HIV prevention with men who have sex with men (MSM) in Togo, West Africa: an ethnographic study
Background: In Togo, as in most African countries, homosexuality is illegal and taboo. Consequently, men who have sex with men (MSM) are rarely addressed by HIV prevention programs despite their elevated risk of infection. Population Services International (PSI) conducted a study of MSM in Togo in 2006 to: (1) document the history, culture, and current practice of male-male sex in Togo; (2) evaluate MSM knowledge of sexually transmitted infections (STIs) and HIV; (3) collect information on sexual behaviors; (4) identify MSMs’ sexual health, information and medical care needs; and (5) solicit suggestions for an effective MSM HIV prevention strategy.
Methods: Using the Hawkins and Price ethnographic method, researchers developed study questions through focus groups with a snowball sample of 20 MSM, conducted in-depth interviews with this sample, and trained them to conduct in-depth peer interviews. 122 MSM and 10 non-MSM elders were interviewed in four Togo cities. Qualitative data were analyzed to produce findings.
Results: Research findings confirmed that male-male sex occurs in Togo. 51% of the participants had been tested for HIV and 67% could cite two or more modes of HIV prevention, but only 21% reported systematic condom use. Participants judged their HIV risk as the same or lower than the general population, based on the belief that HIV is contracted from sexual encounters with women. Participants reported a need for targeted HIV prevention messages, access to affordable condoms and lubricant, and links to MSM-appropriate medical care and HIV testing.
Conclusions: Through this study, PSI/Togo gained access to this highly marginalized group and validated their HIV prevention needs to key stakeholders. Based on the identified strategy, PSI developed an MSM peer education program to disseminate HIV and STI prevention information, increase risk perception, encourage behavior change, distribute condoms and lubricant, and promote STI treatment and HIV counseling and testing.
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