Kelly Sans Culotte


MSM and HIV in Ghana

Appendix
Terms of reference, questionnaire, and footnotes
Related Sections
Gay Mundo
Africa

Contents
A. Overview
1. Background
2. Literature Review
3. Findings —
3.1 Background of Respondents
3.2 Areas of Operation / Known MSM Sites
3.3 Factors Influencing MSM in Ghana
3.4 STI/HIV/AIDS and MSM
3.5 Health Problems Associated with MSM
3.6 Bridging from Bisexual Men to Women
4. Conclusions and Recommendations
5. Appendix: Terms, Survey, References
6. Acknowledgements
7. Abbreviations and Acronyms


Terms of Reference
A Situational Appraisal of Men That Have Sex With Men in Accra
Background

The HIV/AIDS pandemic has become a global threat to mankind. Governments and civil society groups in sub-Sahara African countries are aware that they host almost two-thirds of the world population of PLWHA. The percentage of HIV-positive adults in the region who are women was 58% at the end of 2002.

Women’s vulnerability to the pandemic especially in this part of the world has been well described. Among them, female sex workers (FSW) have been closely linked to the rapid spread of HIV and other sexually transmitted infections (STI). Statistics showing high prevalence rates of HIV among FSW are well known and, they often constitute a basis for designing outreach programmes.

In some countries in West Africa, i.e. Ghana, Benin and Senegal these programmes have started showing either a stabilization of HIV and STI within the FSW sub-population or a dramatic decrease of the infection rates. Recently, efforts to reach out to male clients of FSW have been initiated. In Benin and in Ghana, results of studies conducted among the clients of FSW showed HIV and STI prevalence rates higher than in the general adult population.

Besides, despite the fact that the main mode of transmission of HIV in sub-Saharan Africa is heterosexual, there is growing concern about the presence in big towns in Africa of Men that have Sex with Men (MSM). In Ghana, if this was proved to be real, it might have dramatic negative consequences in fighting HIV.

At the MOH-CIDA joint committee meeting of the West Africa Project to Combat AIDS and STIs held recently in April 2003, one of the recommendations made by the joint committee stressed that the project should intensify its efforts in collaborating with other agencies to develop strategies to reach out to male sex workers. In the absence of any baseline data on MSM in Ghana, WAPCAS is commissioning this study on the situational appraisal of MSM in Accra.

General Objectives
The goal of the study is to assess the situation of MSM in Accra, Ghana.

Secondary Objectives
To describe the situation of MSM in Accra;
To define the social dynamics among MSM;
To assess the knowledge, behaviours, attitudes and practices towards HIV/AIDS and STI;
To identify intervention strategies to reduce risk and vulnerability among MSM.

Methodology
The consultant will make exploratory contacts with organizations and agencies, which have bearing on the study. He/She will review any existent materials on MSM with focus on the African region.

To collect data, the consultant will undertake as much as possible the following qualitative activities: case studies with MSM and pimps (if any), key informant interviews with MSM, pimps, employers, local authorities, health officials, etc.

The consultant will try to capture findings of importance relating to MSM activities: who are they? What are their ages? Where do they live? Are they organized? Where do they operate from? Who plays the man’s role and who is the receiver? Do they use condoms? Where do they go for treatment for their STI? What is the proportion of those who are involved in exclusive homosexual relations? Are they in bisexual relationships? What is the proportion? What is the level of their knowledge on STI and HIV/AIDS? Are there any outreach programmes targeting MSM in Accra? Any other significant information will be collected and presented.

The consultant will analyse data generated from the study.

Deliverables
The consultant will produce a comprehensive report in line with the above goal and objectives.


Study Questionnaire
EXPLORATORY STUDY OF MSM SITUATION IN ACCRA

Name of interviewer: ………………………. Date: ……… Place of interview: …………….

1.0 BACKGROUND INFORMATION

  1. Name / identification: ………………………………………………………….
  2. Age group 15-19 ____ 20-24 ____ 25-29 ____ 30-34 ____35-39 ____ 40+ ___
  3. Educational Status None ____ Primary — JSS ____ 2nd or SSS ____ Tertiary ___ Other _________________
  4. Marital status Single _____ Married ____ Divorced ____ Separated ____ Widowed ___
  5. Occupation ________________________
  6. Religion: Christian ____ Moslem ____ ATR ____ None ____ Other (specify) _____
  7. Ethnicity Ga/Dangme ____ Ewe ______ Akan/Fante _____ Northner _____ Other _____
  8. Displacement/Refugee: yes ____ No _______ Separation from family Yes _____ No _____
  9. Does your family support you Yes _____ No _____ N/A ______
  10. Area(s) of operation ______________, ________________, ______________
  11. Known MSM locations Accra ___________, ___________, ____________, _____________, ______________, ________________, ________________, ________________
  12. Anywhere else in Ghana ___________, ___________, ____________, _____________, ______________, ________________, ________________, ________________

2.0 PRACTICES

  1. Reasons for MSM? money Yes……… No ……; pleasure Yes……… No ……
  2. How were you introduced to MSM? Peers Yes.… No ….; parent/relative Yes…… No …… older person/superior Yes……… No ……; rape Yes……… No …… Other (specify) ………....
  3. Which type of sex do you engage in?
  • Mutual masturbation Yes……… No ……
  • Fellatio Yes………… No ………………..
  • Anal intercourse Yes………… No ………………..
  1. For anal sex, which role(s) do you play?
  • Receptive intercourse only Yes………… No ………………..
  • Insertive intercourse only Yes………… No ………………..
  • Both receptive and insertive intercourses Yes………… No ………………..
  1. Will you describe yourself as exclusively gay Yes .… No ….or bisexual - Yes….. No …….?
  2. If bi-, who are your female partners? Wife/wives Yes .… No ….; girlfriend(s) Yes .… No ….; casual partners: Yes ..… No .….; CSWs Yes .… No …. Other ……………………………….
  3. If for money, what is your average number of daily customers? ………………….
  4. If for pleasure, how many partners do you have? …………………………
  5. Who are your customers? Local Yes…… No ……..; Foreigners Yes….… No …….; Blacks Yes………… No …………, whites Yes………… No ………………
  6. Do you know a lot of men involved in MSM? Yes ….. No ……. Approx number …………….
  7. Of those you know what proportion do you consider bi-? ______ %
  8. How long have you been involved in MSM? ………………………
  9. Have you experienced any social problems as a result of MSM?
  • Rejection by relatives and friends? Yes ………. No ………
  • Stigmatised Yes …………. No …………..
  • Denial (people refusing to recognise you as such) Yes ……… No ……….
  • Others: …………………………………………………………………………
    • …………………….……………………………………………………
    • ……………………………….…………………………………………
  1. How do you address these problems?
  • ………………………………………………………………………………………………….
  • …………………………………………………………………………………………………….
  • ……………………………………………………………………………………………….
  • ………………………………………………………………………………………………….
  1. Do you belong to any MSM Association or organisation? Yes ……….. No ……..
  2. What is the approximate membership of your association? ……………………………
  3. Are there other MSM Organisations in Ghana that you know of? Yes…… No ………
  • Name of organisation ……………………………………….. Estimate of membership …………
  • Name of organisation ……………………………………….. Estimate of membership …………
  • Name of organisation ……………………………………….. Estimate of membership …………
  • Name of organisation ……………………………………….. Estimate of membership …………
  1. Of the MSM you know of, approximately what proportion does not belong to any organisations ……………..%
  2. Is your Association affiliated to any other Associations in Ghana? Yes …… No ………
  3. Name(s) of Affiliated Association(s) ………………………………………………………………
  4. Affiliation with any global gay networks? Yes…… No ………
  5. What type of benefit do you receive from these affiliated Organisations? ……………………

……………………………………………………………………………………………………………….

……………………………………………………………………………………………………………….

3.0 OTHER INFORMATION

  1. Do you use drugs for MSM? Yes ……….. No ……….
  • Type of drugs: - Poppers (methamphetamine or inhaled nitrites): Yes…… No ………
  • Other drugs (list) …………………………………………………………………………….
  1. Do you share toys or body piercing instruments with your colleagues? Yes …….. No …….

4.0 KNOWLEDGE OF STI/HIV/AIDS

  1. What Sexually Transmitted Infections (STIs) do you know of? a) ……….…..…………………
  2. b) …………………………..… c) ………...……….………… d) …………….……………………

  3. Which of these can you get through MSM? a) ……….…..………………………………………
  4. b) …………………………..… c) ………..………….………… d) …………………………………

  5. How is HIV/AIDS transmitted? a) ……….…..……………………… b) ……………………..… c) ………..………….………… d) …………………………………… e) …………………….
  6. What are the signs and symptoms of the STIs you listed?
  7. Sexually Transmitted Infection

    Signs and Symptoms

    1.

     

    2.

     

    3.

     

    4.

     
  8. Do you think you can get any of these infections from the following partner(s)?
    • Male partner(s)/customers Yes ……. No ……..
    • Female partner(s) Yes …… No …… N/A ………. (If you do not have female partner(s) mark N/A)
  9. Do you think you can infect any of the following partner(s)?
    • Male partner(s)/customers Yes ……. No ……..
    • Female partner(s) Yes …… No …… N/A ………. (If you do not have female partner(s) mark N/A)
  10. As far as HIV/AIDS is concerned, which in your opinion do you think is safer?
  • Anal sex: Yes …… No …..
  • Vaginal sex: Yes ….. No …….
  • Both are safe: Yes …… No ……..
  • None is safe: yes …….. No ………

5.0 PREVENTION AND CARE

  1. a) How do you protect yourself against infection?

Condoms for/with:

Never

Sometimes

Most of the time

Always

MSM

       

Female partner(s)

       

(Please ignore female partner(s) if you do not have one and for sometimes of most of the time please indicate a percentage)

b) Other methods of protection?

  • Drugs e.g. antibiotics: Yes …….. No ……..
  • Herbal preparations: Yes ……… No ……….
  • Prayers or spiritually: Yes ………... No ………..
  • Others (specify) ………………………………………………………………………..
  • Nothing (I just try my luck): Yes ……… No…….
  1. Are you able to negotiate for protection with customers Yes ………… No……..…. or partner(s) Yes ……… No…….?
  2. Have you ever had any of the following problems associated with MSM?

  • Incontinence Yes…… No ………
  • Discharge: Urethral Yes…… No ……… Anal Yes…… No …… Other Yes…… No ………
  • Ulcers penile Yes…… No ……… Anal Yes…… No …… Others Yes…… No ………
  • Swellings Yes…… No ………
  • Other problems (specify) …………………………………………………………….
  1. How were the problems managed? Self managed Yes …… No ……… Gov’t Hospital ….. Private Hospitals ………… Herbalist ……….. Spiritualist ………… Other …………
  2. Do you know of any interventions targeting MSM? Yes …… No ………

In Accra? (List)……..……………………………………………………..……………………………

In Ghana? (List)………….…………………………………………………………………………….

  1. Would you consider going through Voluntary Counselling and Testing to determine your HIV status? Yes …………… No …………..

6.0 SUGGESTIONS FOR STRATEGIES

  1. In your opinion what can we do to make MSM safer?
  • Nothing …………………………..
  • Improve access of MSM to preventive services: Yes ……. No ……..
  • Improve access to curative services and or referrals to health care institutions Yes ……. No ……..
  • Others ……………………………………………………………………………...………………

…………………………………………………………………………………………..……………….

  1. Would you patronise services designed to reach out to MSM? Yes …………. No: …………..
  2. Would you welcome the introduction of the following for MSM?
  • Peer education: Yes …………. No: …………..
  • Outreach services: Yes …………. No: …………..
  • Others (List) ……………………………………………………………………………………..
  1. Which would you prefer to have?
  • Male outreach workers only: Yes …………. No: …………..
  • Female outreach workers only: Yes …………. No: …………..
  • Both male and female outreach workers: Yes …………. No: …………..

7.0 Other Comments

Do you have any other comments that you think could be helpful to this study? ……………...

………………….

THANK YOU VERY MUCH FOR YOUR CO-OPERATION


References

1 Kwaku Sakyi-Addo (October-December 2003), Tough to be a Gay; BBC Focus on Africa Magazine
2 Max Essex, Souleymane Mboup, Phillis J. Kanki, Richard G. Marlink, and Sheila D. Tlou, 2002, AIDS in Africa Second Edition, Kluwer Academic Plenum Publishers, New York
3 Anthony PM Coxon, Male Homosexuality and HIV; AIDS in the World II, Global Dimensions, Social Roots and Responses; The Global AIDS Policy Coalition; (Page 252), Edited By Jonathan Mann and Daniel JM Tarantola; Oxford University Press, New York, 1996
4 Oussama Tawil, Kevin O'Reilly, Issa Malik Coulibaly, Antoinette Tiemele, Hakima Himmich, Amine Boushaba, Kumar Pradeep, Michel Carael, 1999, HIV prevention among vulnerable populations: Outreach in the developing world; AIDS 1999, Vol. 13 (Suppl. A) Pages S239-S247
5 Stephen Tabet, Jorge Sanchez, Javier Lama, Pedro Goicochea, Pablo Campos, Manuel Rouillon, Jose Luis Cairo, Lucia Ueda, Douglas Watts, Connie Celum and King K. Holmes, 2002, HIV, Syphilis and Heterosexual Bridging among Peruvian Men who have Sex with Men, AIDS 2002, Vol. 16 No. 9, Pages 1271-1277.
6 Ibid
7 Harriet Birungi; (Sept. 2003) - 'Responding to the HIV/STI Risks and Health needs of men in Africa. Access to Care - 13th ICASA Nairobi 2003 International Conference on AIDS and STIs in Africa (September 21st - 26th, 2003) - Abstract Book - Article No. 949060 Pge 253
8 Population Council, (2002). Meeting the Sexual Health Needs of Men Who Have sex With Men in Senegal, Washington; Horizons Program/USAID: 19 p.
9 Keya Acharya, Sexual Taboos Hamper India's Fight Against AIDS, The Spectator, March 29, 2003 (Page 4)
10 Ibid
11 Republic of Ghana, 10th December 1999, Consolidation of Criminal Code, 1960, Act 29, Section 104, Sub-Section 2
12 The Chronicle: - Wednesday, December 17, 2003, Vol. 12 No. 76
13 Joe Bradford Nyinah, (Friday, August 8, 2003); "Four Homosexuals Jailed 2 years each" Daily Graphic: - No. 148893, Cover Page
14 Kwadwo A. Gyan-Apenteng (Saturday, September 20, 2003); Crowd attacks man in woman's dress, The Mirror: - Page 11
15 William A Asiedu, (Saturday November 8, 2003); Measures to check sodomy in prisons underway; The Mirror
16 UNAIDS, 2002, Report on the Global HIV/AIDS Epidemic
17 Ibid
18 Republic of Ghana, 2000, Ghana HIV/AIDS Response Analysis
19 Ghana AIDS Commission, 2000, Ghana HIV/AIDS Strategic Framework 2001-2005
20 National AIDS/STI Control Programme, Disease Control Unit, Ministry of Health (December 2001), HIV/AIDS in Ghana (Background, Projections, Impacts, Interventions and Policy) 3rd Edition
21 UNAIDS, UNICEF, WHO (2002 Update) Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections - Ghana
22 Ministry of Health of Government of Ghana; January 2002; The Second Health Sector 5-Year Programme of Work 2002-2006: - Partnerships For Health: Bridging the Inequalities Gap.
23 Ghana Health Service, The Code of Ethics


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