fighting hiv in ghana requires addressing homosexuality

By Dr. Dela Attipoe

March 2004: Since the onset of the HIV/AIDS pandemic, tremendous shifts have been recorded in health management due to the growing understanding of it as a social issue that requires broad approaches going beyond the remit of the health sector.

The HIV/AIDS pandemic has also brought about a shift in some social mores, as it forced us to begin discussions of taboo topics such as sex. As a result, health services have been extended to prostitutes, long considered social outcasts.

However, one aspect of our society that has either not been recognised, or is being denied, but which could reverse any gain made in the fight against HIV/AIDS, is ‘same-sex sex’ particularly ‘men that have sex with men’ (MSM) since sex is the commonest mode of transmission of HIV.

This study was intended to assess the MSM situation in and around Accra, Ghana, so as to make recommendations for the introduction of measures to control sexually transmitted infections (STI), including HIV/AIDS among MSM, in support of the national response to the HIV/AIDS menace.

Methodology
The study, which is exploratory in nature, was carried out using a semi-structured questionnaire. Members of NGOs which have been working with the gay, lesbian, bisexual and trans-sexual community were used as research assistants (RAs) to collect the data using a snowball referral system. Every willing practicing MSM either known or referred to the RAs was interviewed and regular meetings were held with them to correct any deficiencies and to fill in the gaps.

In all 156 questionnaires were returned. Six were considered inconsistent or unreliable and were discarded from the analysis.

Key Findings
1. MSM are real in Ghana with Ghanaians fully involved. It is not a recent phenomenon being visited on Ghana and Ghanaians by ‘whites’ or foreigners.

2. Youth are actively being drawn into MSM activities by their peers and older colleagues and relatives, most of them at a very young age.

3. MSM in Ghana cut across all social classes, religions, and ethnicities. Married men are involved.

4. It is practically happening everywhere, particularly where people gather for celebrations and merry making in urban areas, along with other places most people would never suspect.

5. There are many prevailing factors that make MSM attractive particularly to youths, including adventure-seeking, poverty, ignorance, lure of older gays looking for partners and the belief that anal sex is safer than vaginal sex.

6. Society's reaction to gays and homosexuality has driven them underground where it difficult to provide them with health services.

The current state of affairs comes with a high price that could potentially set back the national response to HIV/AIDS. This is seen in the following:
1. Very poor knowledge of STIs other than gonorrhoea and HIV
2. Erroneous belief that these infections could not be transmitted through anal sex because they believe that anal sex is safer than vaginal sex
3. High level of promiscuity with multiple sex partners/customers, yet with a high level of trust in sex partners
4. Low usage of condom for protection against infection during gay anal sex with the erroneous belief that antibiotics, herbal preparation and spiritualism could offer protection
5. Fairly high rate of MSM related health problems making them potential candidates for HIV infection
6. Active bridging between bisexual men and their women partners without protection creating more avenues for the spread of HIV.

A large majority of respondents will welcome the introduction of curative and preventive interventions, and have suggested ways of making this possible.

Conclusions and Recommendations
HIV/AIDS is taking its toll on the socio-economic lives of many in Sub-Saharan Africa, and it is possible that MSM are contributing significantly to the statistics. Without any health intervention targeting MSM, the struggle against HIV/AIDS cannot succeed. The Ministry of Health / Ghana Health Service (MoH/GHS), in accordance with its mission, vision and code of ethics and the Health Partners, owes it to the nation and to posterity to improve health care overal and reduce inequalities in it for all people living in Ghana, including men that have sex with men. To this end, we recommend the following short term and long-term measures:

In the short-term, a confidence-building programme should be initiated with NGOs working with the gay community and youths to start developing and implementing both curative and preventive services around the existing STI Clinics. Health workers in these clinics should be re-oriented in the management of MSM related health problems, and members of the gay community invited and trained as peer educators.

In the long term, the health sector and its partners should work with other sectors including the judiciary, the media, and public to remove all obstacles to resource mobilisation for the successful and smooth implementation of health interventions for MSM.

The challenges posed by the HIV/AIDS pandemic are real and require very pragmatic solutions. Ghana cannot afford to fail in this regard and should seize the opportunity to act now.