Introduction Intimate partners (IP) of female sex workers (FSW) are a population of growing interest in Ghana. The study objectives were to: explore the emotional, financial, and power dynamics within these relationships; describe the sexual behaviours and HIV knowledge and vulnerabilities of both partners; and document the perceived availability and accessibility of social support and health services.

Methods In-depth interviews (IDIs) were conducted with 24 male IP of FSW. Two focus group discussions were conducted with 13 male IPs and three with 20 FSWs. The age range of IPs was from 20–60 years and FSWs from 18–50.

Results The IPs met their FSWs through introductions by close friends, patronising FSW’s services and/or by FSWs going after the IPs. The nature of relationships ranged from the IP offering protection for financial support (transactional), meeting emotional needs (intimate) to consensual reciprocal relationships. Forty percent of IPs were monogamous with their FSW partner, and about 50% of IPs and FSW couples used condoms. Lack of condom use was considered a sign of intimacy. The majority of respondents had some knowledge of HIV transmission and consequences. All respondents understood that condoms offer protection against HIV infection, but many FSW respondents reported difficulty in convincing regular clients to use condoms. Over half of the men who participated in the IDIs had recently tested for HIV, and half the men knew their FSW partner’s HIV status. Respondents showed varying levels of awareness of HIV testing options and pricing, and had suggestions for how to improve services.

Conclusion Study results show a nuanced picture of IP of FSW relationships, and these dynamics are important in the context of HIV and STI transmission prevention. Expanded community-based services for FSW and IP and initiatives that increase availability and acceptability of condom use should be pursued.

Disclosure of interest statement This study was implemented by Boston University in collaboration with the Kwame Nkrumah  University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Agency for International Development under Project SEARCH Task Order No. GHH-I-00- 07–00023–00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the US Government.