This document discusses the impact of religion, culture, and stigma on HIV prevention strategies for men who have sex with men (MSM) in sub-Saharan Africa. It notes that MSM are a key population with higher estimated HIV prevalence than national figures, but population size is unknown due to widespread prohibition and criminalization. Religion and culture strongly influence identities and behaviors in sub-Saharan Africa and stigma surrounding diseases is common. As a result, most HIV prevention strategies aimed at MSM, including behavior change communication, structural prevention policies, and biomedical approaches face high levels of impact from religion, culture, and stigma in the region. More research and integration of MSM-specific health services into mainstream public health are recommended to

1. The impact of religion, culture, and
multiple stigmas on HIV prevention
with Men who have Sex with Men in
Sub-Saharan Africa
Thomas Agyarko-Poku
BSc, MBCh.B, DipGUM, MPhil, M.Sc., Ph.D. FRSPH
Dr Thomas Agyarko-Poku CFAR SSA JUL 17
2016

2. Outline
• The Core issues ; Religion, Culture, Stigma
• In the context of Sub-Saharan Africa
• Over view of the Key HIV prevention strategies
• Impact of religion, culture and stigma on key
prevention strategies
Dr Thomas Agyarko-Poku CFAR SSA JUL 17
2016

3. Current Situation
MSM part of Key population
– Estimated HIV prevalence higher than national
figures
– Population size unknown
– Wide spread prohibition and criminalization
– All service ‘ neglected’
– Purely individual business
– Underground practicing
Dr Thomas Agyarko-Poku CFAR SSA JUL 17
2016

4. Current Situation
• Inadequate information/data on MSM
– Population size not well defined
– HIV Prevalence not accurate
• Very Few studies done
– Mostly among younger MSM
– Among urban dwellers
– Very difficult to identify and recruit older MSM
Dr Thomas Agyarko-Poku CFAR SSA JUL 17
2016

5. Religion/Culture
• Way of life of the people
• Largely influenced by the environment
there is no culture or religion but coping
strategies of the people
 ‘Religion’ is describe as alien way of life in
many African communities
Dr Thomas Agyarko-Poku CFAR SSA JUL 17
2016

6. Religion/Culture
• Study questionnaire ( prototype)
Socio demographic characteristics
Q3. Religion
a) Christianity, b) Islam c) Traditional d) others
Dr Thomas Agyarko-Poku CFAR SSA JUL 17
2016

7. Religion/Culture
Practices
Q 5 . Do you take alcohol?
a) Yes b) No c) I can’t tell
Q 6. Give reason (s) for your answer in Q5
1. No. I am a Muslim (Rel)
2. No. My church forbids us from taking alcohol (Rel)
3. No. nobody takes alcohol in the family, our
ancestors to it and they die. ( Trad)
4. Yes, I can’t tell you ( Others)
Dr Thomas Agyarko-Poku CFAR SSA JUL 17
2016

8. Religion/Culture
• Identities/Orientations of Key players
– Law makers
– Health care providers
– Social workers
– Civil Society Organizers
– Community/Opinion leaders
– Law enforcing agencies
Total Confusion!
Dr Thomas Agyarko-Poku CFAR SSA JUL 17
2016

9. Religion/Culture
Sex, Sexual Health and Sexually Transmitted Infection:
HOW MUCH IS KNOWN;
• Perception on risk STI through peno-anal sex in Ghanaian
population is low
– Lower in the indigenous rural communities than urban
areas (Agyarko-Poku et al, 2015 n.p)
- Predominantly heterosexual
- Sexuality : not issues for children and younger adults
- Adult MUST have a partner (F=>30yrs Male >35 yrs)
- Hugging, hanging around among a male partner
acceptable ( Adu Sarkodie et al, 2014)
- Transgender : impossibilityDr Thomas Agyarko-Poku CFAR SSA JUL 17
2016

10. Stigma and Discrimination
• A known practice in many societies globally
• As old as the earth itself
• More specific for
– Obvious contagious diseases ( Leprosy, Chicken)
– Diseases considered caused by evil forces ( Chronic
Illness; Diabetes, Mental, AIDS, Cancers)
• Evil doing, curses: considered major causes:
hence the STIGMA
• Sympathy – May be the Will of the God
Dr Thomas Agyarko-Poku CFAR SSA JUL 17
2016

11. HIV Prevention Strategies
Behaviour
Change
Communication
Structural
Prevention
Biomedical
Prevention
Dr Thomas Agyarko-Poku CFAR SSA JUL 17
2016

12. Behaviour Change Communication
Activities Impact of Culture/Religion/Stigma
One-on-One
Communication
High
- Health Care Providers High
- Community Counsellor Very High
Media : Print/Electronic Very High
Public Education Low to High
Dr Thomas Agyarko-Poku CFAR SSA JUL 17
2016

13. Structural Prevention
Activities Impact of
Culture/Religion/Stigma
- Post Exposure Prophylaxis
(PEP)
High
- Pre Exposure Prophylaxis Very high
- Health Service policy Very Low
- National Policy / The Law Very High
Dr Thomas Agyarko-Poku CFAR SSA JUL 17
2016

14. Biomedical Prevention
Treatment as prevention Impact of
Religion/Culture/Stigma
- HIV testing and
Counselling
Low
- Antiretroviral therapy Low to high
- PEP Low to High
- PrEP Low to High
- Test and Treat Very Low
Dr Thomas Agyarko-Poku CFAR SSA JUL 17
2016

15. Way Forward
• More studies with effective strategies aiming at
– Recruiting older MSM required
– Including the indigenous rural communities
– Address issues on access to care and treatment
for KP (MSM)
• Integration of KP (MSM) services in to the
main stream Public Health Services
Dr Thomas Agyarko-Poku CFAR SSA JUL 17
2016

16. Thank you !
Dr Thomas Agyarko-Poku CFAR SSA JUL 17
2016