Abstract
Insomnia symptoms, including difficulty sleeping and daytime fatigue, are prevalent among people living with HIV, particularly men who have sex with men. In Ghana, criminalization and marginalization exacerbate these sleep disturbances. Our study analyzed 2017 survey data from 225 men who have sex with men living with HIV using logistic regression and generalized boosted models. Results showed 42.1% reported insomnia symptoms, with 33.8% finding them distressing. Enacted stigma, internalized stigma, same-sex behavior stigma, and perceived stress were key risk factors, whereas a sense of community and basic needs satisfaction were protective. Given these findings, integrating routine sleep assessments into HIV care, incorporating stigma-reduction interventions, and strengthening community-based support programs can improve sleep and overall health. Tailored psychosocial interventions addressing stress and stigma, alongside structural policies fostering inclusion, can enhance engagement in HIV care and mitigate sleep-related health disparities.