0
Number of Observations 90 20 28 41 47 53 16 75 50 2
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 79
Table A5. Percent of Service Uptake for Clients at Mobile Outreach Centers by Ecological 
Zone
FSW MSM
Savannah Forest Coastal Average Forest Coastal Average
Has been to a drop-in 
center in past 12 
months
28.1 27.1 55.5 36.9 13.2 26.5 19.9
Number of Observations 32 85 245 68 230
Of those who have been to a drop-in center in past 12 months:
HIV risk reduction 
counselling 88.9 82.6 85.3 85.6 88.9 96.7 92.8
HIV counseling and 
testing 77.8 47.8 66.2 63.9 88.9 95.1 92.0
Screening for STI 66.7 65.2 67.7 66.5 88.9 85.3 87.1
Referral for treatment of 
STI 55.6 21.7 39.7 39.0 44.4 70.5 57.5
Emergency contraception 
or referral for EC 33.3 4.4 18.4 18.7
Contraceptive methods 
other than condoms or 
referral
33.3 21.7 14.7 23.3
Pregnancy test or referral 
for pregnancy test
33.3 13.0 13.2 19.9
Referral for primary 
health care 22.2 4.4 25.7 17.4 11.1 62.3 36.7
Referral for mental 
health services 11.1 8.7 8.8 9.5 0.0 36.1 18.0
Referral for drug/alcohol 
addiction 22.2 8.7 10.3 13.7 0.0 39.3 19.7
Referral for legal 
assistance
22.2 8.7 8.1 13.0 0.0 39.3 19.7
Referral for clinical care 44.4 8.7 5.9 19.7 11.1 39.3 25.2
Referral for PMTCT 44.4 8.7 9.6 20.9
Sexual assault/rape crisis 
services or referral 22.2 13.0 7.4 14.2 0.0 39.3 19.7
Condoms 66.7 52.2 72.8 63.9 77.8 98.4 88.1
Lubricant 66.7 43.5 65.4 58.5 77.8 96.7 87.3
Information about 
reducing risk of HIV 66.7 56.5 74.3 65.8 88.9 96.7 92.8
Number of Observations 9 23 136 9 61
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 80
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 81
APPENDIX 2. EVALUATION TOOLS
Ghana’s National HIV Prevention Programme for MARPS
Key Informant Interview
Informant Name: _______________________________________
Informant Title: ________________________________________
Length of time Informant has served on the MARP TWG: ________________________
Interview Date: ________________________________________
Interviewer Name: ______________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 82
INTRODUCTION:
Thank you for agreeing to talk with us today. We are interviewing key stakeholders, like yourself, in the 
National HIV Prevention Programme for MARPS, in particular for FSW and MSM. We are interested in your 
point of view on the current status of HIV prevention programming for MARP, progress made in achieving 
national goals for programme coverage, scope, and quality, and in gaps that still remain in programming. 
CONSENT PROCESS
READ TO, OR HANDVOVER CONSENT FORM TO KEY INFORMANT TO READ
CONSENT FORM 
Title: A Performance Evaluation of Ghana’s HIV Prevention Program for At-Risk Populations
Principal Investigator: Amos Laar, PhD, 
Department of Population, Family and Reproductive Health, School of Public Health, College of Health 
Sciences, University of Ghana, Box Lg 13 Legon, 0244982176, alaar@ug.edu.gh or aklaar@yahoo.com 
General Information about Research 
The purpose of this research study is to gather information about the organizations in Ghana who provide 
health and social services to female sex workers and men who have sex with men. We are interviewing 
professionals like you in order to better the difficulties and opportunities you face in maintaining service 
records, training staff, and structuring your organization. We also would like to learn more about the kind 
of services you are able to provide and what support might benefit your organization’s efforts to provide the 
highest possible quality services. This will take no more than an hour of your time. 
Possible Risks and Discomforts
We are asking questions about your organization and other organizations providing health and social 
services to men who have sex with men and/or female sex workers. We would also like to learn more about 
the challenges you face in management, finance, data collection, and other organizational tasks. While 
nothing you tell us will be shared with anyone other than the researchers, some questions may make you 
uncomfortable or you may not know the answer to a particular question. You are free to skip any question 
that you are not comfortable answering. 
Possible Benefits
The information gathered from your organization and others like it will help the Ghana AIDS Commission and 
other partners working with female sex workers and men who have sex with men in Ghana to improve the 
services being provided and to better support service providers in their efforts to improve HIV prevention 
services for their communities. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 83
Confidentiality
We will protect information about you to the best of our ability. You will not be named in any reports. Your 
employers will not be made aware of your responses. Some staff of The University of Ghana and the 
University of North Carolina may sometimes look at your research records. However, no one other than 
authorized study personnel will be able to access your information. 
Compensation
No compensation is provided for participation in this survey interview. However, we appreciate your time to 
help us learn how to improve health service provision for female sex workers and/or men who have sex with 
men in Ghana.
Voluntary Participation and Right to Leave the Research
Your participation in this research is completely voluntary. Also, you can choose to end your participation at
any time during the interview.
Contacts for Additional Information
Principal Investigator: Amos Laar, PhD, Department of Population, Family and Reproductive Health, School of 
Public Health, College of Health Sciences, University of Ghana, Box Lg 13 Legon, 0244982176, 
alaar@ug.edu.gh or aklaar@yahoo.com 
Your rights as a Participant
This research has been reviewed and approved by the Institutional Review Board of Noguchi Memorial
Institute for Medical Research (NMIMR-IRB). If you have any questions about your rights as a research 
participant you can contact the IRB Office between the hours of 8am-5pm through the landline 0302916438 
or email addresses: nirb@noguchi.mimcom.org or HBaidoo@noguchi.mimcom.org . You may also contact 
the chairman, Rev. Dr. Ayete-Nyampong through mobile number 0208152360 when necessary.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 84
VOLUNTEER AGREEMENT
The above document describing the benefits, risks and procedures for the research title (A Performance 
Evaluation of Ghana’s HIV Prevention Program for At-Risk Populations) has been read and explained to me. I 
have been given an opportunity to have any questions about the research answered to my satisfaction. I 
agree to participate as a volunteer.
_______________________ _____________________________________ 
Date Name and signature or mark of volunteer
If volunteers cannot read the form themselves, a witness must sign here: 
I was present while the benefits, risks and procedures were read to the volunteer. All questions were 
answered and the volunteer has agreed to take part in the research.
_______________________ _________________________________________
Date Name and signature of witness
I certify that the nature and purpose, the potential benefits, and possible risks associated with participating 
in this research have been explained to the above individual.
_______________________ _____________________________________
Date Name Signature of Person Who Obtained Consent 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 85
BEGIN ASKING QUESTIONS
1. Do you feel that the national MARP programme as it is being implemented on the ground 
TODAY is of sufficient scope, quality, and coverage to reach the goal of reaching 80% of MSM 
and FSW with services by 2015? Why or why not? 
 _________________________________________________________________________
 _________________________________________________________________________
 _________________________________________________________________________
2. What do you think is the biggest barrier to achieving the goal of reaching 80% of MSM and 
FSW in Ghana with HIV prevention services by 2015? Do you think this barrier can be 
overcome? How? 
 _________________________________________________________________________
 _________________________________________________________________________
 _________________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 86
3. What do you think are the biggest opportunities for the National HIV prevention programme
for MSM and FSW in working towards their goal of reaching 80% of MSM and FSW by 2015? 
Do you think those opportunities are being fully exploited? Why or why not? How can the 
programme take better advantage of these opportunities?
 _________________________________________________________________________
 _________________________________________________________________________
 _________________________________________________________________________
4. What information about MARP programming do you feel that you still lack in order to 
adequately understand how the National Programme as a whole is performing?
 _________________________________________________________________________
 _________________________________________________________________________
 _________________________________________________________________________
•
5. What information about the MARP programming do you think has been or will be 
particularly useful for you in understanding how the National Programme as a whole is 
performing? Why has this data been particularly useful? 
 _________________________________________________________________________
 _________________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 87
 _________________________________________________________________________
•
6. Do you think any changes could or should be made in the legal, political, and social spheres 
in Ghana to supplement the services being provided directly to MSM and FSW by the 
National HIV Prevention Programme for MARPS? What changes do you feel are the most 
pressing priorities? What obstacles or opportunities do you see for getting these changes in 
place?
 _________________________________________________________________________
 _________________________________________________________________________
 _________________________________________________________________________
•
7. What gaps, if any, do you feel still exist in the range of services being provided to MSM and 
FSW under the National Programme as it is being implemented on the ground TODAY? What 
services would you add? What services would you delete? Would you change recruitment, 
client data collection, or geographic coverage? Anything else about the range of services as 
offered today that you would like to see change in an “ideal” scenario?
 _________________________________________________________________________
 _________________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 88
 _________________________________________________________________________
•
8. What role do you feel the TWG plays in the ultimate ability of the MARP programme to 
succeed or fail in its goal of reaching 80% of MARP populations by 2015? Do you think there 
are challenges or opportunities for the TWG to better facilitate the work of programme 
implementers? What are these challenges for the TWG? What are these opportunities for the 
TWG?
 _________________________________________________________________________
 _________________________________________________________________________
 _________________________________________________________________________
 _________________________________________________________________________
 _________________________________________________________________________
 _________________________________________________________________________
•
9. Is there anything else you would like to tell us about the work of the TWG and the 
performance of the MARP programme? Any other gaps or strengths in the program you 
would like to mention? Any recommendations for ways you would like to see the 
programme improve? 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 89
 _________________________________________________________________________
 _________________________________________________________________________
 _________________________________________________________________________
 _________________________________________________________________________
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 90
A Performance Evaluation of 
Ghana’s HIV Prevention Program 
for At-Risk Populations
HIV Prevention Services for FSW 
and MSM in Ghana
ASSESSING MANAGEMENT CAPACITY AMONG 
LOCAL NON-GOVERNMENTAL ORGANIZATIONS 
(LNGOS) IMPLEMENTING HIV PREVENTION 
PROGRAMMES FOR MARPS
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 91
INTERVIEW OF NGO
MANAGER
Name of Organization: 
Address: 
Telephone Number: 
Name of Person Interviewed: 
Position: 
Name of Interviewer: 
Date of Interview: 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 92
CONSENT FORM 
Title: A Performance Evaluation of Ghana’s HIV Prevention Program for At-Risk Populations
Principal Investigator: Amos Laar, PhD, 
Department of Population, Family and Reproductive Health, School of Public Health, College of Health 
Sciences, University of Ghana, Box Lg 13 Legon, 0244982176, alaar@ug.edu.gh or aklaar@yahoo.com 
General Information about Research 
The purpose of this research study is to gather information about the organizations in Ghana who 
provide health and social services to female sex workers and men who have sex with men. We are 
interviewing professionals like you in order to better the difficulties and opportunities you face in 
maintaining service records, training staff, and structuring your organization. We also would like to 
learn more about the kind of services you are able to provide and what support might benefit your 
organization’s efforts to provide the highest possible quality services. This will take no more than an 
hour of your time. 
Possible Risks and Discomforts
We are asking questions about your organization and other organizations providing health and social 
services to men who have sex with men and/or female sex workers. We would also like to learn more 
about the challenges you face in management, finance, data collection, and other organizational tasks. 
While nothing you tell us will be shared with anyone other than the researchers, some questions may 
make you uncomfortable or you may not know the answer to a particular question. You are free to 
skip any question that you are not comfortable answering. 
Possible Benefits
The information gathered from your organization and others like it will help the Ghana AIDS 
Commission and other partners working with female sex workers and men who have sex with men in 
Ghana to improve the services being provided and to better support service providers in their efforts 
to improve HIV prevention services for their communities. 
Confidentiality
We will protect information about you to the best of our ability. You will not be named in any reports. 
Your employers will not be made aware of your responses. Some staff of The University of Ghana and 
the University of North Carolina may sometimes look at your research records. However, no one other 
than authorized study personnel will be able to access your information. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 93
\ 
Compensation
No compensation is provided for participation in this survey interview. However, we appreciate your 
time to help us learn how to improve health service provision for female sex workers and/or men who 
have sex with men in Ghana.
Voluntary Participation and Right to Leave the Research
Your participation in this research is completely voluntary. Also, you can choose to end your 
participation at any time during the interview.
Contacts for Additional Information
Principal Investigator: Amos Laar, PhD, Department of Population, Family and Reproductive Health, 
School of Public Health, College of Health Sciences, University of Ghana, Box Lg 13 Legon, 
0244982176, alaar@ug.edu.gh or aklaar@yahoo.com 
Your rights as a Participant
This research has been reviewed and approved by the Institutional Review Board of Noguchi Memorial 
Institute for Medical Research (NMIMR-IRB). If you have any questions about your rights as a research 
participant you can contact the IRB Office between the hours of 8am-5pm through the landline 
0302916438 or email addresses: nirb@noguchi.mimcom.org or HBaidoo@noguchi.mimcom.org . You 
may also contact the chairman, Rev. Dr. Ayete-Nyampong through mobile number 0208152360 when 
necessary. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 94
VOLUNTEER AGREEMENT
The above document describing the benefits, risks and procedures for the research title (A Performance 
Evaluation of Ghana’s HIV Prevention Program for At-Risk Populations) has been read and explained to 
me. I have been given an opportunity to have any questions about the research answered to my 
satisfaction. I agree to participate as a volunteer.
_______________________ _____________________________________ 
Date Name and signature or mark of volunteer
If volunteers cannot read the form themselves, a witness must sign here:
I was present while the benefits, risks and procedures were read to the volunteer. All questions were 
answered and the volunteer has agreed to take part in the research.
_______________________ _________________________________________
Date Name and signature of witness
I certify that the nature and purpose, the potential benefits, and possible risks associated with 
participating in this research have been explained to the above individual.
_______________________ _____________________________________
Date Name Signature of Person Who Obtained Consent 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 95
Section 1. ORGANIZATIONAL PROFILE
No. Question Response Skip
101 Could you please give me the name and title of two people besides yourself that should
serve as contacts for the study in your organization:
1. Name: _________________________________________________
 Title: __________________________________________________
2. Name: _________________________________________________
 Title: __________________________________________________
102 Please give the name, title and length of service in current position of three most senior 
officials of the organization:
3. Name: _________________________________________________
 Title: __________________________________________________
 Length of Service: _______________________________________
4. Name: _________________________________________________
 Title: __________________________________________________
 Length of Service: _______________________________________
5. Name: _________________________________________________
 Title: __________________________________________________
 Length of Service: _______________________________________
103 In what year was your organization
founded?
__________________________Year
Don’t Know
Refused
Missing
104 Is your organization registered with 
a government agency or umbrella 
organization?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No skip to 
106
105 What is the name of the agency or 
organization?
_____________________________________Name
Don’t Know
Refused
Missing
106 Is your organization affiliated with 
a religious group, political 
organization, trade union or other 
group?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No skip to 
108
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 96
No. Question Response Skip
107 If yes, what is the name of the 
group?
_____________________________________Name
Don’t Know
Refused
Missing
108 Does your organization have a 
Board of Directors?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No, SKIP to 
111.
109 If yes, how many board member 
positions are there?
_____________________ #
Don’t Know
Refused
Missing
110 How often are board members 
elected?
Circle one
Annually
Biannually
Other
No Policy
Don’t Know
Refused
Missing
111 Would you please tell me which of 
the following services are offered 
by your organization to your target 
population?
Circle all that apply
a) Condoms/Lube
b) Emergency Contraception
c) Regular contraceptive methods other than 
condoms
d) Pregnancy tests
e) Mobile outreach 
f) VCT 
g) HIV Risk Assessment 
h) Rape counseling
i) STI Screening and Referral 
j) Mental Health Referral 
k) Mfriend Referral
l) HIV treatment referral
m) PMTCT referral 
n) Other Referral 
o) Text me! Flash me! Call Me! Helpline
p) Mhealth information by text
q) Other (Specify): _________________________
r) Don’t Know
s) Refused
t) Missing
112 How many MSM were reached by 
your organization in the last 12 
months?
_______________________________
Don’t Know
Refused
Missing
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 97
No. Question Response Skip
113 How many FSW were reached by 
your organization in the last 12 
months?
_______________________________
Don’t Know
Refused
Missing
114 How does your organization define 
programme “reach”?
_________________________________________
_________________________________________
Don’t Know
Refused
Missing
115 How does your organization avoid 
double counting when counting 
people reached?
_________________________________________
_________________________________________
Don’t Know
Refused
Missing
116 Sometimes double counting is hard 
to avoid, despite an organization’s 
best efforts. How often do you feel 
that double counting is a problem 
for reporting in your service 
delivery programs for FSW and 
MSM?
Circle one
Never a problem
Rarely a problem
Sometimes a problem
Often a problem
Always a problem
Don’t Know
Refused
Missing
117 Does your NGO have a written list 
or description of all 
geographic/catchment areas in 
which your FSW and MSM services 
are provided?
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing 
118 How many paid, full-time 
employees does your organization 
have (not including peer educators 
or Ghana Health Service Nurses)
____________________________
Don’t Know
Refused
Missing
119 Is there a written organizational 
chart for your organization? 
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing
120 What is the total budget (in local 
currency) of your organization for 
the current fiscal year? 
_____________________________
Don’t Know
Refused
Missing
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 98
No. Question Response Skip
121 Do you currently receive any 
funding from an international 
donor or NGO?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No skip to 
section 2.
122 What is the amount (in local 
currency) of the largest grant or 
contract currently being managed 
by your organization?
________________________________
Don’t Know
Refused
Missing
123 What donor provided the grant or 
contract? 
________________________________
Don’t Know
Refused
Missing
Section 2. KNOWLEDGE OF THE COMMUNITY
No. Question Response Skip
201 How does your organization promote community participation in its decision- making? 
NOTE TO INTERVIEWER (DO NOT READ): Do not prompt but probe by asking "Any other 
ways that participation is promoted?"
Circle Yes to all that were mentioned. No to all that were not mentioned.
201a Method of community
participation 
Yes
No
Don’t Know
Refused
Missing
201b Consultation with community
members 
Yes
No
Don’t Know
Refused
Missing
202 Consultation with community
leaders 
Yes
No
Don’t Know
Refused
Missing
203 Field workers that mobilize
community
Yes
No
Don’t Know
Refused
Missing
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 99
No. Question Response Skip
204 User groups or community
committees
Yes
No
Don’t Know
Refused
Missing
205 Representation on NGO Board Yes
No
Don’t Know
Refused
Missing
201g Other: 
(Specify)______________________
Yes
No
Don’t Know
Refused
Missing
202 Based on your knowledge of the
communities targeted by your 
MARP HIV prevention program, 
what are the major obstacles and 
opportunities to reaching FSW and 
MSM with quality HIV prevention 
services?
Obstacles: 
__________________________________________
__________________________________________
__________________________________________
Opportunities:
__________________________________________
__________________________________________
__________________________________________
Section 3. PLANNING
I would like to ask you a few questions about how planning takes place in your organization.
No. Question Response Skip
301 Is there any written statement of 
the over-all goal of your 
organization?
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing
302 Is there a written Organizational 
Development plan for your 
organization?
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 100
No. Question Response Skip
303 Is there a written work plan for 
your organization that covers the 
current year?
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing
If No skip to 
309
304 What is the time period covered by 
the plan?
____________________________
Don’t Know
Refused
Missing
305 When was the work plan 
approved?
____________________________
Don’t Know
Refused
Missing
306 Who approved the work plan? _______________________________
Don’t Know
Refused
Missing
307 Has the plan ever been revised 
since approval?
Circle one
Yes
No
Don’t Know
Refused
Missing
308 How is progress on the plan 
monitored?
309 Is there a written set of objectives 
for the organization?
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing
310 Is there a written calendar of 
activities for the organization? 
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 101
No. Question Response Skip
311 Have you received 
mentoring/coaching from an 
outside organization in 
strengthening organizational 
capacity of your own organization 
within the last 12 months?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No skip to 
313
312 How many mentoring/coaching 
sessions have you received in the 
last 12 months?
____________________
Don’t Know
Refused
Missing
313 Have you personally participated in 
a community of practice for MSM 
or FSW service providers in the last 
12 months?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No skip to 
section 4.
314 How frequently have you 
personally participated in a 
community of practice for FSW and 
MSM providers in the last 12 
months?
Circle one
Very Often
Often
Sometimes
Occasionally
Never
Don’t Know
Refused
Missing
Section 4. HUMAN RESOURCES MANAGEMENT
Now we would like to ask about your paid staff and employees. The following set of questions does not refer to 
peer educators or other unpaid staff who are not full-time employees of your organization.
No. Question Response Skip
401 Is each employee given a written 
copy of their job description?
Circle one
Yes
No
Don’t Know
Refused
Missing
402 Is there a personnel manual?
Circle one and attach if available
No
Yes, provided a copy
Yes, could not provide a copy
Don’t Know
Refused
Missing
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 102
No. Question Response Skip
403 Is there an orientation program 
for all new staff?
Circle one
Yes
No
Don’t Know
Refused
Missing
404 Are there annual written 
performance objectives 
established for each employee?
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing
405 Are annual evaluations of staff 
conducted?
Circle one
Yes
No
Don’t Know
Refused
Missing
406 Is there a written performance 
appraisal form used for 
evaluating employees?
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing
407 Is there a written plan for staff 
training?
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing
408 Is there a list of all employees 
currently employed by your 
organization?
Circle one
Yes
No
Don’t Know
Refused
Missing
409 How many of your staff have 
resigned or been fired in the last 12 
months?
Circle one
Yes
No
Don’t Know
Refused
Missing
410 Is there a manual that establishes 
standards for managing the needs 
of FSW and/or MSM clients by 
organization staff? 
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 103
Section 5. MANAGING PEER EDUCATORS
No. Question Response Skip
501 Does your organization currently 
support peer educators?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No go to 
section 6.
502 How many peer educators do you 
currently have on the rolls?
___________________
Don’t Know
Refused
Missing
503 Do you have written criteria that 
are used when choosing peer 
educators?
Circle one
Yes
No
Don’t Know
Refused
Missing
504 Is each peer educator given a 
written statement of his or her 
objectives for each year?
Circle one
Yes
No
Don’t Know
Refused
Missing
If no skip to 
507
505 Does your organization currently 
support peer educators?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No go to 
section 6.
506 Who prepared the peer educators 
objectives for the year?
Circle one
Supervisor
Peer educator
Jointly by peer educator and supervisor
Don’t Know
Refused
Missing
507 Is there a standard training that all 
peer educators attend?
Circle one
Yes
No
Don’t Know
Refused
Missing
508 Do you provide any equipment or 
materials to the peer educators? 
Circle one
Yes
No
Don’t Know
Refused
Missing
If No skip to 
510
509 What equipment and/or materials 
do you provide to peer educators?
________________________________________
________________________________________
Don’t Know
Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 104
Missing
No. Question Response Skip
510 How many peer educator 
supervisors do you employ?
Circle one
Yes
No
Don’t Know
Refused
Missing
511 Have peer educator supervisors 
received any special training in 
supervision?
Circle one
Yes
No
Don’t Know
Refused
Missing
512 Has a supervisory checklist been 
provided to supervisors of peer 
educators?
Circle one
Yes
No
Don’t Know
Refused
Missing
513 Are there group meetings of peer 
educators?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No skip to 
section 6.
514 When was the last such group 
meeting of peer educators? 
(Month, Year)
__________Month _____________Year
Don’t Know
Refused
Missing
515 What is discussed at these group 
meetings?
_______________________________________
_______________________________________
_______________________________________
Don’t Know
Refused
Missing
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 105
Section 6. MANAGEMENT INFORMATION SYSTEMS
No. Question Response Skip
601 Has your organization established
any indicators of the quantity or 
volume of services provided to 
your target population?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No, SKIP to 
603.
602 If Yes, please list these indicators: _________________________________________
_________________________________________
_________________________________________
Don’t Know
Refused
Missing
603 Do you collect data on the quantity 
or volume of services provided to 
your target population?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No skip to 
605
604 How do you collect this data?
Circle all that apply
Service Statistics
Surveys
Focus Groups
Other (Specify)_____________________________
Don’t Know
Refused
Missing
605 How often do you personally 
receive a report on the quantity or 
volume of services provided?
Circle one
Weekly
Monthly
Quarterly
Once every 6 months
Once per year
Other (Specify)_____________________________
Don’t Know
Refused
Missing
606 Do you review reports with 
program staff?
Circle one
Yes
No
Don’t Know
Refused
Missing
607 How is the information from the
reports used?
_________________________________________
_________________________________________
Don’t Know
Refused
Missing
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 106
No. Question Response Skip
608 Has your organization established 
any indicators of the impact of 
services provided on your target 
population?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No, SKIP to 
610.
609 If yes, what are the indicators? _________________________________________
_________________________________________
Don’t Know
Refused
Missing
610 Do you collect data on the impact 
of services provided to your target 
population?
Circle one
Yes
No
Don’t Know
Refused
Missing 
If No, SKIP to 
614.
611 How do you collect this data?
Circle all that apply
Service Statistics
Surveys
Focus Groups
Other (Specify)_____________________________
Don’t Know
Refused
Missing 
612 How often do you personally 
receive a report on the impact of 
services provided?
Circle one
Weekly
Monthly
Quarterly
Once every 6 months
Once per year
Other (Specify)_____________________________
613 Do you review reports with 
program staff?
Circle one
Yes
No
Don’t Know
Refused
Missing
614 Has your organization established
any key indicators of its financial 
status? 
Circle one
Yes
No
Don’t Know
Refused
Missing
If No, SKIP to 
616.
615 If yes, what are the indicators? _________________________________________
_________________________________________
Don’t Know
Refused
Missing
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 107
No. Question Response Skip
616 How often do you personally 
receive a report on the financial 
management of the organization
Circle one
Weekly
Monthly
Quarterly
Once every 6 months
Once per year
Other (Specify)_____________________________
617 Do you review reports with 
program staff?
Circle one
Yes
No
Don’t Know
Refused
Missing
618 How are the reports on programme services, impact, and finances used? (Do not 
prompt but probe by asking "Are there any other ways you use the information?")
Circle Yes for all mentioned.
618a Adjust performance targets Yes
No
Don’t Know
Refused
Missing
618b Resource allocation Yes
No
Don’t Know
Refused
Missing
618c Adjust work loads Yes
No
Don’t Know
Refused
Missing
618d Change service delivery strategies Yes
No
Don’t Know
Refused
Missing
618e Commodity procurement Yes
No
Don’t Know
Refused
Missing
618f Quality of care interventions Yes
No
Don’t Know
Refused
Missing
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 108
No. Question Response Skip
618g Staff appraisal Yes
No
Don’t Know
Refused
Missing
618h Other (specify)
___________________________
Yes
No
Don’t Know
Refused
Missing
619 Have you provided any staff or peer 
educators with training in M&E in 
the last 12 months?
Circle one
Yes
No
Don’t Know
Refused
Missing
620 To whom did you provide M&E 
training?
Circle one
Headquarters staff
Field staff
Peer educators
Other
Don’t Know
Refused
Missing
621 What are the biggest barriers that your organization faces in collecting, analyzing, or using 
information needed for managing your MARP programs?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Section 7. COMMODITY LOGISTICS MANAGEMENT
701 Does your organization currently 
distribute any commodities to 
MSM or FSW?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No go to 
section 8.
702 If yes, what commodities does your 
organization currently distribute?
Circle all that apply
Condoms
Lube
IEC materials
HIV test kits
Other (Specify):____________________________
Don’t Know
Refused
Missing
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 109
No. Question Response Skip
703 Does your organization have a 
written policy for procuring the 
commodities?
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing
704 Does your organization have a 
warehouse or storage facility for 
commodities?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No skip to 
706
705 If yes, how would you characterize 
your commodity storage facility?
Circle best choice
Completely satisfactory
Somewhat satisfactory
Satisfactory
Somewhat unsatisfactory
Completely unsatisfactory
No opinion
Don’t Know
Refused
Missing
706 Does your organization have a 
written policy for forecasting 
commodity requirements?
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing
707 In the last three years has there 
been an audit of your commodity 
management system?
Circle one
Yes
No
Don’t Know
Refused
Missing
708 How does your organization obtain 
condoms, lube, and HIV test kits?
_________________________________________
_________________________________________
Don’t Know
Refused
Missing
709 Have you been out of stock of any 
commodities in the last 6 months?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No go to 
section 8.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 110
No. Question Response Skip
710 If yes, of what commodity or 
commodities have you been out of 
stock?
Circle all that apply
Condoms
Lube
IEC materials
HIV test kits
Other (Specify):____________________________
Don’t Know
Refused
Missing
711 How did you respond to the stock 
out?
Circle best choice
Direct clients to return when commodity was back 
in stock
Obtain emergency supply of commodity from an 
alternate source
Direct client to alternate source of commodity
Other (specify):____________________________
_________________________________________
Don’t Know
Refused
Missing
Section 8. BUDGETING AND FINANCIAL MANAGEMENT
801 Is there a budget for your 
organization covering the current 
fiscal year? 
Circle one
Yes
No
Don’t Know
Refused
Missing
802 Is there a budget performance 
report that compares actual to 
projected expenditures? 
Circle one
Yes
No
Don’t Know
Refused
Missing
803 How often is the budget 
performance report issued?
Every month 
Every quarter
Every six months
Other(specify):______________________________
Don’t Know
Refused
Missing
804 Is there a balance sheet for the 
organization?
Circle one
Yes
No
Don’t Know
Refused
Missing
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 111
No. Question Response Skip
805 Has there ever been an external 
audit of the organization’s 
finances?
Circle one
Yes
No
Don’t Know
Refused
Missing
806 Is there a register for recording 
receipt of cash and checks?
Circle one
Yes
No
Don’t Know
Refused
Missing
807 Is there a fixed assets register?
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing
808 Has there been an inventory of 
fixed assets conducted in the last 
12 months?
Circle one
Yes
No
Don’t Know
Refused
Missing
809 Are written bids obtained for 
purchases above a fixed amount? 
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing
810 Is there a register for accounts 
payable? 
Circle one and attach if available
Yes, can provide copy
Yes, cannot provide copy
No
Don’t Know
Refused
Missing
811 Does your organization currently 
charge any fees for its MARP 
services?
Circle one
Yes
No
Don’t Know
Refused
Missing
If No then 
END.
812 If yes, please describe amounts 
charged for specific products or 
services.
_________________________________________
_________________________________________
Don’t Know
Refused
Missing
END. We have reached the end of our survey. Many thanks for your time and the information 
provided
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 112
FSW HIV Service Quality Focus Group Guide
Focus group discussion facilitator: ______________________
Notetaker (if applicable): ______________________________ 
Geographic region: ________________________
Date:_______________________ 
Location:_______________________ 
Time discussion started: __________ Time ended:________________
# of Women Participating in Focus Group:_____________
Brothel-based: 1. Client 2. Non-client
Roamer: 1. Client 2. Non-client
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 113
INTRODUCE MODERATORS, NOTE-TAKER:
INTRODUCE THE PURPOSE OF THE GROUP:
Let’s go ahead and get started. My name is _____________________ and this is my colleague 
____________________.We work for _____________________________. We are very interested in 
learning about some of the concerns and needs of female sex workers in this community. We’re 
especially interested in hearing about the some of the issues that FSW face in trying to protect 
themselves from HIV and the experiences of FSW who have received HIV prevention services so that we 
can make recommendations about how services can be improved. We’re not asking for specific stories, 
so please don’t use any names. We will not use your names or even write down your names, so 
everything you share in this group today will be confidential and will not be directly connected back to 
you. We will only share the information we learn today in a general way and in a way that does not 
reveal the identity of anyone in the group. It’s important that the information shared in this group does 
not leave this group, so we ask everyone to not share who was here or what was said in the group with 
others outside the group when you leave here. We really want to hear what you have to say and want 
you to feel comfortable in answering questions however you want to. There are no right or wrong 
answers.
________________ is taking notes to make sure that we don’t miss what you have to say. This will help 
us later when we go back and organize all the information that was shared today. The group should last 
for [insert amount of time].
Does anyone have any questions before we begin?
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 114
FSW all over the world are faced with many challenges that make life difficult for them. We 
are interested in knowing more about the challenges faced by FSW in general and in [town 
name] specifically. 
1. In your opinion, what are the biggest problems faced by FSW in Ghana/[specific 
location]?
•
• IF HIV IS NOT MENTIONED: What about getting HIV/ Protecting yourself from 
getting HIV?
•
We would like to learn more about the things that FSW may or may not do to try to stay 
healthy. 
2. In general, where do FSW go for health care - that is, if they are sick or want to see a doctor 
or nurse? 
PROBE: Where do FSW go if they have a question about their health or are worried 
about their health? Why do FSW go to those places and not others?
PROBE: Why do you think some FSW might not go for health care?
3. How comfortable would it be to disclose to the doctor you are an FSW if you visit the doctor 
for healthcare?
PROBE: What kinds of things would make her more likely to tell the doctor? What kind 
of things would make her less likely to tell the doctor? What would happen if she told 
the doctor?
Now I’m going to ask you a few questions specifically about HIV. 
4. What kinds of things do FSW do to try to avoid getting HIV? 
PROBE: What about using condoms? Getting tested for HIV?
5. In general, in your community, if a FSW wants to get tested for HIV where would she go?
PROBE: What about drop-in centers? Mobile outreach? Peer educators? Are there 
places that FSW definitely would not go to get tested for HIV? 
PROBE: How do FSW find out about places that offer HIV testing?
We know that FSW are at risk of HIV, but only some get tested for HIV. 
6. What types of things prevent FSW from getting tested for HIV? 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 115
PROBE: Why do some FSW not get tested for HIV?
Now imagine that you have a friend who is also a FSW. Your friend goes to get tested for HIV. 
Afterwards when you see her, your friend tells you that getting tested was a really wonderful 
experience. 
7. What types of things do you think would make getting tested a good experience for her?
PROBE: What would the staff do? What would they say? What would the setting be 
like? 
Now imagine that this same friend goes to get tested for HIV, but this time when you see her, 
this friend tells you that getting tested was a terrible experience. 
8. What types of things would make getting tested a bad experience for her?
PROBE: What would the staff do? What would they say? What would the setting be 
like?
Now I’m going to ask you a few questions about condoms and lubricant.
9. In general, if a FSW wanted to get condoms and lubricant, where would she go?
PROBE: What about drop-in centers? Mobile outreach? Peer educators? Are there 
places that FSW definitely would not go to get condoms and lubricant?
• We know that condoms can reduce the risk of HIV if used correctly, but not all FSW 
use condoms.
10. What types of things prevent FSW from using condoms?
11. How does being a sex worker influence how you are treated by different people in your life? 
PROBE: What about by your family? Friends? Doctors or health care workers? Police?
PROBE: In what ways are you treated differently because you are a sex worker?
Earlier we talked about problems faced by FSW in Ghana.
12. What about violence? To what extent is violence a problem for FSW in Ghana?
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 116
 PROBE: How does violence affect a FSW’s ability to protect her health and avoid HIV?
PROBE: What about physical violence? Sexual Violence? Who is committing the violence? Paying 
partners? Boyfriends/Spouses? Police? In what kinds of settings does violence occur?
Now think about an ideal situation in which anything is possible. In this ideal situation, there are 
plenty of resources and anything you want to happen can happen.
13. In this ideal situation, what types of services would be available for FSW? Where would 
these services be available?
PROBE: What would you recommend to someone who was developing health care 
services specifically for FSW? What about HIV prevention services specifically for FSW?
End. Thank you for your time and opinions. Your views are invaluable and will help improve MARP 
services in your community
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 117
A Performance Evaluation of Ghana’s HIV Prevention Program for At-Risk 
Populations
SITE VISIT TO MSM/FSW Fixed Service Delivery Points
Name of Organization _
Name/number/site of Service Delivery Point
Contact person at Service Delivery Point
Date _________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 118
SERVICE DELIVERY POINTS ASSESSMENT: 
CONSENT FORM
Title: A Performance Evaluation of Ghana’s HIV Prevention Program for At-Risk Populations
Principal Investigator: Amos Laar, PhD, 
Department of Population, Family and Reproductive Health, School of Public Health, College of Health 
Sciences, University of Ghana, Box Lg 13 Legon, 0244982176, alaar@ug.edu.gh or aklaar@yahoo.com 
General Information about Research 
The purpose of this research study is to gather information about the services provided to female sex 
workers and men who have sex with men at fixed service delivery points. We are interviewing professionals 
like you in order to better understand the difficulties faced by providers in delivering high quality and 
confidential services to female sex workers and men who have sex with men. We also would like to learn 
more about the kind of services you are able to provide at your location or facility. This will take no more 
than an hour of your time. 
Possible Risks and Discomforts
We are asking about your work providing health and social services to men who have sex with men and/or 
female sex workers. We would also like to learn more about the challenges you face in providing these 
services at a fixed location or facility. While nothing you tell us will be shared with anyone other than the 
researchers, some questions may make you uncomfortable or you may not know the answer to a particular 
question. You are free to skip any question that you are not comfortable answering. 
Possible Benefits
The information gathered from public health professionals like you will help the Ghana AIDS Commission 
and other partners working with female sex workers and men who have sex with men in Ghana to improve 
the services being provided and to better support service providers in their efforts to improve HIV 
prevention services for their communities. 
Confidentiality
We will protect information about you to the best of our ability. You will not be named in any reports. Your 
employers will not be made aware of your responses. Some staff of The University of Ghana and the 
University of North Carolina may sometimes look at your research records. However, no one other than 
authorized study personnel will be able to access your information. 
Compensation
No compensation is provided for participation in this survey interview. However, we appreciate your time to 
help us learn how to improve health service provision in your community.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 119
Voluntary Participation and Right to Leave the Research
Your participation in this research is completely voluntary. Also, you can choose to end your participation at 
any time during the interview.
Contacts for Additional Information
Principal Investigator: Amos Laar, PhD, Department of Population, Family and Reproductive Health, School 
of Public Health, College of Health Sciences, University of Ghana, Box Lg 13 Legon, 0244982176, 
alaar@ug.edu.gh or aklaar@yahoo.com
Your rights as a Participant
This research has been reviewed and approved by the Institutional Review Board of Noguchi Memorial 
Institute for Medical Research (NMIMR-IRB). If you have any questions about your rights as a research 
participant you can contact the IRB Office between the hours of 8am-5pm through the landline 0302916438 
or email addresses: nirb@noguchi.mimcom.org or HBaidoo@noguchi.mimcom.org . You may also contact 
the chairman, Rev. Dr. Ayete-Nyampong through mobile number 0208152360 when necessary.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 120
VOLUNTEER AGREEMENT
The above document describing the benefits, risks and procedures for the research title (A Performance 
Evaluation of Ghana’s HIV Prevention Program for At-Risk Populations) has been read and explained to me. I 
have been given an opportunity to have any questions about the research answered to my satisfaction. I 
agree to participate as a volunteer.
_______________________ _________________________________________________ 
Date Name and signature or mark of volunteer
If volunteers cannot read the form themselves, a witness must sign here:
I was present while the benefits, risks and procedures were read to the volunteer. All questions were 
answered and the volunteer has agreed to take part in the research.
_______________________ ___________________________________
Date Name and signature of witness
I certify that the nature and purpose, the potential benefits, and possible risks associated with participating 
in this research have been explained to the above individual.
_______________ _______________________________________________
Date Name Signature of Person Who Obtained Consent
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 121
No. Question Response Skip
101 What type of facility is this?
Circle one
1 Drop In Centre
2 Field Office
3 Other (specify-------------------------------) 
99 Don’t Know
88 Refused
102 How long has this facility been 
operating in its current location?
1 _________Years/Months
(circle appropriate time frame)
99 Don’t Know
88 Refused
103 What are the categories and 
numbers of staff and volunteers 
that provide services associated 
with this location?
Category
1 Program officer(s)
2 VCT counselor(s)
3 Ghana Health Service 
4 Nurse(s)
5 Peer Educator(s)
6 Cleaners
7 Other 
(specify)_____________
99 Don’t Know
88 Refused
Number of Staff
________________
________________
________________
________________
________________
________________
________________
________________
104 Does this facility have running 
water?
Circle one
1 Yes, specify ____________________
2 No
99 Don’t Know
88 Refused
105 Does this facility have a working 
toilet?
Circle one
1 Yes, working that day 
2 Yes, not working that day 
3 No
99 Don’t Know
88 Refused
106 Does this facility have working 
internet access?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
107 Does this facility have at least one 
working computer?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
108 Does this facility have a lockable 
storage room?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 122
No. Question Response Skip
109 Does this facility have a lockable 
filing cabinet?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
110 Does this facility have a confidential 
room for providing HIV counseling 
and testing and/or medical exams?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
112.
111 How many confidential exam 
/counseling rooms do you have?
_______________ total #
99 Don’t Know
88 Refused
112 Please list the hours that services 
are provided on each day of the
week
Day 
1 S
2 M
3 T
4 W
5 R
6 F
7 S 
Hours
___________
___________
___________
___________
___________
___________
___________
113 Is your street/neighborhood aware 
of the services you are providing 
here and the type of clients you 
serve?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
114 How tolerant is the 
street/neighborhood of the 
services you are providing?
Circle one
1 Very tolerant
2 Somewhat tolerant
3 Tolerant
4 Somewhat intolerant
5 Very intolerant
99 Don’t Know
88 Refused
115 How do most of your clients access 
your location?
Circle one
1 Public transportation
2 Taxi
3 Private vehicle
4 Walk
5 Other(Specify): 
_____________________________
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 123
No. Question Response Skip
116 How easily accessible do you feel 
your physical location is for your 
target population and community?
Circle one
1 Very accessible
2 Somewhat accessible
3 Accessible
4 Somewhat inaccessible
5 Very inaccessible
99 Don’t Know
88 Refused
Section 2. Knowledge of Local MARP Community
No. Question Response Skip
201 Do you have a written description 
or map of your catchment area?
Circle one
1 Yes, provided a copy
2 Yes, cannot provide a copy
3 No
99 Don’t Know
88 Refused
202 Can you provide a size estimate of 
FSW in your catchment area:
1 FSW:____________
99 Don’t Know
88 Refused
203 Can you provide a size estimate of 
MSM in your catchment area:
2 MSM:___________
99 Don’t Know
88 Refused
204 What is the source of the size 
estimates above?
Circle one
1 IBBSS (Integrated Biological and Behavioral, 
Surveillance Survey) 
2 Special Study (define):__________________
3 Expert opinion
4 Other (specify):________________________
99 Don’t Know
88 Refused
205 What are all the ways you recruit 
new clients to your facility?
CIRCLE ALL THAT APPLY
1 Word of mouth
2 Group Events
3 Peer Educators
4 Self-referral
5 Other (Specify):________________________
99 Don’t Know
88 Refused
206 What is the most common way you 
recruit new clients to your facility?
Circle one
1 Word of mouth
2 Group Events
3 Peer Educators
4 Self-referral
5 Other (Specify):________________________
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 124
No. Question Response Skip
207 Are there other service providers 
who are providing MARP HIV 
prevention services in your 
catchment area (other than the 
Ghana Health Service?)
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
301.
208 If yes, what are the other service providers providing MARP HIV prevention services in 
your area?
________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
209 Are these services overlapping or complementary to the services you provide? For 
example do these organizations provide different services or target different groups from 
your organization? Please describe.
________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 125
Section 3. Services
Thank you for completing this questionnaire. I am now going to ask you questions relating to services you offer 
here 
No. Question Response Skip
301 What target MARP groups do you 
serve?
Circle all that apply
1 MSM
2 Roamer FSW
3 Seater FSW
4 Partners of FSW (Nonpaying partners)
5 Other(Specify):
99 Don’t Know
88 Refused
302 Do you provide any of the following 
services? 
Circle all that apply
(PROBE)
1. HIV counseling and testing
2. HIV risk assessment
3. Condoms/lube
4. Emergency contraception
5. Regular contraceptive methods other 
than condoms 
(Specify):______________________
6. Pregnancy Tests
7. STI screening and referral
8. Rape counseling
9. Mental health referral
10. Mfriends referrals
11. Referral for HIV treatment
12. Referral for PMTCT
13. Other referral (Specify):___________________
14. Text me! Flash me! Call Me! Helpline
15. MARP specific IEC materials
16. Delivery of Mhealth messages
17. Mobile outreach
18. Group events (education and health 
promotion)
19. Internet access
20. Safe physical spaces for MARP
21. Other (specify):_________________________
99. Don’t Know
88. Refused
•
303 Do you charge any fees for any of 
the products or services you 
provide? 
Circle one
1 Yes
2 No
99 Don’t Know
88Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 126
No. Question Response Skip
304 Please name the product or service 
and the associated fee for any fee￾based service.
(Every one should be filled out as 
zero if free up to however many 
Ghana Cedis.)
1. Assessments of HIV risk
2. Condoms and lube
3. Emergency contraception
4. Contraceptive methods other 
than condoms and EC
5. Pregnancy tests
6. Rape counseling
7. Information about correct 
and consistent condom use
8. Information on the Text me! 
Flash me! Call Me! Helpline
9. Text (MHealth) health 
information messages to 
clients
10. Other in-person HIV 
prevention information for 
MARP
11. Referrals for HIV testing
12. Referrals for PMTCT
13. Referrals for Mental Health 
Services
14. Referrals for STI services
15. Referrals for Mfriend 
services
16. Other services: (specify) 
_________________________
99. Don’t Know
88. Refused
•
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
305 Do you track client referrals?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If no, skip to 
308
306 How do you track client referrals?
Circle one
1 Referral slips
2 Phone call to client
3 Follow up at next visit
4 Other 
mechanism(specify)____________________
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 127
307 How often do you feel you are able 
to successfully determine if a client 
completes a referral
Circle one
1 Always
2 Often
3 Sometimes
4 Rarely
5 Never
99 Don’t Know
88 Refused
308 Are there any services you would like to provide but cannot currently offer your clients? 
What are these services and why do you think they are important for your clients?
________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
309 When offering mobile outreach, how often do you host external (off site) events?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
310 How do you determine/arrange for a location for external (off site) events?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
311 How do you advertise external (off site events)?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 128
Section 4. Commodities
We are almost done. I will now like to ask you questions on the communities that you use to do your work. 
No. Question Response Skip
401 Do you have a written inventory of 
commodities and supplies?
Verify
Circle one
1 Yes, verified 
2 Yes, but could not verify 
3 No
99 Don’t Know
88 Refused
402 Do you have the following 
commodities and supplies in stock?
READ OUT
CIRCLE ALL THAT APPLY
1. HIV test kits
2. Gloves
3. Biohazard disposal
4. Condoms
5. Lubricant
6. Contraceptive methods
7. Penis model
8. Text me! Flash me! Brochures
9. IEC brochures and flyers specific to 
MARP
10. IEC posters on display
11. Mfriends list
12. Referral list
99 Don’t Know
a) 88 Refused
403 Where do you store commodities 
during client hours?
Circle one
1 Unlocked cabinet or closet
2 Locked cabinet or closet
3 Other (Specify):________________________
99 Don’t Know
88 Refused
404 Where do you store commodities 
while the facility is closed?
Circle one
1 Unlocked cabinet or closet
2 Locked cabinet or closet
3 Other (Specify):________________________
99 Don’t Know
88 Refused
405 What is the most common way the 
facility responds to a stock out?
Circle one
1 Tell client to come back when commodity is back 
in stock 
2 Procure an emergency supply of the commodity 
from an alternate source
3 Direct client to an alternate source of the 
commodity or service
4 Never had a stockout
5 Other
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 129
Section 5. Data collection and Reporting
No. Question Response Skip
501 Do you collect client names and 
contact information?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
503.
502 Where do you record this 
information?
Circle one
1 Client list or register
2 Individual client files
3 Other (Specify):________________________
99 Don’t Know
88 Refused
503 Do you assign clients a unique 
identifier code?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
506.
504 Do you give clients a written copy 
of their unique identifier code?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
505 How often do clients remember or 
can recover their unique identifier 
code?
PLEASE VERIFY ANSWERE 
Circle one
1. Always
2. Often
3. Sometimes
4. Rarely
5. Never
99 Don’t Know
88 Refused
506 Can you provide a copy of the following client data forms:
506a Register
Circle one
1. Yes, can provide a copy
2. Yes, cannot provide a copy
3. No
99. Don’t know
88. Refused
506b Referral Form
Circle one
1. Yes, can provide a copy
2. Yes, cannot provide a copy
3. No
99. Don’t know
88. Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 130
506c HIV testing log
Circle one
1. Yes, can provide a copy
2. Yes, cannot provide a copy
3. No
99. Don’t know
88. Refused
506d Other 
(specify):_____________________
___ Data collector to verify 
response 
Circle one
1. Yes, can provide a copy
2. Yes, cannot provide a copy
3. No
99. Don’t know
88. Refused
507 What data do you routinely collect 
for each FIRST TIME client?
CIRCLE ALL THAT APPLY
1. Name
2. Address
3. Mobile number
4. Service requested
5. Service received
6. Other (Specify):________________________
99. Don’t Know
88. Refused
508 What data do you routinely collect 
for each REPEAT client?
CIRCLE ALL THAT APPLY
1. Name
2. Address
3. Mobile number
4. Service requested
5. Service received
6. Other (Specify):________________________
99. Don’t Know
88. Refused
509 Do you have a way to know for 
sure if a client has had contact with 
a peer educator or attended 
another drop in center or other 
event or service offered by your 
organization?
Circle one
1. Yes
2. No
99. Don’t Know
88. Refused
If no, skip to 
511
510 How can you tell if a new client (for you) has had contact with a peer educator or other 
service offered by your organization?
________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
______________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 131
511 How do you record your client 
contact information?
Circle one
1. Client registers
2. Individual Client Files
3. Other (Specify):________________________
99. Don’t Know
88. Refused
512 How often do you report Client 
data to a supervisor or someone 
else at your organization?
Circle one
1. Weekly
2. Monthly
3. Quarterly
4. Other (Specify):________________________
99. Don’t Know
88. Refused
513 Who collates and reports this 
information (please provide title, 
not name of individual)?
_____________________________________(title)
99. Don’t Know
88. Refused
514 Has this person received formal 
training in how to collect and 
report client data for your 
organization?
Circle one
1. Yes
2. No
99. Don’t Know
88. Refused
No. Question Response Skip
515 Who performed this training in 
collecting and reporting client 
data? (Title not name)
______________________________(title)
99. Don’t Know
88. Refused
516 How many NEW client contacts 
have you had in the past 30 days?
FSW______________ # new past 30 days
99. Don’t Know
88. Refused
517 How many REPEAT client contacts 
have you had in the past 30 days?
FWS______________ # repeat past 30 days
99. Don’t Know
88. Refused
518 How many NEW client contacts 
have you had in the past 30 days?
MSM______________ # new past 30 days
99. Don’t Know
88. Refused
1.
519 How many REPEAT client contacts 
have you had in the past 30 days?
MSM______________ # repeat past 30 days
99. Don’t Know
88. Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 132
2.
520 Overall, how confident do you feel 
about your facility’s ability to 
accurately record and report your 
client and service related data?
Circle one
3. Very confident
4. Somewhat confident
5. Somewhat unconfident
6. Very unconfident
99. Don’t Know
88. Refused
521 Where is client data stored during client hours and events?
________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
522 Where is client data stored when the facility is closed?
________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
523 What is your organization’s definition of clients “reached” by services?
________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
524 How many FSW and/or MSM has your facility “reached” in the last 12 months?
________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Section 6. Barriers and Opportunities for Better Serving MARP Communities
601 Of the client groups you serve, are there some that are harder to reach than others? If 
yes, Why?
________________________________________________________________________
_________________________________________________________________________
________________________________________________________________________
_________________________________________________________________________
What are these factors or groups? 
________________________________________________________________________
_________________________________________________________________________
What makes them hard to reach?
________________________________________________________________________
_________________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 133
What might make this group easier to reach?
________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
602 In what ways could MARP friendly health services be improved to reach more MARP? 
________________________________________________________________________
_________________________________________________________________________
In what ways could they be improved to increase quality of services delivered?
________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
603 Is there anything else you would like to tell the Ghana AIDS commission and the 
organizers of this study about services for MARP in your community?
________________________________________________________________________
_________________________________________________________________________
________________________________________________________________________
_________________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 134
A Performance Evaluation of Ghana’s 
HIV Prevention Program for At-Risk 
Populations 
HIV Prevention Services for FSW and 
MSM in Ghana
PEER EDUCATOR SURVEY
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 135
INTERVIEW OF PEER EDUCATOR
Name of Organization: 
Address/Location: 
Supervisor: 
Name of Person Interviewed: 
Position: 
Sex of Peer Educator: 
Name of Interviewer: 
Date of Interview: _____________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 136
CONSENT FORM
Title: A Performance Evaluation of Ghana’s HIV Prevention Program for At-Risk Populations
Principal Investigator: Amos Laar, PhD, 
Department of Population, Family and Reproductive Health, School of Public Health, College of 
Health Sciences, University of Ghana, Box Lg 13 Legon, 0244982176, alaar@ug.edu.gh or 
aklaar@yahoo.com 
General Information about Research 
The purpose of this research study is to gather information about the services provided to female 
sex workers and men who have sex with men by peer educators. We are interviewing peer 
educators like yourself in order to better understand the difficulties in reaching men who have sex 
with men and female sex workers with services and the kind of services you are able to provide. We 
would like to ask you questions about your work as a peer educator. This will take no more than an 
hour of your time. 
Possible Risks and Discomforts
We are asking about your work as a peer educator and also asking some questions about services 
that you yourself have used. While nothing you tell us will be shared with anyone other than the 
researchers, some questions may make you uncomfortable or you may not want to answer a 
particular question. You are free to skip any question that you are not comfortable answering. 
Possible Benefits
The information gathered from peer educators like yourself will help the Ghana AIDS Commission 
and other partners working with female sex workers and men who have sex with men in Ghana to 
improve the services being provided and to better support peer educators in their efforts to improve 
HIV prevention for their communities. 
Confidentiality
We will protect information about you to the best of our ability. You will not be named in any 
reports. Your employers will not be made aware of your responses. Some staff of The University of 
Ghana and the University of North Carolina may sometimes look at your research records. However, 
no one other than authorized study personnel will be able to access your information. 
Compensation
You will be given GHS10.00 for participation in this survey interview. We appreciate your time to 
help us learn how to improve health services in your community.
Voluntary Participation and Right to Leave the Research
Your participation in this research is completely voluntary. Also, you can choose to end your 
participation at any time during the interview.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 137
Contacts for Additional Information
Principal Investigator: Amos Laar, PhD, Department of Population, Family and Reproductive Health, 
School of Public Health, College of Health Sciences, University of Ghana, Box Lg 13 Legon, 
0244982176, alaar@ug.edu.gh or aklaar@yahoo.com
Your rights as a Participant
This research has been reviewed and approved by the Institutional Review Board of Noguchi 
Memorial Institute for Medical Research (NMIMR-IRB). If you have any questions about your rights 
as a research participant you can contact the IRB Office between the hours of 8am-5pm through the 
landline 0302916438 or email addresses: nirb@noguchi.mimcom.org or 
HBaidoo@noguchi.mimcom.org . You may also contact the chairman, Rev. Dr. Ayete-Nyampong 
through mobile number 0208152360 when necessary.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 138
VOLUNTEER AGREEMENT
The above document describing the benefits, risks and procedures for the research title (A 
Performance Evaluation of Ghana’s HIV Prevention Program for At-Risk Populations) has been read 
and explained to me. I have been given an opportunity to have any questions about the research 
answered to my satisfaction. I agree to participate as a volunteer.
_______________________ ______________________________________ 
Date Name and signature or mark of volunteer
If volunteers cannot read the form themselves, a witness must sign here:
I was present while the benefits, risks and procedures were read to the volunteer. All questions were 
answered and the volunteer has agreed to take part in the research.
_______________________ _____________________________________
Date Name and signature of witness
I certify that the nature and purpose, the potential benefits, and possible risks associated with 
participating in this research have been explained to the above individual.
_______________________ ____________________________________
Date Name Signature of Person Who Obtained Consent
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 139
Section 1. Personal Information 
In this section we are interested in learning more about you. This information will help us better understand your 
background and point of view as a peer educator and what perspective and experience you bring to your role. Remember 
that this interview is confidential and no one will ever know of your responses to these questions.
No. Question Response Skip
11 How old were you on your last 
birthday?
Circle one
______________Years
99. Don’t Know
88. Refused
11 What is your marital status?
Circle one
1 Living with spouse
2 Separated
3 Divorced
4 Widowed
5 Never Married
99 Don’t Know
 88 Refused
11 How many living children do you have?
Circle one
______________ # living children
99. Don’t Know
88. Refused
20
04
What is the highest level of education 
that you have completed?
Circle one
1. Primary
2. Middle/Secondary/JHS
3. Secondary/SHS/Technical/Vocational
4. Higher
5. None
 99. Don’t Know
 88. Refused
12 What is your profession?
Circle one/Or write down paid 
occupation EXCLUDING PEER 
EDUCATION.
 1 Specify:_____________________________
 99 Don’t Know
 88 Refused
12 What is your income (per month)? 
Please estimate if you do not know 
exactly.
Circle one
1. _____________________ per month
 99. Don’t Know
 88.Refused
12 How frequently do you use a mobile 
phone to send or receive texts?
Circle one
1. Often
2. Sometimes
3. Rarely 
4. Never
 99. Don’t Know
 88. Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 140
No. Question Response Skip
12 How frequently do you use the 
internet to access health information 
for MSM and/or FSW?
Circle one
1. Often
2. Sometimes
3. Rarely 
4. Never
 99. Don’t Know
 88. Refused
12 How long have your been a peer 
educator?
 1 ________ Years/Months
 (circle appropriate time frame)
 99. Don’t Know
 88. Refused
12 How long have you worked with your 
current organization as a peer 
educator?
 1 ________ Years/Months 
 (circle appropriate time frame)
 99. Don’t Know
 88. Refused
12 What sources have you personally 
used to access health information in 
the past 30 days?
CIRCLE ALL THAT APPLY
(PROBE)
1. Internet
2. Text health message from your 
organization Text me!Flash me! 
Helpline
3. Peer educator training
4. Peer educator IEC print materials
5. Peers/friends
6. Health clinician (e.g. nurse)
7. Drop In Centre staff or program
8. None
9. Other(specify)________________________
 99. Don’t Know
 88. Refused
12 Have you, yourself been screened for 
an STI in the last 12 months?
Circle one
1. Yes
2. No
 99. Don’t Know
 88. Refused
12 Have you, yourself, received an HIV 
test in the last 12 months?
Circle one
1. Yes
2. No
 99. Don’t Know
 88. Refused
If NO, SKIP to 
119.
13 If YES, where did you receive your HIV 
test?
1. Specify:__________________________________
 99. Don’t Know
 88. Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 141
No. Question Response Skip
115 Did you receive the results of your 
test?
Circle one
 1. Yes
 2. No
 99. Don’t Know
 88. Refused
If no, skip to 
119 
116 Do you mind sharing the results of your 
most recent test?
Circle one
1. Yes, I do mind
2. No, I don’t mind; NB indicate result 
here:
• ------------------------------------
 99. Don’t Know
 88. Refused
117 Are you receiving care and treatment? 
(ASK ONLY THOSE WHOSE RESULTS 
WERE “POSITIVE”
Circle one
1. Yes
2. No
 99. Don’t Know
 88. Refused
If no skip to 
119
118 Where do you go for care and 
treatment services?
1. Specify:_____________________________
 99. Don’t Know
 88. Refused
119
Why did you choose to become a peer educator?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
120 What do you enjoy most about being a peer educator? 
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
• 121. What do you enjoy least about being a peer educator?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 142
Section 2. Client Base and Recruitment
In this section we would like to learn more about the clients you serve and how you recruit new clients. 
No. Question Response Skip
206 What MARP group do you work with 
most
Circle one
1. MSM
2. Roamer FSW
3. Seater FSW
4. Partners of FSW
5. Other 
(Specify):____________________________
 99. Don’t Know
 88. Refused
207 Where or how do you usually recruit 
new peers as clients?
Circle one
1. Word of mouth
2. Internet
3. Drop in Centres
4. Bars/café’s
5. Streets/hangouts
6. Brothels
7. Bus stations
8. Other 
(Specify):____________________________
 99. Don’t Know
 88. Refused
208 Where do you usually go to meet with 
first time clients?
Circle one 
1. Online chat rooms
2. Drop In Centres
3. Bars/café’s
4. Streets/hangouts
5. Brothels
6. Bus stations
7. Other 
(Specify):____________________________
 99. Don’t Know
 88. Refused
209 Where do you go usually to meet with 
return clients?
Circle one 
1. Online chat rooms
2. Drop In Centres
3. Bars/café’s
4. Streets/hangouts
5. Brothels
6. Bus stations
7. Other 
(Specify):____________________________
 99. Don’t Know
 88. Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 143
No. Question Response Skip
210 How do you most frequently contact 
clients for follow up?
Circle one
1. I contact them by phone, text, or email
2. They contact me by phone, text, or 
email
3. Chance meeting
4. Schedule follow up meeting at each 
contact
5. No way to follow up
6. Other (Specify):_________________________
 99. Don’t Know
 88. Refused
211 How easy or difficult is it to recruit new 
clients?
Circle one
1. Very Easy
2. Somewhat Easy
3. Neither Easy nor Difficult
4. Somewhat Difficult
5. Very Difficult
 99. Don’t Know
 88. Refused
212 How easy or difficult is it to maintain 
existing clients?
Circle one
1. Very Easy
2. Somewhat Easy
3. Neither Easy nor Difficult
4. Somewhat Difficult
5. Very Difficult
 99. Don’t Know
 88. Refuse
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 144
Section 3. Services Provided
In this section we would like to learn more about the specific services you provide to your clients.
No. Question Response Skip
315 What services do you provide to clients 
as a peer educator?
CIRCLE ALL THAT APPLY
(PROBE)
1. Assessments of HIV risk
2. Condoms and lube
3. Emergency contraception
4. Contraceptive methods other 
than condoms and EC
5. Pregnancy tests
6. Rape counseling
7. Information about correct and 
consistent condom use
8. Information on the Text me! Flash 
me! Call Me! Helpline
9. Text (MHealth) health 
information messages to clients
10. Other in-person HIV prevention 
information for MARP
11. Referrals for HIV testing
12. Referrals for PMTCT
13. Referrals for Mental Health 
Services
14. Referrals for STI services
15. Referrals for Mfriend services
16. Other services 
(specify):______________________
• 99. Don’t Know
• 88. Refused
•
316 Do you have a written referral form to 
give clients?
Circle one
1. Yes, can provide a copy
2. Yes, cannot provide a copy
3. No
 99. Don’t know
 88. Refused
317 Do you have a written list of referral 
locations/Mfriends to use when 
making a referral?
Circle one
1. Yes, can provide a copy
2. Yes, cannot provide a copy
3. No
 99. Don’t know
 88. Refused
318 How often is this list updated?
Circle one
1. Quarterly
2. Biannually
3. Annually
4. Other Specify
 99. Don’t know
 88. Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 145
No. Question Response Skip
319 What supplies do you carry when 
seeing clients?
CIRCLE ALL THAT APPLY
1. Condoms
2. Lube
3. Referral forms
4. Client register/notebook
5. IEC materials
6. Referral lists
7. Other 
(Specify):____________________________
320 Where do you get the supplies you 
carry?
1. Specify:_____________________________
 99. Don’t Know
 88. Refused
307 What do you do if you are out of 
supplies?
 1. Specify:______________________________
 99. Don’t Know
 88. Refused
308 Do you send health information by text 
to clients?
Circle one
1. Yes
2. No
 99. Don’t Know
 88. Refused
If no skip to 
310
309 Where do you get the information you 
deliver by text to clients?
1. Specify:__________________________________
 99. Don’t Know
 88. Refused
310 How do you make sure that clients 
understand how to use condoms/lube? 
Circle all that apply
1. Ask if they have questions
2. Do a condom use demonstration
3. Provide education materials
4. Other specify___________________________
311 Do you charge fees for condoms/lube 
or any other services?
Circle one
1. Yes
2. No
 99. Don’t Know
 88. Refused
No. Question Response Skip
312 What services are provided for a fee 
and what is the fee?
(Every one should be filled out as 
zero if free up to however many 
Ghana Cedis.)
1. Assessments of HIV risk
2. Condoms and lube
3. Emergency contraception
4. Contraceptive methods 
other than condoms and 
EC
5. Pregnancy tests
6. Rape counseling
7. Information about correct 
and consistent condom use
8. Information on the Text 
me! Flash me! Call Me! 
Helpline
9. Text (MHealth) health 
information messages to 
clients
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Fee:____
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 146
10. Other in-person HIV 
prevention information for 
MARP
11. Referrals for HIV testing
12. Referrals for PMTCT
13. Referrals for Mental Health 
Services
14. Referrals for STI services
15. Referrals for Mfriend 
services
16. Other services: (specify) 
_________________________
• 99. Don’t Know
• 88. Refused
Fee:____
Fee:____
Fee:____
313 How do you think peer educators are 
perceived by the client community in 
your areas?
Circle one
1. Very positively
2. Somewhat positively
3. Somewhat negatively
4. Very negatively
 99. Don’t Know
 88. Refused
314 How valued do you feel peer educators 
are by your support organization?
Circle one
1. Very valued
2. Somewhat valued
3. Somewhat undervalued
4. Very undervalued
 99. Don’t Know
 88. Refused
315 How important do you think the following are in providing services to your clients?
No. Question Response Skip
315a. Being nice/friendly
Circle one
1. Very important
2. Somewhat important
3. Somewhat unimportant
4. Very unimportant
 99. Don’t Know
 88.Refused
315b. Protecting client confidentiality
Circle one
1. Very important
2. Somewhat important
3. Somewhat unimportant
4. Very unimportant
 99. Don’t Know
 88. Refused
315c. Listening to clients with respect
Circle one
1. Very important
2. Somewhat important
3. Somewhat unimportant
4. Very unimportant
 99. Don’t Know
 88. Refused
315d. Encouraging clients to tell friends 
about service
1. Very important
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 147
Circle one
2. Somewhat important
3. Somewhat unimportant
4. Very unimportant
Don’t Know
Refused
315e. Following up with clients
Circle one
1. Very important
2. Somewhat important
3. Somewhat unimportant
4. Very unimportant
 99. Don’t Know
 88.Refused
315f. Providing accurate information
Circle one
1. Very important
2. Somewhat important
3. Somewhat unimportant
4. Very unimportant
 99. Don’t Know
 88. Refused
No. Question Response Skip
315g. Encouraging client questions
Circle one
1. Very important
2. Somewhat important
3. Somewhat unimportant
4. Very unimportant
 99. Don’t Know
 88. Refused
315h. Reminding clients to replenish supplies 
of condoms/lube before they run out
Circle one
1. Very important
2. Somewhat important
3. Somewhat unimportant
4. Very unimportant
 99. Don’t Know
 88. Refused
315i. Reminding clients to be tested for HIV 
and STIs
Circle one
1. Very important
2. Somewhat important
3. Somewhat unimportant
4. Very unimportant
 99. Don’t Know
 88. Refused
315j. Asking client about ways to improve 
services
Circle one
1. Very important
2. Somewhat important
3. Somewhat unimportant
4. Very unimportant
 99. Don’t Know
 88. Refused
315k. Making oneself available for follow up 
(easy to find)
Circle one
1. Very important
2. Somewhat important
3. Somewhat unimportant
4. Very unimportant
 99.Don’t Know
 88. Refused
315l. Feeling confident about quality of 1. Very important
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 148
referral services
Circle one
2. Somewhat important
3. Somewhat unimportant
4. Very unimportant
 99. Don’t Know
 88. Refused
No. Question Response Skip
316 Overall, how satisfied are you with the 
quality of services you are able to 
provide as a peer educator?
Circle one
1. Very satisfied
2. Somewhat satisfied
3. Somewhat unsatisfied
4. Very unsatisfied
 99. Don’t Know
 88.Refused
317 How do you ensure client confidentiality and privacy when meeting with clients?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
318 What do you do when a client asks a question and you do not know the answer?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
319 What are the most common questions or concerns asked or expressed by the clients you work 
with?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Section 4. Training, Supervision, and Support
In this section of the questionnaire we would like to learn more about any training you have received as a peer educator 
and any supervision or support you receive from your organization.
No. Question Response Skip
411 Did you receive training or orientation 
when you first became a peer 
educator?
Circle one
1. Yes
2. No
 99. Don’t Know
 88.Refused
If NO, SKIP to 
403.
412 Who provided your first 
training/orientation when you became 
a peer educator?
Circle one
1. A senior peer educator/mentor
2. A supervisor
3. Other 
(specify)____________________________
 99. Don’t Know
 88. Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 149
No. Question Response Skip
413 Have you received any additional or 
refresher training since becoming a 
peer educator?
Circle one
1. Yes
2. No
 99. Don’t Know
 88. Refused
414 If yes, who provided it? 1. Specify------------------------------------
99 Don’t know
88 Refused 
415 How often have you received training 
in the last 12 months as a peer 
educator? If you have not been a peer 
educator for 12 months, how often 
have you received training since 
becoming a peer educator?
1. Specify:_____________________________
• ____________________________________________
__________________________
 99. Don’t Know
 88. Refused
416 What specific kinds of training have 
you received in the last 12 months as a 
peer educator?
2. Client data collection
3. Reporting client data
4. HIV knowledge and attitudes
5. Client confidentiality
6. Mhealth
7. Other 
(specify)____________________________
 99. Don’t Know
 88. Refused
417 Do you receive supervision as a peer 
educator?
Circle one
1. Yes
2. No
 99. Don’t Know
 88. Refused
If No, SKIP to 
409.
418 How often do you meet with your peer 
educator supervisor?
1. Specify:__________________________________
 99. Don’t Know
 88. Refused
419 Have you received a written 
supervision checklist for your work as a 
peer educator?
Circle one
NB: Please Verify if yes.
1. Yes, can provide copy
2. Yes, cannot provide copy
3. No
 99. Don’t Know
 88. Refused
420 Have you received a written job 
description of your responsibilities as a 
peer educator?
Verify
Circle one
1. Yes, can provide copy
2. Yes, cannot provide copy
3. No
 99. Don’t Know
 88. Refused
421 Have you received written 
performance objectives for the year as 
a peer educator?
Verify
1. Yes, can provide copy
2. Yes, cannot provide copy
3. No
 99. Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 150
Circle one
 88. Refused
No. Question Response Skip
422 Have you had a formal performance 
appraisal performed by a supervisor in 
the last 12 months?
Circle one
1. Yes
2. No
 99. Don’t Know
 88. Refused
423 When you have a question about how 
to respond appropriately to a client’s 
needs as a peer educator, who do you 
most often ask for advice?
Circle one
1. Another peer educator
2. A supervisor
3. Another person 
(specify)______________________
 99. Don’t Know
 88. Refused
424 What incentives, rewards, or 
compensation do you receive as a peer 
educator? These could be material 
(money, supplies, clothing, etc.) or 
immaterial (status in community, 
feeling of doing good in community, 
etc.)
1. Specify:__________________________________
 99. Don’t Know
 88. Refused
425 Do you feel the incentives or 
compensation you receive as a peer 
educator are adequate?
Circle one
1. Very adequate
2. Somewhat adequate
3. Somewhat inadequate
4. Very inadequate
 99. Don’t Know
 88. Refused
426 Overall, how confident are you that 
you have the training and supplies 
needed to provide quality peer 
education?
Circle one
1. Very confident
2. Somewhat confident
3. Somewhat unconfident
4. Very unconfident
 99. Don’t Know
 88. Refused
427 What additional training or support (if any) do you feel would be useful to you in doing your job as 
a peer educator?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
428 Has there been a time when you have been unsure of how to execute your role as a peer 
educator? Provide an example. How did you respond to this situation?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 151
Section 5. Data Collection and Reporting
Now that we understand your background and training and the services you provide, we would like to understand how 
you collect data on your service provision and clients and how that data is reported to your organization.
516 Do you collect client names and 
contact information?
Circle one
1. Yes
2. No
 99. Don’t Know
 88. Refused
If No, SKIP to 
503.
517 Where do you record this information?
Circle one
1. Client Register
2. Notebook
3. Other specify
 99. Don’t Know
 88. Refused
518 Do you assign clients a unique 
identifier code?
Circle one
1. Yes
2. No
 99. Don’t Know
 88. Refused
If No, SKIP to 
506.
519 Do you give clients a written copy of 
their unique identifier code?
Circle one
1. Yes
2. No
 99. Don’t Know
 88. Refused
520 How often do clients remember or can 
recover their unique identifier code?
Circle one
1. Always
2. Sometimes
3. Rarely
4. Never
 99. Don’t Know
 88. Refused
521 What data do you routinely collect for 
each FIRST TIME client?
CIRCLE ALL THAT APPLY
1. Name
2. Address
3. Mobile number
4. Service requested
5. Service received
6. Other specify--------------------------------
-------
 99. Don’t Know
 88. Refused
522 What data do you routinely collect for 
each REPEAT client?
CIRCLE ALL THAT APPLY
1. Name
2. Address
3. Mobile number
4. Service requested
5. Service received
6. Other specify
 99. Don’t Know
 88. Refused
No. Question Response Skip
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 152
523 Do you have a way to know for sure if a 
client has had contact with another 
peer educator or attended a drop in 
center or other event or service 
offered by your organization?
Circle one
1. Yes
2. No 
 99. Don’t Know
 88. Refused
If No, SKIP TO 
510
524 How can you tell if a new client (for 
you) has had contact with another peer 
educator or service offered by your 
organization?
Circle one
1. Specify:_____________________________-
___________________________________
_________________________________________
 99. Don’t Know
 88. Refused
525 How do you record your client contact 
information?
Circle one
1. Notebook
2. Client registers
3. Mobile phone
4. Other specify______________________
 99. Don’t Know
 88. Refused
526 How often do you report client data to 
a supervisor or other person at your 
organization?
Circle one
1. Weekly
2. Monthly
3. Quarterly
4. Other specify________________________
 99. Don’t Know
 88. Refused
527 Have you received formal training in 
how to collect and report client data 
for your organization?
Circle one
1. Yes
2. No
 99. Don’t Know
 88. Refused
If No, SKIP to 
515.
528 Who performed this training in 
collecting and reporting client data?
Circle one
1. Supervisor
2. Another peer educator
3. Other Specify_______________________
 99. Don’t Know
 88. Refused
529 When was your last training in 
collecting and reporting client data?
Circle one
1. Specify:_____________________________
 99. Don’t Know
 88. Refused
530 How many NEW client contacts have 
you had in the past 30 days?
1. Specify:____________________# new past 
30 days
 99. Don’t Know
 88. Refused
No. Question Response Skip
531 How many REPEAT client contacts 
have you had in the past 30 days?
1. Specify:__________________# repeat past 
30 days 
 99. Don’t Know
 88. Refused
532 Overall, how confident do you feel 
about your ability to accurately record 
and report your client and service 
1. Very confident
2. Somewhat confident 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 153
related data?
Circle one
3. Somewhat unconfident
4. Very unconfident
 99. Don’t Know
 88. Refused
533 How do you define a client contact for recording purposes?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
534 What is the biggest challenge you face in recording and reporting client and service delivery data 
and why?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
535 What aspect or element of client and service data collection and reporting do you feel most 
comfortable and confident about and why?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 154
Section 6. HIV knowledge and Attitudes 
In the following section we will ask you about general HIV knowledge and attitudes. For many of these questions there is 
no “right” answer. Many people have different opinions and views. Remember that no one will know or see your answers 
to these questions and they will not be used in any way to judge your performance as a peer educator. 
No. Question Response Skip
622 Is HIV spread by kissing?
Circle one
1 Yes
2 No
99.Don’t Know
 88.Refused
623 Can a person get HIV by sharing 
kitchens and bathrooms with someone 
with HIV/AIDS?
Circle one
1 Yes
2 No
99.Don’t Know
 88.Refused
624 Can men give HIV to women?
Circle one
1 Yes
2 No
99.Don’t Know
 88.Refused
625 Can women give HIV to men?
Circle one
1 Yes
2 No
99.Don’t Know
 88.Refused
626 Can a man or woman get HIV from a 
same-sex partner?
Circle one
1 Yes
2 No
99.Don’t Know
 88.Refused
627 Must a person have many different 
partners to get HIV?
Circle one
1 Yes
2 No
99.Don’t Know
 88.Refused
628 Can you get HIV by touching someone 
with HIV?
Circle one
1 Yes
2 No
99.Don’t Know
 88.Refused
629 Does washing after sex help protect 
against HIV?
Circle one
1 Yes
2 No
99.Don’t Know
 88.Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 155
No. Question Response Skip
630 Is HIV/AIDS caused by 
spirits/supernatural forces?
Circle one
1 Yes
2 No
99.Don’t Know
 88.Refused
631 Can a pregnant woman give HIV to her 
baby? 
Circle one
1 Yes
2 No
99.Don’t Know
 88.Refused
632 Can a person get rid of HIV by having 
sex with a virgin?
Circle one
1 Yes
2 No
99.Don’t Know
 88.Refused
633 Is HIV the virus that causes AIDS?
Circle one
1 Yes
2 No
99.Don’t Know
 88.Refused
634 Is there a cure for HIV or AIDS?
Circle one
1 Yes
2 No
99.Don’t Know
 88.Refused
• FOR THE FOLLOWING QUESTIONS, INDICATE WETHER YOU AGREE OR DISAGREE TO THE 
STATEMENTS 
635 Getting tested for HIV helps people 
feel better
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
636 Getting tested for HIV helps people 
from getting HIV 
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
637 People in my life would leave me if I 
had HIV
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
638 People who test HIV positive should 
hide it from others
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 156
 99. Don’t Know
 88. Refused
639 I would rather not know if I have HIV
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
640 People who have HIV are dirty 
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
641 People who have HIV are cursed
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
642 People who have HIV cannot be 
trusted
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
643 People who have HIV are like 
everybody else
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
644 People who have HIV should be 
ashamed
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
645 People who have HIV have nothing to 
feel guilty about
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
646 Most people become HIV positive by 
being weak or foolish 
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 157
4. Strongly disagree
 99. Don’t Know
 88. Refused
647 It is safe for people who have HIV to 
work with children
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
648 People who have HIV must expect 
restrictions on their freedom
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
649 A person with HIV must have done 
something wrong and deserves to be 
punished
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
650 People who have HIV should be 
isolated
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
651 I do not want to be friends with 
someone who has HIV
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
652 People who have HIV should not be 
allowed to work
Circle one
1. Strongly agree
2. Somewhat agree
3. Somewhat disagree
4. Strongly disagree
 99. Don’t Know
 88. Refused
653 Name two ways a person can protect him or herself against infection with HIV? 
________________________________________________________________________
________________________________________________________________________
What is the best way? 
Why?
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 158
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
654 Name two factors that could put one of your clients at risk of HIV infection. 
________________________________________________________________________
________________________________________________________________________
What is the most common risk factor among your clients? 
________________________________________________________________________
________________________________________________________________________
How would you recommend this risk be reduced?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Section 7. Barriers and Opportunities for Reaching MSM and FSW
Thank you for your time and your candid participation. In this final section of our interview today we would like to take a 
little time to learn more about your ideas on barriers your clients face in accessing services and ways to improve services 
for your clients and community. 
No. Question Response Skip
701 Of the client groups you serve, are there some that are harder to reach than others? If Yes, Why?
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
________________________________________________________________________
What are these factors or groups? 
________________________________________________________________________
________________________________________________________________________
What makes them hard to reach? 
________________________________________________________________________
________________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 159
What might make this group easier to reach?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
702 In what ways could MARP friendly health services be improved to reach more MARP? 
________________________________________________________________________
________________________________________________________________________
In what ways could they be improved to increase quality of services delivered?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
703 Are there any health or other social services that could benefit your clients that are NOT being 
currently offered in your community, that you feel should be?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
704 Is there anything else you would like to tell the Ghana AIDS commission and the organizers of this 
study about services for MARP in your community?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
End. Thank you for your time and opinions! Your point of view is unique and the information 
you have provided will be invaluable in improving MARP services in your community!
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 160
 A Performance Evaluation of Ghana’s HIV Prevention Program for At-Risk Populations
 FSW Client Service Quality Survey
 Type of FSW: Roamer 1 [ ] Seater 2[ ] 
 Date: ____________________________________ 
 Study ID: _________________________________
 Venue: ______________________________
 
 Geographic region _________________________
 Specific region: ____________________________
 Neighborhood: ____________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 161
PARTICIPANT CONSENT FORM 
Title: A Performance Evaluation of Ghana’s HIV Prevention Program for At-Risk Populations
Principal Investigator: Amos Laar, PhD, 
Department of Population, Family and Reproductive Health, School of Public Health, College of Health 
Sciences, University of Ghana, Box Lg 13 Legon, 0244982176, alaar@ug.edu.gh or aklaar@yahoo.com 
General Information about Research 
You are being asked to participate in a research study to learn more about the experiences of certain key 
populations with HIV prevention services in Ghana. The purpose of the research is to learn: 1) how these 
populations have used HIV prevention services in Ghana, 2) the quality of these services, 3) how satisfied 
these populations are with these services and 4) what barriers exist to using HIV prevention services. Your 
participation in this research should take approximately 60-90 minutes. You will be asked to participate in a 
one-on-one interview and/or group discussion about your experience using HIV prevention services. Your 
participation will help improve HIV prevention services for both the key populations and the general 
population in Ghana.
Possible Risks and Discomforts
The risks of your participation are minimal. The main risk resulting from your participation is feeling 
uncomfortable answering some of the questions. Your participation is completely voluntary. Should you feel 
uncomfortable answering any question(s), you can choose to skip that question(s) and continue with the 
interview. You are also welcome to end the interview at any time. 
Possible Benefits
You are not likely to personally benefit from participating in this research study. However, your participation 
will help improve HIV prevention services for both the key populations and the general population in Ghana.
Alternatives to Participation
There are no alternatives to participation. The only alternative to participation is to simply not participate.
Confidentiality
All information that you share with the interviewer will be protected to the best of our ability. You will not 
be named in any reports. Any documents with identifying information will be kept in a locked filing cabinet 
for 5 years after the study is completed and then will be destroyed. Any identifying information that is 
stored electronically (i.e., on a computer) will be kept on a secure computer and will require a password to 
access. Only staff who work on this research project will have access to your research information.
Compensation
You will be given 10 Ghana Cedis for participating in a survey interview or group discussion. This 
compensation will be provided to you in cash at the end of the interview. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 162
Additional Cost 
There are no additional costs that may result from participation in this research.
Voluntary Participation and Right to Leave the Research
Your participation in the survey interview or focus group is completely voluntary. You have the right to not 
participate in this research or to end your participation at any point in time. You also have the right to not 
answer any questions that you choose not to answer. Not participating or withdrawing from this research 
will not have any negative consequences and will not impact your ability to receive HIV prevention services.
Contacts for Additional Information
If you have any questions about the research, please contact Amos Laar, PhD, 
Department of Population, Family and Reproductive Health, School of Public Health, College of Health 
Sciences, University of Ghana, Box Lg 13 Legon, 0244982176, alaar@ug.edu.gh or aklaar@yahoo.com 
Your rights as a Participant
This research has been reviewed and approved by the Institutional Review Board of Noguchi Memorial 
Institute for Medical Research (NMIMR-IRB). If you have any questions about your rights as a research 
participant you can contact the IRB Office between the hours of 8am-5pm through the landline 0302916438 
or email addresses: nirb@noguchi.mimcom.org or HBaidoo@noguchi.mimcom.org . You may also contact 
the chairman, Rev. Dr. Ayete-Nyampong through mobile number 0208152360 when necessary.
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 163
VOLUNTEER AGREEMENT
The above document describing the benefits, risks and procedures for the research title (name of research)
has been read and explained to me. I have been given an opportunity to have any questions about the 
research answered to my satisfaction. I agree to participate as a volunteer.
ORAL CONSENT VERIFICATION:
I was present while the benefits, risks and procedures were read to the volunteer. All questions were 
answered and the volunteer has agreed to take part in the research.
_______________________ __________________________________________
Date Name and signature of witness
I certify that the nature and purpose, the potential benefits, and possible risks associated with participating 
in this research have been explained to the above individual.
_______________________ _____________________________________
Date Name Signature of Person Who Obtained Consent 
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 164
Section 1. Demographics
To start our interview, I would first like to ask just a few questions to learn more about you.
No. Question Response Skip
101. What nationality are you?
Circle one
1 Ghana
2 Nigeria
3 Togo
4 Ivory Coast
5 Burkina Faso
6 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
If not 1 skip to 
103
102. What ethnicity are you?
Circle one
1 Akan
2 Ewe
3 Ga Adangbe
4 Hausa
5 Krobo
6 Mole/Dagbani
7 Grusi
8 Gruma
9 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
103. How old were you on your last 
birthday?
Circle one
______________Years
99 Don’t Know
88 Refused
104. What is your marital status?
Circle one
6 Living with spouse
7 Separated
8 Divorced
9 Widowed
10 Never Married
99 Don’t Know
88 Refused
If 1 skip to 106
105. Do you currently live with a boyfriend 
or partner who is not a spouse? :
Circle one
 1 Yes
 2 No
99 Don’t Know
88 Refused
106. What is your religion?
Circle one
1 Christian
2 Muslim
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 165
3 Traditional
4 Other 
(Specify)_________________________
5 No religion
99 Don’t Know
88 Refused
107. Have you ever attended school?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 10
108. What is the highest level of school you 
have attended?
Circle one
1 Primary
2 Middle/Junior Secondary/JHS
3 Senior 
Secondary/SHS/Technical/Vocational
4 Higher/Tertiary
99 Don’t Know
88 Refused
109. How many living children do you have?
Circle one
Number of children______________
99 Don’t Know
88 Refused
110. Do you have a cell phone?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If Yes, SKIP to 11
111. IF NO: Do you have access to a cell 
phone?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
112. How often do you use a cell phone?
Circle one
1 Always
2 Sometimes
3 Rarely
4 Never
99 Don’t Know
88 Refused
113. In the past 12 months, have you ever 
received health information – such as 
information about how to reduce your 
risk of HIV - by text message?
Circle one
1 No
2 Yes, one time
3 Yes, more than once
99 Don’t Know
88 Refused
If No, SKIP to 11
114. IF YES: How useful was the health 
information that you received by text 
message?
Circle one
1 Very useful
2 Somewhat useful
3 Not that useful
4 Not useful at all
99 Don’t Know
88 Refused
115. Have you ever heard of the Text me! 
Flash me! Call Me! Helpline? 
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP t 
119.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 166
116. IF YES: In the past 12 months, have you 
used the Text me! Flash me! Call Me! 
Helpline? 
Circle one
1 No
2 Yes, one time
3 Yes, more than once
99 Don’t Know
88 Refused
If No, SKIP t 
118.
117. IF USED: How satisfied were you with 
the Text me! Flash me! Call Me! 
Helpline? 
Circle one
1 Very satisfied
2 Somewhat satisfied
3 Neither satisfied nor dissatisfied
4 Somewhat dissatisfied
5 Very dissatisfied
99 Don’t Know
88 Refused
SKIP to 119.
118. IF HEARD OF, BUT NOT USED: In 
general, are the things you have heard 
about Text me! Flash me! Call Me! 
Helpline: 
Circle one
1 Very positive
2 Somewhat positive
3 Neither positive nor negative
4 Somewhat negative
5 Very negative
99 Don’t Know
88 Refused
119. In the past 12 months, have you used 
the internet to get information about 
HIV prevention specifically for female 
sex workers?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
120. How often do you use the internet?
Circle one
1 Always
2 Sometimes
3 Rarely 
4 Never
99 Don’t Know
88 Refused
121. How often do you use the internet to 
get information about HIV prevention 
and risk reduction?
Circle one
1 Often
2 Sometimes
3 Rarely 
4 Never
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 167
Section 2. Service use
In the following section I am going to ask you general questions about your knowledge and use of particular health 
services available in your area. 
No. Question Response Skip
201 Have you heard of female sex worker 
peer health educators?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
204.
202 IF YES: In general, are the things you 
have heard about peer health 
educators:
Circle one
1 Very positive 
2 Somewhat positive
3 Somewhat negative
4 Very negative
99 Don’t Know
88 Refused
203 In general, what have you heard about 
peer educators?
1 Specify______________________________
2 ___________________________________
99 Don’t Know
100
88 Refused
204 Why don’t you use the services of FSW 
peer educators in your area?
Circle all that apply
1. Had never heard of them
2. Do not know how to contact/find 
one
3. Am afraid people will find out I am a 
sex worker
4. Am afraid my services/information 
won’t be kept confidential
5. Do not need peer educator services
6. Too busy/not enough time
7. Other 
(specify):___________________
99 Don’t know
89 Refused to answer
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 168
Section 2. Service use
2.1 Peer educators
No. Question Response Skip
205 In the last 12 months, have you 
been in contact with a peer health 
educator?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If Yes, SKIP 
to 203.
205 IF NO to 201: Have you heard of 
peer health educators? (describe 
who a PE is)
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If no SKIP 
to218.
205 IF YES to 201: In general, are the 
things you have heard about peer 
health educators:
Circle one
1 Very positive 
2 Somewhat positive
3 Somewhat negative
4 Very negative
 99 Don’t Know
 88 Refused
205 IF YES to 201: Which organization 
was sponsoring these peer 
educators? (specify)
1 (Specify)_________________________
99 Don’t Know
88 Refused
205 IF YES to 201: How many times 
have you been in contact with a 
peer educator in the past 12 
months?
Circle one
1 Once
2 More than once
3 About every 3 months
4 About once a year
99 Don’t Know
88 Refused
206 In the last 12 months, have you 
ever received the following 
services from a peer educator?
206a HIV risk reduction counseling 
Circle one
1 Yes, more than once
2 Yes, one time
3 No
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 169
99 Don’t Know
88 Refused
206b HIV counseling and testing
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
No. Question Response Skip
206c
Screening for sexually transmitted 
infections
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206d Referral for treatment for sexually 
transmitted infections
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206e Emergency contraception or 
referral for emergency 
contraception
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206f Contraceptive methods other than 
condoms or referral for 
contraceptive methods other than 
condoms
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206g Pregnancy test or referral for 
pregnancy test
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206h Referral for primary health care
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206i Referral for mental health services
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206j Referral for drug/alcohol addiction 1 Yes, more than once
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 170
Circle one
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206k Referral for legal assistance
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206l Referral for antiretroviral therapy
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206m Referral to prevent mother-to￾child transmission of HIV
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206n Sexual assault/Rape crisis services 
or referral 
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206o Any other referral (specify)
__________________________
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
207 In the last 12 months, have you ever received the following items from a peer educator:
207a Condoms
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
207b Lubricants
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
207c Information and materials about 
reducing your risk of HIV
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
208 If you received a referral from a 
peer educator, did you go to the 
place you were referred?
Circle one
1 Yes
2 No
3 Did not receive referral from peer 
educator
99 Don’t Know
If Yes, SKIP 
to 210.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 171
88 Refused
209 IF NO: Why didn’t you go to the 
place you were referred?
CIRCLE ALL THAT APPLY
1 The place I was referred to was too far.
2 Difficult to get there on public 
transportation.
3 The hours are inconvenient.
4 I couldn’t get an appointment.
5 Had to wait a long time for an appointment.
6 The services are too expensive.
7 I lost the referral information.
8 I don’t need the referral services.
9 Heard negative comments about the 
referral.
10 Worried staff will treat me poorly because 
I’m a sex worker.
11 Worried that my privacy won’t be 
protected.
12 Worried people will know I’m a sex worker 
if I go.
13 Worried people will think I have HIV if I go.
14 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
210 If you received a referral from a 
peer educator, did the peer 
educator follow up with you to see 
if you used the referral?
Circle one
1 Yes
2 No
3 Did not receive referral from peer 
educator
99 Don’t Know
88 Refused
If No, SKIP 
to 212.
211 IF YES: How did the peer educator 
follow up with you?
Circle one
1 In person
2 Phone call
3 Text message
4 Email
5 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
For the following questions, think about the LAST TIME you had contact with a peer educator.
212 Overall, how satisfied were you 
with the services provided by the 
peer-educator?
Circle one
1 Very satisfied
2 Somewhat satisfied
3 Somewhat unsatisfied
4 Very unsatisfied
99 Don’t Know
88 Refused
213 The LAST TIME you had contact 
with a peer educator, how 
attentive was the peer educator?
Circle one
1 Very attentive
2 Somewhat attentive
3 Somewhat inattentive
4 Very inattentive
99 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 172
88 Refused
214 The LAST TIME you had contact 
with a peer educator, how 
responsive was the peer educator?
Circle one
1 Very responsive
2 Somewhat responsive
3 Somewhat unresponsive
4 Very unresponsive
99 Don’t Know
88 Refused
215 The LAST TIME you had contact 
with a peer educator, how friendly 
was the peer educator?
Circle one
1 Very friendly
2 Somewhat friendly
3 Not friendly
4 Not friendly at all
99 Don’t Know
88 Refused
216 Would you receive services from a 
peer educator again?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
217 Would you recommend peer 
educators to a friend?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
2.2 Drop-in centers
No. Question Response Skip
218 In the last 12 months, have you 
been to a drop-in center?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If Yes, SKIP 
to 220.
219 IF NO to 218: Have you heard of 
drop-in centers?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
250.
220 In general, how positive or negative 
are the things you have heard 
about drop-in centers:
Circle one
1 Very positive 
2 Somewhat positive
3 Somewhat negative
4 Very negative
99 Don’t Know
88 Refused
221 IF YES to 218: Which drop-in 
center?
1 _______________________(specify)
99 Don’t Know
88 Refused
222 IF YES to 218: How many times 
have you been to a drop-in center 
in the past 12 months?
Circle one
1 Once
2 More than once
3 About every 3 months
4 About once a year
99 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 173
88 Refused
223 In the last 12 months, have you ever received the following services from a drop-in center?
223a HIV risk reduction counseling
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
224b HIV counseling and testing
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223c Screening for sexually transmitted 
infections
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223d Referral for treatment for sexually 
transmitted infections
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223e Emergency contraception or 
referral for emergency 
contraception
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223f Contraceptive methods other than 
condoms or referral for 
contraceptive methods other than 
condoms
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223g Pregnancy test or referral for 
pregnancy test
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223i Referral for primary health care
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223j Referral for mental health services
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223k Referral for drug/alcohol addiction
Circle one
1 Yes, more than once
2 Yes, one time
3 No
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 174
99 Don’t Know
88 Refused
223l Referral for legal assistance
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223
m 
Referral for Antiretroviral therapy
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223n Referral to prevent mother-to-child 
transmission of HIV/PMTCT
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223o Sexual assault/Rape crisis services 
or referral 
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223p Any other referral 
(specify)_____________________
____________________________
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
224 In the last 12 months, have you ever received the following items at a drop-in center:
224a Condoms
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
224b Lubricants
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
224c Information and materials about 
reducing your risk of HIV
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
225 If you received a referral from a 
drop-in center, did you go to the 
place you were referred
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
If Yes, 
SKIP to 227.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 175
226 IF NO: Why didn’t you go to the 
place you were referred?
CIRCLE ALL THAT APPLY
1 The place I was referred to was too far 
away.
2 Difficult to get there on public 
transportation.
3 The hours are inconvenient.
4 I couldn’t get an appointment.
5 I had to wait a long time for an 
appointment.
6 The services are too expensive.
7 I lost the referral information.
8 I don’t need the referral services.
9 Heard negative comments about the 
referral.
10 Worried staff will treat me poorly because 
I’m a sex worker.
11 Worried my privacy won’t be protected.
12 Worried people will know I’m a sex worker 
if I go there.
13 Worried people will think I have HIV if I go 
there.
14 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
227 If you received a referral from a 
drop-in center, did staff from the 
drop-in center follow up with you 
to see if you used the referral?
Circle one
1 Yes
2 No
3 Did not receive referral from drop-in 
center
99 Don’t Know
88 Refused
If No, 
SKIP to 
229.
228 IF YES: How did the drop-in center 
staff follow up with you?
Circle one
1 In person
2 Phone call
3 Text message
4 Email
5 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
For the following questions, think about the LAST TIME you went to a drop-in center educator.
229 Overall, how satisfied were you 
with the services provided at the 
drop-in center?
Circle one
1 Very satisfied
2 Somewhat satisfied
3 Somewhat unsatisfied
4 Very unsatisfied
99 Don’t Know
88 Refused
230 The LAST TIME you went to a drop￾in center, how attentive was the 
staff?
1 Very attentive
2 Somewhat attentive
3 Somewhat inattentive
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 176
Circle one
4 Very inattentive
99 Don’t Know
88 Refused
231 The LAST TIME you went to a drop￾in center, how responsive was the 
staff?
Circle one
1 Very responsive
2 Somewhat responsive
3 Somewhat unresponsive
4 Very unresponsive
99 Don’t Know
88 Refused
232 The LAST TIME you went to a drop￾in center, how friendly was the 
staff?
Circle one
1 Very friendly
2 Somewhat friendly
3 Not friendly
99 Don’t Know
88 Refused
233 In general, how welcome did you 
feel at the center?
Circle one
1 Very welcome
2 Somewhat welcome
3 Somewhat unwelcome
4 Very unwelcome
99 Don’t Know
88 Refused
234 Have you ever felt that you were 
treated unfairly at the drop-in 
center?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
235 In general, how respectful was the 
staff at the center?
Circle one
1 Very respectful
2 Somewhat respectful
3 Somewhat disrespectful
4 Very disrespectful
99 Don’t Know
88 Refused
236 In general, how professional was 
the staff at the center?
Circle one
1 Very professional 
2 Somewhat professional
3 Somewhat unprofessional
4 Very unprofessional
99 Don’t Know
88 Refused
237 In general, how knowledgeable was 
the staff about resources at the 
center?
Circle one
1 Very knowledgeable 
2 Somewhat knowledgeable
3 Not very knowledgeable
4 Not knowledgeable at all
99 Don’t Know
88 Refused
238 In general, how knowledgeable was 
the staff about resources in the 
community?
Circle one
1 Very knowledgeable 
2 Somewhat knowledgeable
3 Not very knowledgeable
4 Not knowledgeable at all
99 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 177
88 Refused
239 Did you feel that your privacy was 
maintained at all times at the drop￾in center?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
240 To what extent did the services you 
received at the center help you 
reduce your risk of HIV?
Circle one
1 A lot
2 Somewhat
3 A little
4 Not at all
99 Don’t Know
88 Refused
241 To what extent did the staff listen 
to your needs and concerns?
Circle one
1 A lot
2 Somewhat
3 A little
4 Not at all
99 Don’t Know
88 Refused
242 To what extent did you feel like the 
staff judged you?
Circle one
1 A lot
2 Somewhat
3 A little
4 Not at all
99 Don’t Know
88 Refused
243 To what extent were the signs and 
photographs at the center 
welcoming?
Circle one
1 A lot
2 Somewhat
3 A little
4 Not at all
99 Don’t Know
88 Refused
244 How safe did you feel at the 
center?
Circle one
1 Very safe
2 Somewhat safe
3 Somewhat unsafe
4 Very unsafe
99 Don’t Know
88 Refused
245 How clean is the center?
Circle one
1 Very clean
2 Somewhat clean
3 Somewhat unclean
4 Very unclean
99 Don’t Know
88 Refused
246 Were you asked to fill out a 
feedback form to improve the 
quality of services at the center?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP 
to 248.
247 IF YES to 246: Did you fill out a 
feedback form to improve the 
1 Yes
2 No
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 178
quality of services at the center?
Circle one
99 Don’t Know
88 Refused
248 Would you receive services at a 
drop-in center again?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
249 Would you recommend the drop-in 
center to a friend?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
2.3 Mobile outreach
The next several questions are going to ask you about services provided by mobile outreach. By mobile 
outreach, I mean a party or other event that is held not at a drop-in center and designed specifically to provide 
information and services to sex workers.
No. Question Response Skip
250 In the last 12 months, have you 
received services from mobile 
outreach staff?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP 
to 253
251 IF YES to 250: Where?
Circle one
(specify)_____________________________
99 Don’t Know
88 Refused
252 IF YES to 250: How many times 
have you received services from 
mobile outreach staff in the past 
12 months?
Circle one
1 Once
2 More than once
3 About every 3 months
4 About once a year
99 Don’t Know
88 Refused
253 IF NO to 250: Have you heard of 
services being provided by mobile 
outreach staff?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP 
to 301.
254 IF YES to 253: In general, how 
positive or negative are the things 
you have heard about the services 
provided by mobile outreach staff:
Circle one
1 Very positive
2 Somewhat positive
3 Somewhat negative 
4 Very negative
99 Don’t Know
88 Refused
255 In the last 12 months, have you ever received the following services from mobile outreach staff?
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 179
255a HIV risk reduction counseling
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255b HIV testing
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255c Screening for sexually transmitted 
infections
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255d Referral for treatment for sexually 
transmitted infections
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255e Emergency contraception or 
referral for emergency 
contraception
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255f Contraceptive methods other than 
condoms or referral for 
contraceptive methods other than 
condoms
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255g Pregnancy test or referral for 
pregnancy test
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255h Referral for primary health care
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255i Referral for mental health services
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255j Referral for drug/alcohol addiction
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 180
255k Referral for legal assistance
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255l Referral for Antiretroviral therapy
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255m Referral to prevent mother-to￾child transmission of HIV/PMTCT
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255n. Sexual assault/Rape crisis services 
or referral 
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255o. Any other referral (specify) 
____________________________
____________________________
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
256 In the last 12 months, have you ever received the following items from mobile outreach staff:
256a. Condoms
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
256b. Lubricants
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
256c. Information and materials about 
reducing your risk of HIV
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
257 If you received a referral from 
mobile outreach staff, did you go 
to the place you were referred?
Circle one
1 Yes
2 No
3 Did not receive referral from mobile 
outreach staff
99 Don’t Know
88 Refused
If Yes, SKIP 
to 259.
258 IF NO: Why didn’t you go to the 
place you were referred?
DO NOT READ LIST BUT CIRCLE 
1 The place I was referred to was too far 
away.
2 Difficult to get there on public 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 181
ALL THAT ARE MENTIONED transportation.
3 The hours are inconvenient.
4 I couldn’t get an appointment.
5 I had to wait a long time for an 
appointment.
6 The services are too expensive.
7 I lost the referral information.
8 I don’t need the referral services.
9 I’ve heard negative comments about 
the referral.
10 Worried staff will treat me poorly 
because I’m a sex worker.
11 Worried my privacy won’t be protected.
12 Worried people will know I’m a sex 
worker if I go there.
13 Worried people will think I have HIV if I 
go there.
14 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
259 If you received a referral from 
mobile outreach staff, did staff 
follow up with you to see if you 
used the referral?
Circle one
1 Yes
2 No 
3 Did not receive referral from mobile 
outreach staff
99 Don’t Know
88 Refused
If No, SKIP 
to 261.
260 IF YES: How did the mobile 
outreach staff follow up with you?
Circle one
1 In person
2 Phone call
3 Text message
4 Email
5 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
For the following questions, think about the LAST TIME you received services from mobile outreach staff.
261 Overall, how satisfied were you 
with the services provided by 
mobile outreach?
Circle one
1 Very satisfied
2 Somewhat satisfied
3 Somewhat unsatisfied
4 Very unsatisfied
99 Don’t Know
88 Refused
262 Overall, how attentive was the 
staff?
Circle one
1 Very attentive
2 Somewhat attentive
3 Somewhat inattentive
4 Very inattentive
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 182
263 How responsive was the staff?
Circle one
1 Very responsive
2 Somewhat responsive
3 Somewhat unresponsive
4 Very unresponsive
99 Don’t Know
88 Refused
264 How friendly was the staff?
Circle one
1 Very friendly
2 Somewhat friendly
3 Not friendly
4 Not friendly at all
99 Don’t Know
88 Refused
265 Would you receive services from 
mobile outreach again?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
266 Would you recommend mobile 
outreach to a friend?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
Section 3. HIV related attitudes and beliefs 
In the next section we are going to talk a little more about your thoughts and opinions about HIV. 
People have many feelings about HIV and there are no right or wrong answers to these questions. 
No. Question Response Skip
301 Please indicate whether you agree or disagree with the following statements.
301a I would be ashamed if someone in my 
family had HIV
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
301b A person with HIV/AIDS should be 
allowed to work with other people
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
301c People with HIV should be allowed to 
participate in social events in this 
community
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 183
99 Don’t Know
88 Refused
301d People with AIDS should be isolated 
from other people
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
301e People who have HIV/AIDS should be 
treated the same as everyone else
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
301f People living with HIV/AIDS in this 
community should be treated the same 
by health care professionals as people 
with other illnesses
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
301g People talk badly about people living 
with or thought to be living with HIV to 
others.
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
301h People living with or thought to be 
living with HIV lose standing or respect 
in their family or community
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
301 Would you be willing to share a meal 
with a person you knew had HIV or 
AIDS?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
302 If a male relative became ill with HIV 
would you be willing to care for him in 
your household?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
303 If a female relative became ill with HIV 
would you be willing to care for her in 
your household?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
304 If a student has HIV but is not sick, 
should he or she be allowed to 
1 Yes
2 No
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 184
continue attending school?
Circle one
99 Don’t Know
88 Refused
305 If a teacher has HIV but is not sick, 
should he or she be allowed to 
continue attending school?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
306 If you knew a shopkeeper or food 
seller had the HIV virus, would you buy 
food from them?
Circle one
3 Yes
4 No
99 Don’t Know
88 Refused
307 If you knew a member of your 
community, such as a neighbor, was 
infected with HIV of had AIDS, do you 
think he or she should be allowed to 
continue his or her community 
activities?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
308 If a member of your family became ill 
with HIV, would you want it to remain 
a secret?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
309 Do you know anyone who is HIV 
positive?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 40
IF YES to 309: In the past year, do you know someone that has had the following things happen to them because they have 
HIV or AIDS?
310 Excluded from social gathering
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
311 Lost customers to buy their produce or 
goods or lost a job
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
312 Had property taken away
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
313 Abandoned by their family or sent away
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
314 Abandoned by their spouse or partner
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
315 Teased or sworn at 1 Yes
2 No
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 185
Circle one 99 Don’t Know
88 Refused
316 Lost respect or standing in their family or 
community
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
317 Gossiped about
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
Section 4. Sex Work
Thank you! In the next section, I would like to talk to you more about your involvement in sex work. 
No. Question Response Skip
401 At what age did you start sex work? 1 _____Years old
2 Don’t Know
3 Refused
402 Who introduced you to sex work?
Circle one
1 Mother
2 Father
3 Other relative
4 Friend
5 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
403 Where do you find most of your 
clients?
Circle one
1 Home
2 Hotel/Guest house /Lodge
3 Bar/Nightclub
4 street
5 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
404 Where do you usually take your 
clients for sex?
Circle one
1 Home
2 Hotel/Guesthouse/lodge
3 Bar/Nightclub
4 Car/vehicle
5 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
405 How do your clients usually pay you?
Circle one
1 In cash
2 In kind (clothing, food, shelter)
3 Both
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 186
406 On average, how much do you earn a 
week from sex work?
1 ________________GHC
99 Don’t Know
88 Refused
407 Other than sex work, do you have 
another means of earning money?
Circle one
1 No
2 Yes
99 Don’t Know
88 Refused
408 How many people did you have sex 
with in the past week?
Circle one
1 ___________ people
99 Don’t Know
88 Refused
409 Of all the people you had sex with in 
the past week, how many were:
(FILL IN ALL AS APPROPRIATE)
1 ______Paying one-time clients
2 ______Paying regular clients
3 ______One-time non-paying partners
4 ______Spouse/lover/boyfriend
5 ______Other (specify) 
_______________________
99 Don’t Know
88 Refused
410 In general, paying one-time clients 
are:
Circle one
1 1-5 years younger than me
2 6-10 years younger than me
3 More than 10 years younger than me
4 Same age as me 
5 1-5 years older than me
6 6-10 years older than me
7 More than 10 years older than me
99 Don’t Know
88 Refused
411 In general, paying regular clients are:
Circle one
1 1-5 years younger than me
2 6-10 years younger than me
3 More than 10 years younger than me
4 Same age as me 
5 1-5 years older than me
6 6-10 years older than me
7 More than 10 years older than me
99 Don’t Know
88 Refused
412 In general, non-paying one-time 
partners are:
Circle one
1 1-5 years younger than me
2 6-10 years younger than me
3 More than 10 years younger than me
4 Same age as me 
5 1-5 years older than me
6 6-10 years older than me
7 More than 10 years older than me
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 187
413. My spouse, lover, or boyfriend is:
Circle one
1 1-5 years younger than me
2 6-10 years younger than me
3 More than 10 years younger than me
4 Same age as me 
5 1-5 years older than me
6 6-10 years older than me
7 More than 10 years older than me
8 I do not have a spouse, lover, or boyfriend
99 Don’t Know
88 Refused
414 The last time you had vaginal 
intercourse with a paying partner, did 
you use a condom?
Circle one
1 Yes
2 No
99 Don’t remember
88 Refused
415 The last time you had vaginal 
intercourse with a non-paying 
partner, did you use a condom?
Circle one
1 Yes
2 No
99 Don’t remember
88 Refused
416 Have you ever had anal sex?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If no skip to 
418
417 The last time you had anal sex with a 
paying partner, did you use a 
condom?
Circle one
1 Yes
2 No
99 Don’t remember
88 Refused
418 The last time you had anal sex with a 
non-paying partner, did you use a 
condom?
Circle one
1 Yes
2 No
99 Don’t remember
88 Refused
419 Have you been treated poorly 
because you are a sex worker?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 50
420. IF YES to 232: By whom have you 
been treated poorly because you are 
a sex worker? 
CIRCLE ALL THAT APPLY
(PROBE, DO NOT READ OUT OPTIONS)
1 Family
2 Friends
3 Health care workers
4 Teacher
5 Stranger
6 Shop keeper
7 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 188
Section 5. Violence
For the following questions, think only about your main or most recent spouse, lover, or boyfriend.
No. Question Response Skip
501 My partner explained his side or suggeste 
a compromise for a disagreement with m
Circle one
1 Never
2 Not in past year, but it did happen befor
 e 
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
502 My partner insulted or swore or shouted 
yelled at me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
503 I had a sprain, bruise, or small cut, or 
felt pain the next day because of a 
fight with my partner
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
•
504 My partner showed respect for, or 
showed that he cared about my feeling 
about an issue we disagreed on
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
505 My partner pushed, shoved, or slapped 
me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
506 My partner punched or kicked or beat￾me-up
Circle one
1 Never
2 Not in past year, but it did happen before
 
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
507 My partner destroyed something 
belonging to me or threatened to hit me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 189
99 Don’t Know
88 Refused
508 I went see a doctor or needed to see a 
doctor because of a fight with my partne
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
509 My partner used force (like hitting, holdin 
down, or using a weapon) to make me 
have sex
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
510 My partner insisted on sex when I did 
not want to or insisted on sex without 
a condom (but did not use physical 
force)
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
511 A paying partner insulted or swore or 
shouted or yelled at me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
512 I had a sprain, bruise, or small cut, or felt 
pain the next day because of a fight with 
paying partner
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
513 A paying partner pushed, shoved, or 
slapped me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
514 A paying partner punched or kicked or 
beat-me-up
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
515 A paying partner destroyed something 
belonging to me or threatened to hit 
me
1 Never
2 Not in past year, but it did happen before
3 Once in past year
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 190
Circle one
4 More than once in past year
99 Don’t Know
88 Refused
516 I went to see a doctor or needed to see 
a doctor because of a fight with a 
paying partner
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
517 A paying partner used force (like hitting, 
holding down, or using a weapon) to mak 
me have sex
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
518 A paying partner insisted on sex when I 
did not want to or insisted on sex 
without a condom (but did not use 
physical force)
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
519 During the last 12 months, have you ever 
avoided arrest by providing a police offic 
with a sexual favor?
Circle one
1 No
2 Yes
3 99Don’t Know
4 88Refused
If No, SKIP to 52
520 IF Yes to 519: How often in the last 12 
months have you avoided arrest by 
providing a police officer with a sexual 
favor?
Circle one
1 Often
2 Sometimes
3 Rarely
4 Never
99 Don’t Know
88 Refused
521 During the last 12 months, have you been 
forced to not use condoms during sex?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 52
522 IF YES to 521: who forced you to not use 
condoms during sex?
Circle one
1 Paying one-time client
2 Paying regular client
3 Non-paying spouse, partner, or boyfriend
4 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
523 During the last 12 months, have you been 
beaten or physically abused as a a result 
doing sex work?
1 Yes
2 No
If No, SKIP to 60
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 191
Circle one
99 Don’t Know
88 Refused
524 IF Yes to 523: who beat you or physically 
abused you as a result of doing sex work?
Circle one
1 Paying one-time client
2 Paying regular client
3 Non-paying spouse, partner, or boyfriend
4 Family member
5 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
Section 6. Substance Use
Now I will ask you some questions about your alcohol use. By alcohol use we mean drinking a bottle of beer, a glass of wine, 
shot of spirits, and glass or can of home or local brews.
No. Question Response Skip
601 How often do you have a drink containin 
alcohol?
Circle one
1 Never
2 Once a month or less
3 2-4 times a month
4 2-3 times a week
5 4 or more times a week
99 Don’t Know
88 Refused
602 How many drinks containing alcohol do 
you have on a typical day when you are 
drinking?
Circle one
1 1 - 2
2 3- 4 
3 5- 6 
4 7– 9 
5 10 or more
99 Don’t Know
88 Refused
603 In the past year how often have you drun 
alcohol before sex?
Circle one
1 Always
2 Sometimes
3 Rarely 
4 Never
5 99Don’t Know
6 88Refused
604 How often do you have 6 or more drinks 
one occasion?
Circle one
1 Never
2 Less than monthly
3 Monthly 
4 Weekly
5 Daily or almost daily
6 99Don’t Know
7 88Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 192
605 How often during the last year have you 
found that you have not been 
able to stop drinking once you 
started?
Circle one
1 Never
2 Less than monthly
3 Monthly 
4 Weekly
5 Daily or almost daily
6 99Don’t Know
7 88Refused
606 How often during the past year have you 
failed to do what was expected 
of you because of drinking?
Circle one
1 Never
2 Less than monthly
3 Monthly 
4 Weekly
5 Daily or almost daily
6 99Don’t Know
7 88Refused
607 How often during the past year did 
you have to use ‘a first drink in the 
morning’ to get yourself going after 
a heavy drinking session?
Circle one
1 Never
2 Less than monthly
3 Monthly 
4 Weekly
5 Daily or almost daily
6 99Don’t Know
7 88Refused
608 How often during the past year have you 
had a feeling of guilt or remorse after 
drinking?
Circle one
1 Never
2 Less than monthly
3 Monthly 
4 Weekly
5 Daily or almost daily
6 99 Don’t Know
7 88 Refused
No. Question Response Skip
609 How often during the past year have you 
been unable to remember what happene
the night before because you had been 
drinking?
Circle one
1 Never
2 Less than monthly
3 Monthly 
4 Weekly
5 Daily or almost daily
99 Don’t Know
88 Refused
610 Have you or someone else been injured 
because of your drinking?
Circle one
1 Never
2 Less than monthly
3 Monthly 
4 Weekly
5 Daily or almost daily
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 193
611 Has a relative, friend, doctor, or 
other health worker been concerned abo 
your drinking or suggested 
that you should cut down?
Circle one
1 Never
2 Less than monthly
3 Monthly 
4 Weekly
5 Daily or almost daily
99 Don’t Know
88 Refused
Now I’m going to ask you about the use of other addictive substances such as cocaine, heroin, and other substances that alte
your mood and are not prescribed by a health care professional.
612 READ: Some people have used a range of such substances. Have you ever used any of these substances, 
even once?
612a Cocaine
Circle one
1 Yes, more than once
2 Yes, one time 
3 No 
99 Don’t Know
88 Refused
612b Heroin
Circle one
1 Yes, more than once
2 Yes, one time 
3 No 
99 Don’t Know
88 Refused
612c Marijuana (Weed)
Circle one
1 Yes, more than once
2 Yes, one time 
3 No 
99 Don’t Know
88 Refused
612d Valium
Circle one
1 Yes, more than once
2 Yes, one time 
3 No 
99 Don’t Know
88 Refused
612e Sleeping pills
Circle one
1 Yes, more than once
2 Yes, one time 
3 No 
99 Don’t Know
88 Refused
612f. Other drugs (specify): 
_____________________________
Circle one 
1 Yes, more than once
2 Yes, one time 
3 No 
99 Don’t Know
88 Refused
613 Some people have tried injecting 
drugs using a syringe. Have you injected 
drugs recreationally in the 
last 12 months?
Circle one
1 Yes, more than once
2 Yes, one time 
3 No 
99 Don’t Know
88 Refused
If No, SKIP to 70
614 If Yes to 613: With how many 
people have you ever shared
1 None
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 194
needles or syringes?
Circle one
2 1-2 people
3 or more people
99 Don’t Know
88 Refused
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 195
Section 7. Service Quality
7.1. HIV-related information and risk reduction services
No. Question Response Skip
701 Have you received HIV-related informatio 
and risk reduction counseling in the past 
12 months?
Circle one
1 Yes, more than once
2 Yes, one time 
3 No 
99 Don’t Know
88 Refused
If Yes, SKIP to 70
702 If NO, In your neighborhood, do you 
know a place where people can get 
advice about AIDS and get tested for 
HIV?
Circle one
1 Yes
2 No
99 Don’t Know88 Refused
If No, Skip to 722
703 IF YES: In the past 12 months, where hav 
you received HIV-related information and 
risk reduction counseling?
Circle one
1 Drop-in center
2 Mobile outreach
3 Peer educator
4 Government health facility
5 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
704 Where was the LAST PLACE that you 
received HIV-related information and 
risk reduction counseling?
Circle one
1 Drop-in center
2 Mobile outreach
3 Peer educator
4 Government health facility
5 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
The following questions refer only to the LAST TIME you received HIV-related information and risk reduction counseling.
705 The last time you received HIV-related 
information and risk reduction 
counseling, how satisfied were you 
with the HIV counseling services?
Circle one
1 Very satisfied
2 Satisfied
3 Not satisfied
4 Very unsatisfied
99 Don’t Know
88 Refused
706 The last time you received HIV-related 
information and risk reduction 
counseling, how professional was the 
staff?
Circle one
1 Very professional 
2 Somewhat professional
3 Somewhat unprofessional
4 Very unprofessional
99 Don’t Know
88 Refused
707 The last time you received HIV-related 
information and risk reduction 
counseling, how friendly was the staff?
1 Very friendly
2 Somewhat friendly
3 Not friendly
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 196
Circle one
4 Not friendly at all
5 Don’t Know
6 Refused
708 Would you use these HIV risk reduction 
counseling services again?
Circle one
1 Yes
2 No
3 Don’t Know
4 Refused
709 Would you recommend these HIV risk 
reduction counseling services to a 
friend?
Circle one
1 Yes
2 No
3 Don’t Know
4 Refused
710 Now think about the last time you 
received HIV risk reduction counseling. 
How much did the risk reduction 
counseling help you?
Circle one
1 Helped a lot
2 Helped some
3 Did not help
4 99Don’t Know
5 88Refused
711 How much helpful information did you 
receive?
Circle one
1 A lot of helpful information
2 A little helpful information
3 No helpful information
99 Don’t Know
88 Refused
712 When you saw the counselor, who 
talked the most?
Circle one
1 I talked the most
2 The counselor talked the most
3 We talked the same amount
99 Don’t Know
88 Refused
713 When you saw the counselor, who 
listened the most?
Circle one
1 I listened the most
2 The counselor listened the most
3 We listened the same amount
99 Don’t Know
88 Refused
714 To what extent did the counselor 
answer your questions and concerns 
about HIV?
Circle one
1 A lot
2 Some
3 Not at all
99 Don’t Know
88 Refused
715 To what extent did the counselor help 
you think about what you were doing 
that puts you at risk for getting HIV?
Circle one
1 A lot
2 Some
3 Not at all
99 Don’t Know
88 Refused
716 To what extent did the counselor help 
you make a plan to protect yourself 
from HIV?
Circle one
1 A lot
2 Some
3 Not at all
99 Don’t Know
88 Refused
717 To what extent did the counselor help 1 A lot
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 197
you come up with small steps you can 
take to make your HIV prevention plan 
work?
Circle one
2 Some
3 Not at all
99 Don’t Know
88 Refused
718 Did the counselor tell you about other 
places you could go for help for HIV 
and health care related services?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
719 In your plan to reduce your HIV risk, 
who came up with the ideas what you 
will do?
Circle one
1 I did
2 The counselor
3 We both did
99 Don’t Know
88 Refused
720 How much did the counselor help you 
with your plan to reduce HIV risk?
Circle one
1 A lot
2 Somewhat
3 A little
4 Not at all
99 Don’t Know
88 Refused
721 How much did you help the counselor 
to develop a plan to reduce your HIV 
risk? 
Circle one
1 A lot
2 Somewhat
3 A little
4 Not at all
99 Don’t Know
88 Refused
722 How much did you tell the counselor 
about your sex life and use of drugs?
Circle one
1 A lot
2 Somewhat
3 A little
4 Not at all
99 Don’t Know
88 Refused
722 How can people reduce their risk of contracting HIV/AIDS? DO NOT READ LIST OUT LOUD
Check YES for all mentioned. Check NO for all not mentioned.
722a Use condoms
Circle one
1 Yes
2 No
88
722b Reduce the number of sexual partners
Circle one
1 Yes
2 No
99
88
722c Be faithful to one partner
Circle one
1 Yes
2 No
722d Do not have casual sex
Circle one
1 Yes
2 No
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 198
722e Do not have sex
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
722f Avoid contaminated needles
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
722g Avoid contact with infected people
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
722h Other (specify) 
________________________________
__________________________
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
Thank you. Now I would like to ask some additional questions about what you know about HIV.
723 Can a healthy looking person be 
infected with HIV?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
Please indicate whether you agree or disagree with the following statements.
No. Question Response Skip
724 If you kiss someone on the cheek that 
has HIV/AIDS, you might get infected
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
725 If you are coughed or sneezed on by 
someone who has HIV/AIDS, you are 
likely to contract the infection
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
726 I fear I could become infected with HIV 
if I were to be exposed to the sweat of 
a person who has HIV/AIDS
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
727 I fear I could become infected with HIV 
if I were to be exposed to the saliva of 
a person who has HIV/AIDS
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 199
728 I have no risk of getting HIV.
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
729 I am at risk of getting HIV.
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
730 I want to reduce my risk of getting HIV.
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
731 I know ways to reduce my risk.
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
732 I have a plan for how I will reduce my 
risk.
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
733 I like my HIV prevention plan.
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
734 I’m sure I can follow my HIV prevention 
plan.
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree
4 Strongly disagree
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 200
7.2 HIV Testing
No. Question Response Skip
735 In the last 12 months, have you been 
offered an HIV test?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
736 In the last 12 months, have you been 
tested for HIV?
Circle one
1 No
2 Yes, one time
3 Yes, more than once
99 Don’t Know
88 Refused
If Yes, SKIP to 
737.Otherwise 
SKIP to 772
737 IF No to 736, why have you not been 
tested for HIV? 
Do not read list but circle all that are 
mentioned
1 I’m worried that people would find out my test results
2 I don’t know where to get tested.
3 Getting tested is too expensive.
4 The places for HIV testing are too far away.
5 The hours for HIV testing are inconvenient.
6 It’s difficult to get to HIV testing places on public 
transportation.
7 The people that provide HIV testing will treat me 
differently because I am a sex worker.
8 I am not at risk for HIV.HIV is not a serious health 
condition.
9 I am worried that people will treat me poorly if the tes 
result is positive.
99 Don’t Know
88 Refused
SKIP to 738.
738 Was the decision to be tested for HIV 
up to you or were you pressured, 
forced, or unknowingly tested?
1 Yes, it was completely my decision to be tested.
2 It was my decision to be tested, but it was under 
pressure from others
3 I was forced to take an HIV test.
4 I was tested without my knowledge
5 I only found out after the test had been done
99 Don’t Know
88 Refused
739 In your opinion, are FSW hesitant to 
take an HIV test due to fear of 
people’s reaction if the test result is 
positive for HIV?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
740 In the last 12 months, where have you 
been tested for HIV? 
Do not read list but circle all that are 
mentioned
1 Drop-in center
2 Mobile outreach
3 Peer educator
4 Government health facility
5 Other (Specify)_________________________
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 201
No. Question Response Skip
741 Where was the last place you were teste 
for HIV?
Circle one
1 Drop-in center
2 Mobile outreach
3 Peer educator
4 Government health facility
5 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
The following questions refer only to the LAST TIME you were tested for HIV.
742 Overall, how satisfied were you with 
the HIV testing services?
Circle one
1 Very satisfied
2 Satisfied
3 Not satisfied
4 Very unsatisfied
99 Don’t Know
88 Refused
743 The last time you were tested for HIV, 
how professional was the staff?
Circle one
1 Very professional 
2 Somewhat professional
3 Somewhat unprofessional
4 Very unprofessional
99 Don’t Know
88 Refused
744 The last time you were tested for HIV, 
how friendly was the staff?
Circle one
1 Very friendly
2 Somewhat friendly
3 Not friendly
4 Not friendly at all
99 Don’t Know
88 Refused
745 Would you use these HIV testing 
services again?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
746 Would you recommend these HIV 
testing services to a friend?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
Again, for the following questions, think only about the last time you were tested for HIV.
747 Before you were tested for HIV, did the 
counselor explain why you should get 
tested for HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
748 Before you were tested for HIV, did the 
counselor explain to you the type of 
test that was used?
1 Yes
2 No 
99 Don’t know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 202
Circle one
88 Refused
749 Before you were tested for HIV, did the 
counselor explain to you the meaning 
of a positive and negative result?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
750 Before you were tested for HIV, did the 
counselor explain to you that if 
managed with antiretroviral therapy 
(ART) and quality clinical care, HIV 
infection may be controlled as a chronic 
condition?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
751 Before you were tested for HIV, did the 
counselor explain to you the test result 
is confidential- that is, no one will know 
the results of your test unless you tell 
them?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
752 Before you were tested for HIV, did the 
counselor explain to you disclosure of a 
positive result is needed to receive 
treatment for HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
753 Before you were tested for HIV, did the 
counselor explain to you that you can 
choose not to get tested and still 
receive all other services that are 
provided?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
Again, for the following questions, think only about the last time you were tested for HIV. 
754 The last time you were tested for HIV, 
were you able to ask questions about 
HIV/AIDS and about getting tested for 
HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
755 The last time you were tested for HIV, 
were you encouraged to ask questions 
about the testing process?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
756 The last time you were tested for HIV, 
did you feel that your confidentiality 
was protected – that is, that no one 
would know that your test result 
unless you told them?
1 Yes
2 No 
99 Don’t know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 203
Circle one
757 The last time you were tested for HIV, 
how long did you have to wait to 
receive the test results?
Circle one
1 A very long time
2 Somewhat long time
3 Not very long
4 Not long at all
99 Don’t Know
88 Refused
Thank you. Now I would like to ask you some personal questions about your HIV testing. Please 
remember that we have not taken your name and all your responses will be completely confidential. No 
one will ever know what you have told me during this interview. I appreciate your trust and honesty.
758 Do you know the result of your most 
recent HIV test?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
If No, SKIP to 
772.
759 IF YES to 758: Have you told a sexual 
partner the results of your most recent 
HIV test?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
760 IF YES to 758: What was the result of 
your most recent HIV test?
Circle one
1 Positive
2 Negative
99 Don’t Know
88 Refused
If POSITIVE, SK 
to 763.
761 If negative: If you had tested positive, 
would you have sought out treatment 
for HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
If Yes, SKIP t 
772
762 IF NO to 760: If you had tested positive, 
why would you have not sought out 
treatment for HIV? 
CIRCLE ALL THAT APPLY
1 I would be worried that people would find out that 
was HIV positive.
2 Treatment for HIV is too expensive.
3 I wouldn’t know where to go to receive treatment f 
HIV.
4 I would be worried that doctors would treat me 
poorly because I am a sex worker.
5 I would be worried that doctors would treat me 
poorly if I were HIV positive.
6 HIV treatment is not effective.
7 The places that provide HIV treatment are too far
away.
8 The places that provide HIV treatment are difficult t 
get to on public transportation.
9 The hours for receiving HIV treatment are 
inconvenient.
10 You have to wait a long time to get an appointment
11 In the past, doctors have treated me poorly because 
am a sex worker.
SKIP to 772
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 204
99 Don’t Know
88 Refused
763 If positive: When you received your 
test results, did you receive a referral 
to care, support and treatment?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
If No, SKIP to 
764
764 If yes to 762: Have you contacted the 
referral to receive care, support and 
treatment?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
765 IF POSITIVE: Are you currently taking 
antiretroviral medications daily for 
HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
If Yes, SKIP to 
766.
766 IF NO to 764: Why are you not 
receiving treatment for HIV? 
CIRCLE ALL THAT APPLY
1 I am worried that people will find out that I am HIV 
positive.
2 Treatment for HIV is too expensive.
3 I don’t know where to go to receive treatment for 
HIV.
4 I’m worried that doctors will treat me poorly becaus 
I am a sex worker.
5 I’m worried that doctors will treat me poorly becaus 
I am HIV positive.
6 HIV treatment is not effective.
7 The places that provide HIV treatment are too far 
away.
8 The places that provide HIV treatment are difficult t 
get to on public transportation.
9 The hours for receiving HIV treatment are 
inconvenient.
10 You have to wait a long time to get an appointment
11 In the past, doctors have treated me poorly
12 Because I am a sex worker.
99 Don’t Know
88 Refused
767 IF POSITIVE: In the last 12 months, 
have you been fearful of any of the 
following things happening to you – 
whether or not they actually have 
happened to you – because you are 
HIV positive?
Circle all that apply
1 Being gossiped about
2 Being verbally insulted, harassed and/or 
threatened 
3 Being physically harassed and/or threatene
4 Being physically assaulted
99 Don’t Know
88 Refused
768 IF POSITIVE: How often have you felt 
excluded from social gatherings or 
activities because of your HIV status?
Circle one
1 Often
2 Sometimes
3 Rarely 
4 Never
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 205
99 Don’t Know
88 Refused
769 IF POSITIVE: How often have you been 
denied health services because of your 
HIV status?
Circle one
1 Often
2 Sometimes
3 Rarely 
4 Never
99 Don’t Know
88 Refused
770 IF POSITIVE: How often have you felt 
gossiped about because of your HIV 
status?
Circle one
1 Often
2 Sometimes
3 Rarely 
4 Never
99 Don’t Know
88 Refused
771 IF POSITIVE In the last 12 months, have 
you experienced any of the following 
feelings because of your HIV status?
Circle all that apply
1 I feel ashamed
2 I feel guilty
3 I blame myself
4 I blame others
5 I have low self-esteem
6 I feel I should be punished
99 Don’t Know
88 Refused
7.3 Quality of condom and lubricant information and distribution services
No. Question Response Skip
772 In the last 12 months, have you 
received condoms, lubricants, or 
information about how to use 
condoms and lubricants to reduce your 
risk of HIV?
Circle one
1 No
2 Yes, one time
3 Yes, more than once
99 Don’t Know
88 Refused
If No, SKIP 
774.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 206
773 If yes to 772: In the last 12 months, 
where did you receive condoms, 
lubricants, or information about how 
to use condoms and lubricants to 
reduce your risk of HIV? 
CIRCLE ALL THAT APPLY
1 Drop-in center
2 Mobile outreach
3 Peer educator
4 Government health facility
5 Private doctor/clinic
6 Pharmacy
7 Bar, restaurant, or nightclub
8 StreetHotel/guest house/lodge
9 Shop/kiosk
10 My partner always gets the condoms
11 Other (Specify)_________________________
99 Don’t Know
88 Refused
774 Where is the last place you received 
condoms, lubricants, or information 
about how to use condoms and 
lubricants to reduce your risk of HIV?
Circle one
1 Drop-in center
2 Mobile outreach
3 Peer educator
4 Government health facility
5 Other 
(Specify)_________________________
99 Don’t Know
88 Refused
The following questions refer only to the LAST TIME you received condoms, lubricants, or information about how to 
use condoms and lubricants to reduce your risk of HIV.
No. Question Response Skip
775 Overall, how satisfied were you with 
the condom and lubricant distribution 
services?
Circle one
1 Very satisfied
2 Satisfied
3 Not satisfied
4 Very unsatisfied
99 Don’t Know
88 Refused
776 Overall, how professional was the 
staff?
Circle one
1 Very professional 
2 Somewhat professional
3 Somewhat unprofessional
4 Very unprofessional
99 Don’t Know
88 Refused
777 Overall, how friendly was the staff?
Circle one
1 Very friendly
2 Somewhat friendly
3 Not friendly
4 Not friendly at all
99 Don’t Know
88 Refused
778 Would you use these condom and 
lubricant distribution services again?
1 Yes
2 No 
99 Don’t know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 207
Circle one 88 Refused
779 Would you recommend these condom 
and lubricant distribution services to a 
friend?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
The LAST TIME you received condoms, lubricants, or information about how to use condoms and 
lubricants to reduce your risk of HIV,
780 Were you asked if you needed any 
information on condoms and condom 
lubricants?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
781 Were you asked if you understood how 
to use condoms and condom￾lubricants?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
782 How comfortable did you feel asking a 
staff member questions about using 
condoms and lubricants?
Circle one
1 Very comfortable
2 Somewhat comfortable
3 Somewhat uncomfortable
4 Very uncomfortable
99 Don’t Know
88 Refused
783 Were condoms provided in a respectful 
manner? 
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
784 Were you provided with enough 
information on how to use condoms?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
785 How often are condoms available?
Circle one
1 Always
2 Sometimes 
3 Rarely 
4 Never
5 99Don’t Know
6 88Refused
786 How often is condom/lube available?
Circle one
1 Always
2 Sometimes 
3 Rarely 
4 Never
5 99Don’t Know
6 88Refused
787 Were you encouraged to come back 
before you were out of condoms and 
1 Yes
2 No
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 208
condom-compatible lubricants?
Circle one
99 Don’t know
88 Refused
788 Were you encouraged to tell friends 
about condom and condom￾compatible lubricants distribution 
service?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
789 Did you feel that your needs for 
condoms and lubricants were met?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
790
For how long have you been receiving 
HIV services from (Organizations 
Name) 
1. Less than 6 Months
2. 6 – 12 month
3. 1 – 2 years
4. Greater than 2 years
99 Don’t Know
88 Refused
791 What recommendations would you give to someone who is developing HIV prevention services 
specifically for sex workers?
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
792 Is there anything else that I haven’t asked you about providing HIV prevention services to FSW that y 
would like to share with me?
_______________________________________________________________________
_______________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 209
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 210
FSW Non-Client Service Quality Survey
 
Type of FSW: Roamer 1 [ ] Seater 2 [ ] 
Date:_______________________ 
 Questionnaire ID:____________________
 Venue::______________________
 
 Geographic region:________________________
 Specific region:________________________
 Neighborhood:________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 211
PARTICIPANT CONSENT FORM 
Title: A Performance Evaluation of Ghana’s HIV Prevention Program for At-Risk Populations
Principal Investigator: Amos Laar, PhD, 
Department of Population, Family and Reproductive Health, School of Public Health, College of Health 
Sciences, University of Ghana, Box Lg 13 Legon, 0244982176, alaar@ug.edu.gh or aklaar@yahoo.com 
General Information about Research 
You are being asked to participate in a research study to learn more about the experiences of certain key 
populations with HIV prevention services in Ghana. The purpose of the research is to learn: 1) how these 
populations have used HIV prevention services in Ghana, 2) the quality of these services, 3) how satisfied 
these populations are with these services and 4) what barriers exist to using HIV prevention services. Your 
participation in this research should take approximately 60-90 minutes. You will be asked to participate in a 
one-on-one interview and/or group discussion about your experience using HIV prevention services. Your 
participation will help improve HIV prevention services for both the key populations and the general 
population in Ghana.
Possible Risks and Discomforts
The risks of your participation are minimal. The main risk resulting from your participation is feeling 
uncomfortable answering some of the questions. Your participation is completely voluntary. Should you feel 
uncomfortable answering any question(s), you can choose to skip that question(s) and continue with the 
interview. You are also welcome to end the interview at any time. 
Possible Benefits
You are not likely to personally benefit from participating in this research study. However, your participation 
will help improve HIV prevention services for both the key populations and the general population in Ghana.
Alternatives to Participation
There are no alternatives to participation. The only alternative to participation is to simply not participate.
Confidentiality
All information that you share with the interviewer will be protected to the best of our ability. You will not 
be named in any reports. Any documents with identifying information will be kept in a locked filing cabinet 
for 5 years after the study is completed and then will be destroyed. Any identifying information that is 
stored electronically (i.e., on a computer) will be kept on a secure computer and will require a password to 
access. Only staff who work on this research project will have access to your research information.
Compensation
You will be given 10 Ghana Cedis for participating in a survey interview or group discussion. This 
compensation will be provided to you in cash at the end of the interview. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 212
Additional Cost 
There are no additional costs that may result from participation in this research.
Voluntary Participation and Right to Leave the Research
Your participation in the survey interview or focus group is completely voluntary. You have the right to not 
participate in this research or to end your participation at any point in time. You also have the right to not 
answer any questions that you choose not to answer. Not participating or withdrawing from this research 
will not have any negative consequences and will not impact your ability to receive HIV prevention services.
Contacts for Additional Information
If you have any questions about the research, please contact Amos Laar, PhD, 
Department of Population, Family and Reproductive Health, School of Public Health, College of Health 
Sciences, University of Ghana, Box Lg 13 Legon, 0244982176, alaar@ug.edu.gh or aklaar@yahoo.com 
Your rights as a Participant
This research has been reviewed and approved by the Institutional Review Board of Noguchi Memorial 
Institute for Medical Research (NMIMR-IRB). If you have any questions about your rights as a research 
participant you can contact the IRB Office between the hours of 8am-5pm through the landline 0302916438 
or email addresses: nirb@noguchi.mimcom.org or HBaidoo@noguchi.mimcom.org . You may also contact 
the chairman, Rev. Dr. Ayete-Nyampong through mobile number 0208152360 when necessary.
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 213
VOLUNTEER AGREEMENT
The above document describing the benefits, risks and procedures for the research title (name of research)
has been read and explained to me. I have been given an opportunity to have any questions about the 
research answered to my satisfaction. I agree to participate as a volunteer.
ORAL CONSENT VERIFICATION:
I was present while the benefits, risks and procedures were read to the volunteer. All questions were 
answered and the volunteer has agreed to take part in the research.
_______________________ __________________________________________
Date Name and signature of witness
I certify that the nature and purpose, the potential benefits, and possible risks associated with participating 
in this research have been explained to the above individual.
_______________________ _____________________________________
Date Name Signature of Person Who Obtained Consent 
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 214
Section 1. Demographics
No. Question Response Skip
101. What nationality are you?
Circle one
7 Ghana
8 Nigeria
9 Togo
10 Ivory Coast
11 Burkina Faso
12 Other 
(Specify)_________________________
100 Don’t Know
89 Refused
If not 1 skip 
to 103
102. What ethnicity are you?
Circle one
10 Akan
11 Ewe
12 Ga Adangbe
13 Hausa
14 Krobo
15 Mole/Dagbani
16 Grusi
17 Gruma
18 Other 
(Specify)_________________________
100 Don’t Know
89 Refused
103. How old were you on your last 
birthday?
Circle one
______________Years
99 Don’t Know
88 Refused
104. What is your marital status?
Circle one
11 Living with spouse
12 Separated
13 Divorced
14 Widowed
15 Never Married
99 Don’t Know
88 Refused
If 1 skip to 106
105. Do you currently live with a boyfriend 
or partner who is not a spouse? :
Circle one
 1 Yes
 2 No
100 Don’t Know
89 Refused
106. What is your religion?
Circle one
6 Christian
7 Muslim
8 Traditional
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 215
9 Other 
(Specify)_________________________
10 No religion
100 Don’t Know
89 Refused
107. Have you ever attended school?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 10
108. What is the highest level of school you 
have attended?
Circle one
5 Primary
6 Middle/Junior Secondary/JHS
7 Senior 
Secondary/SHS/Technical/Vocational
8 Higher/Tertiary
100 Don’t Know
89 Refused
109. How many living children do you have?
Circle one
Number of children______________
99 Don’t Know
88 Refused
110. Do you currently have a cell phone?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If Yes, SKIP to 11
111. IF NO: Do you currently have access to 
a cell phone?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
112. In general, how often do you use a cell 
phone?
Circle one
5 Always
6 Sometimes
7 Rarely
8 Never
100 Don’t Know
89 Refused
113. In the past 12 months, have you ever 
received health information – such as 
information about how to reduce your 
risk of HIV - by text message?
Circle one
4 No
5 Yes, one time
6 Yes, more than once
99 Don’t Know
88 Refused
If No, SKIP to 11
114. IF YES: How useful was the health 
information that you received by text 
message?
Circle one
5 Very useful
6 Somewhat useful
7 Not that useful
8 Not useful at all
100 Don’t Know
89 Refused
115. Have you ever heard of the Text me! 
Flash me! Call Me! Helpline? 
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP t 
119.
116. IF YES: In the past 12 months, have you 4 No If No, SKIP t 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 216 
used the Text me! Flash me! Call Me! 
Helpline? 
Circle one
5 Yes, one time
6 Yes, more than once
99 Don’t Know
88 Refused
118.
117. IF USED: How satisfied were you with 
the Text me! Flash me! Call Me! 
Helpline? 
Circle one
6 Very satisfied
7 Somewhat satisfied
8 Neither satisfied nor dissatisfied
9 Somewhat dissatisfied
10 Very dissatisfied
99 Don’t Know
88 Refused
SKIP to 119.
118. IF HEARD OF, BUT NOT USED: In 
general, are the things you have heard 
about Text me! Flash me! Call Me! 
Helpline: 
Circle one
6 Very positive
7 Somewhat positive
8 Neither positive nor negative
9 Somewhat negative
10 Very negative
99 Don’t Know
88 Refused
119. In the past 12 months, have you used 
the internet to get information about 
HIV prevention specifically for female 
sex workers?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
120. How often do you use the internet to 
get information about HIV prevention 
and risk reduction?
Circle one
5 Often
6 Sometimes
7 Rarely 
8 Never
99 Don’t Know
88 Refused
If there is a service that allows you to 
send text message and request for HIV 
and AIDS information, would you be 
willing to use it? If your confidentiality 
and privacy are completely assured.
• 1 Yes 
• 2 Probably 
• 3 Not sure 
• 4 Probably not 
5 No 
88. Refused
If there is a service that provides 
periodic HIV and AIDS information (e.g 
weekly, month etc) would you be 
willing to allow the program (e.g 
WAPCAS) to send the messages to you 
through your mobile phone? If your 
confidentiality and privacy are 
completely assured.
• 1 Yes 
• 2 Probably 
• 3 Not sure 
• 4 Probably not 
5 No 
88. Refused
•
If there is a service to provide HIV and 
AIDS information to Key Populations 
(MARPs) in Ghana, what would be your 
preferred platform for such a service? 
(read out list and Circle all that apply)
1. Peer educators
2. Drop-in –Centers
3. Mobile Outreach
4. TV/Radio
5. Text Messaging
6. Facebook, 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 217
7. Twitter, 
8. WhatsApp
9. Email
10. Web Portal
11. Other (Specify) 
…………………………………………………
………..
99 Don’t Know
• 88 Refused
If there is a service to provide HIV and 
AIDS information to Key Populations in 
Ghana, what are the three (3) key 
areas that you would like to receive 
information on? (circle maximum of 
three)
1. General HIV Prevention/Risk 
Reduction (A, B, C)
2. HTC
3. Condoms Availability 
4. PMTCT 
5. ART 
6. Lubricants 
7. STIs
8. STI referral 
9. Link to Service Providers
10. Other (specify) 
…………………………………………………
………..
99 Don’t Know
 88 Refused
5
6
121. In general how often do you use the 
internet?
Circle one
7 Always
8 Sometimes
9 Rarely 
10 Never
99 Don’t Know
88 Refused
•
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 218
Section 2. Service use
In the following section I am going to ask you general questions about your knowledge and use of particular health 
services available in your area. 
No. Question Response Skip
205 Have you heard of female sex worker 
peer health educators?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
205.
206 IF YES: In general, are the things you 
have heard about peer health 
educators:
Circle one
5 Very positive 
6 Somewhat positive
7 Somewhat negative
8 Very negative
100 Don’t Know
89 Refused
207 In general, what have you heard about 
peer educators?
3 Specify______________________________
4 ___________________________________
101 Don’t Know
102
89 Refused
208 Why don’t you use the services of FSW 
peer educators in your area?
Circle all that apply
8. Do not know how to contact/find 
one
9. Am afraid people will find out I am a 
sex worker
10. Am afraid my services/information 
won’t be kept confidential
11. Do not need peer educator services
12. Too busy/not enough time
13. Other 
(specify):___________________
99 Don’t know
89 Refused to answer
The next several questions are going to ask you about services provided by mobile outreach. By mobile 
outreach, I mean a party or other event that is held not at a drop-in center and designed specifically to provide 
information and services to sex workers.
No. Question Response Skip
209 Have you heard of services being 
provided by mobile outreach staff?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
216.
210 In general, are the things you have 1 Very positive
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 219
heard about the services provided 
by mobile outreach staff:
Circle one
2 Somewhat positive
3 Somewhat negative 
4 Very negative
99 Don’t Know
88 Refused
211 In general, what have you heard 
about the services provided by 
mobile outreach staff?
1 Specify______________________________
______
2 ___________________________________
_______
99 Don’t Know
88 Refused
212 Why have you, personally, not used 
services provided by mobile 
outreach staff? 
1. Too busy/no time
2. No need for services offered
3. Afraid sex work will become known
4. Hours of outreach are inconvenient
5. Lack of transport
6. Other(specify)____________________
________________________________
________________________________
Now imagine that you wanted to receive information and services about to help reduce your risk of HIV. How 
important would the following aspects of services be to you, personally?
213 The hours are convenient.
Circle one
1 Very important
2 Somewhat important
3 Not important
4 Not important at all
99 Don’t Know
88 Refused
214 Services are low-cost or free.
Circle one
1 Very important
2 Somewhat important
3 Not important
4 Not important at all
99 Don’t Know
88 Refused
215 Location is convenient.
Circle one
1 Very important
2 Somewhat important
3 Not important
4 Not important at all
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 220
216 Location is near public 
transportation.
Circle one
1 Very important
2 Somewhat important
3 Not important
4 Not important at all
99 Don’t Know
88 Refused
217 Staff are friendly
Circle one
1 Very important
2 Somewhat important
3 Not important
4 Not important at all
99 Don’t Know
88 Refused
218 Staff are professional.
Circle one
1 Very important
2 Somewhat important
3 Not important
4 Not important at all
99 Don’t Know
88 Refused
219 Staff are female sex workers
Circle one
1 Very important
2 Somewhat important
3 Not important
4 Not important at all
99 Don’t Know
88 Refused
220 Staff won’t judge me
Circle one
1 Very important
2 Somewhat important
3 Not important
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 221
4 Not important at all
99 Don’t Know
88 Refused
221 In the past 12 months, have you 
been screened for a sexually 
transmitted infection other than 
HIV?
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
222 If yes, where was the last place that 
you were screened for a sexually 
transmitted infection other than 
HIV?
Circle one
1 Government health facility
2 Private clinic/Doctor
3 Other (Specify)_________________
99 Don’t Know
88 Refused
223 In the last 12 months have you 
received family planning services?
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
If no skip to 
221
224 If yes, where was the last place you 
received family planning services?
 1 Government health facility
 2 Private clinic/Doctor
 3 Other (Specify)_________________
99 Don’t Know
88 Refused
225 In the last 12 months have you 
received any pregnancy-related 
services including ANC, PMTC, or 
postabortion care?
 1 Yes, more than once
 2 Yes, one time
 3 No
99 Don’t Know
88 Refused
If no skip to 
227
226. If yes, where is the last place you 
received family planning services?
1 Government health facility
 2 Private clinic/Doctor
 3 Other (Specify)_________________
99 Don’t Know
 88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 222
Section 3. HIV related attitudes and beliefs 
In the next section we are going to talk a little more about your thoughts and opinions about HIV. 
People have many feelings about HIV and there are no right or wrong answers to these questions. 
No. Question Response Skip
301 Please indicate whether you agree or disagree with the following statements.
301a I would be ashamed if someone in my 
family had HIV
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
301b A person with HIV/AIDS should be 
allowed to work with other people
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
301c People with HIV should be allowed to 
participate in social events in this 
community
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
301d People with AIDS should be isolated 
from other people
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
227 In the last 12 months have you 
received any rape-related medical 
care?
 1 Yes, more than once
2 Yes, one time
3No
99 Don’t Know
88 Refused
If no skip to 
301
228 If yes, where was the last place you 
received rape-related medical 
care?
3 Government health facility
 2 Private clinic/Doctor
 3 Other (Specify)_________________
99 Don’t Know
 88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 223
301e People who have HIV/AIDS should be 
treated the same as everyone else
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
301f People living with HIV/AIDS in this 
community should be treated the same 
by health care professionals as people 
with other illnesses
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
301g People talk badly about people living 
with or thought to be living with HIV to 
others.
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
301h People living with or thought to be 
living with HIV lose standing or respect 
in their family or community
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
318 Would you be willing to share a meal 
with a person you knew had HIV or 
AIDS?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
319 If a male relative became ill with HIV 
would you be willing to care for him in 
your household?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
320 If a female relative became ill with HIV 
would you be willing to care for her in 
your household?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
321 If a student has HIV but is not sick, 
should he or she be allowed to 
continue attending school?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
322 If a teacher has HIV but is not sick, 
should he or she be allowed to 
continue attending school?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 224
323 If you knew a shopkeeper or food 
seller had the HIV virus, would you buy 
food from them?
Circle one
5 Yes
6 No
100 Don’t Know
89 Refused
324 If you knew a member of your 
community, such as a neighbor, was 
infected with HIV of had AIDS, do you 
think he or she should be allowed to 
continue his or her community 
activities?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
325 If a member of your family became ill 
with HIV, would you want it to remain 
a secret?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
326 Do you know anyone who is HIV 
positive?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
If No, SKIP to 40
IF YES to 309: In the past year, do you know someone that has had the following things happen to them because they have 
HIV or AIDS?
327 Excluded from social gathering
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
328 Lost customers to buy their produce or 
goods or lost a job
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
329 Had property taken away
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
330 Abandoned by their family or sent away
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
331 Abandoned by their spouse or partner
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
332 Teased or sworn at
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
333 Lost respect or standing in their family or 
community
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
334 Gossiped about
Circle one
1 Yes
2 No
99 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 225
88 Refused
Section 4. Sex Work
Thank you! In the next section, I would like to talk to you more about your involvement in sex work. 
No. Question Response Skip
413 At what age did you start sex work? 4 _____Years old
5 Don’t Know
6 Refused
414 Who introduced you to sex work?
Circle one
6 Mother
7 Father
8 Other relative
9 Friend
10 Boyfriend/Spouse
11 Other 
(Specify)_________________________
100 Don’t Know
89 Refused
415 Where do you find most of your 
clients?
Circle one
6 Home
7 Hotel/Guest house /Lodge
8 Bar/Nightclub
9 Street
10 Other 
(Specify)_________________________
100 Don’t Know
89 Refused
416 Where do you usually take your 
clients for sex?
Circle one
6 Home
7 Hotel/Guesthouse/lodge
8 Bar/Nightclub
9 Car/vehicle
10 Other 
(Specify)_________________________
100 Don’t Know
89 Refused
417 How do your clients usually pay you?
Circle one
4 In cash
5 In kind (clothing, food, shelter)
6 Both
100 Don’t Know
89 Refused
418 On average, how much do you earn a 
week from sex work?
2 ________________GHC
100 Don’t Know
89 Refused
419 Other than sex work, do you have 
another means of earning money?
Circle one
3 No
4 Yes
100 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 226
89 Refused
420 How many people did you have sex 
with in the past week?
Circle one
2 ___________ people
100 Don’t Know
89 Refused
421 Of all the people you had sex with in 
the past week, how many were:
(FILL IN ALL AS APPROPRIATE)
6 ______Paying one-time clients
7 ______Paying regular clients
8 ______One-time non-paying partners
9 ______Spouse/lover/boyfriend
10 ______Other (specify) 
_______________________
100 Don’t Know
89 Refused
422 In general, paying one-time clients 
are:
Circle one
8 1-5 years younger than me
9 6-10 years younger than me
10 More than 10 years younger than me
11 Same age as me 
12 1-5 years older than me
13 6-10 years older than me
14 More than 10 years older than me
100 Don’t Know
88 Refused
423 In general, paying regular clients are:
Circle one
8 1-5 years younger than me
9 6-10 years younger than me
10 More than 10 years younger than me
11 Same age as me 
12 1-5 years older than me
13 6-10 years older than me
14 More than 10 years older than me
100 Don’t Know
89 Refused
424 In general, non-paying one-time 
partners are:
Circle one
8 1-5 years younger than me
9 6-10 years younger than me
10 More than 10 years younger than me
11 Same age as me 
12 1-5 years older than me
13 6-10 years older than me
14 More than 10 years older than me
100 Don’t Know
89 Refused
413. My spouse, lover, or boyfriend is:
Circle one
9 1-5 years younger than me
10 6-10 years younger than me
11 More than 10 years younger than me
12 Same age as me 
13 1-5 years older than me
14 6-10 years older than me
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 227
15 More than 10 years older than me
16 I do not have a spouse, lover, or boyfriend
100 Don’t Know
89 Refused
No. Question Response Skip
414 The last time you had vaginal 
intercourse with a paying partner, 
did you use a condom?
Circle one
3 Yes
4 No
100 Don’t remember
89 Refused
415 The last time you had vaginal 
intercourse with a non-paying 
partner, did you use a condom?
Circle one
3 Yes
4 No
100 Don’t remember
89 Refused
416 Have you ever had anal sex?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
If no skip to 
419
417 The last time you had anal sex with a 
paying partner, did you use a 
condom?
Circle one
3 Yes
4 No
100 Don’t remember
89 Refused
418 The last time you had anal sex with a 
non-paying partner, did you use a 
condom?
Circle one
3 Yes
4 No
100 Don’t remember
89 Refused
419 Have you been treated poorly 
because you are a sex worker?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
If No, SKIP to 50
420 IF YES to 232: By whom have you 
been treated poorly because you are 
a sex worker? 
CIRCLE ALL THAT APPLY
(PROBE, DO NOT READ OUT OPTIONS
8 Family
9 Friends
10 Health care workers
11 Teacher
12 Stranger
13 Shop keeper
14 Other 
(Specify)_________________________
100 Don’t Know
89 Refused
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 228
Section 5. Violence
For the following questions, think only about your main or most recent spouse, lover, or boyfriend. If non-paying partner, ski 
to 511
No. Question Response Skip
525 My partner explained his side or suggeste 
a compromise for a disagreement with m
Circle one
5 Never
6 Not in past year, but it did happen befor
 e 
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
If non-paying 
partner, skip to 
511
526 My partner insulted or swore or shouted 
yelled at me
Circle one
5 Never
6 Not in past year, but it did happen before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
527 I had a sprain, bruise, or small cut, or 
felt pain the next day because of a 
fight with my partner
Circle one
5 Never
6 Not in past year, but it did happen before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
•
528 My partner showed respect for, or 
showed that he cared about my feeling 
about an issue we disagreed on
Circle one
5 Never
6 Not in past year, but it did happen before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
529 My partner pushed, shoved, or slapped 
me
Circle one
5 Never
6 Not in past year, but it did happen before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
530 My partner punched or kicked or beat￾me-up
Circle one
5 Never
6 Not in past year, but it did happen before
 
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
531 My partner destroyed something 
belonging to me or threatened to hit me
Circle one
5 Never
6 Not in past year, but it did happen before
7 Once in past year 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 229
8 More than once in past year
100 Don’t Know
89 Refused
532 I went see a doctor or needed to see a 
doctor because of a fight with my partne
Circle one
5 Never
6 Not in past year, but it did happen before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
533 My partner used force (like hitting, holdin 
down, or using a weapon) to make me 
have sex
Circle one
5 Never
6 Not in past year, but it did happen before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
534 My partner insisted on sex when I did 
not want to or insisted on sex without 
a condom (but did not use physical 
force)
Circle one
5 Never
6 Not in past year, but it did happen before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
NOW I WANT TO TALK TO YOU ABOUT YOYR PAYING PARTNERS 
535 A paying partner insulted or swore or 
shouted or yelled at me
Circle one
5 Never
6 Not in past year, but it did happen before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
536 I had a sprain, bruise, or small cut, or felt 
pain the next day because of a fight with 
paying partner
Circle one
5 Never
6 Not in past year, but it did happen before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
537 A paying partner pushed, shoved, or 
slapped me
Circle one
5 Never
6 Not in past year, but it did happen before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
538 A paying partner punched or kicked or 
beat-me-up
Circle one
5 Never
6 Not in past year, but it did happen before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
539 A paying partner destroyed something 5 Never
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 230
belonging to me or threatened to hit 
me
Circle one
6 Not in past year, but it did happen before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
540 I went to see a doctor or needed to see 
a doctor because of a fight with a 
paying partner
Circle one
5 Never
6 Not in past year, but it did happen before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
541 A paying partner used force (like hitting, 
holding down, or using a weapon) to mak 
me have sex
Circle one
5 Never
6 Not in past year, but it did happen before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
542 A paying partner insisted on sex when I 
did not want to or insisted on sex 
without a condom (but did not use 
physical force)
Circle one
5 Never
6 Not in past year, but it did happen before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
543 During the last 12 months, have you ever 
avoided arrest by providing a police offic 
with a sexual favor?
Circle one
5 No
6 Yes
7 99Don’t Know
8 88Refused
If No, SKIP to 52
544 IF Yes to 519: How often in the last 12 
months have you avoided arrest by 
providing a police officer with a sexual 
favor?
Circle one
5 Often
6 Sometimes
7 Rarely
8 Never
100 Don’t Know
89 Refused
545 During the last 12 months, have you been 
forced to not use condoms during sex?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
If No, SKIP to 52
546 IF YES to 521: who forced you to not use 
condoms during sex?
Circle one
5 Paying one-time client
6 Paying regular client
7 Non-paying spouse, partner, or boyfriend
8 Other 
(Specify)_________________________
100 Don’t Know
89 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 231
547 During the last 12 months, have you been 
beaten or physically abused as a a result 
doing sex work?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
If No, SKIP to 60
548 IF Yes to 523: who beat you or physically 
abused you as a result of doing sex work?
Circle one
6 Paying one-time client
7 Paying regular client
8 Non-paying spouse, partner, or boyfriend
9 Family member
10 Other 
(Specify)_________________________
100 Don’t Know
89 Refused
Section 6. Substance Use
Now I will ask you some questions about your alcohol use. By alcohol use we mean drinking a bottle of beer, a glass of wine, 
shot of spirits, and glass or can of home or local brews.
No. Question Response Skip
615 How often do you have a drink containin 
alcohol?
Circle one
6 Never
7 Once a month or less
8 2-4 times a month
9 2-3 times a week
10 4 or more times a week
100 Don’t Know
89 Refused
If never skip 
to 612
616 How many drinks containing alcohol do 
you have on a typical day when you are 
drinking?
Circle one
6 1 - 2
7 3- 4 
8 5- 6 
9 7– 9 
10 10 or more
100 Don’t Know
89 Refused
617 In the past year how often have you drun 
alcohol before sex?
Circle one
7 Always
8 Sometimes
9 Rarely 
10 Never
11 99Don’t Know
12 88Refused
618 How often do you have 6 or more drinks 
one occasion?
Circle one
8 Never
9 Less than monthly
10 Monthly 
11 Weekly
12 Daily or almost daily
13 99Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 232
14 88Refused
619 How often during the last year have you 
found that you have not been 
able to stop drinking once you 
started?
Circle one
8 Never
9 Less than monthly
10 Monthly 
11 Weekly
12 Daily or almost daily
13 99Don’t Know
14 88Refused
620 How often during the past year have you 
failed to do what was expected 
of you because of drinking?
Circle one
8 Never
9 Less than monthly
10 Monthly 
11 Weekly
12 Daily or almost daily
13 99Don’t Know
14 88Refused
621 How often during the past year did 
you have to use ‘a first drink in the 
morning’ to get yourself going after 
a heavy drinking session?
Circle one
8 Never
9 Less than monthly
10 Monthly 
11 Weekly
12 Daily or almost daily
13 99Don’t Know
14 88Refused
622 How often during the past year have you 
had a feeling of guilt or remorse after 
drinking?
Circle one
8 Never
9 Less than monthly
10 Monthly 
11 Weekly
12 Daily or almost daily
13 99 Don’t Know
14 88 Refused
623 How often during the past year have you 
been unable to remember what happene 
the night before because you had been 
drinking?
Circle one
6 Never
7 Less than monthly
8 Monthly 
9 Weekly
10 Daily or almost daily
100 Don’t Know
89 Refused
624 Have you or someone else been injured 
because of your drinking?
Circle one
6 Never
7 Less than monthly
8 Monthly 
9 Weekly
10 Daily or almost daily
100 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 233
89 Refused
625 Has a relative, friend, doctor, or 
other health worker been concerned abo 
your drinking or suggested 
that you should cut down?
Circle one
6 Never
7 Less than monthly
8 Monthly 
9 Weekly
10 Daily or almost daily
100 Don’t Know
89 Refused
Now I’m going to ask you about the use of other addictive substances such as cocaine, heroin, and other substances that alte
your mood and are not prescribed by a health care professional.
626 READ: Some people have used a range of such substances. Have you ever used any of these substances, 
even once?
612a Cocaine
Circle one
4 Yes, more than once
5 Yes, one time 
6 No 
100 Don’t Know
89 Refused
612b Heroin
Circle one
4 Yes, more than once
5 Yes, one time 
6 No 
100 Don’t Know
89 Refused
612c Marijuana (Weed)
Circle one
4 Yes, more than once
5 Yes, one time 
6 No 
100 Don’t Know
89 Refused
612d Valium
Circle one
4 Yes, more than once
5 Yes, one time 
6 No 
100 Don’t Know
89 Refused
612e Sleeping pills
Circle one
4 Yes, more than once
5 Yes, one time 
6 No 
100 Don’t Know
89 Refused
612f. Other drugs (specify): 
_____________________________
Circle one 
4 Yes, more than once
5 Yes, one time 
6 No 
100 Don’t Know
89 Refused
627 Some people have tried injecting 
drugs using a syringe. Have you injected 
drugs recreationally in the 
last 12 months?
Circle one
4 Yes, more than once
5 Yes, one time 
6 No 
100 Don’t Know
89 Refused
If No, SKIP to 70
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 234
628 If Yes to 613: With how many 
people have you ever shared
needles or syringes?
Circle one
4 None
5 1-2 people
6 or more people
100 Don’t Know
89 Refused
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 235
Section 7. Service Quality
7.1. HIV-related information and risk reduction services
No. Question Response Skip
770 Have you received HIV-related informatio 
and risk reduction counseling in the past 
12 months?
Circle one
4 Yes, more than once
5 Yes, one time 
6 No 
100 Don’t Know
89 Refused
If Yes, SKIP to 70
771 If NO, In your neighborhood, do you 
know a place where people can get 
advice about AIDS and get tested for 
HIV?
Circle one
1 Yes
2 No
99 Don’t Know88 Refused
If No, Skip to 722
772 IF YES: In the past 12 months, where hav 
you received HIV-related information and 
risk reduction counseling?
Circle one
6 Drop-in center
7 Mobile outreach
8 Peer educator
9 Government health facility
10 Other 
(Specify)_________________________
100 Don’t Know
89 Refused
773 Where was the LAST PLACE that you 
received HIV-related information and 
risk reduction counseling?
Circle one
6 Drop-in center
7 Mobile outreach
8 Peer educator
9 Government health facility
10 Other 
(Specify)_________________________
100 Don’t Know
89 Refused
The following questions refer only to the LAST TIME you received HIV-related information and risk reduction counseling.
774 The last time you received HIV-related 
information and risk reduction 
counseling, how satisfied were you 
with the HIV counseling services?
Circle one
5 Very satisfied
6 Satisfied
7 Not satisfied
8 Very unsatisfied
100 Don’t Know
89 Refused
775 The last time you received HIV-related 
information and risk reduction 
counseling, how professional was the 
staff?
Circle one
5 Very professional 
6 Somewhat professional
7 Somewhat unprofessional
8 Very unprofessional
100 Don’t Know
89 Refused
776 The last time you received HIV-related 
information and risk reduction 
counseling, how friendly was the staff?
7 Very friendly
8 Somewhat friendly
9 Not friendly
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 236
Circle one
10 Not friendly at all
11 Don’t Know
12 Refused
777 Would you use these HIV risk reduction 
counseling services again?
Circle one
5 Yes
6 No
7 Don’t Know
8 Refused
778 Would you recommend these HIV risk 
reduction counseling services to a 
friend?
Circle one
5 Yes
6 No
7 Don’t Know
8 Refused
779 Now think about the last time you 
received HIV risk reduction counseling. 
How much did the risk reduction 
counseling help you?
Circle one
6 Helped a lot
7 Helped some
8 Did not help
9 99Don’t Know
10 88Refused
780 How much helpful information did you 
receive?
Circle one
4 A lot of helpful information
5 A little helpful information
6 No helpful information
100 Don’t Know
89 Refused
781 When you saw the counselor, who 
talked the most?
Circle one
4 I talked the most
5 The counselor talked the most
6 We talked the same amount
100 Don’t Know
89 Refused
782 When you saw the counselor, who 
listened the most?
Circle one
4 I listened the most
5 The counselor listened the most
6 We listened the same amount
100 Don’t Know
89 Refused
783 To what extent did the counselor 
answer your questions and concerns 
about HIV?
Circle one
4 A lot
5 Some
6 Not at all
100 Don’t Know
89 Refused
784 To what extent did the counselor help 
you think about what you were doing 
that puts you at risk for getting HIV?
Circle one
4 A lot
5 Some
6 Not at all
100 Don’t Know
89 Refused
785 To what extent did the counselor help 
you make a plan to protect yourself 
from HIV?
Circle one
4 A lot
5 Some
6 Not at all
100 Don’t Know
89 Refused
786 To what extent did the counselor help 4 A lot
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 237
you come up with small steps you can 
take to make your HIV prevention plan 
work?
Circle one
5 Some
6 Not at all
100 Don’t Know
89 Refused
787 Did the counselor tell you about other 
places you could go for help for HIV 
and health care related services?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
788 In your plan to reduce your HIV risk, 
who came up with the ideas what you 
will do?
Circle one
4 I did
5 The counselor
6 We both did
100 Don’t Know
89 Refused
789 How much did the counselor help you 
with your plan to reduce HIV risk?
Circle one
5 A lot
6 Somewhat
7 A little
8 Not at all
100 Don’t Know
89 Refused
790 How much did you help the counselor 
to develop a plan to reduce your HIV 
risk? 
Circle one
5 A lot
6 Somewhat
7 A little
8 Not at all
100 Don’t Know
89 Refused
791 How much did you tell the counselor 
about your sex life and use of drugs?
Circle one
5 A lot
6 Somewhat
7 A little
8 Not at all
100 Don’t Know
89 Refused
722 How can people reduce their risk of contracting HIV/AIDS? DO NOT READ LIST OUT LOUD
Check YES for all mentioned. Check NO for all not mentioned.
722a Use condoms
Circle one
3 Yes
4 No
89
722b Reduce the number of sexual partners
Circle one
3 Yes
4 No
100
89
722c Be faithful to one partner
Circle one
3 Yes
4 No
722d Do not have casual sex
Circle one
3 Yes
4 No
89 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 238
722e Do not have sex
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
722f Avoid contaminated needles
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
722g Avoid contact with infected people
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
722h Other (specify) 
________________________________
__________________________
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
Thank you. Now I would like to ask some additional questions about what you know about HIV.
792 Can a healthy looking person be 
infected with HIV?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
Please indicate whether you agree or disagree with the following statements.
No. Question Response Skip
793 If you kiss someone on the cheek that 
has HIV/AIDS, you might get infected
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
794 If you are coughed or sneezed on by 
someone who has HIV/AIDS, you are 
likely to contract the infection
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
795 I fear I could become infected with HIV 
if I were to be exposed to the sweat of 
a person who has HIV/AIDS
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
796 I fear I could become infected with HIV 
if I were to be exposed to the saliva of 
a person who has HIV/AIDS
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 239
797 I have no risk of getting HIV.
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
798 I am at risk of getting HIV.
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
799 I want to reduce my risk of getting HIV.
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
800 I know ways to reduce my risk.
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
801 I have a plan for how I will reduce my 
risk.
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
802 I like my HIV prevention plan.
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
803 I’m sure I can follow my HIV prevention 
plan.
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree
8 Strongly disagree
100 Don’t Know
89 Refused
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 240
7.2 HIV Testing
No. Question Response Skip
804 In the last 12 months, have you been 
offered an HIV test?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
805 In the last 12 months, have you been 
tested for HIV?
Circle one
4 No
5 Yes, one time
6 Yes, more than once
100 Don’t Know
89 Refused
If Yes, SKIP to 
737.Otherwise 
SKIP to 772
806 IF No to 736, why have you not been 
tested for HIV? 
Do not read list but circle all that are 
mentioned
10 I’m worried that people would find out my test results
11 I don’t know where to get tested.
12 Getting tested is too expensive.
13 The places for HIV testing are too far away.
14 The hours for HIV testing are inconvenient.
15 It’s difficult to get to HIV testing places on public 
transportation.
16 The people that provide HIV testing will treat me 
differently because I am a sex worker.
17 I am not at risk for HIV.HIV is not a serious health 
condition.
18 I am worried that people will treat me poorly if the tes 
result is positive.
100 Don’t Know
89 Refused
SKIP to 738.
807 Was the decision to be tested for HIV 
up to you or were you pressured, 
forced, or unknowingly tested?
6 Yes, it was completely my decision to be tested.
7 It was my decision to be tested, but it was under 
pressure from others
8 I was forced to take an HIV test.
9 I was tested without my knowledge
10 I only found out after the test had been done
100 Don’t Know
89 Refused
808 In your opinion, are FSW hesitant to 
take an HIV test due to fear of 
people’s reaction if the test result is 
positive for HIV?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
809 In the last 12 months, where have you 
been tested for HIV? 
Do not read list but circle all that are 
mentioned
6 Drop-in center
7 Mobile outreach
8 Peer educator
9 Government health facility
10 Other (Specify)_________________________
100 Don’t Know
89 Refused
No. Question Response Skip
810 Where was the last place you were teste 
for HIV?
6 Drop-in center
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 241
Circle one
7 Mobile outreach
8 Peer educator
9 Government health facility
10 Other 
(Specify)_________________________
100 Don’t Know
89 Refused
The following questions refer only to the LAST TIME you were tested for HIV.
811 Overall, how satisfied were you with 
the HIV testing services?
Circle one
5 Very satisfied
6 Satisfied
7 Not satisfied
8 Very unsatisfied
100 Don’t Know
89 Refused
812 The last time you were tested for HIV, 
how professional was the staff?
Circle one
5 Very professional 
6 Somewhat professional
7 Somewhat unprofessional
8 Very unprofessional
100 Don’t Know
89 Refused
813 The last time you were tested for HIV, 
how friendly was the staff?
Circle one
5 Very friendly
6 Somewhat friendly
7 Not friendly
8 Not friendly at all
100 Don’t Know
89 Refused
814 Would you use these HIV testing 
services again?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
815 Would you recommend these HIV 
testing services to a friend?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
Again, for the following questions, think only about the last time you were tested for HIV.
816 Before you were tested for HIV, did the 
counselor explain why you should get 
tested for HIV?
Circle one
3 Yes
4 No 
100 Don’t know
89 Refused
817 Before you were tested for HIV, did the 
counselor explain to you the type of 
test that was used?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
818 Before you were tested for HIV, did the 
counselor explain to you the meaning 
of a positive and negative result?
1 Yes
2 No 
99 Don’t know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 242
Circle one
819 Before you were tested for HIV, did the 
counselor explain to you that if 
managed with antiretroviral therapy 
(ART) and quality clinical care, HIV 
infection may be controlled as a chronic 
condition?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
820 Before you were tested for HIV, did the 
counselor explain to you the test result 
is confidential- that is, no one will know 
the results of your test unless you tell 
them?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
821 Before you were tested for HIV, did the 
counselor explain to you disclosure of a 
positive result is needed to receive 
treatment for HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
822 Before you were tested for HIV, did the 
counselor explain to you that you can 
choose not to get tested and still 
receive all other services that are 
provided?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
Again, for the following questions, think only about the last time you were tested for HIV. 
823 The last time you were tested for HIV, 
were you able to ask questions about 
HIV/AIDS and about getting tested for 
HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
824 The last time you were tested for HIV, 
were you encouraged to ask questions 
about the testing process?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
825 The last time you were tested for HIV, 
did you feel that your confidentiality 
was protected – that is, that no one 
would know that your test result 
unless you told them?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
826 The last time you were tested for HIV, 
how long did you have to wait to 
receive the test results?
Circle one
5 A very long time
6 Somewhat long time
7 Not very long
8 Not long at all
100 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 243
89 Refused
Thank you. Now I would like to ask you some personal questions about your HIV testing. Please 
remember that we have not taken your name and all your responses will be completely confidential. No 
one will ever know what you have told me during this interview. I appreciate your trust and honesty.
827 Do you know the result of your most 
recent HIV test?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
If No, SKIP to 
772.
828 IF YES to 758: Have you told a sexual 
partner the results of your most recent 
HIV test?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
829 IF YES to 758: What was the result of 
your most recent HIV test?
Circle one
3 Positive
4 Negative
100 Don’t Know
89 Refused
If POSITIVE, SK 
to 763.
830 If negative: If you had tested positive, 
would you have sought out treatment 
for HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
If Yes, SKIP 
to 772
831 IF Negative to 760: If you had tested 
positive, why would you have not sought 
out treatment for HIV? 
CIRCLE ALL THAT APPLY
12 I would be worried that people would find out that 
was HIV positive.
13 Treatment for HIV is too expensive.
14 I wouldn’t know where to go to receive treatment f 
HIV.
15 I would be worried that doctors would treat me 
poorly because I am a sex worker.
16 I would be worried that doctors would treat me 
poorly if I were HIV positive.
17 HIV treatment is not effective.
18 The places that provide HIV treatment are too far
away.
19 The places that provide HIV treatment are difficult t 
get to on public transportation.
20 The hours for receiving HIV treatment are 
inconvenient.
21 You have to wait a long time to get an appointment
22 In the past, doctors have treated me poorly because 
am a sex worker.
100 Don’t Know
89 Refused
SKIP to 772
832 If positive: When you received your 
test results, did you receive a referral 
to care, support and treatment?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
If No, SKIP to 
764
833 If yes to 763: Have you contacted the 
referral to receive care, support and 
treatment?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 244
834 IF NO to 764: Why are you not 
receiving treatment for HIV? 
CIRCLE ALL THAT APPLY
13 I am worried that people will find out that I am HIV 
positive.
14 Treatment for HIV is too expensive.
15 I don’t know where to go to receive treatment for 
HIV.
16 I’m worried that doctors will treat me poorly becaus 
I am a sex worker.
17 I’m worried that doctors will treat me poorly becaus 
I am HIV positive.
18 HIV treatment is not effective.
19 The places that provide HIV treatment are too far 
away.
20 The places that provide HIV treatment are difficult t 
get to on public transportation.
21 The hours for receiving HIV treatment are 
inconvenient.
22 You have to wait a long time to get an appointment
23 In the past, doctors have treated me poorly
24 Because I am a sex worker.
100 Don’t Know
89 Refused
835 IF POSITIVE: Are you currently taking 
antiretroviral medications daily for 
HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
836 IF POSITIVE: In the last 12 months, 
have you been fearful of any of the 
following things happening to you – 
whether or not they actually have 
happened to you – because you are 
HIV positive?
Circle all that apply
5 Being gossiped about
6 Being verbally insulted, harassed and/or 
threatened 
7 Being physically harassed and/or threatene
8 Being physically assaulted
100 Don’t Know
89 Refused
837 IF POSITIVE: How often have you felt 
excluded from social gatherings or 
activities because of your HIV status?
Circle one
5 Often
6 Sometimes
7 Rarely 
8 Never
100 Don’t Know
89 Refused
838 IF POSITIVE: How often have you been 
denied health services because of your 
HIV status?
Circle one
5 Often
6 Sometimes
7 Rarely 
8 Never
100 Don’t Know
89 Refused
790 IF POSITIVE: How often have you felt 
gossiped about because of your HIV 
status?
Circle one
5 Often
6 Sometimes
7 Rarely 
8 Never
100 Don’t Know
89 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 245
791 IF POSITIVE In the last 12 months, have 
you experienced any of the following 
feelings because of your HIV status?
Circle all that apply
7 I feel ashamed
8 I feel guilty
9 I blame myself
10 I blame others
11 I have low self-esteem
12 I feel I should be punished
100 Don’t Know
89 Refused
7.3 Quality of condom and lubricant information and distribution services
No. Question Response Skip
792 In the last 12 months, have you 
received condoms, lubricants, or 
information about how to use 
condoms and lubricants to reduce your 
risk of HIV?
Circle one
4 No
5 Yes, one time
6 Yes, more than once
100 Don’t Know
89 Refused
If No, SKIP 
to next 
SECTION –
q770 
793 Where is the last place you received 
condoms, lubricants, or information 
about how to use condoms and 
lubricants to reduce your risk of HIV?
Circle one
6 Drop-in center
7 Mobile outreach
8 Peer educator
9 Government health facility
10 Other 
(Specify)_________________________
100 Don’t Know
89 Refused
794 Overall, how professional was the 
staff?
Circle one
5 Very professional 
6 Somewhat professional
7 Somewhat unprofessional
8 Very unprofessional
100 Don’t Know
89 Refused
795 Overall, how friendly was the staff?
Circle one
5 Very friendly
6 Somewhat friendly
7 Not friendly
8 Not friendly at all
100 Don’t Know
89 Refused
The LAST TIME you received condoms, lubricants, or information about how to use condoms and 
lubricants to reduce your risk of HIV,
770 What recommendations would you give to someone who is developing HIV prevention services 
specifically for sex workers?
_______________________________________________________________________
_______________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 246
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
771 Is there anything else that I haven’t asked you about providing HIV prevention services to FSW that y 
would like to share with me?
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
A Performance Evaluation of Ghana’s HIV Prevention Program for At-Risk Populations
MSM Client Service Quality Survey
Date:_______________________ 
Study ID:____________________
Venue code:______________________
 
Geographic region:________________________
Specific region:________________________
Neighborhood:________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 247
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 248
PARTICIPANT CONSENT FORM 
Title: A Performance Evaluation of Ghana’s HIV Prevention Program for At-Risk Populations
Principal Investigator: Amos Laar, PhD, 
Department of Population, Family and Reproductive Health, School of Public Health, College of Health 
Sciences, University of Ghana, Box Lg 13 Legon, 0244982176, alaar@ug.edu.gh or aklaar@yahoo.com 
General Information about Research 
You are being asked to participate in a research study to learn more about the experiences of certain key 
populations with HIV prevention services in Ghana. The purpose of the research is to learn: 1) how these 
populations have used HIV prevention services in Ghana, 2) the quality of these services, 3) how satisfied 
these populations are with these services and 4) what barriers exist to using HIV prevention services. Your 
participation in this research should take approximately 60-90 minutes. You will be asked to participate in a 
one-on-one interview and/or group discussion about your experience using HIV prevention services. Your 
participation will help improve HIV prevention services for both the key populations and the general 
population in Ghana.
Possible Risks and Discomforts
The risks of your participation are minimal. The main risk resulting from your participation is feeling 
uncomfortable answering some of the questions. Your participation is completely voluntary. Should you feel 
uncomfortable answering any question(s), you can choose to skip that question(s) and continue with the 
interview. You are also welcome to end the interview at any time. 
Possible Benefits
You are not likely to personally benefit from participating in this research study. However, your participation 
will help improve HIV prevention services for both the key populations and the general population in Ghana.
Alternatives to Participation
There are no alternatives to participation. The only alternative to participation is to simply not participate.
Confidentiality
All information that you share with the interviewer will be protected to the best of our ability. You will not 
be named in any reports. Any documents with identifying information will be kept in a locked filing cabinet 
for 5 years after the study is completed and then will be destroyed. Any identifying information that is 
stored electronically (i.e., on a computer) will be kept on a secure computer and will require a password to 
access. Only staff who work on this research project will have access to your research information.
Compensation
You will be given 10 Ghana Cedis for participating in a survey interview or group discussion. This 
compensation will be provided to you in cash at the end of the interview. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 249
Additional Cost 
There are no additional costs that may result from participation in this research.
Voluntary Participation and Right to Leave the Research
Your participation in the survey interview or focus group is completely voluntary. You have the right to not 
participate in this research or to end your participation at any point in time. You also have the right to not 
answer any questions that you choose not to answer. Not participating or withdrawing from this research 
will not have any negative consequences and will not impact your ability to receive HIV prevention services.
Contacts for Additional Information
If you have any questions about the research, please contact Amos Laar, PhD, 
Department of Population, Family and Reproductive Health, School of Public Health, College of Health 
Sciences, University of Ghana, Box Lg 13 Legon, 0244982176, alaar@ug.edu.gh or aklaar@yahoo.com 
Your rights as a Participant
This research has been reviewed and approved by the Institutional Review Board of Noguchi Memorial 
Institute for Medical Research (NMIMR-IRB). If you have any questions about your rights as a research 
participant you can contact the IRB Office between the hours of 8am-5pm through the landline 0302916438 
or email addresses: nirb@noguchi.mimcom.org or HBaidoo@noguchi.mimcom.org . You may also contact 
the chairman, Rev. Dr. Ayete-Nyampong through mobile number 0208152360 when necessary.
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 250
VOLUNTEER AGREEMENT
The above document describing the benefits, risks and procedures for the research title (name of research)
has been read and explained to me. I have been given an opportunity to have any questions about the 
research answered to my satisfaction. I agree to participate as a volunteer.
ORAL CONSENT VERIFICATION:
I was present while the benefits, risks and procedures were read to the volunteer. All questions were 
answered and the volunteer has agreed to take part in the research.
_______________________ __________________________________________
Date Name and signature of witness
I certify that the nature and purpose, the potential benefits, and possible risks associated with participating 
in this research have been explained to the above individual.
_______________________ _____________________________________
Date Name Signature of Person Who Obtained Consent 
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 251
Section 1. Demographics
First, I would like to ask a few background questions, just to learn more about you.
No. Question Response Skip
101. What nationality are you?
Circle one
13 Ghana
14 Nigeria
15 Togo
16 Ivory Coast
17 Burkina Faso
18 Other 
(Specify)_________________________
101 Don’t Know
90 Refused
If not 1 skip to 
103
102. What ethnicity are you?
Circle one
19 Akan
20 Ewe
21 Ga Adangbe
22 Hausa
23 Krobo
24 Mole/Dagbani
25 Grusi
26 Gruma
27 Other 
(Specify)_________________________
101 Don’t Know
90 Refused
103. How old were you on your last 
birthday?
Circle one
______________Years
99 Don’t Know
88 Refused
104. What is your marital status?
Circle one
16 Living with spouse
17 Separated
18 Divorced
19 Widowed
20 Never Married
99 Don’t Know
88 Refused
If 1 skip to 106
105. Do you currently live with a boyfriend 
or partner who is not a spouse? 
Circle one
 1 Yes
 2 No
101 Don’t Know
90 Refused
106. What is your religion?
Circle one
11 Christian
12 Muslim
13 Traditional
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 252
14 Other 
(Specify)_________________________
15 No religion
101 Don’t Know
90 Refused
107. Have you ever attended school?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 10
108. What is the highest level of school you 
have attended?
Circle one
9 Primary
10 Middle/Junior Secondary/JHS
11 Senior 
Secondary/SHS/Technical/Vocational
12 Higher/Tertiary
101 Don’t Know
90 Refused
109. How many living children do you have?
Circle one
Number of children______________
99 Don’t Know
88 Refused
110. Do you have a cell phone?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If Yes, SKIP to 11
111. IF NO: Do you have access to a cell 
phone?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
112. How often do you use a cell phone?
Circle one
9 Always
10 Sometimes
11 Rarely
12 Never
101 Don’t Know
90 Refused
113. In the past 12 months, have you ever 
received health information – such as 
information about how to reduce your 
risk of HIV - by text message?
Circle one
7 No
8 Yes, one time
9 Yes, more than once
99 Don’t Know
88 Refused
If No, SKIP to 11
114. IF YES: How useful was the health 
information that you received by text 
message?
Circle one
9 Very useful
10 Somewhat useful
11 Not that useful
12 Not useful at all
101 Don’t Know
90 Refused
115. Have you ever heard of the Text me! 
Flash me! Call Me! Helpline? 
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP t 
119.
116. IF YES: In the past 12 months, have you 7 No If No, SKIP t 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 253
used the Text me! Flash me! Call Me! 
Helpline? 
Circle one
8 Yes, one time
9 Yes, more than once
99 Don’t Know
88 Refused
118.
117. IF USED: How satisfied were you with 
the Text me! Flash me! Call Me! 
Helpline? 
Circle one
11 Very satisfied
12 Somewhat satisfied
13 Neither satisfied nor dissatisfied
14 Somewhat dissatisfied
15 Very dissatisfied
99 Don’t Know
88 Refused
SKIP to 119.
118. IF HEARD OF, BUT NOT USED: In 
general, are the things you have heard 
about Text me! Flash me! Call Me! 
Helpline: 
Circle one
11 Very positive
12 Somewhat positive
13 Neither positive nor negative
14 Somewhat negative
15 Very negative
99 Don’t Know
88 Refused
119. In the past 12 months, have you used 
the internet to get information about 
HIV prevention specifically for men 
who have sex with men?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
120. How often do you use the internet?
Circle one
11 Always
12 Sometimes
13 Rarely 
14 Never
99 Don’t Know
88 Refused
121. How often do you use the internet to 
get information about HIV prevention 
and risk reduction?
Circle one
9 Often
10 Sometimes
11 Rarely 
12 Never
99 Don’t Know
88 Refused
Section 2. Service use
2.1 Peer educators 
No. Question Response Skip
201 In the last 12 months, have you 
been in contact with a peer health 
educator?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If Yes, SKIP 
to 204.
202 IF NO to 201: Have you heard of 
peer health educators?
1 Yes
2 No
If No, SKIP 
to 218.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 254
Circle one 99 Don’t Know
88 Refused
203 IF YES to 202: In general, are the 
things you have heard about peer 
health educators:
Circle one
1 Very positive 
2 Somewhat positive
3 Neither positive nor negative
4 Somewhat negative
5 Very negative
99 Don’t Know
88 Refused
204. IF YES to 201: Which organization 
was sponsoring these peer 
educators?
1 Specify 
_____________________________
99 Don’t Know
88 Refused
205 IF YES to 201: How many times 
have you been in contact with a 
peer educator in the past 12 
months?
Circle one
1 Once
2 More than once
3 About every 3 months
4 About once a year
99 Don’t Know
88 Refused
206 In the last 12 months, have you ever received the following services from a peer educator?
206a HIV counseling and testing
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206b HIV risk reduction counseling
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206c Screening for sexually transmitted 
infections
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206d Referral for treatment for sexually 
transmitted infections
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206e Referral for primary health care
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206f Referral for mental health services
Circle one
1 Yes, more than once
2 Yes, one time
3 No
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 255
99 Don’t Know
88 Refused
206g Referral for drug/alcohol addiction
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206h Referral for legal assistance
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206i Referral for Antiretroviral therapy
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206j Referral for Sexual assault/Rape 
crisis services 
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
206k Any other referral 
__________________________
(specify)
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
207 In the last 12 months, have you ever received the following items from a peer educator:
207a Condoms
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
207b Lubricants
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
207c Information and materials about 
reducing your risk of HIV
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
208 If you received a referral from a 
peer educator, did you go to the 
place you were referred?
Circle one
1 Yes
2 No
3 Did not receive referral from peer 
educator
99 Don’t Know
88 Refused
If Yes, SKIP 
to 210.
209 IF NO: Why didn’t you go to the 
place you were referred?
1 The place I was referred to was too far 
away.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 256
Do not read list but circle all that 
are mentioned
2 Difficult to get there on public 
transportation.
3 The hours are inconvenient.
4 I couldn’t get an appointment.
5 I had to wait a long time for an 
appointment.
6 The services are too expensive.
7 I lost the referral information.
8 I don’t need the referral services.
9 I’ve heard negative comments about the 
referral.
10 Worried that the staff will treat me poorly 
because I have sex with men.
11 Worried that my privacy won’t be 
protected.
12 Worried that people will know I have sex 
with men if I go there.
13 Worried that people will think I have HIV if I 
go there.
14 Other (specify) 
__________________________
210 If you received a referral from a 
peer educator, did the peer 
educator follow up with you to see 
if you used the referral?
Circle one
1. Yes
2. No
3. Did not receive referral from peer 
educator
99 Don’t Know
88 Refused
If No, SKIP 
to 212.
211 IF YES: How did the peer educator 
follow up with you?
Circle one
1 In person
2 Phone call
3 Text message
4 Email
5 Other 
(specify)_________________________
__
99 Don’t Know
88 Refused
For the following questions, think about the LAST TIME you had contact with a peer educator.
212 Overall, how satisfied were you 
with the services provided by the 
peer-educator?
Circle one
1 Very satisfied
2 Somewhat satisfied
3 Somewhat unsatisfied
4 Very unsatisfied
99 Don’t Know
88 Refused
213 The LAST TIME you had contact 
with a peer educator, how 
attentive was the peer educator?
Circle one
1 Very attentive
2 Somewhat attentive
3 Somewhat inattentive
4 Very inattentive
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 257
214 The LAST TIME you had contact 
with a peer educator, how 
responsive was the peer educator?
Circle one
1 Very responsive
2 Somewhat responsive
3 Somewhat unresponsive
4 Very unresponsive
99 Don’t Know
88 Refused
89 Missing
215 The LAST TIME you had contact 
with a peer educator, how friendly 
was the peer educator?
Circle one
1 Very friendly
2 Somewhat friendly
3 Not friendly
4 Not friendly at all
99 Don’t Know
88 Refused
216 Would you receive services from a 
peer educator again?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
217 Would you recommend peer 
educators to a friend?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
2.2 Drop-in centers
No. Question Response Skip
218 In the last 12 months, have you 
been to a drop-in center?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If Yes, SKIP 
to 220.
219 IF NO: Have you heard of drop-in 
centers?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP 
to250.
220 IF YES: In general, how positive or 
negative are the things you have 
heard about drop-in centers:
Circle one
1 Very positive 
2 Somewhat positive
3 Somewhat negative
4 Very negative
99 Don’t Know
88 Refused
221 IF YES: Which drop-in center? 1 Specify 
_____________________________
99 Don’t Know
88 Refused
222 IF YES: How many times have you 
been to a drop-in center in the past 
1 Once
2 More than once
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 258
12 months?
Circle one
3 About every 3 months
4 About once a year
99 Don’t Know
88 Refused
223 In the last 12 months, have you ever received the following services from a drop-in center?
No. Question Response Skip
223a HIV counseling and testing
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223b HIV risk reduction counseling
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223c Screening for sexually transmitted 
infections
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223d Referral for treatment for sexually 
transmitted infections
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223e Referral for primary health care
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223f Referral for mental health services
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223g Referral for drug/alcohol addiction 1 Yes, more than once
2 Yes, one time
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 259
Circle one 3 No
99 Don’t Know
88 Refused
223h Referral for legal assistance
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223i Referral for Antiretroviral therapy
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223j Sexual assault/Rape crisis services 
or referral 
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
223k Any other referral 
(specify)______________________
___________________
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
224 In the last 12 months, have you ever received the following items at a drop-in center:
224a Condoms
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
224b Lubricants
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
224c Information and materials about 
reducing your risk of HIV
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
225 If you received a referral from a 
drop-in center, did you go to the 
place you were referred?
Circle one
1 Yes
2 No
3 Did not receive referral from drop-in 
center
99 Don’t Know
88 Refused
If Yes, SKIP 
to 227.
226 IF NO: Why didn’t you go to the 
place you were referred?
1 The place I was referred to was too far 
away.
2 It’s difficult to get there on public 
transportation.
3 The hours are inconvenient.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 260
4 I couldn’t get an appointment.
5 I had to wait a long time for an 
appointment.
6 The services are too expensive.
7 I lost the referral information.
8 I don’t need the referral services.
9 I’ve heard negative comments about the 
referral.
10 I’m worried that the staff will treat me 
poorly because I have sex with men.
11 I’m worried that my privacy won’t be 
protected.
12 I’m worried that people will know I have 
sex with men if I go there.
13 I’m worried that people will think I have 
HIV if I go there.
14 Other (specify) 
________________________
227 If you received a referral from a 
drop-in center, did staff from the 
drop-in center follow up with you 
to see if you used the referral?
Circle one
1 Yes
2 No
3 Did not receive referral from drop-in 
center
99 Don’t Know
88 Refused
If No, SKIP to 
229.
228 IF YES: How did the drop-in center 
staff follow up with you?
Circle one
1 In person
2 Phone call
3 Text message
4 Email
5 Other (specify) 
_____________________________
99 Don’t Know
88 Refused
For the following questions, think about the LAST TIME you went to a drop-in center educator.
229 Overall, how satisfied were you 
with the services provided at the 
drop-in center?
Circle one
1 Very satisfied
2 Somewhat satisfied
3 Somewhat unsatisfied
4 Very unsatisfied
99 Don’t Know
88 Refused
230 The LAST TIME you went to a drop￾in center, how attentive was the 
staff?
Circle one
1 Very attentive
2 Somewhat attentive
3 Somewhat inattentive
4 Very inattentive
99 Don’t Know
88 Refused
231 The LAST TIME you went to a drop￾in center, how responsive was the 
staff?
1 Very responsive
2 Somewhat responsive
3 Somewhat unresponsive
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 261
Circle one 4 Very unresponsive
99 Don’t Know
88 Refused
232 The LAST TIME you went to a drop￾in center, how friendly was the 
staff?
Circle one
1 Very friendly
2 Somewhat friendly
3 Not friendly
4 Not friendly at all
99 Don’t Know
88 Refused
233 In general, how welcome did you 
feel at the center?
Circle one
1 Very welcome
2 Somewhat welcome
3 Somewhat unwelcome
4 Very unwelcome
99 Don’t Know
88 Refused
234 Have you ever felt that you were 
treated unfairly at the drop-in 
center?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
235 In general, how respectful was the 
staff at the center?
Circle one
1 Very respectful
2 Somewhat respectful
3 Somewhat disrespectful
4 Very disrespectful
99 Don’t Know
88 Refused
236 In general, how professional was 
the staff at the center?
Circle one
1 Very professional 
2 Somewhat professional
3 Somewhat unprofessional
4 Very unprofessional
99 Don’t Know
88 Refused
237 In general, how knowledgeable was 
the staff about resources at the 
center?
Circle one
1 Very knowledgeable 
2 Somewhat knowledgeable
3 Not very knowledgeable
4 Not knowledgeable at all
99 Don’t Know
88 Refused
238 In general, how knowledgeable was 
the staff about resources in the 
community?
Circle one
1 Very knowledgeable 
2 Somewhat knowledgeable
3 Not very knowledgeable
4 Not knowledgeable at all
99 Don’t Know
88 Refused
239 Did you feel that your privacy was 
maintained at all times?
Circle one
1 Yes
2 No
99 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 262
88 Refused
240 To what extent did the services you 
received at the center help you 
reduce your risk of HIV?
Circle one
1 A lot
2 Somewhat
3 A little
4 Not at all
99 Don’t Know
88 Refused
241 To what extent did the staff listen 
to your needs and concerns?
Circle one
1 A lot
2 Somewhat
3 A little
4 Not at all
99 Don’t Know
88 Refused
242 To what extent did you feel like the 
staff judged you?
Circle one
1 A lot
2 Somewhat
3 A little
4 Not at all
99 Don’t Know
88 Refused
243 To what extent were the 
postersand photographs at the 
center welcoming?
Circle one
1 A lot
2 Somewhat
3 A little
4 Not at all
99 Don’t Know
88 Refused
244 How safe did you feel at the 
center?
Circle one
1 Very safe
2 Somewhat safe
3 Somewhat unsafe
4 Very unsafe
99 Don’t Know
88 Refused
245 How clean is the center?
Circle one
1 Very clean
2 Somewhat clean
3 Somewhat unclean
4 Very unclean
99 Don’t Know
88 Refused
246 Were you asked to fill out a 
feedback form to improve the 
quality of services at the center?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If no skip to 
248
247 Did you fill out a feedback form to 
improve the quality of services at 
the center?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 263
248 Would you receive services at a 
drop-in center again?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
249 Would you recommend the drop-in 
center to a friend?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
2.3 Mobile outreach
The next several questions are going to ask you about services provided by mobile outreach. By mobile 
outreach, I mean a party or other event that is held not at a drop-in center and designed specifically to provide 
information and services to MSMs.
No. Question Response Skip
250 In the last 12 months, have you 
received services from mobile 
outreach staff?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
253.
251 IF YES: Where? 1 (specify)_______________________
99 Don’t Know
88 Refused
252 IF YES: How many times have you 
received services from mobile 
outreach staff in the past 12 
months?
Circle one
1 Once
2 More than once
3 About every 3 months
4 About once a year
99 Don’t Know
88 Refused
SKIP to 254.
253 IF NO: Have you heard of services 
being provided by mobile outreach 
staff?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP 
to301.
254 In general, how positive or 
negative are the things you have 
heard about the services provided 
by mobile outreach staff:
Circle one
1 Very positive
2 Somewhat positive
3 Somewhat negative 
4 Very negative
99 Don’t Know
88 Refused
255 In the last 12 months, have you ever received the following services from mobile outreach staff?
255a HIV counseling and testing
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 264
255b HIV risk reduction counseling
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255c Screening for sexually transmitted 
infections
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255d Referral for treatment for sexually 
transmitted infections
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
No. Question Response Skip
255e Referral for primary health care
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255f Referral for mental health services
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255g Referral for drug/alcohol addiction
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255h Referral for legal assistance
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255i Referral for Antiretroviral therapy
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
255j Sexual assault/Rape crisis services 
referral 
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 265
88 Refused
255k Any other referral (specify) 
_____________________________
___________________
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
256 In the last 12 months, have you ever received the following items from mobile outreach staff:
256a Condoms
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
256b Lubricants
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
256c Information and materials about 
reducing your risk of HIV
Circle one
1 Yes, more than once
2 Yes, one time
3 No
99 Don’t Know
88 Refused
257 If you received a referral from 
mobile outreach staff, did you go to 
the place you were referred?
Circle one
1 Yes
2 No
3 Did not receive referral from mobile 
outreach staff
99 Don’t Know
88 Refused
If Yes, SKIP 
to 259.
258 IF NO: Why didn’t you go to the 
place you were referred?
CIRCLE ALL THAT APPLY
1 The place I was referred to was too far 
away.
2 It’s difficult to get there on public 
transportation.
3 The hours are inconvenient.
4 I couldn’t get an appointment.
5 I had to wait a long time for an 
appointment.
6 The services are too expensive.
7 I lost the referral information.
8 I don’t need the referral services.
9 I’ve heard negative comments about the 
referral.
10 I’m worried that the staff will treat me 
poorly because I have sex with men.
11 I’m worried that my privacy won’t be 
protected.
12 I’m worried that people will know I have 
sex with men if I go there.
13 I’m worried that people will think I have 
HIV if I go there.
14 Other (specify) 
__________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 266
99 Don’t Know
88 Refused
259 If you received a referral from 
mobile outreach staff, did staff 
follow up with you to see if you 
used the referral?
Circle one
1 Yes
2 No
3 Did not receive referral from mobile 
outreach staff
99 Don’t Know
88 Refused
If No, SKIP to 
261.
260 IF YES: How did the mobile 
outreach staff follow up with you?
Circle one
1 In person
2 Phone call
3 Text message
4 Email
5 Other (specify) 
____________________________
99 Don’t Know
88 Refused
For the following questions, think about the LAST TIME you received services from mobile outreach staff.
261 Overall, how satisfied were you 
with the services provided by 
mobile outreach?
Circle one
1 Very satisfied
2 Somewhat satisfied
3 Somewhat unsatisfied
4 Very unsatisfied
99 Don’t Know
88 Refused
262 . Overall, how attentive was the 
staff?
Circle one
1 Very attentive
2 Somewhat attentive
3 Somewhat inattentive
4 Very inattentive 
99 Don’t Know
88 Refused
263 The LAST TIME you received 
services from mobile outreach 
staff, how responsive was the staff?
Circle one
1 Very responsive
2 Somewhat responsive
3 Somewhat unresponsive
4 Very unresponsive
99 Don’t Know
88 Refused
264 The LAST TIME you received 
services from mobile outreach 
staff, how friendly was the staff?
Circle one
1 Very friendly
2 Somewhat friendly
3 Not friendly
4 Not friendly at all
99 Don’t Know
88 Refused
265 Would you receive services from 
mobile outreach again?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
266 Would you recommend mobile 
outreach to a friend?
1 Yes
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 267
Circle one
2 No
99 Don’t Know
88 Refused
Section 3. HIV Knowledge and Attitudes
No. Question Response Skip
Please indicate whether you agree or disagree with the following statements.
301.
People living with HIV/AIDS in this 
community should be treated the same 
by health care professionals as people 
with other illnesses
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
302. People talk badly about people living with 
or thought to be living with HIV to others
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
303. People living with or thought to be living 
with HIV lose standing or respect in their 
family or community
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
304. I fear I could become infected with HIV if I 
were to be exposed to the saliva of a 
person who has HIV/AIDS
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
305. If you kiss someone on the cheek that has 
HIV/AIDS, you might get infected
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
306. If you are coughed or sneezed on by 
someone who has HIV/AIDS, you are likely 
to contract the infection
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
307. I fear I could become infected with HIV if I 
were to be exposed to the sweat of a 
person who has HIV/AIDS
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
308. I would be ashamed if someone in my 
family had HIV
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 268
99 Don’t Know
88 Refused
309. A person with HIV/AIDS should be 
allowed to work with other people
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
310. People with HIV should be allowed to 
participate in social events in this 
community
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
311. People with AIDS should be isolated from 
other people
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
312. People who have HIV/AIDS should be 
treated the same as everyone else
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
313. A person with HIV/AIDS should be 
allowed to work with other people
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
314. People with HIV should be allowed to 
participate in social events in this 
community
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
315. People with AIDS should be isolated from 
other people
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
316. People who have HIV/AIDS should be 
treated the same as everyone else
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
317. People living with HIV/AIDS in this 
community should be treated the 
same by health care professionals 
as people with other illnesses
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree 
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 269
318.3 People talk badly about people living 
with or thought to be living with 
HIV to others.
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
319.3 People living with or thought to be living 
with HIV lose standing or respect in 
their family or community
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
Section 4. Transactional Sex: Many MSM receive money or gifts in exchange for sex.
No. Question Response Skip
401 In the past 12 months, have you 
accepted money, housing, food, or 
other items in exchange for sex?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
421.
402 At what age did you start accepting 
money and gifts for sex?
1 _____Years old
99 Don’t Know
88 Refused
403 Who introduced you to this practice (of 
accepting money or food in exchange 
for sex)?
Circle one
1 Mother
2 Father
3 Other relative
4 Friend
5 Other (Specify)________________
99 Don’t Know
88 Refused
404 Where do you find most of your 
clients?
Circle one
1 Home
2 Hotel/Guest house
3 Bar/Nightclub
4 Street
5 Other (Specify)_________________
99 Don’t Know
88 Refused
405 Where do you usually take your clients 
for sex?
Circle one
1 Home
2 Hotel/Guesthouse
3 Bar/Nightclub
4 Car/Vehicle
5 Other (Specify)________________
99 Don’t Know
88 Refused
406 How do your clients usually pay you?
Circle one
1 In cash
2 In kind (clothing, food, shelter)
3 Both
99 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 270
88 Refused
407 On average, how much do you earn a 
week from sex work?
Circle one
1 ________________GHC
99 Don’t Know
88 Refused
408 Other than sex work, do you have 
another means of earning money?
Circle one
1 No
2 Yes
99 Don’t Know
88 Refused
409 How many people did you have sex 
with in the past week?
1 ___________ people
99 Don’t Know
88 Refused
410 Of all the people you had sex with in 
the past week, how many were:
1 ______Paying one-time clients
2 ______Paying regular clients
3 ______One-time non-paying partners
4 ______Spouse/lover/boyfriend
5 ______Other (specify) 
_______________________
99 Don’t Know
88 Refused
411 In general, paying one-time clients 
are:
Circle one
1 1-5 years younger than me
2 6-10 years younger than me
3 More than 10 years younger than me
4 Same age as me 
5 1-5 years older than me
6 6-10 years older than me
7 More than 10 years older than me
99 Don’t Know
88 Refused
412 In general, paying regular clients are:
Circle one
1 1-5 years younger than me
2 6-10 years younger than me
3 More than 10 years younger than me
4 Same age as me 
5 1-5 years older than me
6 6-10 years older than me
7 More than 10 years older than me
99 Don’t Know
88 Refused
413 In general, non-paying one-time 
partners are:
Circle one
1 1-5 years younger than me
2 6-10 years younger than me
3 More than 10 years younger than me
4 Same age as me 
5 1-5 years older than me
6 6-10 years older than me
7 More than 10 years older than me
99 Don’t Know
88 Refused
414 My spouse, lover, or boyfriend is:
Circle one
1 1-5 years younger than me
2 6-10 years younger than me
3 More than 10 years younger than me
4 Same age as me
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 271
5 1-5 years older than me
6 6-10 years older than me
7 More than 10 years older than me
99 Don’t Know
88 Refused
No. Question Response Skip
415 Of all the people (either paying or non￾paying partner) that you have had sex 
with in the past 12 months, were some 
(at least one) females? 
Circle one
1 Yes
2 No
3 Don’t remember
99 Don’t Know
88 Refused
If No, SKIP to 
418.
416 The last time you had vaginal 
intercourse with a paying partner, did 
you use a condom? [ASK ONLY IF 
ANSWERS YES TO Q515]
Circle one
1 Yes
2 No
3 Don’t remember
99 Don’t Know
88 Refused
417 The last time you had vaginal 
intercourse with a non-paying partner, 
did you use a condom?
Circle one
1 Yes
2 No
3 Don’t remember
99 Don’t Know
88 Refused
418 Have you ever had anal sex?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
501.
419 The last time you had anal sex with a 
paying partner, did you use a condom?
Circle one
1 Yes
2 No
99 Don’t remember
88 Refused
420 The last time you had anal sex with a 
non-paying partner, did you use a 
condom?
Circle one
1 Yes
2 No
99 Don’t remember
88 Refused
ALL SKIP to 
501.
FOR MSM WHO HAVE NOT ENGAGED IN SEX WORK:
421 How many people did you have sex 
with in the past week?
Circle one
1 ___________ people
99 Don’t Know
88 Refused
422 Of all the people you had sex with in 
the past week, how many were:
1 ___One-time casual partners
2 ___Spouse/lover/boyfriend/girlfriend
3 ___Other (specify) 
__________________________
99 Don’t Know
88 Refused
423 Of all the people you had sex with in 
the past week, how many were:
1 ___Men
2 ___Women
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 272
99 Don’t Know
88 Refused
No. Question Response Skip
424 In general, are your partners:
Circle one
1 The same age as you
2 1-5 years younger than you
3 6-10 years younger than you
4 More than 10 years younger than you
5 1-5 years older than you
6 6-10 years older than you
7 More than 10 years older than you
99 Don’t Know
88 Refused
425 Have you had vaginal intercourse in 
the past 12 months?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
427.
426 IF YES: The last time you had vaginal 
intercourse, did you use a condom?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
427 Have you had anal intercourse in the 
past 12 months?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
501.
428 IF YES: The last time you had anal 
intercourse, did you use a condom?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
Section 5. Violence
For the following questions, think only about your main or most recent spouse, lover, or boyfriend.
No. Question Response Skip
501 My partner explained his side or 
suggested a compromise for a 
disagreement with me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
502 My partner insulted or swore or 
shouted or yelled at me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
503 I had a sprain, bruise, or small cut, or 
felt pain the next day because of a 
fight with my partner
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 273
88 Refused
504 My partner showed respect for, or 
showed that he cared about my feeling 
about an issue we disagreed on
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
505 My partner pushed, shoved, or slapped 
me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
506 My partner punched or kicked or beat￾me-up
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
507 My partner destroyed something 
belonging to me or threatened to hit 
me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
508 I went see a doctor or needed to see a 
doctor because of a fight with my 
partner
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
509 My partner used force (like hitting, 
holding down, or using a weapon) to 
make me have sex
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
510 My partner insisted on sex when I did 
not want to or insisted on sex without 
a condom (but did not use physical 
force)
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
DATA COLLECTORS: DID THIS PARTICIPANT REPORT ACCEPTING MONEY OR GIFTS FOR SEX IN THE LAST SECTION?
⃝YES ⃝NO 
IF CHECKED YES, SKIP to 601.
If NO, PROCEED TO 511
READ: For the following questions, think only about your paying partners.
No. Question Response Skip
511 A paying partner insulted or swore or 
shouted or yelled at me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 274
512 I had a sprain, bruise, or small cut, or 
felt pain the next day because of a 
fight with a paying partner
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
513 A paying partner pushed, shoved, or 
slapped me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
514 A paying partner punched or kicked or 
beat-me-up
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
515 A paying partner destroyed something 
belonging to me or threatened to hit 
me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
516 I went see a doctor or needed to see a 
doctor because of a fight with a paying 
partner
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
517 A paying partner used force (like 
hitting, holding down, or using a 
weapon) to make me have sex
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
518 A paying partner insisted on sex when I 
did not want to or insisted on sex 
without a condom (but did not use 
physical force)
Circle one
1 Never
2 Not in past year, but it did happen 
before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
519 During the last 12 months, have you 
ever avoided arrest by providing a 
police officer with a sexual favor?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
521.
520 IF yes: How often in the last 12 months 
have you avoided arrest by providing a 
police officer with a sexual favor?
Circle one
1 Often
2 Sometimes
3 Rarely
4 Never
99 Don’t Know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 275
521 During the last 12 months, have you 
been forced to not use condoms during 
sex?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
523.
522 IF YES: who forced you to not use 
condoms during sex?
Circle one
1 Paying one-time client
2 Paying regular client
3 Non-paying spouse, partner, or 
boyfriend
4 Other (specify) 
___________________________
99 Don’t Know
88 Refused
523 During the last 12 months, have you 
been beaten or physically abused as a 
result of doing sex work?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
601.
524 IF Yes: who beat you or physically 
abused you as a result of doing sex 
work?
Circle one
1 Paying one-time client
2 Paying regular client
3 Non-paying spouse, partner, or 
boyfriend
4 Family member
5 Other (specify)_________________
99 Don’t Know
88 Refused
Section 6. Substance Use
Now I will ask you some questions about your alcohol use. By alcohol use we mean drinking a bottle of beer, a glass of wine, 
shot of spirits, and glass or can of home or local brews.
No. Question Response Skip
629 How often do you have a drink containin 
alcohol?
Circle one
11 Never
12 Once a month or less
13 2-4 times a month
14 2-3 times a week
15 4 or more times a week
101 Don’t Know
90 Refused
630 How many drinks containing alcohol do 
you have on a typical day when you are 
drinking?
Circle one
11 1 - 2
12 3- 4 
13 5- 6 
14 7– 9 
15 10 or more
101 Don’t Know
90 Refused
631 In the past year how often have you drun 
alcohol before sex?
13 Always
14 Sometimes
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 276
Circle one
15 Rarely 
16 Never
17 99Don’t Know
18 88Refused
632 How often do you have 6 or more drinks 
one occasion?
Circle one
15 Never
16 Less than monthly
17 Monthly 
18 Weekly
19 Daily or almost daily
20 99Don’t Know
21 88Refused
633 How often during the last year have you 
found that you have not been 
able to stop drinking once you 
started?
Circle one
15 Never
16 Less than monthly
17 Monthly 
18 Weekly
19 Daily or almost daily
20 99Don’t Know
21 88Refused
634 How often during the past year have you 
failed to do what was expected 
of you because of drinking?
Circle one
15 Never
16 Less than monthly
17 Monthly 
18 Weekly
19 Daily or almost daily
20 99Don’t Know
21 88Refused
635 How often during the past year did 
you have to use ‘a first drink in the 
morning’ to get yourself going after 
a heavy drinking session?
Circle one
15 Never
16 Less than monthly
17 Monthly 
18 Weekly
19 Daily or almost daily
20 99Don’t Know
21 88Refused
636 How often during the past year have you 
had a feeling of guilt or remorse after 
drinking?
Circle one
15 Never
16 Less than monthly
17 Monthly 
18 Weekly
19 Daily or almost daily
20 99 Don’t Know
21 88 Refused
No. Question Response Skip
637 How often during the past year have you 11 Never
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 277
been unable to remember what happene 
the night before because you had been 
drinking?
Circle one
12 Less than monthly
13 Monthly 
14 Weekly
15 Daily or almost daily
101 Don’t Know
90 Refused
638 Have you or someone else been injured 
because of your drinking?
Circle one
11 Never
12 Less than monthly
13 Monthly 
14 Weekly
15 Daily or almost daily
101 Don’t Know
90 Refused
639 Has a relative, friend, doctor, or 
other health worker been concerned abo 
your drinking or suggested 
that you should cut down?
Circle one
11 Never
12 Less than monthly
13 Monthly 
14 Weekly
15 Daily or almost daily
101 Don’t Know
90 Refused
Now I’m going to ask you about the use of other addictive substances such as cocaine, heroin, and other substances that alte
your mood and are not prescribed by a health care professional.
640 READ: Some people have used a range of such substances. Have you ever used any of these substances, 
even once?
612a Cocaine
Circle one
7 Yes, more than once
8 Yes, one time 
9 No 
101 Don’t Know
90 Refused
612b Heroin
Circle one
7 Yes, more than once
8 Yes, one time 
9 No 
101 Don’t Know
90 Refused
612c Marijuana (Weed)
Circle one
7 Yes, more than once
8 Yes, one time 
9 No 
101 Don’t Know
90 Refused
612d Valium
Circle one
7 Yes, more than once
8 Yes, one time 
9 No 
101 Don’t Know
90 Refused
612e Sleeping pills
Circle one
7 Yes, more than once
8 Yes, one time 
9 No
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 278
101 Don’t Know
90 Refused
612f. Other drugs (specify): 
_____________________________
Circle one 
7 Yes, more than once
8 Yes, one time 
9 No 
101 Don’t Know
90 Refused
641 Some people have tried injecting 
drugs using a syringe. Have you injected 
drugs recreationally in the 
last 12 months?
Circle one
7 Yes, more than once
8 Yes, one time 
9 No 
101 Don’t Know
90 Refused
If No, SKIP to 70
642 If Yes to 613: With how many 
people have you ever shared
needles or syringes?
Circle one
7 None
8 1-2 people
9 or more people
101 Don’t Know
90 Refused
Section 7. Service Quality
7.1. HIV-related information and risk reduction services
No. Question Response Skip
839 Have you received HIV-related informatio 
and risk reduction counseling in the past 
12 months?
Circle one
7 Yes, more than once
8 Yes, one time 
9 No 
101 Don’t Know
90 Refused
If Yes, SKIP to 70
840 If NO, In your neighborhood, do you 
know a place where people can get 
advice about AIDS and get tested for 
HIV?
Circle one
1 Yes
2 No
99 Don’t Know88 Refused
If No, Skip to 722
841 IF YES: In the past 12 months, where hav 
you received HIV-related information and 
risk reduction counseling?
Circle one
11 Drop-in center
12 Mobile outreach
13 Peer educator
14 Government health facility
15 Other 
(Specify)_________________________
101 Don’t Know
90 Refused
842 Where was the LAST PLACE that you 
received HIV-related information and 
risk reduction counseling?
Circle one
11 Drop-in center
12 Mobile outreach
13 Peer educator
14 Government health facility
15 Other 
(Specify)_________________________
101 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 279
90 Refused
The following questions refer only to the LAST TIME you received HIV-related information and risk reduction counseling.
843 The last time you received HIV-related 
information and risk reduction 
counseling, how satisfied were you 
with the HIV counseling services?
Circle one
9 Very satisfied
10 Satisfied
11 Not satisfied
12 Very unsatisfied
101 Don’t Know
90 Refused
844 The last time you received HIV-related 
information and risk reduction 
counseling, how professional was the 
staff?
Circle one
9 Very professional 
10 Somewhat professional
11 Somewhat unprofessional
12 Very unprofessional
101 Don’t Know
90 Refused
845 The last time you received HIV-related 
information and risk reduction 
counseling, how friendly was the staff?
Circle one
13 Very friendly
14 Somewhat friendly
15 Not friendly
16 Not friendly at all
17 Don’t Know
18 Refused
846 Would you use these HIV risk reduction 
counseling services again?
Circle one
9 Yes
10 No
11 Don’t Know
12 Refused
847 Would you recommend these HIV risk 
reduction counseling services to a 
friend?
Circle one
9 Yes
10 No
11 Don’t Know
12 Refused
848 Now think about the last time you 
received HIV risk reduction counseling. 
How much did the risk reduction 
counseling help you?
Circle one
11 Helped a lot
12 Helped some
13 Did not help
14 99Don’t Know
15 88Refused
849 How much helpful information did you 
receive?
Circle one
7 A lot of helpful information
8 A little helpful information
9 No helpful information
101 Don’t Know
90 Refused
850 When you saw the counselor, who 
talked the most?
Circle one
7 I talked the most
8 The counselor talked the most
9 We talked the same amount
101 Don’t Know
90 Refused
851 When you saw the counselor, who 
listened the most?
Circle one
7 I listened the most
8 The counselor listened the most
9 We listened the same amount
101 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 280
90 Refused
852 To what extent did the counselor 
answer your questions and concerns 
about HIV?
Circle one
7 A lot
8 Some
9 Not at all
101 Don’t Know
90 Refused
853 To what extent did the counselor help 
you think about what you were doing 
that puts you at risk for getting HIV?
Circle one
7 A lot
8 Some
9 Not at all
101 Don’t Know
90 Refused
854 To what extent did the counselor help 
you make a plan to protect yourself 
from HIV?
Circle one
7 A lot
8 Some
9 Not at all
101 Don’t Know
90 Refused
855 To what extent did the counselor help 
you come up with small steps you can 
take to make your HIV prevention plan 
work?
Circle one
7 A lot
8 Some
9 Not at all
101 Don’t Know
90 Refused
856 Did the counselor tell you about other 
places you could go for help for HIV 
and health care related services?
Circle one
5 Yes
6 No
101 Don’t Know
90 Refused
857 In your plan to reduce your HIV risk, 
who came up with the ideas what you 
will do?
Circle one
7 I did
8 The counselor
9 We both did
101 Don’t Know
90 Refused
858 How much did the counselor help you 
with your plan to reduce HIV risk?
Circle one
9 A lot
10 Somewhat
11 A little
12 Not at all
101 Don’t Know
90 Refused
859 How much did you help the counselor 
to develop a plan to reduce your HIV 
risk? 
Circle one
9 A lot
10 Somewhat
11 A little
12 Not at all
101 Don’t Know
90 Refused
860 How much did you tell the counselor 
about your sex life and use of drugs?
Circle one
9 A lot
10 Somewhat
11 A little
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 281
12 Not at all
101 Don’t Know
90 Refused
722 How can people reduce their risk of contracting HIV/AIDS? DO NOT READ LIST OUT LOUD
Check YES for all mentioned. Check NO for all not mentioned.
722a Use condoms
Circle one
5 Yes
6 No
90
722b Reduce the number of sexual partners
Circle one
5 Yes
6 No
101
90
722c Be faithful to one partner
Circle one
5 Yes
6 No
722d Do not have casual sex
Circle one
5 Yes
6 No
90 Refused
722e Do not have sex
Circle one
5 Yes
6 No
101 Don’t Know
90 Refused
722f Avoid contaminated needles
Circle one
5 Yes
6 No
101 Don’t Know
90 Refused
722g Avoid contact with infected people
Circle one
5 Yes
6 No
101 Don’t Know
90 Refused
722h Other (specify) 
________________________________
__________________________
Circle one
5 Yes
6 No
101 Don’t Know
90 Refused
Thank you. Now I would like to ask some additional questions about what you know about HIV.
861 Can a healthy looking person be 
infected with HIV?
Circle one
5 Yes
6 No
101 Don’t Know
90 Refused
Please indicate whether you agree or disagree with the following statements.
No. Question Response Skip
862 If you kiss someone on the cheek that 
has HIV/AIDS, you might get infected
Circle one
9 Strongly agree
10 Somewhat agree
11 Somewhat disagree
12 Strongly disagree
101 Don’t Know
90 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 282
863 If you are coughed or sneezed on by 
someone who has HIV/AIDS, you are 
likely to contract the infection
Circle one
9 Strongly agree
10 Somewhat agree
11 Somewhat disagree
12 Strongly disagree
101 Don’t Know
90 Refused
864 I fear I could become infected with HIV 
if I were to be exposed to the sweat of 
a person who has HIV/AIDS
Circle one
9 Strongly agree
10 Somewhat agree
11 Somewhat disagree
12 Strongly disagree
101 Don’t Know
90 Refused
865 I fear I could become infected with HIV 
if I were to be exposed to the saliva of 
a person who has HIV/AIDS
Circle one
9 Strongly agree
10 Somewhat agree
11 Somewhat disagree
12 Strongly disagree
101 Don’t Know
90 Refused
866 I have no risk of getting HIV.
Circle one
9 Strongly agree
10 Somewhat agree
11 Somewhat disagree
12 Strongly disagree
101 Don’t Know
90 Refused
867 I am at risk of getting HIV.
Circle one
9 Strongly agree
10 Somewhat agree
11 Somewhat disagree
12 Strongly disagree
101 Don’t Know
90 Refused
868 I want to reduce my risk of getting HIV.
Circle one
9 Strongly agree
10 Somewhat agree
11 Somewhat disagree
12 Strongly disagree
101 Don’t Know
90 Refused
869 I know ways to reduce my risk.
Circle one
9 Strongly agree
10 Somewhat agree
11 Somewhat disagree
12 Strongly disagree
101 Don’t Know
90 Refused
870 I have a plan for how I will reduce my 
risk.
Circle one
9 Strongly agree
10 Somewhat agree
11 Somewhat disagree
12 Strongly disagree
101 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 283
90 Refused
871 I like my HIV prevention plan.
Circle one
9 Strongly agree
10 Somewhat agree
11 Somewhat disagree
12 Strongly disagree
101 Don’t Know
90 Refused
872 I’m sure I can follow my HIV prevention 
plan.
Circle one
9 Strongly agree
10 Somewhat agree
11 Somewhat disagree
12 Strongly disagree
101 Don’t Know
90 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 284
7.2 HIV Testing
No. Question Response Skip
873 In the last 12 months, have you been 
offered an HIV test?
Circle one
5 Yes
6 No
101 Don’t Know
90 Refused
874 In the last 12 months, have you been 
tested for HIV?
Circle one
7 No
8 Yes, one time
9 Yes, more than once
101 Don’t Know
90 Refused
If Yes, SKIP to 
737.Otherwise 
SKIP to 772
875 IF No to 736, why have you not been 
tested for HIV? 
Do not read list but circle all that are 
mentioned
19 I’m worried that people would find out my test results
20 I don’t know where to get tested.
21 Getting tested is too expensive.
22 The places for HIV testing are too far away.
23 The hours for HIV testing are inconvenient.
24 It’s difficult to get to HIV testing places on public 
transportation.
25 The people that provide HIV testing will treat me 
differently because I am a sex worker.
26 I am not at risk for HIV.HIV is not a serious health 
condition.
27 I am worried that people will treat me poorly if the tes 
result is positive.
101 Don’t Know
90 Refused
SKIP to 738.
876 Was the decision to be tested for HIV 
up to you or were you pressured, 
forced, or unknowingly tested?
11 Yes, it was completely my decision to be tested.
12 It was my decision to be tested, but it was under 
pressure from others
13 I was forced to take an HIV test.
14 I was tested without my knowledge
15 I only found out after the test had been done
101 Don’t Know
90 Refused
877 In your opinion, are MSM hesitant to 
take an HIV test due to fear of 
people’s reaction if the test result is 
positive for HIV?
Circle one
5 Yes
6 No
101 Don’t Know
90 Refused
878 In the last 12 months, where have you 
been tested for HIV? 
Do not read list but circle all that are 
mentioned
11 Drop-in center
12 Mobile outreach
13 Peer educator
14 Government health facility
15 Other (Specify)_________________________
101 Don’t Know
90 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 285
No. Question Response Skip
879 Where was the last place you were teste 
for HIV?
Circle one
11 Drop-in center
12 Mobile outreach
13 Peer educator
14 Government health facility
15 Other 
(Specify)_________________________
101 Don’t Know
90 Refused
The following questions refer only to the LAST TIME you were tested for HIV.
880 Overall, how satisfied were you with 
the HIV testing services?
Circle one
9 Very satisfied
10 Satisfied
11 Not satisfied
12 Very unsatisfied
101 Don’t Know
90 Refused
881 The last time you were tested for HIV, 
how professional was the staff?
Circle one
9 Very professional 
10 Somewhat professional
11 Somewhat unprofessional
12 Very unprofessional
101 Don’t Know
90 Refused
882 The last time you were tested for HIV, 
how friendly was the staff?
Circle one
9 Very friendly
10 Somewhat friendly
11 Not friendly
12 Not friendly at all
101 Don’t Know
90 Refused
883 Would you use these HIV testing 
services again?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
884 Would you recommend these HIV 
testing services to a friend?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
Again, for the following questions, think only about the last time you were tested for HIV.
885 Before you were tested for HIV, did the 
counselor explain why you should get 
tested for HIV?
Circle one
5 Yes
6 No 
101 Don’t know
90 Refused
886 Before you were tested for HIV, did the 
counselor explain to you the type of 
test that was used?
1 Yes
2 No 
99 Don’t know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 286
Circle one
88 Refused
887 Before you were tested for HIV, did the 
counselor explain to you the meaning 
of a positive and negative result?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
888 Before you were tested for HIV, did the 
counselor explain to you that if 
managed with antiretroviral therapy 
(ART) and quality clinical care, HIV 
infection may be controlled as a chronic 
condition?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
889 Before you were tested for HIV, did the 
counselor explain to you the test result 
is confidential- that is, no one will know 
the results of your test unless you tell 
them?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
890 Before you were tested for HIV, did the 
counselor explain to you disclosure of a 
positive result is needed to receive 
treatment for HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
891 Before you were tested for HIV, did the 
counselor explain to you that you can 
choose not to get tested and still 
receive all other services that are 
provided?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
Again, for the following questions, think only about the last time you were tested for HIV. 
892 The last time you were tested for HIV, 
were you able to ask questions about 
HIV/AIDS and about getting tested for 
HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
893 The last time you were tested for HIV, 
were you encouraged to ask questions 
about the testing process?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
894 The last time you were tested for HIV, 
did you feel that your confidentiality 
was protected – that is, that no one 
would know that your test result 
unless you told them?
1 Yes
2 No 
99 Don’t know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 287
Circle one
895 The last time you were tested for HIV, 
how long did you have to wait to 
receive the test results?
Circle one
9 A very long time
10 Somewhat long time
11 Not very long
12 Not long at all
101 Don’t Know
90 Refused
Thank you. Now I would like to ask you some personal questions about your HIV testing. Please 
remember that we have not taken your name and all your responses will be completely confidential. No 
one will ever know what you have told me during this interview. I appreciate your trust and honesty.
896 Do you know the result of your most 
recent HIV test?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
If No, SKIP to 
772.
897 IF YES to 758: Have you told a sexual 
partner the results of your most recent 
HIV test?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
898 IF YES to 758: What was the result of 
your most recent HIV test?
Circle one
5 Positive
6 Negative
101 Don’t Know
90 Refused
If POSITIVE, SK 
to 763.
899 If negative: If you had tested positive, 
would you have sought out treatment 
for HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
If Yes, SKIP t 
772
900 IF NO to 760: If you had tested positive, 
why would you have not sought out 
treatment for HIV? 
CIRCLE ALL THAT APPLY
23 I would be worried that people would find out that 
was HIV positive.
24 Treatment for HIV is too expensive.
25 I wouldn’t know where to go to receive treatment f 
HIV.
26 I would be worried that doctors would treat me 
poorly because I am a sex worker.
27 I would be worried that doctors would treat me 
poorly if I were HIV positive.
28 HIV treatment is not effective.
29 The places that provide HIV treatment are too far
away.
30 The places that provide HIV treatment are difficult t 
get to on public transportation.
31 The hours for receiving HIV treatment are 
inconvenient.
32 You have to wait a long time to get an appointment
33 In the past, doctors have treated me poorly because 
am a sex worker.
ALL SKIP to 
772
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 288
101 Don’t Know
90 Refused
901 If positive: When you received your 
test results, did you receive a referral 
to care, support and treatment?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
If No, SKIP to 
764
902 If yes to 762: Have you contacted the 
referral to receive care, support and 
treatment?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
903 IF POSITIVE: Are you currently taking 
antiretroviral medications daily for 
HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
If Yes, SKIP to 
767.
904 IF NO to 765: Why are you not 
receiving treatment for HIV? 
CIRCLE ALL THAT APPLY
25 I am worried that people will find out that I am HIV 
positive.
26 Treatment for HIV is too expensive.
27 I don’t know where to go to receive treatment for 
HIV.
28 I’m worried that doctors will treat me poorly becaus 
I am a sex worker.
29 I’m worried that doctors will treat me poorly becaus 
I am HIV positive.
30 HIV treatment is not effective.
31 The places that provide HIV treatment are too far 
away.
32 The places that provide HIV treatment are difficult t 
get to on public transportation.
33 The hours for receiving HIV treatment are 
inconvenient.
34 You have to wait a long time to get an appointment
35 In the past, doctors have treated me poorly
36 Because I am a sex worker.
101 Don’t Know
90 Refused
905 IF POSITIVE: In the last 12 months, 
have you been fearful of any of the 
following things happening to you – 
whether or not they actually have 
happened to you – because you are 
HIV positive?
Circle all that apply
9 Being gossiped about
10 Being verbally insulted, harassed and/or 
threatened 
11 Being physically harassed and/or threatene
12 Being physically assaulted
101 Don’t Know
90 Refused
906 IF POSITIVE: How often have you felt 
excluded from social gatherings or 
activities because of your HIV status?
Circle one
9 Often
10 Sometimes
11 Rarely 
12 Never
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 289
101 Don’t Know
90 Refused
907 IF POSITIVE: How often have you been 
denied health services because of your 
HIV status?
Circle one
9 Often
10 Sometimes
11 Rarely 
12 Never
101 Don’t Know
90 Refused
796 IF POSITIVE: How often have you felt 
gossiped about because of your HIV 
status?
Circle one
9 Often
10 Sometimes
11 Rarely 
12 Never
101 Don’t Know
90 Refused
797 IF POSITIVE In the last 12 months, have 
you experienced any of the following 
feelings because of your HIV status?
Circle all that apply
13 I feel ashamed
14 I feel guilty
15 I blame myself
16 I blame others
17 I have low self-esteem
18 I feel I should be punished
101 Don’t Know
90 Refused
7.3 Quality of condom and lubricant information and distribution services
No. Question Response Skip
798 In the last 12 months, have you 
received condoms, lubricants, or 
information about how to use 
condoms and lubricants to reduce your 
risk of HIV?
Circle one
7 No
8 Yes, one time
9 Yes, more than once
101 Don’t Know
90 Refused
If No, SKIP 
774.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 290
799 If yes to 772: In the last 12 months, 
where did you receive condoms, 
lubricants, or information about how 
to use condoms and lubricants to 
reduce your risk of HIV? 
CIRCLE ALL THAT APPLY
12 Drop-in center
13 Mobile outreach
14 Peer educator
15 Government health facility
16 Private doctor/clinic
17 Pharmacy
18 Bar, restaurant, or nightclub
19 StreetHotel/guest house/lodge
20 Shop/kiosk
21 My partner always gets the condoms
22 Other (Specify)_________________________
100 Don’t Know
89 Refused
800 Where is the last place you received 
condoms, lubricants, or information 
about how to use condoms and 
lubricants to reduce your risk of HIV?
Circle one
11 Drop-in center
12 Mobile outreach
13 Peer educator
14 Government health facility
15 Other 
(Specify)_________________________
101 Don’t Know
90 Refused
The following questions refer only to the LAST TIME you received condoms, lubricants, or information about how to 
use condoms and lubricants to reduce your risk of HIV.
No. Question Response Skip
801 Overall, how satisfied were you with 
the condom and lubricant distribution 
services?
Circle one
5 Very satisfied
6 Satisfied
7 Not satisfied
8 Very unsatisfied
100 Don’t Know
89 Refused
802 Overall, how professional was the 
staff?
Circle one
9 Very professional 
10 Somewhat professional
11 Somewhat unprofessional
12 Very unprofessional
101 Don’t Know
90 Refused
803 Overall, how friendly was the staff?
Circle one
9 Very friendly
10 Somewhat friendly
11 Not friendly
12 Not friendly at all
101 Don’t Know
90 Refused
804 Would you use these condom and 
lubricant distribution services again?
1 Yes
2 No 
99 Don’t know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 291
Circle one 88 Refused
805 Would you recommend these condom 
and lubricant distribution services to a 
friend?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
The LAST TIME you received condoms, lubricants, or information about how to use condoms and 
lubricants to reduce your risk of HIV,
806 Were you asked if you needed any 
information on condoms and condom 
lubricants?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
807 Were you asked if you understood how 
to use condoms and condom￾lubricants?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
808 How comfortable did you feel asking a 
staff member questions about using 
condoms and lubricants?
Circle one
5 Very comfortable
6 Somewhat comfortable
7 Somewhat uncomfortable
8 Very uncomfortable
100 Don’t Know
89 Refused
809 Were condoms provided in a respectful 
manner? 
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
810 Were you provided with enough 
information on how to use condoms?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
772 How often are condoms available?
Circle one
7 Always
8 Sometimes 
9 Rarely 
10 Never
11 99Don’t Know
12 88Refused
773 How often is condom/lube available?
Circle one
7 Always
8 Sometimes 
9 Rarely 
10 Never
11 99Don’t Know
12 88Refused
774 Were you encouraged to come back 
before you were out of condoms and 
1 Yes
2 No
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 292
condom-compatible lubricants?
Circle one
99 Don’t know
88 Refused
775 Were you encouraged to tell friends 
about condom and condom￾compatible lubricants distribution 
service?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
776 Did you feel that your needs for 
condoms and lubricants were met?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
777 For how long have you been receiving 
HIV services from (Organizations 
Name)
5. Less than 6 Months
6. 6 – 12 month
7. 1 – 2 years
8. Greater than 2 years
99 Don’t Know
88 Refused
Now I’m going to ask you a few questions about the things that MSM may or may not do to try to stay healthy.
778 In general, where do MSM go for health care - that is, if they are sick or want to see a 
doctor or nurse? 
 PROBE: Where do MSM go if they have a question about their health or 
 are worried about their health? Why do MSM go to those places and not 
 others?
PROBE: Why do you think some MSM might not go for health care?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
779 Now imagine that an MSM goes to the doctor.
How would he decide whether or not to tell the doctor that he has sex with men?
 PROBE: What kinds of things would make him more likely to tell the doctor 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 293
 that he is an MSM? What kind of things would make him less likely to tell 
 the doctor? What would happen if he told the doctor?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
780 We know that MSM are at risk of HIV, but only some get tested for HIV. 
What types of things prevent MSM from getting tested for HIV? 
 PROBE: What about stigma? Concerns about privacy?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
781 What types of things prevent MSM from getting treatment for HIV? 
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
782 What would you recommend to someone who was developing health care services 
specifically to get more MSM to use HIV prevention services?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 294
783 Is there anything else that I haven’t asked you about providing HIV prevention services to 
MSM that you would like to share with me?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
784 There has been emotive debate in recent past on whether or not the rights of MSM 
should be upheld. Can you enumerate the instances where your rights have been violated 
or denied because you were known or perceived to be MSM? [List as many instances as 
you are able to recall]
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Thank you for taking the time to share your thoughts and experiences with me today.
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 295
MSM Non-Client Service Quality Survey
Date:_______________________ 
Questionnaire ID:____________________
Venue:______________________
 
Geographic region:________________________
Specific region:________________________
Neighborhood:________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 296
PARTICIPANT CONSENT FORM 
Title: A Performance Evaluation of Ghana’s HIV Prevention Program for At-Risk Populations
Principal Investigator: Amos Laar, PhD, 
Department of Population, Family and Reproductive Health, School of Public Health, College of Health 
Sciences, University of Ghana, Box Lg 13 Legon, 0244982176, alaar@ug.edu.gh or aklaar@yahoo.com 
General Information about Research 
You are being asked to participate in a research study to learn more about the experiences of certain key 
populations with HIV prevention services in Ghana. The purpose of the research is to learn: 1) how these 
populations have used HIV prevention services in Ghana, 2) the quality of these services, 3) how satisfied 
these populations are with these services and 4) what barriers exist to using HIV prevention services. Your 
participation in this research should take approximately 60-90 minutes. You will be asked to participate in a 
one-on-one interview and/or group discussion about your experience using HIV prevention services. Your 
participation will help improve HIV prevention services for both the key populations and the general 
population in Ghana.
Possible Risks and Discomforts
The risks of your participation are minimal. The main risk resulting from your participation is feeling 
uncomfortable answering some of the questions. Your participation is completely voluntary. Should you feel 
uncomfortable answering any question(s), you can choose to skip that question(s) and continue with the 
interview. You are also welcome to end the interview at any time. 
Possible Benefits
You are not likely to personally benefit from participating in this research study. However, your participation 
will help improve HIV prevention services for both the key populations and the general population in Ghana.
Alternatives to Participation
There are no alternatives to participation. The only alternative to participation is to simply not participate.
Confidentiality
All information that you share with the interviewer will be protected to the best of our ability. You will not 
be named in any reports. Any documents with identifying information will be kept in a locked filing cabinet 
for 5 years after the study is completed and then will be destroyed. Any identifying information that is 
stored electronically (i.e., on a computer) will be kept on a secure computer and will require a password to 
access. Only staff who work on this research project will have access to your research information.
Compensation
You will be given 10 Ghana Cedis for participating in a survey interview or group discussion. This 
compensation will be provided to you in cash at the end of the interview. 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 297
Additional Cost 
There are no additional costs that may result from participation in this research.
Voluntary Participation and Right to Leave the Research
Your participation in the survey interview or focus group is completely voluntary. You have the right to not 
participate in this research or to end your participation at any point in time. You also have the right to not 
answer any questions that you choose not to answer. Not participating or withdrawing from this research 
will not have any negative consequences and will not impact your ability to receive HIV prevention services.
Contacts for Additional Information
If you have any questions about the research, please contact Amos Laar, PhD, 
Department of Population, Family and Reproductive Health, School of Public Health, College of Health 
Sciences, University of Ghana, Box Lg 13 Legon, 0244982176, alaar@ug.edu.gh or aklaar@yahoo.com 
Your rights as a Participant
This research has been reviewed and approved by the Institutional Review Board of Noguchi Memorial 
Institute for Medical Research (NMIMR-IRB). If you have any questions about your rights as a research 
participant you can contact the IRB Office between the hours of 8am-5pm through the landline 0302916438 
or email addresses: nirb@noguchi.mimcom.org or HBaidoo@noguchi.mimcom.org . You may also contact 
the chairman, Rev. Dr. Ayete-Nyampong through mobile number 0208152360 when necessary.
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 298
VOLUNTEER AGREEMENT
The above document describing the benefits, risks and procedures for the research title (name of research)
has been read and explained to me. I have been given an opportunity to have any questions about the 
research answered to my satisfaction. I agree to participate as a volunteer.
ORAL CONSENT VERIFICATION:
I was present while the benefits, risks and procedures were read to the volunteer. All questions were 
answered and the volunteer has agreed to take part in the research.
_______________________ __________________________________________
Date Name and signature of witness
I certify that the nature and purpose, the potential benefits, and possible risks associated with participating 
in this research have been explained to the above individual.
_______________________ _____________________________________
Date Name Signature of Person Who Obtained Consent 
 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 299
Section 1. Demographics
First, I would like to ask a few background questions, just to learn more about you.
No. Question Response Skip
101. What nationality are you?
Circle one
19 Ghana
20 Nigeria
21 Togo
22 Ivory Coast
23 Burkina Faso
24 Other 
(Specify)_________________________
102 Don’t Know
91 Refused
If not 1 skip
to 103
102. What ethnicity are you?
Circle one
28 Akan
29 Ewe
30 Ga Adangbe
31 Hausa
32 Krobo
33 Mole/Dagbani
34 Grusi
35 Gruma
36 Other 
(Specify)_________________________
102 Don’t Know
91 Refused
103. How old were you on your last 
birthday?
Circle one
______________Years
99 Don’t Know
88 Refused
104. What is your marital status?
Circle one
21 Living with spouse
22 Separated
23 Divorced
24 Widowed
25 Never Married
99 Don’t Know
88 Refused
If 1 skip to
106
105. Do you currently live with a boyfriend 
or partner who is not a spouse? 
Circle one
 1 Yes
 2 No
102 Don’t Know
91 Refused
106. What is your religion?
Circle one
16 Christian
17 Muslim
18 Traditional
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 300
19 Other 
(Specify)_________________________
20 No religion
102 Don’t Know
91 Refused
107. Have you ever attended school?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 10
108. What is the highest level of school you 
have attended?
Circle one
13 Primary
14 Middle/Junior Secondary/JHS
15 Senior 
Secondary/SHS/Technical/Vocational
16 Higher/Tertiary
102 Don’t Know
91 Refused
109. How many living children do you have?
Circle one
Number of children______________
99 Don’t Know
88 Refused
110. Do you CURRENTLY have a cell phone?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If Yes, SKIP to 11
111. IF NO: Do you CURRENTLY have access 
to a cell phone?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
112. IN GENERAL, how often do you use a 
cell phone?
Circle one
13 Always
14 Sometimes
15 Rarely
16 Never
102 Don’t Know
91 Refused
IF NEVER 
SKIP TO 115
113. In the past 12 months, have you ever 
received health information – such as 
information about how to reduce your 
risk of HIV - by text message?
Circle one
10 No
11 Yes, one time
12 Yes, more than once
99 Don’t Know
88 Refused
If No, SKIP to 11
114. IF YES: How useful was the health 
information that you received by text 
message?
Circle one
13 Very useful
14 Somewhat useful
15 Not that useful
16 Not useful at all
102 Don’t Know
91 Refused
115. Have you ever heard of the Text me! 
Flash me! Call Me! Helpline? 
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP t 
119.
116. IF YES: In the past 12 months, have you 10 No If No, SKIP t 
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 301
used the Text me! Flash me! Call Me! 
Helpline? 
Circle one
11 Yes, one time
12 Yes, more than once
99 Don’t Know
88 Refused
118.
117. IF USED: How satisfied were you with 
the Text me! Flash me! Call Me! 
Helpline? 
Circle one
16 Very satisfied
17 Somewhat satisfied
18 Somewhat dissatisfied
19 Very dissatisfied
99 Don’t Know
88 Refused
SKIP to 119.
118. IF HEARD OF, BUT NOT USED: In 
general, are the things you have heard 
about Text me! Flash me! Call Me! 
Helpline: 
Circle one
16 Very positive
17 Somewhat positive
18 Somewhat negative
19 Very negative
99 Don’t Know
88 Refused
119. In the past 12 months, have you used 
the internet to get information about 
HIV prevention specifically for men 
who have sex with men?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
120. How often do you use the internet to 
get information about HIV prevention 
and risk reduction?
Circle one
13 Often
14 Sometimes
15 Rarely 
16 Never
99 Don’t Know
88 Refused
121. In general, how often do you use the 
internet?
Circle one
15 Always
16 Sometimes
17 Rarely 
18 Never
99 Don’t Know
88 Refused
122 If there is a service that allows you to 
send text message and request for HIV 
and AIDS information, would you be 
willing to use it? If your confidentiality 
and privacy are completely assured.
• 1 Yes 
• 2 Probably 
• 3 Not sure 
• 4 Probably not 
5 No 
88. Refused
123 If there is a service that provides 
periodic HIV and AIDS information (e.g 
weekly, month etc) would you be 
willing to allow the program (e.g 
WAPCAS) to send the messages to you
through your mobile phone? If your 
confidentiality and privacy are 
completely assured.
• 1 Yes 
• 2 Probably 
• 3 Not sure 
• 4 Probably not 
5 No 
88. Refused
•
124 If there is a service to provide HIV and 
AIDS information to Key Populations 
12. Peer educators
13. Drop-in –Centers
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 302
(MARPs) in Ghana, what would be your 
preferred platform for such a service? 
(read out list and Circle all that apply)
14. Mobile Outreach
15. TV/Radio
16. Text Messaging
17. Facebook, 
18. Twitter, 
19. WhatsApp
20. Email
21. Web Portal
22. Other (Specify) 
…………………………………………………
………..
100 Don’t Know
• 88 Refused
125 If there is a service to provide HIV and 
AIDS information to Key Populations in 
Ghana, what are the three (3) key 
areas that you would like to receive 
information on? (circle maximum of 
three)
11. General HIV Prevention/Risk 
Reduction (A, B, C)
12. HTC
13. Condoms Availability 
14. PMTCT 
15. ART 
16. Lubricants 
17. STIs
18. STI referral 
19. Link to Service Providers
20. Other (specify) 
…………………………………………………
………..
99 Don’t Know
 88 Refused
•
Section 2. Service use
In the following section I am going to ask you general questions about your knowledge and use of particular health 
services available in your area. 
No. Question Response Skip
226 Have you heard of MSM peer health 
educators?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
205.
227 IF YES: In general, are the things you 
have heard about peer health 
educators:
Circle one
9 Very positive 
10 Somewhat positive
11 Somewhat negative
12 Very negative
101 Don’t Know
90 Refused
228 In general, what have you heard about 
peer educators?
5 Specify______________________________
6 ___________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 303
103 Don’t Know
90 Refused
229 Why don’t you use the services of 
MSM peer educators in your area?
Circle all that apply
14. Had never heard of them
15. Do not know how to contact/find 
one
16. Am afraid people will find out I am a 
sex worker
17. Am afraid my services/information 
won’t be kept confidential
18. Do not need peer educator services
19. Too busy/not enough time
20. Other 
(specify):___________________
99 Don’t know
89 Refused to answer
The next several questions are going to ask you about services provided by mobile outreach. By mobile 
outreach, I mean a party or other event that is held not at a drop-in center and designed specifically to provide 
information and services to sex workers.
No. Question Response Skip
230 Have you heard of services being 
provided by mobile outreach staff?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
216.
231 In general, are the things you have 
heard about the services provided 
by mobile outreach staff:
Circle one
5 Very positive
6 Somewhat positive
7 Somewhat negative 
8 Very negative
100Don’t Know
89 Refused
232 In general, what have you heard 
about the services provided by 
mobile outreach staff?
3 Specify______________________________
______
4 ___________________________________
_______
100Don’t Know
89 Refused
233 Why have you, personally, not used 
services provided by mobile 
outreach staff? 
7. Too busy/no time
8. No need for services offered
9. Afraid sex work will become known
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 304
10. Hours of outreach are inconvenient
11. Lack of transport
12. Other(specify)____________________
________________________________
________________________________
Now imagine that you wanted to receive information and services about to help reduce your risk of HIV. How 
important would the following aspects of services be to you, personally?
234 The hours are convenient.
Circle one
5 Very important
6 Somewhat important
7 Not important
8 Not important at all
100Don’t Know
89 Refused
235 Services are low-cost or free.
Circle one
5 Very important
6 Somewhat important
7 Not important
8 Not important at all
100Don’t Know
89 Refused
236 Location is convenient.
Circle one
1 Very important
2 Somewhat important
3 Not important
4 Not important at all
99 Don’t Know
88 Refused
237 Location is near public 
transportation.
Circle one
1 Very important
2 Somewhat important
3 Not important
4 Not important at all
99 Don’t Know
88 Refused
238 Staff are friendly
Circle one
1 Very important
2 Somewhat important
3 Not important
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 305
4 Not important at all
99 Don’t Know
88 Refused
239 Staff are professional.
Circle one
1 Very important
2 Somewhat important
3 Not important
4 Not important at all
99 Don’t Know
88 Refused
240 Staff are men who have sex with 
men
Circle one
1 Very important
2 Somewhat important
3 Not important
4 Not important at all
99 Don’t Know
88 Refused
241 Staff won’t judge me
Circle one
1 Very important
2 Somewhat important
3 Not important
4 Not important at all
99 Don’t Know
88 Refused
242 In the past 12 months, have you 
been screened for a sexually 
transmitted infection other than 
HIV?
Circle one
4 Yes, more than once
5 Yes, one time
6 No
100Don’t Know
89 Refused
243 If yes, where was the last place that 
you were screened for a sexually 
4 Government health facility
5 Private clinic/Doctor
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 306
Section 3. HIV Knowledge and Attitudes
No. Question Response Skip
Please indicate whether you agree or disagree with the following statements.
309.
People living with HIV/AIDS in this 
community should be treated the same 
by health care professionals as people 
with other illnesses
Circle one
5 Strongly agree
6 Somewhat agree
7 Somewhat disagree 
8 Strongly disagree
100 Don’t Know
89 Refused
3010. People talk badly about people living with 
or thought to be living with HIV to others
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
3011. People living with or thought to be living 
with HIV lose standing or respect in their 
family or community
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
3012. I fear I could become infected with HIV if I 
were to be exposed to the saliva of a 
person who has HIV/AIDS
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
3013. If you kiss someone on the cheek that has 
HIV/AIDS, you might get infected
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
3014. If you are coughed or sneezed on by 
someone who has HIV/AIDS, you are likely 
to contract the infection
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
3015. I fear I could become infected with HIV if I 
were to be exposed to the sweat of a 
1 Strongly agree
2 Somewhat agree
transmitted infection other than 
HIV?
Circle one
6 Other (Specify)_________________
100Don’t Know
89 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 307
person who has HIV/AIDS
Circle one
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
3016. I would be ashamed if someone in my 
family had HIV
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
316. A person with HIV/AIDS should be 
allowed to work with other people
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
317. People with HIV should be allowed to 
participate in social events in this 
community
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
318. People with AIDS should be isolated from 
other people
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
319. People who have HIV/AIDS should be 
treated the same as everyone else
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
320. A person with HIV/AIDS should be 
allowed to work with other people
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
321. People with HIV should be allowed to 
participate in social events in this 
community
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
322. People with AIDS should be isolated from 
other people
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
320. People who have HIV/AIDS should be 
treated the same as everyone else
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 308
99 Don’t Know
88 Refused
321. People living with HIV/AIDS in this 
community should be treated the 
same by health care professionals 
as people with other illnesses
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
322.3 People talk badly about people living 
with or thought to be living with 
HIV to others.
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
323.3 People living with or thought to be living 
with HIV lose standing or respect in 
their family or community
Circle one
1 Strongly agree
2 Somewhat agree
3 Somewhat disagree 
4 Strongly disagree
99 Don’t Know
88 Refused
Section 4. Transactional Sex: Many MSM receive money or gifts in exchange for sex.
No. Question Response Skip
429 In the past 12 months, have you 
accepted money, housing, food, or 
other items in exchange for sex?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
If No, SKIP to 
421.
430 At what age did you start accepting 
money and gifts for sex?
2 _____Years old
100 Don’t Know
89 Refused
431 Who introduced you to this practice (of 
accepting money or food in exchange 
for sex)?
Circle one
6 Mother
7 Father
8 Other relative
9 Friend
10 Boy/friend/spouse
11 Other (Specify)________________
100 Don’t Know
89 Refused
432 Where do you find most of your 
clients?
Circle one
6 Home
7 Hotel/Guest house
8 Bar/Nightclub
9 Street
10 Other (Specify)_________________
100 Don’t Know
89 Refused
433 Where do you usually take your clients 
for sex?
Circle one
6 Home
7 Hotel/Guesthouse
8 Bar/Nightclub
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 309
9 Car/Vehicle
10 Other (Specify)________________
100 Don’t Know
89 Refused
434 How do your clients usually pay you?
Circle one
4 In cash
5 In kind (clothing, food, shelter)
6 Both
100 Don’t Know
89 Refused
435 On average, how much do you earn a 
week from sex work?
Circle one
2 ________________GHC
100 Don’t Know
89 Refused
436 Other than sex work, do you have 
another means of earning money?
Circle one
3 No
4 Yes
100 Don’t Know
89 Refused
437 How many people did you have sex 
with in the past week?
2 ___________ people
100 Don’t Know
89 Refused
438 Of all the people you had sex with in 
the past week, how many were:
6 ______Paying one-time clients
7 ______Paying regular clients
8 ______One-time non-paying partners
9 ______Spouse/lover/boyfriend
10 ______Other (specify) 
_______________________
100 Don’t Know
89 Refused
439 In general, paying one-time clients 
are:
Circle one
8 1-5 years younger than me
9 6-10 years younger than me
10 More than 10 years younger than me
11 Same age as me 
12 1-5 years older than me
13 6-10 years older than me
14 More than 10 years older than me
100 Don’t Know
89 Refused
440 In general, paying regular clients are:
Circle one
1 1-5 years younger than me
2 6-10 years younger than me
3 More than 10 years younger than me
4 Same age as me 
5 1-5 years older than me
6 6-10 years older than me
7 More than 10 years older than me
99 Don’t Know
88 Refused
441 In general, non-paying one-time 
partners are:
1 1-5 years younger than me
2 6-10 years younger than me
3 More than 10 years younger than me
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 310
Circle one 4 Same age as me
5 1-5 years older than me
6 6-10 years older than me
7 More than 10 years older than me
99 Don’t Know
88 Refused
442 My spouse, lover, or boyfriend is:
Circle one
1 1-5 years younger than me
2 6-10 years younger than me
3 More than 10 years younger than me
4 Same age as me 
5 1-5 years older than me
6 6-10 years older than me
7 More than 10 years older than me
99 Don’t Know
88 Refused
No. Question Response Skip
443 Of all the people (either paying or non￾paying partner) that you have had sex 
with in the past 12 months, were some 
(at least one) females? 
Circle one
4 Yes
5 No
6 Don’t remember
100 Don’t Know
89 Refused
If No, SKIP to 
418.
444 The last time you had vaginal 
intercourse with a paying partner, did 
you use a condom? [ASK ONLY IF 
ANSWERS YES TO Q515]
Circle one
1 Yes
2 No
3 Don’t remember
99 Don’t Know
88 Refused
445 The last time you had vaginal
intercourse with a non-paying partner, 
did you use a condom?
Circle one
1 Yes
2 No
3 Don’t remember
99 Don’t Know
88 Refused
446 Have you ever had anal sex?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
If No, SKIP to 
501.
447 The last time you had anal sex with a 
paying partner, did you use a condom?
Circle one
3 Yes
4 No
100 Don’t remember
89 Refused
448 The last time you had anal sex with a 
non-paying partner, did you use a 
condom?
Circle one
3 Yes
4 No
100 Don’t remember
89 Refused
ALL SKIP to 
501.
FOR MSM WHO HAVE NOT ENGAGED IN SEX WORK:
449 How many people did you have sex 
with in the past week?
Circle one
2 ___________ people
100 Don’t Know
89 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 311
450 Of all the people you had sex with in 
the past week, how many were:
4 ___One-time casual partners
5 ___Spouse/lover/boyfriend/girlfriend
6 ___Other (specify) 
__________________________
100 Don’t Know
89 Refused
451 Of all the people you had sex with in 
the past week, how many were:
3 ___Men
4 ___Women
100 Don’t Know
89 Refused
No. Question Response Skip
452 In general, are your partners:
Circle one
8 The same age as you
9 1-5 years younger than you
10 6-10 years younger than you
11 More than 10 years younger than you
12 1-5 years older than you
13 6-10 years older than you
14 More than 10 years older than you
100 Don’t Know
89 Refused
453 Have you had vaginal intercourse in 
the past 12 months?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
If No, SKIP to 
427.
454 IF YES: The last time you had vaginal 
intercourse, did you use a condom?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
455 Have you had anal intercourse in the 
past 12 months?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
501.
456 IF YES: The last time you had anal 
intercourse, did you use a condom?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
Section 5. Violence
For the following questions, think only about your main or most recent spouse, lover, or boyfriend.
No. Question Response Skip
525 My partner explained his side or 
suggested a compromise for a 
disagreement with me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
526 My partner insulted or swore or 
shouted or yelled at me
1 Never
2 Not in past year, but it did happen before
3 Once in past year
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 312
Circle one 4 More than once in past year
99 Don’t Know
88 Refused
527 I had a sprain, bruise, or small cut, or 
felt pain the next day because of a 
fight with my partner
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
528 My partner showed respect for, or 
showed that he cared about my feeling 
about an issue we disagreed on
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
529 My partner pushed, shoved, or slapped 
me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
530 My partner punched or kicked or beat￾me-up
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
531 My partner destroyed something 
belonging to me or threatened to hit 
me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
532 I went see a doctor or needed to see a 
doctor because of a fight with my 
partner
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
533 My partner used force (like hitting, 
holding down, or using a weapon) to 
make me have sex
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
534 My partner insisted on sex when I did 
not want to or insisted on sex without 
a condom (but did not use physical 
force)
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
DATA COLLECTORS: DID THIS PARTICIPANT REPORT ACCEPTING MONEY OR GIFTS FOR SEX IN THE LAST SECTION?
⃝YES ⃝NO 
IF CHECKED YES, SKIP to 601.
If NO, PROCEED TO 511
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 313
READ: For the following questions, think only about your paying partners.
No. Question Response Skip
535 A paying partner insulted or swore or 
shouted or yelled at me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
536 I had a sprain, bruise, or small cut, or 
felt pain the next day because of a 
fight with a paying partner
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
537 A paying partner pushed, shoved, or 
slapped me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
538 A paying partner punched or kicked or 
beat-me-up
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
539 A paying partner destroyed something 
belonging to me or threatened to hit 
me
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
540 I went see a doctor or needed to see a
doctor because of a fight with a paying 
partner
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
541 A paying partner used force (like 
hitting, holding down, or using a 
weapon) to make me have sex
Circle one
1 Never
2 Not in past year, but it did happen before
3 Once in past year 
4 More than once in past year
99 Don’t Know
88 Refused
542 A paying partner insisted on sex when I 
did not want to or insisted on sex 
without a condom (but did not use 
physical force)
Circle one
5 Never
6 Not in past year, but it did happen 
before
7 Once in past year 
8 More than once in past year
100 Don’t Know
89 Refused
543 During the last 12 months, have you 
ever avoided arrest by providing a 
police officer with a sexual favor?
1 Yes
2 No
99 Don’t Know
88 Refused
If No, SKIP to 
521.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 314
Circle one
544 IF yes: How often in the last 12 months 
have you avoided arrest by providing a 
police officer with a sexual favor?
Circle one
5 Often
6 Sometimes
7 Rarely
8 Never
100 Don’t Know
89 Refused
545 During the last 12 months, have you 
been forced to not use condoms during 
sex?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
If No, SKIP to 
523.
546 IF YES: who forced you to not use 
condoms during sex?
Circle one
5 Paying one-time client
6 Paying regular client
7 Non-paying spouse, partner, or 
boyfriend
8 Other (specify) 
___________________________
100 Don’t Know
89 Refused
547 During the last 12 months, have you 
been beaten or physically abused as a 
result of doing sex work?
Circle one
3 Yes
4 No
100 Don’t Know
89 Refused
If No, SKIP to 
601.
548 IF Yes: who beat you or physically 
abused you as a result of doing sex 
work?
Circle one
6 Paying one-time client
7 Paying regular client
8 Non-paying spouse, partner, or 
boyfriend
9 Family member
10 Other (specify)_________________
100 Don’t Know
89 Refused
Section 6. Substance Use
Now I will ask you some questions about your alcohol use. By alcohol use we mean drinking a bottle of beer, a glass of wine, 
shot of spirits, and glass or can of home or local brews.
No. Question Response Skip
643 How often do you have a drink containin 
alcohol?
Circle one
16 Never
17 Once a month or less
18 2-4 times a month
19 2-3 times a week
20 4 or more times a week
102 Don’t Know
91 Refused
644 How many drinks containing alcohol
do you have on a typical day when you a 
drinking?
16 1 - 2
17 3- 4 
18 5- 6
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 315
Circle one
19 7– 9
20 10 or more
102 Don’t Know
91 Refused
645 In the past year how often have you drun 
alcohol before sex?
Circle one
19 Always
20 Sometimes
21 Rarely 
22 Never
23 99Don’t Know
24 88Refused
646 How often do you have 6 or more drinks 
one occasion?
Circle one
22 Never
23 Less than monthly
24 Monthly 
25 Weekly
26 Daily or almost daily
27 99Don’t Know
28 88Refused
647 How often during the last year have you 
found that you have not been 
able to stop drinking once you 
started?
Circle one
22 Never
23 Less than monthly
24 Monthly 
25 Weekly
26 Daily or almost daily
27 99Don’t Know
28 88Refused
648 How often during the past year have you 
failed to do what was expected 
of you because of drinking?
Circle one
22 Never
23 Less than monthly
24 Monthly 
25 Weekly
26 Daily or almost daily
27 99Don’t Know
28 88Refused
649 How often during the past year did 
you have to use ‘a first drink in the 
morning’ to get yourself going after 
a heavy drinking session?
Circle one
22 Never
23 Less than monthly
24 Monthly 
25 Weekly
26 Daily or almost daily
27 99Don’t Know
28 88Refused
650 How often during the past year have you 
had a feeling of guilt or remorse after 
drinking?
Circle one
22 Never
23 Less than monthly
24 Monthly 
25 Weekly
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 316
26 Daily or almost daily
27 99 Don’t Know
28 88 Refused
No. Question Response Skip
651 How often during the past year have you 
been unable to remember what happene 
the night before because you had been 
drinking?
Circle one
16 Never
17 Less than monthly
18 Monthly 
19 Weekly
20 Daily or almost daily
102 Don’t Know
91 Refused
652 Have you or someone else been injured 
because of your drinking?
Circle one
16 Never
17 Less than monthly
18 Monthly 
19 Weekly
20 Daily or almost daily
102 Don’t Know
91 Refused
653 Has a relative, friend, doctor, or 
other health worker been concerned abo 
your drinking or suggested 
that you should cut down?
Circle one
16 Never
17 Less than monthly
18 Monthly 
19 Weekly
20 Daily or almost daily
102 Don’t Know
91 Refused
Now I’m going to ask you about the use of other addictive substances such as cocaine, heroin, and other substances that alte 
your mood and are not prescribed by a health care professional.
654 READ: Some people have used a range of such substances. Have you ever used any of these substances, 
even once?
612a Cocaine
Circle one
10 Yes, more than once
11 Yes, one time 
12 No 
102 Don’t Know
91 Refused
612b Heroin
Circle one
10 Yes, more than once
11 Yes, one time 
12 No 
102 Don’t Know
91 Refused
612c Marijuana (Weed)
Circle one
10 Yes, more than once
11 Yes, one time 
12 No 
102 Don’t Know
91 Refused
612d Valium
Circle one
10 Yes, more than once
11 Yes, one time 
12 No
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 317
102 Don’t Know
91 Refused
612e Sleeping pills
Circle one
10 Yes, more than once
11 Yes, one time 
12 No 
102 Don’t Know
91 Refused
612f. Other drugs (specify): 
_____________________________
Circle one 
10 Yes, more than once
11 Yes, one time 
12 No 
102 Don’t Know
91 Refused
655 Some people have tried injecting 
drugs using a syringe. Have you injected 
drugs recreationally in the 
last 12 months?
Circle one
10 Yes, more than once
11 Yes, one time 
12 No 
102 Don’t Know
91 Refused
If No, SKIP to 70
656 If Yes to 613: With how many 
people have you ever shared
needles or syringes?
Circle one
10 None
11 1-2 people
12 or more people
102 Don’t Know
91 Refused
Section 7. Service Quality
7.1. HIV-related information and risk reduction services
No. Question Response Skip
908 Have you received HIV-related informatio 
and risk reduction counseling in the past 
12 months?
Circle one
10 Yes, more than once
11 Yes, one time 
12 No 
102 Don’t Know
91 Refused
If Yes, SKIP to 70
909 If NO, In your neighborhood, do you 
know a place where people can get 
advice about AIDS and get tested for 
HIV?
Circle one
1 Yes
2 No
99 Don’t Know
88 Refused
If No, Skip to 722
910 IF YES: In the past 12 months, where hav 
you received HIV-related information and 
risk reduction counseling?
Circle one
16 Drop-in center
17 Mobile outreach
18 Peer educator
19 Government health facility
20 Other 
(Specify)_________________________
102 Don’t Know
91 Refused
911 Where was the LAST PLACE that you 
received HIV-related information and 
16 Drop-in center
17 Mobile outreach
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 318
risk reduction counseling?
Circle one
18 Peer educator
19 Government health facility
20 Other 
(Specify)_________________________
102 Don’t Know
91 Refused
The following questions refer only to the LAST TIME you received HIV-related information and risk reduction counseling.
912 The last time you received HIV-related 
information and risk reduction 
counseling, how satisfied were you 
with the HIV counseling services?
Circle one
13 Very satisfied
14 Satisfied
15 Not satisfied
16 Very unsatisfied
102 Don’t Know
91 Refused
913 The last time you received HIV-related 
information and risk reduction 
counseling, how professional was the 
staff?
Circle one
13 Very professional 
14 Somewhat professional
15 Somewhat unprofessional
16 Very unprofessional
102 Don’t Know
91 Refused
914 The last time you received HIV-related 
information and risk reduction 
counseling, how friendly was the staff?
Circle one
19 Very friendly
20 Somewhat friendly
21 Not friendly
22 Not friendly at all
99 Don’t Know
88 Refused
915 Would you use these HIV risk reduction 
counseling services again?
Circle one
13 Yes
14 No
15 Don’t Know
16 Refused
916 Would you recommend these HIV risk 
reduction counseling services to a 
friend?
Circle one
13 Yes
14 No
99 Don’t Know
88 Refused
917 Now think about the last time you 
received HIV risk reduction counseling. 
How much did the risk reduction 
counseling help you?
Circle one
16 Helped a lot
17 Helped some
18 Did not help
99Don’t Know
88Refused
918 How much helpful information did you 
receive?
Circle one
10 A lot of helpful information
11 A little helpful information
12 No helpful information
102 Don’t Know
91 Refused
919 When you saw the counselor, who 
talked the most?
Circle one
10 I talked the most
11 The counselor talked the most
12 We talked the same amount
102 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 319
91 Refused
920 When you saw the counselor, who 
listened the most?
Circle one
10 I listened the most
11 The counselor listened the most
12 We listened the same amount
102 Don’t Know
91 Refused
921 To what extent did the counselor 
answer your questions and concerns 
about HIV?
Circle one
10 A lot
11 Some
12 Not at all
102 Don’t Know
91 Refused
922 To what extent did the counselor help 
you think about what you were doing 
that puts you at risk for getting HIV?
Circle one
10 A lot
11 Some
12 Not at all
102 Don’t Know
91 Refused
923 To what extent did the counselor help 
you make a plan to protect yourself 
from HIV?
Circle one
10 A lot
11 Some
12 Not at all
102 Don’t Know
91 Refused
924 To what extent did the counselor help 
you come up with small steps you can 
take to make your HIV prevention plan 
work?
Circle one
10 A lot
11 Some
12 Not at all
102 Don’t Know
91 Refused
925 Did the counselor tell you about other 
places you could go for help for HIV 
and health care related services?
Circle one
7 Yes
8 No
102 Don’t Know
91 Refused
926 In your plan to reduce your HIV risk, 
who came up with the ideas what you 
will do?
Circle one
10 I did
11 The counselor
12 We both did
102 Don’t Know
91 Refused
927 How much did the counselor help you 
with your plan to reduce HIV risk?
Circle one
13 A lot
14 Somewhat
15 A little
16 Not at all
102 Don’t Know
91 Refused
928 How much did you help the counselor 
to develop a plan to reduce your HIV 
risk? 
Circle one
13 A lot
14 Somewhat
15 A little
16 Not at all
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 320
102 Don’t Know
91 Refused
929 How much did you tell the counselor 
about your sex life and use of drugs?
Circle one
13 A lot
14 Somewhat
15 A little
16 Not at all
102 Don’t Know
91 Refused
722 How can people reduce their risk of contracting HIV/AIDS? DO NOT READ LIST OUT LOUD
Check YES for all mentioned. Check NO for all not mentioned.
722a Use condoms
Circle one
7 Yes
8 No
91
722b Reduce the number of sexual partners
Circle one
7 Yes
8 No
102
91
722c Be faithful to one partner
Circle one
7 Yes
8 No
722d Do not have casual sex
Circle one
7 Yes
8 No
91 Refused
722e Do not have sex
Circle one
7 Yes
8 No
102 Don’t Know
91 Refused
722f Avoid contaminated needles
Circle one
7 Yes
8 No
102 Don’t Know
91 Refused
722g Avoid contact with infected people
Circle one
7 Yes
8 No
102 Don’t Know
91 Refused
722h Other (specify) 
________________________________
__________________________
Circle one
7 Yes
8 No
102 Don’t Know
91 Refused
Thank you. Now I would like to ask some additional questions about what you know about HIV.
930 Can a healthy looking person be 
infected with HIV?
Circle one
7 Yes
8 No
102 Don’t Know
91 Refused
Please indicate whether you agree or disagree with the following statements.
No. Question Response Skip
931 If you kiss someone on the cheek that 13 Strongly agree
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 321
has HIV/AIDS, you might get infected
Circle one
14 Somewhat agree
15 Somewhat disagree
16 Strongly disagree
102 Don’t Know
91 Refused
932 If you are coughed or sneezed on by 
someone who has HIV/AIDS, you are 
likely to contract the infection
Circle one
13 Strongly agree
14 Somewhat agree
15 Somewhat disagree
16 Strongly disagree
102 Don’t Know
91 Refused
933 I fear I could become infected with HIV 
if I were to be exposed to the sweat of 
a person who has HIV/AIDS
Circle one
13 Strongly agree
14 Somewhat agree
15 Somewhat disagree
16 Strongly disagree
102 Don’t Know
91 Refused
934 I fear I could become infected with HIV 
if I were to be exposed to the saliva of 
a person who has HIV/AIDS
Circle one
13 Strongly agree
14 Somewhat agree
15 Somewhat disagree
16 Strongly disagree
102 Don’t Know
91 Refused
935 I have no risk of getting HIV.
Circle one
13 Strongly agree
14 Somewhat agree
15 Somewhat disagree
16 Strongly disagree
102 Don’t Know
91 Refused
936 I am at risk of getting HIV.
Circle one
13 Strongly agree
14 Somewhat agree
15 Somewhat disagree
16 Strongly disagree
102 Don’t Know
91 Refused
937 I want to reduce my risk of getting HIV.
Circle one
13 Strongly agree
14 Somewhat agree
15 Somewhat disagree
16 Strongly disagree
102 Don’t Know
91 Refused
938 I know ways to reduce my risk.
Circle one
13 Strongly agree
14 Somewhat agree
15 Somewhat disagree
16 Strongly disagree
102 Don’t Know
91 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 322
939 I have a plan for how I will reduce my 
risk.
Circle one
13 Strongly agree
14 Somewhat agree
15 Somewhat disagree
16 Strongly disagree
102 Don’t Know
91 Refused
940 I like my HIV prevention plan.
Circle one
13 Strongly agree
14 Somewhat agree
15 Somewhat disagree
16 Strongly disagree
102 Don’t Know
91 Refused
941 I’m sure I can follow my HIV prevention 
plan.
Circle one
13 Strongly agree
14 Somewhat agree
15 Somewhat disagree
16 Strongly disagree
102 Don’t Know
91 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 323
7.2 HIV Testing
No. Question Response Skip
942 In the last 12 months, have you been 
offered an HIV test?
Circle one
7 Yes
8 No
102 Don’t Know
91 Refused
943 In the last 12 months, have you been 
tested for HIV?
Circle one
10 No
11 Yes, one time
12 Yes, more than once
102 Don’t Know
91 Refused
If Yes, SKIP to 
737.Otherwise 
SKIP to 772
944 IF No to 736, why have you not been 
tested for HIV? 
Do not read list but circle all that are 
mentioned
28 I’m worried that people would find out my test results
29 I don’t know where to get tested.
30 Getting tested is too expensive.
31 The places for HIV testing are too far away.
32 The hours for HIV testing are inconvenient.
33 It’s difficult to get to HIV testing places on public 
transportation.
34 The people that provide HIV testing will treat me 
differently because I am a sex worker.
35 I am not at risk for HIV.HIV is not a serious health 
condition.
36 I am worried that people will treat me poorly if the tes 
result is positive.
102 Don’t Know
91 Refused
SKIP to 738.
945 Was the decision to be tested for HIV 
up to you or were you pressured, 
forced, or unknowingly tested?
16 Yes, it was completely my decision to be tested.
17 It was my decision to be tested, but it was under 
pressure from others
18 I was forced to take an HIV test.
19 I was tested without my knowledge
20 I only found out after the test had been done
102 Don’t Know
91 Refused
946 In your opinion, are MSM hesitant to 
take an HIV test due to fear of 
people’s reaction if the test result is 
positive for HIV?
Circle one
7 Yes
8 No
102 Don’t Know
91 Refused
947 In the last 12 months, where have you 
been tested for HIV? 
Do not read list but circle all that are 
mentioned
16 Drop-in center
17 Mobile outreach
18 Peer educator
19 Government health facility
20 Other (Specify)_________________________
102 Don’t Know
91 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 324
No. Question Response Skip
948 Where was the last place you were teste 
for HIV?
Circle one
16 Drop-in center
17 Mobile outreach
18 Peer educator
19 Government health facility
20 Other 
(Specify)_________________________
102 Don’t Know
91 Refused
The following questions refer only to the LAST TIME you were tested for HIV.
949 Overall, how satisfied were you with 
the HIV testing services?
Circle one
13 Very satisfied
14 Satisfied
15 Not satisfied
16 Very unsatisfied
102 Don’t Know
91 Refused
950 The last time you were tested for HIV, 
how professional was the staff?
Circle one
13 Very professional 
14 Somewhat professional
15 Somewhat unprofessional
16 Very unprofessional
102 Don’t Know
91 Refused
951 The last time you were tested for HIV, 
how friendly was the staff?
Circle one
13 Very friendly
14 Somewhat friendly
15 Not friendly
16 Not friendly at all
102 Don’t Know
91 Refused
952 Would you use these HIV testing 
services again?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
953 Would you recommend these HIV 
testing services to a friend?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
Again, for the following questions, think only about the last time you were tested for HIV.
954 Before you were tested for HIV, did the 
counselor explain why you should get 
tested for HIV?
Circle one
7 Yes
8 No 
102 Don’t know
91 Refused
955 Before you were tested for HIV, did the 
counselor explain to you the type of 
test that was used?
1 Yes
2 No 
99 Don’t know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 325
Circle one
88 Refused
956 Before you were tested for HIV, did the 
counselor explain to you the meaning 
of a positive and negative result?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
957 Before you were tested for HIV, did the 
counselor explain to you that if 
managed with antiretroviral therapy 
(ART) and quality clinical care, HIV 
infection may be controlled as a chronic 
condition?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
958 Before you were tested for HIV, did the 
counselor explain to you the test result 
is confidential- that is, no one will know 
the results of your test unless you tell 
them?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
959 Before you were tested for HIV, did the 
counselor explain to you disclosure of a 
positive result is needed to receive 
treatment for HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
960 Before you were tested for HIV, did the 
counselor explain to you that you can 
choose not to get tested and still 
receive all other services that are 
provided?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
Again, for the following questions, think only about the last time you were tested for HIV. 
961 The last time you were tested for HIV, 
were you able to ask questions about 
HIV/AIDS and about getting tested for 
HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
962 The last time you were tested for HIV, 
were you encouraged to ask questions 
about the testing process?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
963 The last time you were tested for HIV, 
did you feel that your confidentiality 
was protected – that is, that no one 
would know that your test result 
unless you told them?
1 Yes
2 No 
99 Don’t know
88 Refused
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 326
Circle one
964 The last time you were tested for HIV, 
how long did you have to wait to 
receive the test results?
Circle one
13 A very long time
14 Somewhat long time
15 Not very long
16 Not long at all
102 Don’t Know
91 Refused
Thank you. Now I would like to ask you some personal questions about your HIV testing. Please 
remember that we have not taken your name and all your responses will be completely confidential. No 
one will ever know what you have told me during this interview. I appreciate your trust and honesty.
965 Do you know the result of your most 
recent HIV test?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
If No, SKIP to 
772.
966 IF YES to 758: Have you told a sexual 
partner the results of your most recent 
HIV test?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
967 IF YES to 758: What was the result of 
your most recent HIV test?
Circle one
7 Positive
8 Negative
102 Don’t Know
91 Refused
If POSITIVE, SK 
to 763.
968 If negative: If you had tested positive, 
would you have sought out treatment 
for HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
If Yes, SKIP t 
772
969 IF NO to 760: If you had tested positive, 
why would you have not sought out 
treatment for HIV? 
CIRCLE ALL THAT APPLY
34 I would be worried that people would find out that 
was HIV positive.
35 Treatment for HIV is too expensive.
36 I wouldn’t know where to go to receive treatment f 
HIV.
37 I would be worried that doctors would treat me 
poorly because I am a sex worker.
38 I would be worried that doctors would treat me 
poorly if I were HIV positive.
39 HIV treatment is not effective.
40 The places that provide HIV treatment are too far 
away.
41 The places that provide HIV treatment are difficult t 
get to on public transportation.
42 The hours for receiving HIV treatment are 
inconvenient.
43 You have to wait a long time to get an appointment
44 In the past, doctors have treated me poorly because 
am a sex worker.
ALL SKIP to 
772
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 327
102 Don’t Know
91 Refused
970 If positive: When you received your 
test results, did you receive a referral 
to care, support and treatment?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
If No, SKIP to 
764
971 If yes to 762: Have you contacted the 
referral to receive care, support and 
treatment?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
972 IF POSITIVE: Are you currently taking 
antiretroviral medications daily for 
HIV?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
If Yes, SKIP to 
767.
973 IF NO to 765: Why are you not 
receiving treatment for HIV? 
CIRCLE ALL THAT APPLY
37 I am worried that people will find out that I am HIV 
positive.
38 Treatment for HIV is too expensive.
39 I don’t know where to go to receive treatment for 
HIV.
40 I’m worried that doctors will treat me poorly becaus 
I am a sex worker.
41 I’m worried that doctors will treat me poorly becaus 
I am HIV positive.
42 HIV treatment is not effective.
43 The places that provide HIV treatment are too far 
away.
44 The places that provide HIV treatment are difficult t 
get to on public transportation.
45 The hours for receiving HIV treatment are 
inconvenient.
46 You have to wait a long time to get an appointment
47 In the past, doctors have treated me poorly
48 Because I am a sex worker.
102 Don’t Know
91 Refused
974 IF POSITIVE: In the last 12 months, 
have you been fearful of any of the 
following things happening to you – 
whether or not they actually have 
happened to you – because you are 
HIV positive?
Circle all that apply
13 Being gossiped about
14 Being verbally insulted, harassed and/or 
threatened 
15 Being physically harassed and/or threatene
16 Being physically assaulted
102 Don’t Know
91 Refused
975 IF POSITIVE: How often have you felt 
excluded from social gatherings or 
activities because of your HIV status?
Circle one
13 Often
14 Sometimes
15 Rarely 
16 Never
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 328
102 Don’t Know
91 Refused
976 IF POSITIVE: How often have you been 
denied health services because of your 
HIV status?
Circle one
13 Often
14 Sometimes
15 Rarely 
16 Never
102 Don’t Know
91 Refused
811 IF POSITIVE: How often have you felt 
gossiped about because of your HIV 
status?
Circle one
13 Often
14 Sometimes
15 Rarely 
16 Never
102 Don’t Know
91 Refused
812 IF POSITIVE In the last 12 months, have 
you experienced any of the following 
feelings because of your HIV status?
Circle all that apply
19 I feel ashamed
20 I feel guilty
21 I blame myself
22 I blame others
23 I have low self-esteem
24 I feel I should be punished
102 Don’t Know
91 Refused
7.3 Quality of condom and lubricant information and distribution services
No. Question Response Skip
813 In the last 12 months, have you 
received condoms, lubricants, or 
information about how to use 
condoms and lubricants to reduce your 
risk of HIV?
Circle one
10 No
11 Yes, one time
12 Yes, more than once
102 Don’t Know
91 Refused
If No, SKIP 
774.
814 Overall, how satisfied were you with 
the condom and lubricant distribution 
services?
Circle one
9 Very satisfied
10 Satisfied
11 Not satisfied
12 Very unsatisfied
101 Don’t Know
90 Refused
815 Overall, how professional was the 
staff?
Circle one
13 Very professional 
14 Somewhat professional
15 Somewhat unprofessional
16 Very unprofessional
102 Don’t Know
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 329
91 Refused
816 Overall, how friendly was the staff?
Circle one
13 Very friendly
14 Somewhat friendly
15 Not friendly
16 Not friendly at all
102 Don’t Know
91 Refused
817 Would you use these condom and 
lubricant distribution services again?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
818 Would you recommend these condom 
and lubricant distribution services to a 
friend?
Circle one
1 Yes
2 No 
99 Don’t know
88 Refused
Now I’m going to ask you a few questions about the things that MSM may or may not do to try to stay healthy. 
These questions are about MSM generally and may or may not reflect what you yourself do.
785 In general, where do MSM go for health care - that is, if they are sick or want to see a 
doctor or nurse? 
 PROBE: Where do MSM go if they have a question about their health or 
 are worried about their health? Why do MSM go to those places and not 
 others?
PROBE: Why do you think some MSM might not go for health care?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
786 Now imagine that an MSM goes to the doctor.
How would he decide whether or not to tell the doctor that he has sex with men?
 PROBE: What kinds of things would make him more likely to tell the doctor 
 that he is an MSM? What kind of things would make him less likely to tell 
 the doctor? What would happen if he told the doctor?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________ 
787 We know that MSM are at risk of HIV, but only some get tested for HIV. 
What types of things prevent MSM from getting tested for HIV? 
 PROBE: What about stigma? Concerns about privacy?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 330
___________________________________________________________________
___________________________________________________________________
788 What types of things prevent MSM from getting treatment for HIV? 
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
789 What would you recommend to someone who was developing health care services 
specifically to get more MSM to use HIV prevention services?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
790 Is there anything else that I haven’t asked you about providing HIV prevention services to 
MSM that you would like to share with me?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
791 There has been emotive debate in recent past on whether or not the rights of MSM 
should be upheld. Can you enumerate the instances where your rights have been violated 
or denied because you were known or perceived to be MSM? [List as many instances as 
you are able to recall]
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Thank you for taking the time to share your thoughts and experiences with me today.
Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana 331
RECRUITMENT TRACKING TOOL
Data Collection Tool:______________________________________________
Data Collection Zone:______________________________________________
Supervisor name: 
_________________________________________________
Date (MM/DD/YY) Total No. refused to 
be screened (walk 
aways)
No. ineligible (<18) No. 
ineligible 
(not a 
MARP)
No. 
ineligible 
(not a 
client/non￾client)
No. 
ineligible 
(already 
participated)
No. eligible 
(declined 
to 
participate)
No. eligible ( 
participated)