by Mark S. Luckie
At the entrance to the University of Ghana's Legon campus is a dirt sidewalk and a few trees that obscure a dingy billboard with large blue letters. The faces of the happy, heterosexual couple on the sign have faded, but their wide grins are still visible next to the "ABCs" of avoiding AIDS: abstain, be faithful, and condom use.
The warning is lost on most of Ghana's estimated two million gay men and women. The billboard, and many others like it, features a man and woman, which leads many to believe straight couples must be the only Ghanaians at risk for AIDS.
Homosexuality is illegal in the country and many Ghanaians blame gays for the spread of the disease, yet there is no government agency that directly targets the prevention of HIV/AIDS within the gay community.
Ghana has one of the lowest HIV/AIDS infection rates in Africa—an estimated 3.1 percent according to the CIA World Factbook—but the country's gays and lesbian make up a disproportionate part of that number.
"A significant amount of funding is channeled for HIV programs but not for work that targets the (gay) community," said Cary Alan Johnson, senior specialist for Africa of the International Gay and Lesbian Human Rights Commission. "People are entitled to equal access."
The majority of HIV/AIDS related advertisements and outreach in Ghana is sponsored by the Ghana AIDS Commission, a government agency founded in 2000. Because homosexuality is illegal, the Ghana AIDS Commission does not address the needs of the gay community or collect statistics about sexual orientation.
The heterosexual imagery of HIV/AIDS in public health campaigns has led to ignorance and misinformation about HIV transmission, according to the International Gay and Lesbian Human Rights Commission.
Most gay men in Ghana know HIV can be transmitted sexually, but many believe vaginal sex poses a greater risk of infection than anal sex, according to a 2004 study of gay men in the country commissioned by the West Africa Project to Combat AIDS and Sexually Transmitted Infections. Those polled were more likely to use condoms with women than men, if they used them at all.
A small number of volunteer organizations like the Accra-based Gay and Lesbian Association of Ghana and the Centre for Popular Education and Human Rights Ghana are working to counteract government neglect by educating the gay community about HIV/AIDS prevention.
The Centre for Popular Education has a volunteer base of about 30 men and women who travel throughout Accra to educate gay men and women and clarify myths about HIV transmission.
The Gay and Lesbian Association of Ghana, in conjunction with the Centre, also provides condoms, lubrication to use with the condoms, and counseling for people living with HIV/AIDS, commercial gay sex workers and gay men and women.
Centre volunteers sell or distribute more than 1,500 condoms and dozens of tubes of latex-compatible lubrication every month. The organization estimates it has reached hundreds of men for both informal and intensive HIV prevention counseling.
Condoms are available at some small shops and street vendors in the country, but are generally difficult to find. Small packets of lubrication are even more scarce and are prohibitively expensive.
Those who can't afford lubricants often use alternatives such as cooking oil, saliva or petroleum jelly, all of which can lower the effectiveness of condoms.
Lubricants are both popular and risky for gay men, said Prince MacDonald, president of the Gay and Lesbian Association. Possession of lubrication is a tell-tale sign a man is having gay sex and could be grounds for arrest.
"People look on it as suspicious," MacDonald said. "You're either hurting your woman or you're using it on a man."
Condoms and lubrication are often distributed together, but some Ghanaian men use lubrication without the condom, which defeats the purpose of promoting safe sex.
"People still want to have sex without protection, but they want to use lube to make it feel good," MacDonald said.
The volunteer organizations have aided thousands of people, but they don't reach everybody in time. Those diagnosed with a sexually transmitted disease are sometimes referred to a clinic, but clinics often refuse service because of their sexual orientation.
Many health clinics in Ghana require those diagnosed with sexually transmitted diseases to bring their partners to the clinic before they can receive treatment, something most gay men and women are unwilling to do for fear of discrimination.
"We often hear of NGOs working in places like Ghana, but time after time I found that they were religiously oriented and hardly accepting of anyone that doesn't fit with their approval," said Travis Sherer, founder of the Health Equity Project.
The prejudice gays and lesbians face at health centers often leads them to treat themselves for sexually transmitted diseases using ineffective home remedies or by taking leftover drugs from friends who have had similar illnesses, according to the International Gay and Lesbian Human Rights Commission . Ultimately, most get sicker and infect others.
Sherer, a graduate student at New York University, founded the Health Equity Project after hearing stories from marginalized people such as gay men and women and prostitutes who were denied access to healthcare.
The organization initially received a lukewarm reception from gay Ghanaians. Most were happy such a program existed but few actually took advantage of it.
"We asked around and realized that people were just afraid to openly identify as LGBT," Sherer said. "Even though we didn't require this, it was still an area of concern."
Eventually the Health Equity Project joined forces with the Accra-based West Africa AIDS Foundation, which serves marginalized populations, so those seeking help wouldn't have to worry about identifying themselves as gay or lesbian.
The foundation promotes voluntary HIV testing, offers counseling and workshops and distributes condoms in and around Ghana.
"We did attempt some on the ground work there but found it very hard to work openly with LGBT populations as outsiders and thought it was best to support locals in their efforts," Sherer said. "They are not a gay organization by any means, but they are very open and we work with them on a variety of projects."
The new crop of volunteer organizations in Ghana has been a boon to the gay community, but most operate on little financial support.
The Centre for Popular Education has difficulty acquiring funds for programs that support the gay community. The volunteer organization, and many others like it, depends on contributions from its members and unofficial support from the United Nations.
Sherer has had little luck procuring money from the U.S. government and depends on supportive individuals and companies.
"With our current government, we would be laughed at if we applied for grants or funding," Sherer said.
"When we've turned to the LGBT community (in America), we were saddened to learn that most people expressed support, but weren't really interested in gays in Africa—or elsewhere," Sherer said. "It seemed that most individuals are focused more on their local community, as are gay businesses."
MacDonald appealed to Western gays and lesbian activists to support the gay community in Africa.
"We need help. We need resources so we can continue to do good work in Ghana," he said.