Sunday, 8 November 2009

Myth or Reality? An Ethnographic Exploration in Togo, West Africa

Presented at 5th African Population Conference
Arusha, Tanzania (December 2007)
Virgile Capo-Chichi, Regional Researcher for West & Central Africa, Population Services International
Sethson Kassegné, Research Director. Population Services International - Togo.

§ Same-sex relations are denied in most African countries even though studies have found cultural and traditional practices that demonstrate their existence for centuries (Roscoe & Murray, 1998).
§ Compared to other regions, Africa has the lowest levels of awareness and communication with regards to male-to-male sex (McKenna, 1996) and the most repressive laws against it.
§ Men-who-have-sex-with-men (MSM) are particularly vulnerable to HIV infection as demonstrated by studies in many settings (UNAIDS, 2000).
§ Except in South Africa, little is known about how male-to-male sexual activity takes place in sub-Saharan Africa.

Study Objectives
§ Explore current practices as well as historical and cultural perspectives relative to male-to-male sex and homosexuality in Togo, West Africa.
§ Understand the sexual behavior of MSM
§ Identify factors related to HIV preventive behaviour among MSM

Background: Togo
§ Small West African country bordered by Republic of Benin (East), Ghana (West), Burkina Faso (North) & Atlantic Ocean (South).
§ Total land area = 56,600 km²
§ Population = ~ 5.3 million
§ Life expectancy = 55 years (UNDP, 2006)
§ Ranked 147 in Human Development Index (United Nations, 2006)
§ HIV prevalence ~ 3.2% among general population (UNAIDS

Data & Methods
§ Study conducted in two phases using gate-keeper interviews and an adapted peer ethnographic (PEER) approach (Price and Hawkins 2001).
§ The study was conducted in four communities in Togo: Lomé, Aneho, Sokode & Kara
Phase 1: Exploratory phase with gatekeepers in each study community
§ 20 MSM identified through members of various NGOs working in HIV
prevention (first wave of participants)
§ Focus group discussion (FGD) conducted by the study team with the first wave of participants
§ Individual interviews with those 20 MSM using open – ended questions
§ Training of those 20 MSM
Phase 2: Discussions with MSM
§ 102 additional participants identified by the 20 initial MSMs through snowballing and peer networking (second wave of participants)
§ Individual interviews conducted by peer interviewers with the second wave of participants
§ With all study respondents, a survey of knowledge and behavior regarding STIs and HIV/AIDS was also administered
§ Data were collected using local languages (Mina in the south and Kabyè in the north).
§ The data were audio – recorded and later transcribed
§ Data analysis using qualitative data analysis software The Ethnograph™

Lack of agreement among gatekeepers about the existence or history of male-to-male sex in their communities
§ Some gatekeepers strongly deny the existence of male-to-male sex and homosexuality in their communities. Even some local journalists believe that the “phenomenon” must have been imported from the west.

“…homosexuality as it exists nowadays is unknown to traditional African societies. There was no man-to–man sex… In contrast, traditional chiefs of priests in the process of their enthronization were known to have lived in isolation and therefore participated in ‘recurrent’ masturbation to satisfy their sexual desires. This is what was perceived as homosexuality.”
(gatekeeper, Kara)

§ Other gatekeepers believe that same sex relations and homosexuality have always existed in traditional societies in Togo

“…tendencies towards homosexual behavior have always existed among men as well as women. It is more pronounced among men and that’s why they were called ‘nyonu – sunu’ (man – woman); that is, a man living as a woman. Or, alternatively, ‘sunu nyonu’ (woman-man) because they tend to behave like a person of the opposite sex.” (Gatekeeper, Aneho)

§ Homosexuality is also believed to be linked to some magical and mystical practices used to acquire power and test the validity of amulets and “charms”.

“Becoming homosexual” in Togo
§ Some FGD participants described their experience as a “natural” progression from childhood sexual play to a homosexual identity realised in adulthood.

“If a boy who is used to bathing and sleeping in the same bed as his boyhood peers from the time he is young, when he grows into adolescence he would want to do the same. As an adult he will realise that he is attracted by other males.” (participant focus group # 1)

“… Homosexuality has never come from somewhere else… from your childhood. What you do and your habits show that you will become homosexual. One is born with it. It is not acquired.” (participant focus group # 2).

§ Other FGD participants believe that a tendency toward male-to-male sex can be acquired from forced or agreed sexual relations with another man, or social pressure.

“You become homosexual out of necessity…because you want to behave just as your friend.” (participant, focus group # 1)

“Some people are attracted by other homosexuals. When they (homosexuals) are attracted to a heterosexual, they will do everything (they can) to take make him a part of their group. If it pleases him, then he will stay.” (participants, focus group # 1)

§ Most participants agreed that men who are innately attracted to other men remain homosexual for life. Those who have “become homosexual” may change their preferences toward men or women during the course of their life.

Lifestyles and community perceptions
§ Self-identification for the 122 MSM that participated in this study was as follows:
o 44% active homosexual (playing a “male” role during intercourse)
o 18% passive homosexuals (playing a “female” role during intercourse)
o 26% versatile homosexual (could play either role)
o 12% bisexual (sexually active with both male and females)
§ Participants explained that MSM use coded language to identify one another. The most common local term used to refer to homosexuality is “Zangboin”. Passive homosexuals are called “Zangbointés” and active ones are called “Zangbointeurs”. The place where homosexuals have sex is called “Zangbointoir”.

There was a unanimous perception among all participants (gatekeepers and MSM) that community perceptions of homosexuality are negative. This results in discriminatory
behaviours against homosexuals, such as insults and sometimes beatings.

Social organisation
§ Social networking is used as a survival mechanism for MSM in Togo. Networking serves to create solidarity among men. Network members have specific places to meet, discuss and exchange their views.
§ According to participants, social networks can be formal or informal. Formal networks are considered as true institutions with clear rules and group leaders.

“A group needs clear rules to function…before you accept someone into your group, you must make sure he will be able to comply to those rules.” (participant focus group # 2).

HIV and STI awareness
§ 75% of MSM could identify at least one STI; 71% cited gonorrhoea and 49% cited syphilis.
§ Correct knowledge about symptoms of STIs was low (less than 20%).
§ 90% of MSM are aware of HIV/AIDS, but only 40% cited unprotected sex as a source of infection.
§ The vast majority of MSM (81%) who cited sexual transmission as a source of infection believe that transmission only occurs during sex with a woman and therefore do not feel vulnerable to HIV infection when having sex with men.
§ Approximately 60% of MSM cited fidelity as the only means for avoiding HIV

Sexual behaviour
§ Age at first male-to-male sex ranged from 9 to 20 years with a mean of 17.6 years
§ First male partner was
o a friend: 65%
o a family relative (uncle, cousin, brother or other family member): 19%
§ Approximately 48% reporting having had intercourse with women prior to their
first sexual intercourse with a man
§ Reported numbers of current male sexual partners was:
o None: 18%
o 1: 50%
o 2 or more: 32%
§ 30% of respondents reported having concurrent male partners
Condom use
§ Approximately 32% of MSM reported using a condom during their first sexual
intercourse with a man
§ 60% reported condom use during their last sexual intercourse with a man
§ 21% reported consistently using condoms with male partners
§ Reasons for non-use of condoms included:
o Trust in partner
o Condoms not available
o Lack of pleasure while using condoms
o Partner’s refusal
o Negative beliefs about condoms

§ This study demonstrates that male-to-male sexual activity occurs in Togo and that many MSM self-identify as homosexual
§ Sexual practices among MSM put them at increased risk for HIV infection
§ There is urgency in addressing the needs of MSM in Togo, including:
o Improving awareness about STIs and HIV transmission during male-to male sex
o Promoting MSM-friendly services to improve access to condoms and VCT services
§ Using existing social networks among MSM to disseminate messages and recruit
peer educators

You can read this in full here.
For more interesting reading, click on The Politics of Homosexuality in Africa.

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