Health Problems Associated with MSM
Plus problems getting treated.

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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

Respondents have had a fair share of health problems associated with MSM, which makes them potential candidates for HIV infection. In all 99 or 66% of the respondents have had one or more health problems they attribute to MSM.

The most commonly reported health problems are soreness or ulcers of the penis (55 or 36.7%) followed by urethral discharge (50 or 33.3%) and anal soreness or ulcers (47 or 31.3%). Poor lubrication of the anal canal may have been responsible for the soreness of both the penis and the anus, which the interviewers confused with ulcers that the study was seeking to establish. It is also not clear what most respondents reported as swellings. These are findings that will need to be explored further during when an intervention is introduced.

A third of the respondents have experienced urethral discharge and 18.7% have had anal discharge. Anal bleeding was reported in a few cases.

Table 23: - Health Problems attributed to MSM

Management of Associated Health Problems
Responses given as to where the affected respondents sought treatment for their health problems were quite revealing. Government, or public health institutions, were the least preferred choices for seeking treatment for an MSM related condition. In one instance a respondent claimed that when he sought treatment at a Government Institution there was too much suspicion about him.

— "I was asked too many questions when I visited a government clinic when I was sick with a swelling in the scrotum. They suspected me of having anal sex."
A teenager who wants the introduction of special clinics for gay men.

Most respondents (85.9%) said they managed the conditions themselves by buying drugs over the counter. A good number also resorted to private health institutions (37.4%) and to herbalists (26.3%), where not too many questions would be asked for treatment. Only 17.2% of those affected utilised the services of public health institutions.

— "Most gay men are afraid to come forward for treatment. So they use herbs for treatment. Some have anal ulcers, so [a gay-oriented] programme would be a good one for them."
A bisexual

Table 24: - Where treatment was sought for an MSM related condition

A total of 81 (54.0%) respondents expressed their readiness to undergo voluntary counselling and testing for HIV infection as against 50 (33.3%) who categorically rejected the idea for various reasons ranging from the assurance that anal sex is very safe; partner is faithful; to the fear of the unknown ‘the moment I know I am positive, I will die.’

Table 25: Willingness to go for VCT

Introduction of an Intervention Strategy
Questions regarding the introduction of a health intervention for MSM received the most confusing and interesting answers. This level of confusion was traced to the level of fear among the MSM community, and the level of uncertainty of many respondents as to the genuineness of the introduction of an intervention.

It is interesting to note that 7.3% of respondents do not want the introduction of any intervention at all. While 87.3% of respondents will welcome the introduction of preventive and curative services, only 67.3% expressed the willingness to patronise such services. Peer education and outreach services would not be welcomed by a further 10.7% and 14.7% respectively.

Some of the fears expressed by the respondents are as follows:

— "I will only patronise services if the place is safe."

— "In my opinion, it will be a waste of time attending such a programme, since Ghanaians will never accept us in society."

— "I think the introduction of an intervention for MSM is a right decision and a right choice. But I hope it will not lead to arresting us in our hideout."

— "I doubt if this programme will work in Accra."

Table 26: - Responses given to the introduction of an intervention for MSM

Other comments made by those who fear exposure include:

— "Being in an association is very good; but I would not like to be identified through this act. I will only come out for such meetings at night."

— "In my opinion, I think this research will not be beneficial to us. We will only expose ourselves for people to see."

— "I don't want many people to know I am gay or MSM."

— "I prefer staying in the closet to coming out to be stigmatised. Please don't tell anyone about me. I don't want the introduction of any intervention for MSMs."

— "I would prefer private visits i.e. peer education to public outreach services. My household does not know about my lifestyle and I would prefer it to remain that way."

— "This act is normal and not painful. In the sight of God I do not think it is a sin. But due to the attitude of Ghanaians, I will continue to be in the closet until they change their attitudes."

— "This would be a nice opportunity, but I am not single. So it would be very difficult for me to patronise such programmes, since my partner does not allow me to involve myself in such programmes."
A houseboy who does it only for money

— "I will not patronise the services because my girlfriend would not allow me, even though she suspects me."

For those who would welcome the introduction of outreach services, the gender of the outreach worker also matters. Almost three-quarters of the respondents prefer males only as outreach workers, and only 4% would welcome female only outreach workers, and where females must be involved, it was preferred that men accompany them. Another preference expressed by respondents is that peer educators and outreach workers must be of the gay, bisexual, lesbian and transsexual (GBLT) community: - "I will only accept outreach workers if they are gays."

Table 27: - Preferred gender of Outreach Workers

Preferred gender of outreach worker	Number of Respondents (n=150)	Percentage
Males only	89	71.2%
Females only	5	4.0%
Both	46	36.8%

"Gays like being with lesbians and other gay men. It will be very difficult for an ordinary woman to walk to a gay and talk with him and get the facts needed; but easy for a gay or a lesbian to do that."
Additional information provided by CPEHRG

For most respondents, there is a feeling of desperation and a silent cry for help. This cry is summarised by this comment made by a young man in his early 20s who describe himself as exclusively gay.

—"I suggest you get in touch with foreign based MSM groups to collaborate with health institutions to provide health care and improve relationships with MSMs. Interested groups should get in touch with medical practitioners, lawyers, counsellors and other intellectuals to help and provide MSMs with better health care and liberate us from the silent suffering we find ourselves in."
A gay man in his early 20s

As part of outreach strategies, some respondents are calling for a massive education of both the gay community and the Ghanaian public. Calls for the education of gays include:

— "Educate gays on the use of condoms and water-based lubricants."

— "Introduce safe-sex training, counselling and advice for MSM."

— "Introduce education and health promotion on STIs and HIV for MSM."

— "Programmes should be organised in our secondary schools to educate students on these issues, including the use of condoms, because some think condoms cannot be used for anal sex."
A bisexual student

— "I want gays in Ghana to be educated on single partnership. They change sexual partners too frequently."

Some have suggested the introduction of public fora, discussions, songs, drama and popular education as a way of creating public awareness on MSM.

— "I think that society should be made more aware that there are people like this in society, and that they are humans and not animals as others think they. That is, gays are human, too."

— "We have a lot of gays in Ghana, and I want people to know that gay sex is normal."

— "The security agencies should be educated to stop harassing gays."

— "Openly discuss MSM rights."

— "Educate the public about discrimination against MSM and sexual rights of MSM."

A number of respondents have called for the review or removal of laws that drive them underground, and recommend replacing them with laws that recognise gay rights and facilitate the introduction and patronage of services for gay men.

— "The laws used against MSM should be repealed so we can attend programmes and be educated on sexual health issues."

— "Parliament should pass laws to allow us gays to go around freely."