Amsterdam 2015
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| Abstract #2200 - Cape to Casablanca: MSM in Africa | ||||
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Session: 20.1: Cape to Casablanca: MSM in Africa (Parallel) on Wednesday @ 16.30-18.00 in C104 Chaired by Theo Sandfort, Mike Ross Authors: Presenting Author: Ms. Akua Gyamerah - Columbia University, United States |
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| Additional Authors: | ||||
| Aim: Over the past decade, a growing number of African national AIDS policies have expanded their focus on key populations (KP) at risk for HIV to include men who have sex with men (MSM). These policy shifts are occurring in contexts where male same-sex acts are criminalized and homosexuality is becoming increasingly politicized. This contradictory policy context has implications for how MSM AIDS policies are framed and implemented and how the men experience them. | ||||
| Method / Issue: This paper draws on a 12-month qualitative field study examining: Ghana's emerging role as a model country in sub-Saharan Africa (SSA) for MSM HIV prevention policies and efforts how these efforts are implemented and how the men experience them. Using Ghana as a case study, I present findings from participant observations, 43 in-depth interviews with policymakers, HIV prevention service providers, key informants, MSM, and focus group discussions with 18 peer educators on how and why the Ghanaian government came to include MSM in the National Strategic Plan (NSP), what MSM HIV prevention activities exist and their scope, and challenges and successes of these efforts. | ||||
| Results / Comments: Findings indicate that Ghana shifted to prioritize MSM in their NSP due to various factors including the availability of epidemiological data on MSM HIV prevalence changes in intergovernmental, multilateral, and international development agencies’ AIDS funding frameworks to include sexual rights discourse and MSM as a KP and advocacy efforts by local/international sexual health/rights groups. The past 5 years has seen increased strategic effort from state actors, including Ghana AIDS Commission, Police and Prisons agencies, the Commission on Human Rights and Administrative Justice, as well as non-state actors, including UNAIDS, USAID, local and international NGOs, to address the epidemic among MSM, a KP whose HIV prevalence is almost 17 times that of the general population. Despite the multiple stakeholders involved, some actors like aid donors and government agencies have more influence while others, like MSM and their rights advocacy groups, hold a more marginal position. Current prevention activities are primarily done through peer education outreach (condom/lube distribution group education), centers with HIV/STD testing services, and field HIV testing and sex education. Successes identified by interviewees include collaboration between stakeholders, inclusion of MSM in developing prevention efforts, and expansion of prevention programs. Challenges included the criminalization of MSM, social stigma, anti-gay violence, and insufficient funding. Another key challenge is that many MSM HIV prevention efforts are modeled after those targeting female sex workers (FSW), thus overlooking critical differences between the prevention needs of MSM and FSW. | ||||
| Discussion: Ghana’s efforts to address the HIV epidemic among MSM have earned them the status of a model country in SSA. Despite making good progress towards this end, there are many complex dynamics both shaping the policy process and arising from it: in Ghana, there has been a simultaneous backlash against MSM as HIV carriers who pose a threat to public health. Thus, it is critical that policymakers evaluate prevention efforts comprehensively for their impact, particularly in relation to the wider social context in which they are carried out. | ||||
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