MSM and STI/HIV/AIDS
Their dangerous ignorance.

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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

Knowledge of STIs/HIV/AIDS
Knowledge of STIs in general among respondents is fairly low. The best-known STIs are HIV/AIDS and gonorrhoea, for which the majority could give at least one or two major symptoms. However, even though 96% and 85.3% of respondents know of HIV and gonorrhoea respectively, not all of these know or believe these infections could be transmitted through anal sex.

Very little is known of the other STIs. Less than half of the respondents mentioned syphilis and very few mentioned chlamydia, herpes genitalis and hepatitis. Only a negligible number of those who mentioned these other STIs demonstrated any knowledge of their symptoms and fewer still believed they could be transmitted through anal sex.

Of importance is that almost all respondents attributed the symptoms to the penis and only a very insignificant number attributed any of the symptoms to the oral and anal region without prompting. However as many as 142 (96.6%) respondents (n=147) believe that it is possible for them to infect their male partners or vice versa and 62 (89.9%) bisexuals (n=69) believe they can infect their female partners or vice versa if they are infected.

Table 18: Degree of knowledge of STIs

It is also of importance that one respondent mentioned big breasts and a pale complexion as symptoms of gonorrhoea.

Of which sex is safer between anal and vaginal sex, the majority i.e. 111 or 74.0% believe none is safe, while 30 (20.0%) believe anal sex is safer, 5 or 3.3% believe vaginal sex is safer, and 4 or 2.7% believe both are safe.

— "Both are safe because it depends on how you play it. I have been having unprotected anal sex and I have tested for HIV on 3 occasions but still test negative. So it is better you know what you are doing. I believe that once people are liberated they can build their own potentials."
A middle-aged gay man, who was introduced to homosexuality by his housemaster and has been practicing for 14 years.

— "Both vaginal and anal sex are not safe not because of sex but that the virus can be acquired even by ignorance - so I think life now is at risk."

Modes of transmission of HIV
Even though the majority of respondents (88.7%) know that sex is the major mode of transmission of HIV, some believe erroneously that the sex in question is vaginal sex and not gay anal sex. More than half of the respondents were able to give other modes of transmission such as blood (52.0%) and sharing of sharp instruments (56.0%). It is of importance to note that some respondents listed mosquito bites, sharing of sponge and deep kissing as modes of transmission.

Table 19: - Modes of transmission of HIV given by respondents

Other respondents were quite emphatic in their belief that HIV is not transmitted through anal sex as seen below:

— "I don't think you can get AIDS through MSM."

— "You get gonorrhoea, but it is not likely you get AIDS through MSM."
A Bisexual, who practices both insertive and receptive anal sex, always uses condoms for vaginal sex, but not for anal sex. He has suffered urethral discharge before, but is not prepared to go for VCT.

— "STDs are transmitted through normal sex, and I don't have normal sex, so I cannot get them. It becomes unsafe when you do not have sex well; that is, when you get a cut; but when there is no cut, it is safe."

— "The anus is safer because you do not often have sex with it. So your chances of infection are slim. I also practice withdrawal because if the sperm enters into the anus, you may be infected."

A few respondents, however, felt that the vagina should be safer because the presence of faeces in the anus made it less healthy.

Protection Against STI
Despite the fairly high level of awareness of HIV and gonorrhoea, protection against infection is very low. Only 11.6% claim to always use condoms for anal sex as opposed to 21.1% who never use it; 52.4% use it sometimes and 15.0% use it more than half of the time. Considering the fact that respondents are more likely to overstate their condom usage, it could safely be concluded that almost 90% of them are at risk of infection from lack of or inadequate protection during anal sex.

Table 20: - Use of condom for anal sex

The reasons given by most respondents for the low or lack of protection during sex are very interesting. Most respondents would not use a condom because of the trust they have in their partners. Others look at faces and ‘if customer looks handsome and is attractive’, he is trusted and will not let the opportunity pass. Still others find it difficult to negotiate the use of condom with certain groups of people especially "Whites" or partners of a higher class.

— "I don't always use a condom because I know and trust most of my friends."
A gay who described the number of his partners as - More

— "I don't use a condom all the time because - their wish is my command."
A gay commercial sex worker

— "The use of a condom generates heat, which takes away the enjoyment from the act."
A gay public servant

— "Knowledge of condoms is high, but use for anal sex by gays is low."
A young gay

— "I use condoms only for vaginal sex to prevent pregnancy, and not for anal sex."
A bisexual

— "I never use condoms for MSM, but I use it at sometimes for my female partners because of the trust I have in my male partners. When you are the one inserting, the risk is not high."
A bisexual who said he was always the insertive partner in anal sex

A good number of respondents also believed in other forms of protection against STIs such as the use of antibiotics, herbal preparations, and even in spiritual protection. Only 25 (17.0%) said they did not rely on any form of protection against infection.

Table 21: - Other types of protection

In spite of these findings, over half of the respondents said they were able to negotiate the use of condoms for anal sex both for economic reasons and for fun or pleasure.

Table 22: Ability to negotiate the use of condom