A Cross-Sectional Evaluation of Health, Sexual Beliefs and Abuse in a Sample of Sexual and Gender Minorities from Accra, Ghana

Background
The repression of LGBTQ+ communities in African contexts is increasingly widely-discussed and well known. Despite this, a paucity of work exists which considers these communities in their entireties, with a bias for MSM and cisgender narratives in broader research.
Methods
This work is an observational study of Accra’s LGBTQ+ community. Ninety-nine participants (75 assigned male at birth and 24 assigned female at birth) were recruited, through mixed convenience and snowball sampling, and interviewed using questions adapted from the 2008 and 2014 Ghana Demographic and Health Surveys (DHS). Domains evaluated included demographic data, health behaviors, and experiences of abuse and violence. Results for respondents were compared to data from the 2008 and 2014 DHS. Responses from respondents assigned male at birth were also compared to data from the Ghana Men’s Study/Integrated Behavioral and Biological Surveillance Survey (IBBSS), when appropriate. Analyses were performed using chi square, Fischer’s and t-tests.
Results
Respondents were found to be more likely than DHS control to report participation in post-Secondary education, positive HIV/AIDS status, tobacco use, and to report barriers to health care access. Respondents assigned male sex at birth were also found to be more likely than DHS control to respond correctly to questions regarding HIV transmission, and to express positive attitudes about people living with HIV/AIDS. Respondents were found to be more likely than DHS control to consider physical abuse within intimate relationships justifiable. 80% of respondents reported experiences of abuse, and 32% of respondents reported experiences of physical abuse. Overall, these indicate myriad social, medical and human rights challenges to Accra’s LGBTQ+ community. NGOs, Ghana’s Council on Human Rights and Administrative Justice and LGBTQ+ friendly healthcare practitioners were identified as figures important to resolving these challenges, and to health, advocacy and justice for the community.