HEALTH PERSPECTIVE OF LGBT IN GHANA

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Venue: Ghana Nurses Registered Hall

Date : 14^th July 2017

Gideon Adjaka for

Dr. Naa Ashiley Vanderpuye - Donton

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Why does it matter?

• Clinicians are faced with incomplete information about the health status of the LGBT community.
• Marginalized groups
• Complexity of issues!
• Social & Structural Inequities: Stigma and Discrimination
• Engagement in Practices by some that lead to higher risk of certain medical conditions
• Conditions that require more

expensive treatment

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Objectives:

• Get a better picture of health related issues amongst LGBT in Ghana

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• Give broadly, areas to consider when thinking about strategies to adopt for the health of LGBT’s

Overview:

- Lesbians / Female bisexuals :

• Not much of specific physical health matters (but mental health)
• Physical health issues not much different than heterosexual women
• Health facility level stigma not all that relevant to them

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- Gays / Male bisexuals (MSM)

• More health related issues (Both physical and mental)
• Mental health (depression / anxiety, Substance abuse)
• Physical Health issues
• Non infectious anal health issues
• Infectious anal and general health issues.
• High levels of Stigma and Discrimination

- Transgender:

• Fit into both of the above categories

STIGMA

• EXTERNAL STIGMA
• Treated different from others
• INTERNAL STIGMA

- Stigma causes discrimination, discrimination leads to internal stigma.

- Internal stigma is the results of internalization and acceptance of the lived situations of stigma and discrimination that a person or group endures over time.

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• Where is it likely for a young MSM in Ghana to meet stigma?
• What if this young man is also HIV infected with presence of anal warts?

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Signs of external stigma

Signs of internal stigma

• Self-exclusion from services out of fear
• Low self-esteem
• Social withdrawal
• Avoidance of being open about their sexual orientation/identity
• Avoiding seeking health care
• Depression
• Substance abuse
• Suicide
• Other high risk behaviors

Double stigma

• Individuals may experience double stigma for those that belong to LGBT and are HIV+

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• The double stigma directed at these individuals amplify the consequences

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STIGMA MENTAL HEALTH ISSUES

Effects of STIGMA

• Refusal to access timely healthcare
• Practicing SELF-MEDICATION
• Increase in further transmission and getting re-infected in the case of HIV
• Increase in DEATH rates

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MSM - Physical Health Issues

• Violence and physical attacks

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• Non infectious anorectal conditions
• Pain
• Cuts, ruptures
• Hemorrhoids
• Infectious anorectal conditions
• Syphilis
• Gonorrhoea/Chlamydia
• Herpes
• Warts (HPV)
• HIV
• Fecal–oral transmission (diarrhoea diseases)

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Sexual transmitted infections

• MSM especially are at great risk of sexually transmitted infections (STIs) partly due to high rates of partner change and low rates of consistent condom and lubricants use.

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• Many STIs can present only with anorectal symptoms.- not easy to diagnose by HCW!

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• Sexual practice of anal intercourse results in increased risk of anorectal STIs, especially receptive anal sex (its treatment can be expensive).

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• Trauma from receptive anal sex as well as infection with HIV increases risk of non-infectious anorectal conditions

Link between HIV and STIs

• Anal sex is the highest-risk sexual behaviour. Receptive anal sex (bottoming) is riskier than insertive anal sex (topping).

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• Those infected with an STI can contract the HIV virus more easily (calls for: effective treatment of STI’s)

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• Those who are HIV+ and also have another STI can transmit the HIV virus more easily to sexual partners

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• Both are due to increased bleeding and exposure to open sores caused by STIs.

PrEP

STIs common among MSM

• HIV
• Gonorrhea
• Chlamydia
• Herpes
• Syphilis (Treponema palidum)
• Condyloma acuminatum (genital warts)
• Hepatitis A
• Hepatitis B
• Chancroid (H. ducreyi)

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Genital warts

Due to location- delay of seeking health care

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- Treatment options

• High cost!
• HIV co-infection

Approaches to protecting the health of LGBT

Involves at least four broad areas of commitment:

1) Enhanced engagement of Gay, (Lesbians) Bisexual, Transgenders and strategic partners

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2) Expand effective prevention programs (prevent the STI’s)

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3) Reduce and prevent Stigma and discrimination at all levels but especially at the health facility level

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4) Evaluate, communicate as well as timely dissemination of information.

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• Healthcare providers are not expected to be experts in MSM mental health but it is useful to have some knowledge to provide support and offer appropriate referrals when possible.

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So now ... Way forward:

• What should be some of the strategies to consider to ensure health for all LGBT in Ghana?

Engage:

• Improve the understanding of LGBT health disparities and needs
• Increase two-way communication with key LGBT and LGBT partners
• Promote LGBT program services, education and communication products, data collection, and research

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Expand Effective Prevention

• Bring science-based, community, group and individual-level STI/HIV prevention interventions to community-based service providers and local health departments including:
• Adequate Cost of STI treatment, PrEP , PEP, Condoms with Lubricants
• Enhance the capacity to implement effective interventions at the district and community levels, to reduce the spread of HIV and STIs, and to promote healthy behaviours.

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Reduction and prevention of stigma and discrimination

• Community and political leaders must become “LGBT & HIV competent”
• Identify and change language that stigmatizes
• Promote compassion for all marginalized peoples.
• Actively support prevention activities.
• Contribute towards efforts to provide care, comfort, support for LGBT and/or those living with HIV

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Addressing stigma/tackling stigma directed at LGBT and HIV&AIDS (Health Care level)

• Treat all LGBT with respect
• Careful use of language-avoid stigmatizing language
• Health workers, to make friends with at least one LGBT or individual who is HIV+.
• Challenge counselors, health care workers, family, friends, etc. who show stigmatizing behavior
• Provide accurate information and disseminate knowledge
• Increase your own knowledge
• Talk to community members about MSM and those with HIV&AIDS and their health care needs
• Get to know LGBT individuals to enable break down stereotypes you may have

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Surveillance, Research, Evaluation

• Conduct research, evaluate and share best practices to foster innovative behavioural health interventions that promote physical, sexual, and mental well-being among the LGBT community.
• Effective dissemination of such findings.

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Thank you!

• Questions?