Conclusions and Recommendations
Addressing homophobia in Ghana is first step in halting HIV among MSM.
By Dr. Dela Attipoe

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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

Based on this study, the following general conclusions can be made to guide decision-making on MSM in Ghana:

MSM is real in Ghana with Ghanaians fully involved. It is not a recent phenomenon, and from all indication it is part and parcel of the way of life for some Ghanaians primarily, and foreigners secondarily. There are many factors in this country that affect MSM. Denial and wishing it away is not the solution. These factors include:

1. People's belief that MSM is their sex orientation
2. Poverty and the desire of many youth to make quick money
3. Peer pressure and adults playing on the ignorance of the youth
4. Thrill of adventure for youths, including the desire to travel abroad in search of greener pastures
5. Lure of older gays looking for partners
6. Belief that anal sex is safer than vaginal sex
7. The public's reaction to gays and homosexuality, which is driving MSM underground and creating a safe haven for it, while at the same time making it almost impossible to reach out to them
8. Slow but growing pool of boys, who after being introduced to it themselves, become active members and maintain the cycle by introducing others

The price we end up paying as a country for ignoring MSM is that a good number of Ghanaians are left to their fate with untold repercussion on themselves, the rest of the population and the nation as a whole.

1. The majority of MSM ignorantly engage in a lot of unsafe sex including:
— Anal sex with inadequate lubrication
— Multiple sex partners/customers
2. Inadequate knowledge of most STIs, including HIV, so they don't take necessary precautions
3. Inadequate protection against infection during gay anal sex, and an erroneous belief that antibiotics, herbal preparations and spiritual protections work against HIV
4. A fair share of MSM related health problems making them potential candidates for HIV infection and
5. Active bridging between bisexual men and their women partners creating more innocent avenues for the spread of HIV, as has been reported in other places.

As a country we need to acknowledge homosexuality and all its ramifications to develop strategies and outreach programmes to make it safer, and thus remove any untoward complications associated with it.

Globally Sub-Saharan Africa is home to 2/3 of all HIV/AIDS cases in the world. It is possible that MSM represent a significant part of the statistics. Without any health outreach targeting MSM, the struggle against HIV/AIDS cannot succeed. The Ministry of Health/ Ghana Health Service (MoH/GHS) has a mandate to bring about ‘improved overall health status and reduced inequalities in health outcomes for all people living in Ghana’ (italics mine).

By the same token, the mission of MoH/GHS is to ‘work in collaboration with all partners in the health sector to ensure that every individual, household and community is adequately informed about health; and has equitable access to high quality health and related health interventions’.²² The code of ethics of the GHS mandates all service personnel to respect the rights of patients and safeguard the clients’ confidence. Service personnel are also mandated not to discriminate against clients on the grounds of the nature of illness.²³

The MoH/GHS, therefore, is obligated to ensure that men having sex with other men in Ghana are not left out of their stated vision and mission, as is currently the case.

A health outreach programme should be introduced for the homosexual community, and in doing this, it must not be assumed that the introduction of such programmes will bring about automatic patronage. A number of issues of interest to the gay community must be addressed to ensure that there will be the desired patronage. The following recommendations are therefore made in support of the national response to HIV/AIDS.

Short-term Recommendations
In the short-term, the Ghana Health Services and her partners should implement strategies similar to those used by the West Africa Project to Combat AIDS and STI (WAPCAS) for female commercial sex workers, even in the face of legal obstacles and a hostile public. These strategies include:

1. Dissemination of the findings and recommendations of this study widely to the relevant sections of the public and decision-makers
2. Starting a confidence building process by involving CPEHRG and other NGOs working with youths e.g. YPEP and Salvation Army to develop a programme of intervention for MSM. As a first step, the following could be done:
— Supplying NGOs with lubricants and condoms to be sold or distributed to members and other gays
— Supporting the educational programmes of CPEHRG as a way of building trust and addressing health problems facing gays
— Recruiting and training GBLTs as peer educators and outreach workers
3. Officially recognizing clandestine gay associations and encouraging the formation of many such associations
4. Training and re-orienting health workers and services in the STI clinics in the management of homosexual related health conditions, particularly in issues of privacy, confidentiality and the rights of the patient
5. Including MSM as part of IE&C messages on safe sex for youths and developing health promotion/education materials on the dangers and precautions in anal sex
6. Ensuring that the HIV/AIDS programme of the police and other uniformed personnel includes IE&C messages on MSM, not only to protect gays and the public, but also the police themselves from infection
7. As part of the outreach programme to be introduced, a nation-wide study should be mounted to better understand MSM in the country.

Long-term Recommendations
The long-term recommendations are those that aim at removing all obstacles to the successful implementation of health outreach programmes for MSM, including the removal of legal and social barriers. These will be more difficult, and will require a lot of advocacy to persuade decision-makers and the public to implement them. They include:

1. Decriminalising homosexuality by removing laws on our statute books that criminalize it. This will not only make it possible to fully implement outreach programmes for MSM, but will also make it possible for mobilising resources for such programmes
2. Public education to remove social barriers that drive MSM underground, such as stigmatisation, discrimination and denial of male homosexuals
3. Educating all sectors of the public, especially youths, and giving them the right information to take informed decision on their lives
4. Reviewing national documents on HIV/AIDS to give recognition to gays as a vulnerable group and MSM as a potential mode of HIV transmission
5. Mobilising resources to support programmes including the management of MSM related health conditions and NGOs working with gays and youths

The challenges posed by the HIV/AIDS pandemic are real and require very pragmatic solutions in the face of the odds, which are real, but not insurmountable. Ghana cannot afford to fail in this regard and should seize the opportunity to act immediately.