Major themes and categories developed.

It can be challenging for sexual minority men (SMM) to decide whether or not to disclose their sexual orientation or behavior. The implications of this decision are significant, especially when considering how their family might react. We interviewed individuals living in slum communities (n = 12) in Accra and Kumasi, Ghana. Our study found that two factors primarily influenced the decision of SMM to disclose their sexual orientation. Firstly, SMM feared facing harm from their families and, secondly, the close ties of SMM families to religious institutions in their communities, which taught against LGBTQ+ activities in the country. These findings contribute to understanding why SMM in Ghanaian slum communities choose to keep their sexual orientation anonymous. While no single intervention is enough to address the challenges associated with coming out, participants in the study agreed that a social support intervention that provides opportunities to educate and inform their families and community on LGBTQ+ activities could help them assimilate comfortably in their communities.