Background This qualitative study was designed to examine vulnerability to HIV infection and health-related needs among young men who have sex with men (MSM) in Kumasi, Ghana. Study objectives were to explore substance use (SU) and transactional sex (TS), overlap between SU and TS, beliefs related to SU and TS, and HIV knowledge and risk behaviours in this population.

Methods Adolescents (aged 15–17 years) and young adults (aged 18–29 years) who self-reported male-to-male sex in the previous 12 months and who either used alcohol or illicit substances or engaged in TS were recruited using snowball sampling. Data were collected through 44 in-depth interviews and eight focus group discussions, and analysed using QSR NVivo 10.0 software.

Results A total of 99 MSM participated. Most reported engaging in alcohol use and TS; a minority used substances, mainly marijuana. The majority displayed knowledge of HIV transmission and prevention, though few understood the basics of HIV treatment. Most perceived they were at high risk of HIV infection due to inconsistent condom use. Their risky behaviours also encompassed group sex, multiple sexual partners, and SU. Most expressed specific health needs, including education, screening, and treatment for sexually transmitted infections. They reported having only one clinic that provides services specific to MSM, and requested shorter wait times at facilities. Barriers to health and HIV services access included stigmatisation, ill-treatment by providers, poor quality of services, fear of testing positive, and lack of privacy, health insurance, and not knowing where to access services. Participants suggested legalising male-to-male sex, educating the public about MSM, and providing MSM with jobs to alleviate their challenges.

Conclusion Young MSM in Kumasi engage in high-risk behaviours and indicate a need for interventions to improve access to health and HIV-related services, increase HIV treatment knowledge, and reduce stigma among health providers and society.