Table 7: Ethnicity of Respondents
Ethnicity Total Percentage
Ga / Dangme 52 34.7%
Akan / Fante 43 28.7%
Ewe 32 21.3%
Northner 11 7.3%
Other 8 5.3%
Not stated 4 2.7%
Total 150 100.0
A few respondents described themselves as displaced due to conditions in their home countries. Beside these 8 men, 29 others claim they are separated from their families. At least 111 (75%) of respondents gave indication that they are involved in MSM while staying with their families the majority of which is not known to the members of their families.
1.1 Areas of Operation / Known MSM Sites
According to respondents, MSM is practically happening everywhere. Sites that were listed include homes, out with friends, nightclubs, gay-friendly bars and spots, hotels, restaurants, schools and campuses, harbour etc. Geographically, 66 areas/suburbs of the Accra Metropolis and its environs and 37 urban areas outside the capital have been mentioned as known MSM locations. Areas in and around Accra mentioned by at least 10 respondents are listed in Table 8 below.
Table 8: - Areas of Operation of MSM in and around the Accra Metropolis
MSM Locations No. of Respondents MSM Locations No. of Respondents
1. Osu 91 12. Chorkor 21
2. Adabraka 82 13. Jamestown 20
3. Tema 54 14. Dansoman 18
4. Labadi 41 15. Newtown 16
5. Kaneshie 38 16. Achimota 15
6. Bukom 29 17. Mallam 14
7. Nima 27 18. Ga Mashie 11
8. Odorkor 26 19. Legon 11
9. Teshie 26 20. Abossey Okai 10
10. Madina 24 21. Mamprobi 10
11. Abeka Lapaz 23
MSM is not only limited to the capital city and its environs. Other known MSM locations outside of the capital city mentioned by at least 6 respondents are also urban areas. These are listed in Table 9 below.
Table 9: - Known MSM Locations Outside the Accra Metropolis
MSM Locations No. of Respondents MSM Locations No. of Respondents
1. Kumasi 89 7. Tarkwa 9
2. Cape Coast 58 8. Tafo 6
3. Takoradi 51 9. Dodowa 6
4. Koforidua 41 10. Somanya 6
5. Obuasi 10 11. Nkawkaw 6
6. Ho 9
1.1 Factors Influencing MSM in Ghana
Respondents engage in MSM for a number of reasons. Some of these include:
1.1.1 Pleasure Versus Economic Reasons
The role played by money in MSM cannot be over-emphasised. A total of 137 respondents or 91.3% engage in MSM for pleasure while 80 or 53.3% do it for economic reasons even though only 2 or 1.3% regard themselves as commercial sex workers. Almost half of the respondents (71 or 47.3%) do it both for pleasure and for economic reasons. Some of these claim money may not be the prime reason for MSM but they are in a relationship in which they benefit economically just as a man showers his girlfriend with money and gifts for sexual favours. Some 56 respondents or 37.3% do it for pleasure only, 6 or 4.0% do it for economic reasons only and a small number 4 or 2.7% find themselves in it neither for money nor fun.
Table 10: - Reasons for engaging in MSM
Pleasure Total (for money)
Economic Reasons Yes No Not stated
Yes 71 6 3 80 (53.3%)
No 56 4 0 60 (40.0%)
Not stated 10 0 0 10 (6.7%)
Total (for pleasure) 137 (91.3%) 10 (6.7%) 3 (2.0%) 150 (100%)
For those who are engaged in it purely for economic reasons, Caucasians and foreigners from the Advanced Countries are the priority customers because of the belief that they will pay more and the possibility of establishing connections to travel to the �greener pastures�. It has also been gathered that some of the youth are involved purely out of adventure, curiosity and the thrill of being exposed to the genitals of other men.
1.1.2 How Respondents were introduced to MSM
Peers account for the major mode by which respondents were introduced to MSM representing over half of them followed by older/superior persons; then close relatives. Only 3 (2.0%) were introduced through rape, 2 of them by policemen. Beside the 17 (11.3%) who believe that they were born this way, many other respondents believe that irrespective of the modes of introduction they were born gay.
Table 11: - How Respondents were introduced to MSM
How introduced No. of respondents Percentage
Peer 80 53.3
Older or superior person 32 21.3
Parent or a relative 17 11.3
Rape 3 2.0
Born this way 17 11.3
Not stated 1 0.7
Total 150 100
Even tough the role of technology in promoting MSM has not been explored by the study; its influence cannot be under estimated. At least one respondent claims he uses the Internet to actively seek and meet foreign partners.
1.1.1 Type of Sex Respondents Engage in
Most respondents engage in a combination of different types of sex including mutual masturbation by 92.7%, oral sex by 72.7% and anal sex by 98.0%. Only 3 or 2% claim they did not engage in anal sex.
Roles played by those who engage in anal sex are also varied. Of those who engaged in anal sex, the majority i.e. 46.0% engage in both insertive and receptive intercourse, while 28.7% engage in only receptive intercourse and 22.7% in only insertive intercourse.
Table 12: - Type of sex engaged in Table 13: - Anal sex role of Respondents
Type of Sex Number of Respondents Percentage (n=150) Sex Role Number of Respondents Percentage (n=150)
Mutual masturbation 138 92.0% Receptive intercourse only 43 28.7
Oral sex (felatio) 109 72.7% Insertive intercourse only 34 22.7
Anal sex 147 98.0% Both receptive & insertive 69 46.0
No anal intercourse 3 2.0
Not stated 1 0.7
Total 150 100
Male sex partners of respondents include regular partners, causal sex partners for fun and customers for those who do it for economic reasons.
1.1.2 Multiple Male Sex Partnership among Respondents
The study recorded a very high rate of sexual promiscuity among those who engage in MSM for fun or pleasure. Only 43 or 31.4% of respondents claim to have 1 regular male sex partner, with the majority 82 or 59.9% having 2-4 regular partners and others having 5 or more. Most respondents admit having casual partners besides the regular ones. Others who could not be specific described the number of their partners as �uncountable� �more� and �a lot�. One said, �I don�t have any regular partner. I have it with anyone who asks for it.�
Table 14: - Regular male sex partners Table 15: - Male customers of respondents
Number of Partners No. of Respondents (n=137) Percentage Number of daily customers No. of Respondents (n=80) Percentage
1 43 31.4% <6 a week 18 22.5%
2-4 82 59.9% 1 daily 9 11.3%
5 and above 9 6.6% 2-4 daily 24 30.0%
Not stated 3 2.2% 5 and above daily 20 25.0%
Total 137 100 Not stated 9 11.3%
Total 80 100.0%
In spite of the fact that only 2 regarded themselves as commercial sex workers, almost half of the respondents did have customers, the number of which varies widely from less than 6 a week in 22.5% of cases to 2-4 customers a day for 30.0% and 5 or more customers a day for 25.0% of respondents.
The majority of male partners and customers of respondents are Ghanaians in 98.0% of cases and blacks in 98.6% of cases. Foreigners make up 37.4% of cases and Whites 32.7% of cases. MSM can therefore not be said to be alien to Ghana and perpetrated by foreigners or Caucasians on Ghanaians. Ghanaians and Blacks are actively involved.
Table 16: - Origin of partners and customers
Type of partners / customer Number of Respondents (n=147) Percentage
Ghanaian 144 98.0%
Black 145 98.6%
Foreigner 55 37.4%
White 48 32.7%
1.1.3 Sharing of Body piercing Instruments and Use of Drugs
Body piercing and sharing of sex toys and the use of drugs are not very common among respondents. Only 10 or 6.7% are involved in body piercing and sharing of sex toys. Apart from alcohol in all its forms and cigarette in some cases, drugs do not seem to play a role in MSM in the metropolis. Only 3 respondents (2%) have reported using methamphetamines or inhaled nitrites (poppers) for MSM. One respondent who was introduced through rape claims he likes to be inflicted with some kind of pain such as biting during sex.
1.1.4 Social Problems and Coping Strategies
In the face of the stiff abhorrence of the Ghanaian communities to homosexuality, the survival of the homosexual in Ghana is dependent on the adoption of strategies to cope or live with the associated social problems. The study found out that the majority of respondents i.e. 58% practise MSM on the blind side of their friends and relatives without them knowing or suspecting it. This strategy paid off by ensuring that they did not face any social problem from their immediate neighbours. Only 16.0% and 24.7% of respondents claim they faced rejection and stigmatisation respectively and 9.3% faced denial or family and relatives refusing to recognise them as such. The remaining 10% claim they are accepted as gays by their relatives.
Table 17: - Social problems faced by respondents
No. of Respondents (n=150) Percentage
Practice in secret 87 58.0%
Stigmatisation 37 24.7%
Rejection 24 16.0%
Denial 14 9.3%
Accepted 15 10%
Below are samples of the comments on how respondents have managed to hide this part of their identity.
Respondents resort to various strategies in coping with insults and being called feminine names. These strategies vary from �I do nothing� or �I mind my own business� believing �people are living in ignorance� to replying to the insults and in some cases outright brawl or fisticuffs. �I fight people who call me names�.
? �I was insulted, abused and forced out by my landlord�
? �I was blackmailed by young friend and later arrested by the Police. The law was applied and I was released�
? �I don�t care! I know one day Ghana will change and our sexual rights will be respected�
A Bisexual who has received beatings from family,
faced rejection denial and discrimination
? �I was dismissed from work. Initially I was very much disturbed, but when I came to accept my situation, I gathered courage and went about my life without any fear and intimidation�
A Waiter in his early 20�s who was introduced to
MSM through rape and had been doing it for 12 years.
? �I was beaten by my family and forced to leave the house to stay with friends. I see it as normal since gay life is not acceptable in Ghana I am trying to deal with the social stigma calmly�
Still others claimed they have tried to stop but failed. A teenager said, �I blame myself and try daily to change but I can�t change from this�.
A few however, find strength in associating in small clandestine social groups in the communities known only to members for social events such as funerals and parties. Some of these groups are the Saso Kpee in Ga Mashie with about 14 members and in Kaneshie with about 9 members, and M?waam? Kpee in Jamestown with a membership of about 27.
One registered NGO, which has been involved in organising homosexual men and women for the purposes of awareness creation, information dissemination, communication and education and provision of care and support is the NGO called CPEHRG, which assisted in the study. CPEHRG, which currently has a membership of 30 members is itself plagued with a number of problems due to difficulties in accessing funds and other resources for its activities even from the GAFUND. The NGO therefore depends on contributions from its members and some unofficial support from UNAIDS and international MSM networks such as �Behind the Mask�.
CPEHRG, individual social groups and some members have strong links with other gay networks in the international community. These networks provide fora and avenues for sharing of information, exchange of ideas, advocacy, encouragement and advice.
Membership of these social networks among respondents is however very low. Only 22 (14.7%) of the 150 respondents belong to any association at all and most are not interested in belonging to any association for fear of exposure.
1.1 STI/HIV/AIDS AND MSM
1.1.1 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
STI mentioned by Respondents Knowledge of STI (n=150) Degree of knowledge of listed STIs (n=150)
Claims to know listed STIs Knows listed STIs can be transmitted through anal sex Adequate Knowledge Could give at least 1 major symptom Gave wrong or unrelated Symptoms Gave no symptoms at all or provided no answer
HIV 144 (96.0%) 129 (86.0%%) 2 (1.3%) 119 (79.3%) 13 (8.7%) 16 (10.7%)
Gonorrhoea 128 (85.3%) 115 (76.7%) 2 (1.3%) 102 (68.0%) 11 (7.3%) 35 (23.3%)
Syphilis 62 (41.3%) 23 (15.3%) 2 (1.3%) 13 (8.7%) 7 (4.7%) 128 (85.3%)
Chlamydia 10 (6.7%) 0 (0.0%) 0 (0.0%) 1 (0.7%) 3 (2.0%) 146 (97.3%)
Hepatitis 8 (5.3%) 5 (3.3%) 1 (0.7%) 2 (1.3%) 0 (0.0%) 147 (98.0%)
Herpes 2 (1.3%) 0 (0.0%) 0 (0.0%) 1 (0.7%) 0 (0.0%) 149 (99.3%)
Candida 2 (1.3%) 0 (0.0%) 0 (0.0%) 1 (0.7%) 0 (0.0%) 149 (99.3%)
It is also of importance that one respondent mentioned big breast and 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.
1.1.1 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
Mode of transmission No. of Respondents Percentage (n=150)
Sex 133 88.7%
Blood 78 52.0%
Sharing of sharp instruments 84 56.0%
Vertical 8 5.3%
Other respondents were quite emphatic in their belief that HIV is not transmitted through anal sex as in the box below:
A few respondents however felt that the vagina should be safer because the presence of faeces in the anus makes it less healthy.
1.1.2 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 use condom always for anal sex as against 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
Use of condom for anal sex (n= 147)
Number Percentage
Never 31 21.1%
Sometimes 77 52.4%
Most of the time 22 15.0%
Always 17 11.6%
Total 147 100.0%
The reasons given by most respondents for the low or lack of protection during sex are very interesting. Most respondents would not use the condom because of the trust they have in their partners, others look at faces and �if customer looks handsome and attractive�, he is trusted and will not let the opportunity pass. Still others find it difficult to negotiate the use of condom with certain class of people especially �Whites� or high-class partners.
A good number of respondents also believe in other forms of protection against STI such as the use of antibiotics, herbal preparations and even in spiritual protection. Only 25 (17.0%) believed they do not rely on any form of protection against infection.
Table 21: - Other types of protection
Type of protection No. of Respondents (n=147) Percentage
Drugs including antibiotics 94 63.9%
Use of herbal preparations 68 46.3%
Spiritual protection 21 14.3%
No protection 25 17.0%
In spite of these findings, over half of the respondents claim they are 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
Answers MSM for economic reasons (n=80) MSM for pleasure (n=137)
Number Percentage Number Percentage
Yes 47 58.8% 99 72.3%
No 23 28.8% 38 27.7%
No answer 10 12.5% 0 0.0%
Total 80 100.0% 137 100.0%
1.2 Health Problems Associated with MSM
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
Health Problems Number of Respondents Percentage (n=150)
Penile ulcers/soreness 55 36.7%
Urethral discharge 50 33.3%
Anal ulcers/soreness 47 31.3%
Swellings 38 25.3%
Anal discharge 28 18.7%
Incontinence 9 6.0%
Anal bleeding
1.2.1 Management of Associated Health Problems
Responses given to where the affected respondents sought treatment for their health problems were quite revealing. Government or Public Health Institutions were the least preferred choice 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.
Most respondents (85.9%) claim 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%) respectively where too many questions will not be asked for treatment and only 17.2% of those affected utilised the services of public health institutions.
Table 24: - Where treatment was sought for an MSM related condition
Where treatment was sought Number of Respondents (n=99) Percentage
Self management 85 85.9%
Private Hospital 37 37.4%
Herbalist 26 26.3%
Public Hospital 17 17.2%
Spiritualist 0 0.0%
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�.