Almost three decades into HIV epidemic in Ghana: What have we learnt, what are the challenges, and what is the way forward?

•Issues: In March 1986, Ghana's first case of AIDS was reported. In 2007 HIV prevalence was estimated at 2.6% from 3.6% in 2003 with national adult prevalence of 1.9%. The Ghana AIDS Commission projects that by 2014, without concerted efforts, nearly 1.36 million Ghanaians could be infected. •Description: Steps taken by governments such as sentinel surveys, policies, and education are analyzed. I discuss the roles of culture, hard to reach group (MSM,), poverty, pro natalist values, criminalizing commercial and same sex acts, attitude toward condom, and youth sexuality, in HIV propagation. I analyzed the political economy of HAART, PMCT, HIV funding, understanding the dynamics of HIV research in Africa, and HIV prevalence of Ghana's neighbors. •Lessons Learned: Ghana has only 56 NGOs in malaria but 3,000+ in HIV even though malaria kills more people. From 2005-2007 about 2.7%, 6.3% and 10.1% respectively, of HIV infected pregnant women received antiretrovirals. Only 15.57% of the PLWHAs are currently receiving antiretrovirals. Stigma and inadequacy of funds make it difficult to aggressively promote other aspects of prevention (massive screening of at-risk individuals and prevention for positives hence increasing incident cases). •Recommendations: I call for New Directions to include leaders of sub populations (MSM and CSWs) in designing interventions and evaluating programs targeted at sub populations, improve data collection to get HIV epidemiologic profile, and funding longitudinal research on ARV recipients. Legal, policy, and other reforms to prevent discrimination and stigma such as media and judicial sensitization, and the use of entertainment education are imperative.