Kelly Sans Culotte

MSM and HIV in Ghana

Objectives, Methodology, Limitations

Related Sections
Gay Mundo

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
3.5 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
The HIV/AIDS pandemic continues to be the one disease or social condition that has, and will continue, to test all aspects of the political, economic and social development of nations and the international community. It has already proven that health is also a social condition, the management of which goes beyond the scope of the health sector to involve other sectors of the economy. It has made the various sectors of the economy recognise the need to have a vested interest in the health and social lives of their workforce to sustain productivity.

National leaders have assumed full responsibility for spearheading the fight against the disease. HIV/AIDS has also led to many issues such as sex, long considered to be a taboo topic, to be brought into the open for discussion. It has also brought about the introduction of health services to female sex workers, even in countries where prostitution is not legalised.

Another topical issue that has either not received much attention in many African countries, or is being denied, but which can potentially reverse any gains so far made in the fight against HIV/AIDS or have dramatic negative consequences is ‘same sex-sex’ particularly ‘men having sex with men’ (MSM). This is even more important since sex is proven to be the commonest mode of transmission of HIV.

As a nation, we have not stopped to ask whether men are having sex with men in Ghana, and if so, what the potential contribution to the HIV/AIDS epidemic could be. Our national response to the epidemic failed to recognise MSM as a vulnerable group, and does not include programmes to curtail any potential threat from MSM. Recent developments in the country as captured by the media rather bring to the fore the level of intolerance of the system to homosexuality, and the obstacles that would have to be overcome in introducing an intervention for MSM.

Aims and Objectives of the Study
The main objective of the study is to assess the MSM situation in 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. The specific objectives are:

To describe the situation of MSM in Accra Metropolitan Area and its environs
To define the social dynamics among MSM
To assess the knowledge, attitudes, behaviour and practices of MSM toward HIV/AIDS and STI and
To identify intervention strategies to reduce risk and vulnerability among MSM

The study was carried out during a period in which several stories concerning homosexuality made the headlines in the print and electronic media. This made it very difficult to get willing respondents to come forward as most were driven even further underground for security reasons. The search for willing respondents eventually led to the recruitment of three members of a Non-Governmental Organisation (NGO), which has been working with the homosexual community called Centre for Popular Education and Human Rights Ghana (CPEHRG) as research assistants. CPEHRG was established to provide care and support, peer education, advocacy, condom distribution, counselling and capacity building for People Living with HIV/AIDS (PLWHAs), commercial gay sex workers, homosexual men and youth, and lesbian women and youth.

A semi-structured questionnaire was developed (Annex 2) based on available literature on MSM from other countries. This was discussed with the NGO for acceptability, since some of the questions might have been considered too sensitive, or the reason for asking them might have been misinterpreted.

The study is an attempt to describe the MSM situation, combining qualitative and quantitative methods. The Research Assistants administered the questionnaires to as many willing respondents as they could get without going through any sampling procedure. Starting with members of the NGO, the Interviewers proceeded to interview other willing known non-members or other men that were recommended to them (snowball referral).

Regular meetings were held with the interviewers to review answers provided for consistency, and to prepare them to ask follow-up questions and gather additional information. Notes were made of any additional information and included in the final report. Where possible the Assistants were asked to go back and collect additional information or seek clarification on answers provided.

A fourth Research Assistant from another NGO called Youngsters Peer Education Project (YPEP) who had prior experience working on sexual health issues in some communities in Accra was later added, and the same procedure followed.

In all 156 questionnaires were administered, and each of the four Assistants had very varied responses, which could be explained by the different groups interviewed by each Assistant. Six (6) questionnaires were deleted from the final analysis because they were either too inconsistent, or looked suspiciously similar.

Limitations of the Study
Caution must be exercised in interpreting the findings of this study, in that it cannot be generalised to the universal set of MSM in Ghana. As could be observed from the analysis, not many business executives were interviewed, even though comments gathered from respondents indicate that there are top business executives and politicians who engage in MSM.

The validity of the study is also dependent on the frankness of those interviewed against the backdrop of the sensitive nature of the questions; a high level of insecurity among members; fear of a significant number of interviewees of undue exposure from the interview; and the desire to remain underground.

Even though the findings of this study cannot be said to be representative of MSM in the Greater Accra Metropolitan Area, it nevertheless presents us with more than enough information to start a health intervention programme for MSM in Ghana. The introduction of an intervention will undoubtedly lead to other intervention studies, which will hopefully lead to a better understanding of MSM in this part of the world.

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