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Advances in Applied Sociology, 2016, 6, 12-27
Published Online January 2016 in SciRes. http://www.scirp.org/journal/aasoci
http://dx.doi.org/10.4236/aasoci.2016.61002
How to cite this paper: Norman, I. D., Awiah, B., Norvivor, F. A., Komesuor, J., Kweku, M., & Binka, F. N. (2016). Homosex-
uality in Ghana. Advances in Applied Sociology, 6, 12-27. http://dx.doi.org/10.4236/aasoci.2016.61002
Homosexuality in Ghana
I. D. Norman, B. Awiah, F. A. Norvivor, J. Komesuor, M. Kweku, F. N. Binka
School of Public Health, University of Health and Allied Sciences, Ho, Ghana
Received 21 November 2015; accepted 15 January 2016; published 20 January 2016
Copyright © 2016 by authors and Scientific Research Publishing Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/
Abstract
Although homosexuality is a crime in Ghana, like many others in Africa, it is practiced in both the
provincial towns and communities and in the major urban centres. Generally the society is reti-
cent about discussing sex, yet the national society is as over-sexualized as those societies that
openly discuss sex. This paper investigated the incidence and prevalence of homosexuality and
lesbianism in Ghana. Assessment was done on association among psychosocial background, sexual
attitudes and homosexuality, including the use of paraphernalia in the sexual lives of the people.
This cross-sectional study consisted of questionnaire survey and documentary review on the in-
ternet. Respondents completed self-administered and anonymous survey with open-ended ques-
tion about their sexuality and sexual preferences. The sample consisted of N = 1068 respondents.
Sampling selection was of random, pre-stratified by gender and region, which was based on the
population survey by the Ghana Statistical Service for 2009. We found that the national attitudes
towards homosexuality in general were changing from ambivalence to focused activism and agita-
tion against homosexuality on one hand and acceptance on the other hand. Homosexuality and
lesbian practices are prevalent in all socio-economic classes and ages of society. The study re-
vealed that pornography and other sex media were accepted as part of the sexual repertoire of
Ghanaian society. The societal reticence about sexuality that exists among the population tends to
distort sexual beliefs, and imposes fear and dishonesty in sexual identification. This situation may
complicate interventions for sexually transmitted diseases, as well as sexual or mental health.
Keywords
Homosexuality, Bisexuality, Lesbianism, Homophobia, Ghana
1. Introduction
The predominant sexual group in Ghana is those who describe themselves as heterosexual. It is fair to think that
homosexual and bisexual as well as transgender sexual individuals are also present in Ghana although this in-
I. D. Norman et al.
13
vestigation is about homosexuality in both men and women (Appiah, 2006). The anti-homosexual sentiments
have moved from total ambivalence to sustained interests and agitation to condemnation of the practice by men
and women of different religious and moral proclivities. Several studies maintain that those who exhibit nega-
tive sexual attitudes to male homosexuality are more likely to be religious and attend church frequently. They
also tend to follow conservative religious dogma and ideology (Alston, 1974; Nyberg & Alston, 1976; Cameron
& Ross, 1981; Herek, 1984; Bhugra, 2010). It is argued that the negative reaction towards male homosexuality
is a defensive mechanism by the perpetrator to reinforce masculine stereotypes (Black & Stevenson, 1984). The
national homophobia stretches from university professors, lecturers, and students, to the clergy, government mi-
nisters and their respective bureaucracies, and the average person. It has also been reported that homophobic in-
dividuals are described as status-conscious, anal retentive, authoritarian, sexually-rigid persons, who see homo-
sexuals as sick people (Kan et al., 2009; Smith, 1987; Bleek, 1976; Lumby, 1976; Osei, 2011). Those who have
positive attitudes towards homosexual are more likely to have personal contact with homosexuals (Milham et al.,
1976; Glassner & Owen, 1979; Bowman, 1979).
Apart from the clergy and other people similarly situated, many in the medical community also take a hostile
attitude towards homosexuality. Such negativity also affects the health concerns of homosexuals. Due to homo-
phobic tendencies among the medical profession, concerns have been raised about the health and treatment of
homosexuals in many jurisdictions, where homosexuals are reticent about disclosing sexuality (Rose, 1994;
McFarlane, 1998; Parker & Bhugra, 2000). Communication about sexuality between patients and doctors is
strained or self-censored in the face of HIV and AIDS and associated high risk behaviours such as men who
have sex with men and other practices such as anal sex between men and women, which are part of the reper-
toire of both heterosexuality and homosexuality (Rose, 1994; Valleroy et al., 2000; Hinchliff, Gott, & Galena,
2005; Adams, McCreanor, & Braun, 2008; Kan et al., 2009; Biaya, 1999).
The Consolidation of Criminal Code, 1960 (Act 29), Chapter 6 section 102 through 105 contains prohibitions
against homosexuality. Ghana’s official policy towards the gay male is homophobic and in consonance with the
code. Considering the restrictions imposed on homosexuality by the Criminal Code, there appears to be the
justification to bring homosexuals under the protective cover provided in Article 17 (1) through (3). Although
male-to-male sex is illegal in Ghana, female-on-female sex is not and it is practiced by girls in boarding
schools as a birth control mechanism to avoid having penile penetrative sex and thereby avoid pregnancy; adult
lesbianism, like adult male homosexuality is also present in Ghana’s society (Ankomah, 2001). The only dif-
ference is that while adult homosexuality is taken seriously with adverse consequences on the gay man, female
homosexuality is not. It is often reasoned that a lesbian is still capable of sex with a male partner. But such lib-
eral assessment of the potential of sex with a lesbian is not returned to the male homosexual who also has the
innate capacity to father a child (Glassner et al.; 1979). Such a double standard in Ghana in terms of male and
female homosexuality, may, perhaps, be explained by the value the national culture places on virility and pro-
creation.
The psychosocial life of Ghana is male-centric and supported by the concept of male virility (Leiber, 2006;
Norman et al., 2001; Carlson, McNutt, & Choi, 2003; Norman, 2005; Ali, 2002; Kimmel, 1987; Buah, 1998).
Women are deliberately kept in subordinate socio-political positions in terms of power dynamics in both domes-
tic and professional lives (Pleck, Sonenstein & Ku, 1993; Yamba, 2004; Bluwey, 1998; Ninsin, 2007; Vaughan,
1991). Since the end of colonial rule, the nation has undergone many socio-political and economic changes that
are too numerous to enumerate. Despite the changes, the social norms of the nation regarding courtship, mar-
riage, sexual behaviours, sexual freedoms and family, remains largely conventional in the urban centres and pa-
rochial in the rural areas (Archard, 1998; Norman, 2005). It is estimated that about two thirds of Ghana’s current
population live in the rural and peri-urban areas of the country. About 45% of the population is under 15 years
of age, with 52% between 15 and 64 years of age, and about 3% of the population is considered to be 65 years
and older. The average life expectancy has improved considerably from 54 in 1995 to 57 years of age in 2010.
Ankomah (2001) described the sexual culture of Ghana as a paradox. He proffered that, though many cultural
artefacts such as Ghanaian traditional fables, tales and “high life” music, dances, jokes, and gibes were fre-
quently woven around sex, the topic hardly came into the forefront for any formal discussion. Music, dance,
jokes and gibes are not contradictory, neurotic or evanescent expressions. They are alternative media through
which communication is established as a means of aggregation and abstraction of current socio-economic de-
velopments and its influences on the body politic (Bennett, 1999; Ashline, 2002; Smith, 2004; Anderson, 2009).
Ankomah, therefore, took a limited view of what communication was or ought to be, and thus ran counter to the
I. D. Norman et al.
14
diversity of communication articulated by Bennet, Ashline and Anderson.
Many people in both developed and developing societies are reticent about discussing sexual matters in pri-
vate, let alone, in public. Such reticence is not unique to Ghana but pervades the cultures of many nations and
families, which is manifested even in private settings of family counsellors and psychologists (McFarland,
Uecker, & Regnerus, 2011; Boyd-Franklin, 1989, 1993; Davis & Poctor, 1989; Falicov, 1983, 1998; McGol-
drick et al., 1996; Minuchin et al., 1967; Okun, 1996; Pinderhughes, 1989). Religion also plays very significant
roles in the lives of people. There are three main religions in Ghana, namely Christianity with (50% of the pop-
ulation), Muslim has (14%) and Traditional religion has (22%) (Ghana Census Bureau, Statistical Service, 2010).
Although other national experts have reported that Ghana is tolerant about religion and that there is no evidence
of religious intolerance, in a recent study of violence and harassment in public universities and professional
training institutions of Ghana, the study found the incidence of ethnic, racial and religious violence to be higher
in comparison to sexual harassment (Norman et al., 2011).
Religion plays very influential role in moderating sexual desires and activities among the members of a par-
ticular group (McFarland, Uecker, & Regnerus, 2011; Brothers, 1993; Burton, 1992; Butler & Harper, 1994;
Prest & Keller, 1993). McFarland et al. (2011) reported that elevated religiosity, which they defined as church
attendance and strength of religious identification, reduced the incidence of premarital sex among Catholics and
conservative Protestants. However, the same was not true among liberal or moderate Protestants (Cochran,
Chamlin, Beeghley, & Fenwick, 2004). This suggests that religion may shape people’s relationship to sexual ac-
tivities such as masturbation, oral and anal sex, kissing and having multiple partners (McFarland, Uecker, &
Regnerus, 2011).
Despite the role of religion in limiting sexual experimentation of a given religious group, there appears to be
other socio-demographic developments in the national sexual landscape that needs to be understood. These in-
clude the relationship between education and sexual freedom, marital union and quality of life, homosexuality
and education and autoerotic behaviours (Carvalho & Nobre, 2011; Nobre, 2006; Kerslake, 2004).
Homosexuality is a growing sexual behaviour which is trending among different societies; meanwhile there is
a general homophobic attitude towards them in most African countries including Ghana. Also, because of the
general belief systems across a country like Ghana, homosexuality is generally not tolerated.
This study is evidence based, which highlights the fact that though homosexuality is a crime in Ghana, it is
indeed being practiced among some members of the population. There is general agitation and focused activism
against homosexuality on one hand and acceptance on the other hand. It is therefore imperative to encourage
open and honest discussion of sex, sexuality and sexual activities in order to identify the gaps in the socio-cul-
tural framework as well as in the legislative framework and address them.
2. Methods
This is a cross-sectional study. It consisted of questionnaire survey, desktop and internet review. The study tar-
geted the general population of Ghana but looked at only people who were at least 16 years old. The study was
purely exploratory and did not test any hypothesis. Performing a house-to-house survey was not the best in this
case since it was quite impossible obtaining a sampling frame regarding housing distributions at that time. Also
due to the sensitive nature of the study, it was better to interview them out of their (respondents) homes. Sam-
pling selection was thus of random nature, pre-stratified by gender and region according to projections from the
Ghana Statistical Service for that year (2009).
We recruited three research assistants and over a period of one week provided them with about 20 hours of
lecture, discussion, and case studies of previous research on sex, sexuality, incest, homosexuality and lesbianism,
cultural and religious views on sex, procreation and male dominance over females. We also identified and dis-
cussed the prevailing cultural and national attitudes towards gender roles and the family. The study formed part
of a large study on sexual harassment and violence as well as ethnic and religious harassment and violence
within institutions of Ghana. The nation was divided among the three research assistants by region. Between
June and July of 2009, they travelled to their respective locations to administer the questionnaires based on the
pre-determined sample sizes for each region by a simple random method. At each stratum, respondents were in-
vited anonymously to fill out the questionnaire after which they handed it over to the research assistant. The re-
search assistant was available to provide help if need be.
After the collection, data entry was done using the Statistical Package for Social Sciences (SPSS). Descriptive
I. D. Norman et al.
15
and exploratory analyses were carried out using SPSS to assess if there are trends in the sexual mores of a con-
ventional society (Ghana); and to assess if there is association between psychosocial background and sexual at-
titudes. Analyses were also carried out to find the demographic characteristics of respondents as well as their
sexual attitudes and behaviors. Further analyses using SPSS and STATA (Chi-square tests and logistic regres-
sion methods) were also carried out to explore if there were associations between respondents’ background,
sexual behaviours and orientation.
Internet search was also conducted using carefully designed keywords such as “homosexuality, Ghana”,
“trends, sexuality modern Ghana”, or “Ghana, heterosexuality, lesbianism, bisexuality”, “Developments in ma-
rital union”, “Pornography, prostitution, Ghana”. The result was overwhelming, running into millions of data on
sexuality in general, but on Ghana specific sexuality issues, there were over 70,000 results obtained most of
which did not only concern Ghana. Despite the large volume of literature on sexuality on the internet, there were
a few studies that alluded to trends in the sexual mores of Ghana such as that of Ankomah (1992), but did not
provide a more comprehensive investigative outcome. The results from the search that were deemed pertinent to
the study were analyzed and incorporated into the literature review. Additionally, the legislative framework on
sexual offences was compared with international best practices.
3. Results
The response rate to the questionnaire developed for this purpose was 974/1068 (91.2%). This may be attributa-
ble to those who decline to associate with a particular age group or perhaps did not know their correct ages.
There were 484 females and the rest were males. Of the females, 307/484 (63.4%) were between ages 21 and 30.
Among the male respondents of 490, 278/490 (57%) were also between ages 21 and 30. For the females 90/484
(19%) ranged in age from 31 to 46 and over, whiles the men at the same range were 154/490 (31.4%).
Of the females, 320/464 (69%) were single whiles among the men, the singles were 328/477 (69%) as well.
Those married were 114/464 (25%) for females and 112/477 (24%) for males. Divorced were 30/464 (7%) and
37/477 (8%) for females and males respectively as demonstrated in Table 1
3.1. Commencement of Sexual Activities
Between ages 10 and 14, 13% of both the females and males have lost their virginity. This number increases
dramatically between ages 15 and 20 where 58% of the females and 49% of the males reported having had sex
at least once already as shown in Figure 1. The timing of sexual intercourse in this study is consistent with
findings from other places among the youth and adolescence (Crockett, Bingham, Chopak, & Vicary, 1996).
3.1.1. Experience with Anal Sex or Homosexuality and Sexual Experimentation
About 27% of the respondents have had either anal sex or have had homosexual experience before as shown in
Figure 2 and Figure 3.
The curiosity of Ghanaians in sex appears to be quite extensive. They seem ready to try multiple configura-
tions of sexual activities, including having sex with multiple partners (ménage-a-trois) at the same time. More
than 24% of the males and 19% of the females said they would like to try to have sex with three, four or five
persons at the same time as shown in Figure 4.
3.1.2. Getting Turned on
According to Table 2, while the females consider genitals of their partner as a more arousing agent in them,
followed by the lips, the males consider their partner’s breast as the instigator of sexual desires in them, fol-
lowed by the lips.
These were also characteristic of respondent who had been exposed to, or practiced homosexuality.
3.2. Analysis of Sexual Trends Captured in Table 3
In Table 3, the cross tabulation of the background of the respondents and their sexual orientation showed that a
number of Ghanaians have had bi-sexual experiences before, irrespective of religious affiliations. Looking at re-
ligious orientation and sexuality, it was revealed that 184/442 (42%) of Christians and 45/108 (42%) of
I. D. Norman et al.
16
Table 1. Background characteristics of respondents.
Background characteristics Female n (%) Male n (%) Total n (%)
Age
16 - 20
21 - 25
26 - 30
31 - 35
36 - 40
41 - 45
46 and over
87 (18.0)
191 (39.5)
116 (24.0)
35 (7.2)
31 (6.4)
11 (2.3)
13 (2.7)
58 (11.8)
149 (30.4)
129 (26.3)
71 (14.5)
34 (6.9)
22 (4.5)
27 (5.5)
145 (14.9)
340 (34.9)
245 (25.2)
106 (10.9)
65 (6.7)
33 (3.4)
40 (4.1)
Total 484 (100.0) 490 (100.0) 974 (100.0)
Marital Status Single
Married
Divorced
320 (69.0)
114 (24.6)
30 (6.5)
328 (68.8)
112 (23.5)
37 (7.8)
648 (68.9)
226 (24.0)
67 (7.1)
Total 464 (100.0) 477 (100.0) 941 (100.0)
Parental Status*
Single parent
Married with children
Married without children
Not applicable
102 (20.8)
96 (19.6)
39 (8.0)
253 (51.6)
34 (6.7)
104 (20.6)
59 (11.7)
308 (61.0)
136 (13.7)
200 (20.1)
98 (9.8)
561 (56.4)
Total 490 (100.0) 505 (100.0) 995 (100.0)
Religious
Orientation
Atheist
Christian
Moslem
Animist
35 (8.0)
337 (77.1)
57 (13.0)
8 (1.8)
54 (11.4)
328 (69.1)
75 (15.8)
18 (3.8)
89 (9.8)
665 (72.9)
132 (14.5)
26 (2.9)
Total 437 (100.0) 475 (100.0) 912 (100.0)
Educational level
completed
JSS
SSS
Vocational
Technical
University
39 (9.8)
208 (52.1)
61 (15.3)
40 (10.0)
51 (12.8)
30 (7.2)
209 (50.5)
20 (4.8)
101 (24.4)
54 (13.0)
69 (8.5)
417 (51.3)
81 (10.0)
141 (17.3)
105 (12.9)
Total 399 (100.0) 414 (100.0) 813 (100.0)
Race
Black
White
Asian
Arab
Mixed Race
376 (81.4)
24 (5.2)
21 (4.5)
20 (4.3)
21 (4.5)
389 (82.1)
6 (1.3)
34 (7.2)
26 (5.4)
19 (4.0)
765 (81.7)
30 (3.2)
55 (5.9)
46 (4.8)
40 (4.3)
Total 462 (100.0) 474 (100.0) 936 (100.0)
*The large number “Not Applicable”, 561 (56.4%) may be attributed to those who were either without children or declined to an-
swer.
Table 2. Getting Turned on.
Getting turned on Female n (%) Male n (%) Total n (%) p-value
I get turned on
by my lover’s
Foot
Arms
Legs
Breast
Lips
Eyes
Genitals
Shoes
Silk clothes
None of the above
14 (4.6)
8 (2.6)
13 (4.2)
26 (8.5)
34 (11.1)
26 (8.5)
92 (30.0)
8 (2.6)
8 (2.6)
78 (25.4)
24 (8.5)
16 (5.7)
10 (3.6)
89 (31.7)
23 (8.2)
26 (9.3)
31 (11.0)
9 (3.2)
8 (2.8)
45 (16.0)
38 (6.5)
24 (4.1)
23 (3.9)
115 (19.6)
57 (9.7)
52 (8.8)
123 (20.9)
17 (2.9)
16 (2.7)
123 (20.9)
0.000
Total 307 (100.0) 281 (100.0) 588 (100.0)
I. D. Norman et al.
17
Figure 1. The figure shows the commencement of sexual activities between males and
females (showing percentages within the individual sexes).
Figure 2. The figure shows the experience of respondents with anal sex.
Figure 3. The figure shows experience with homosexuality among respondents.
I. D. Norman et al.
18
Figure 4. The figure shows experimentation with multiple partners.
Table 3. Multiple-crosstabs between background of respondents and sexual orientation (showing Pearson chi-square/
Fisher’s exact test p-values).
Sexual Orientation [n (%)]
Background Variables Homosexual Heterosexual Bi-sexual Total p-value
Age (years)
16 - 20
21 - 25
26 - 30
31 - 35
36 - 40
41 - 45
46 and over
8 (9.4)
8 (3.7)
8 (4.2)
3 (3.3)
2 (3.2)
2 (6.7)
7 (18.4)
32 (37.6)
123 (57.5)
91 (47.4)
63 (68.5)
40 (64.5)
23 (76.7)
18 (47.4)
45 (52.9)
83 (38.8)
93 (48.4)
26 (28.3)
20 (32.3)
5 (16.7)
13 (34.2)
85 (100.0)
214 (100.0)
192 (100.0)
92 (100.0)
62 (100.0)
30 (100.0)
38 (100.0)
0.000
Sex
Female
Male
19 (5.5)
18 (5.0)
191 (55.5)
190 (53.2)
134 (39.0)
149 (41.7)
344 (100.0)
357 (100.0) 0.747
Marital Status
Single
Married
Divorced
20 (4.8)
6 (2.9)
10 (15.9)
216 (52.0)
131 (63.9)
24 (38.1)
179 (43.1)
68 (33.2)
29 (46.0)
415 (100.0)
205 (100.0)
63 (100.0)
0.000
Parents
Single parent
Married with children
Married without children
10 (8.1)
9 (4.9)
7 (7.8)
47 (37.9)
98 (53.3)
38 (42.2)
67 (54.0)
77 (41.8)
45 (50.0)
124 (100.0)
184 (100.0)
90 (100.0)
0.090
Religious Orientation
Non-believer
Christian
Moslem
Animist
10 (12.7)
15 (3.4)
8 (7.4)
3 (12.5)
32 (40.5)
243 (55.0)
55 (50.9)
7 (29.2)
37 (46.8)
184 (41.6)
45 (41.7)
14 (58.3)
79 (100.0)
442 (100.0)
108 (100.0)
24 (100.0)
0.002
Educ. level completed
JSS
SSS
Vocational
Technical
University
8 (14.5)
10 (3.9)
4 (5.0)
9 (7.2)
2 (2.6)
17 (30.9)
139 (54.1)
48 (60.0)
71 (56.8)
34 (43.6)
30 (54.5)
108 (42.0)
28 (35.0)
45 (36.0)
42 (53.8)
55 (100.0)
257 (100.0)
80 (100.0)
125 (100.0)
78 (100.0)
0.001
Race
Black
White
Asian
Lebanese
Syrian
Persian
Mixed Race
25 (4.7)
1 (3.3)
3 (10.3)
1 (2.6)
0 (0.0)
3 (50.0)
3 (7.9)
306 (57.3)
6 (20.0)
11 (37.9)
16 (42.1)
0 (0.0)
1 (16.7)
22 (57.9)
203 (38.0)
23 (76.7)
15 (51.7)
21 (55.3)
3 (100.0)
2 (33.3)
13 (34.2)
534 (100.0)
30 (100.0)
29 (100.0)
38 (100.0)
3 (100.0)
6 (100.0)
38 (100.0)
0.000
*We have classified the dominant Arab populations in Ghana into their respective nationalities to provide a clearer picture and to show their distinct
identities.
I. D. Norman et al.
19
Table 4. Summary of logistic regression odds ratios (sexual orientation (dependent) based on socio-demographic factors
(predictors) which were run separately).
Odds Ratios (95% C.I. for Odds Ratios)
Dependent Variables
Independent Variables Homosexual Heterosexual Bisexual
Age (years)
116 - 20
21 - 25
26 - 30
31 - 35
36 - 40
41 - 45
46 and over
3, 4
0.374 (0.136, 1.031)
0.418 (0.152, 1.155)
0.324 (0.083, 1.266)
0.321 (0.066, 1.567)
0.688 (0.138, 3.435)
2.173 (0.726, 6.508)
3, 4
2.239 (1.337, 3.749)2
1.492 (0.885, 2.516)
3.598 (1.933, 6.697)2
3.011 (1.525, 5.947)2
5.442 (2.098, 14.114)2
1.491 (0.688, 3.230)
3, 4
0.563 (0.339, 0.935)2
0.835 (0.501, 1.392)
0.350 (0.188, 0.652)2
0.423 (0.214, 0.837)2
0.178 (0.062, 0.508)2
0.462 (0.209, 1.023)
Sex
1Female
Male
0.908 (0.468, 1.761)
0.911 (0.677, 1.227)
1.123 (0.830, 1.518)
Marital Status
1Single
Married
Divorced
3, 4
0.595 (0.235, 1.506)
3.726 (1.655, 8.389)2
3, 4
1.631 (1.156, 2.301)2
0.567 (0.329, 0.977)2
3, 4
0.654 (0.461, 0.928)2
1.125 (0.660, 1.915)
Parental Status
1Single parent
Married with children
Married without children
3
0.586 (0.231, 1.487)
0.961 (0.351, 2.630)
3, 4
1.867 (1.174, 2.970)2
1.197 (0.688, 2.083)
3, 4
0.612 (0.387, 0.969)2
0.851 (0.494, 1.465)
Religious Orientation
1Non-believer
Christian
Moslem
Animist
3, 4
0.242 (0.105, 0.561)2
0.552 (0.207, 1.469)
0.986 (0.248, 3.916)
3, 4
1.793 (1.102, 2.918)2
1.524 (0.848, 2.740)
0.605 (0.225, 1.625)
3
0.810 (0.501, 1.309)
0.811 (0.452, 1.455)
1.589 ((0.631, 4.004)
Educ. Level Completed
1JSS
SSS
Vocational
Technical
University
3, 4
0.238 (0.089, 0.634)2
0.309 (0.088, 1.084)
0.456 (0.166, 1.253)
0.155 (0.031, 0.759)2
3, 4
2.633 (1.413, 4.906)2
3.353 (1.622, 6.930)2
2.939 (1.500, 5.758)2
1.727 (0.836, 3.571)
3, 4
0.604 (0.336, 1.085)
0.449 (0.222, 0.905)2
0.469 (0.246, 0.893)2
0.972 (0.486, 1.944)
Educational Status
1Never been to school
Dropped out of JSS
Still in school
0.566 (0.056, 5.686)
0.380 (0.043, 3.379)
4
1.556 (0.167, 14.455)
4.365 (0.505, 37.743)
4
0.975 (0.164, 5.787)
0.432 (0.078, 2.387)
Race
1Black
White
Asian
Lebanese
Syrian
Persian
Mixed Race
3, 4
0.702 (0.092, 5.364)
2.349 (0.666, 8.288)
0.550 (0.073, 4.175)
0.000 (None)
20.360 (3.911, 106.004)2
1.745 (0.502, 6.064)
3, 4
0.186 (0.075, 0.463)2
0.455 (0.211, 0.983)2
0.542 (0.278, 1.055)
0.000 (None)
0.149 (0.017, 1.284)
1.025 (0.526, 1.995)
3, 4
5.357 (2.258, 12.710)2
1.747 (0.826, 3.695)
2.014 (1.038, 3.908)2
2.634E9 (None)
0.815 (0.148, 4.491)
0.848 (0.424, 1.695)
1Logistic regression reference variable; 2Significant variable(s) within model; Model satisfies Hosmer-Leme show goodness-of-fit test;
4Overall model significant to each variable in each segment.
Moslems reported being bi-sexual. Among those aged between 16 and 20, 53% of them had had bi-sexual en-
counter before, while only 39% of those aged between 21 and 25, and 48% of those aged between 26 - 30 re-
ported being bi-sexual. Despite their small number, 7/38 (18%) of those aged 46 and above said they were ho-
mosexuals, with another 13/38 (34%) reporting bi-sexuality among both sexes. A separate look at gender re-
vealed that, 134/344 (39%) of the females were bi-sexual, while the males were even greater, recording 149/357
(42%) as bi-sexual. Marital status was not a bar to bi-sexuality. Among the married, 68/205 (33%) reported be-
I. D. Norman et al.
20
ing bi-sexual with another 6/205 (3%) being homosexual. This could simply mean that even though the individ-
ual is married, he or she considers himself or herself as a homosexual. Homosexuality amongst the divorce was
10/63 (16%) and bi-sexuality in their group was 29/63 (46%).
Summary of Logistic Regression
From the logistic regression equations, the study found that those above 20 years and older were less likely to be
bisexual; compared to those between 16 and 20 years of age. In the case of homosexuality, those above 46 were
more likely to be gay compared to those below 46 years of age. In the case of divorcees, they seemed to be three
times more likely to be homosexuals than those married or single but less likely to be heterosexual. Please see
Table 4 below for other comparisons.
Interpretation: e.g. Compared to Blacks (indigenous Ghanaians), Whites were 0.186 times more likely to be
heterosexual (or 1/0.186 = 5.376 times less likely because 0.186 is less than (1). The model to test heterosexual-
ity among the different races is significant (3, 4) although not all the categories are (2).
4. Discussion
The sexual health of a transitional society like Ghana presents a complex matrix for analysis due to the sheer
size and the belief systems of the social groups involved. Culturally, each group may have a different set of
goals for its self-determination within the collective (Archard, 1998). Additionally, their quality of life issues are
undercut by religion, socio-cultural norms and limitations as well as demographic differences. We began this
investigation by looking at what sexual health may mean to the people of Ghana. In Ghana there is no clear ar-
ticulation of what sexual health means and so we borrowed from the World Health Organization (WHO). In
2006, WHO defined sexual health as:
“… a state of physical, emotional, mental, and social well-being in relation to sexuality; it is not merely the
absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to
sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual expe-
riences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the
sexual rights of all persons must be respected, protected and fulfilled.” (WHO, 2006).
This provides the basis for the protection of both heterosexual and homosexual relationships. Embedded in
the WHO definition are medical and mental health issues, aside of the ethical and legal protections that the defi-
nition and national laws impose on member states to honour. For example, the 1992 Constitution of Ghana, Ar-
ticle 14 (1) guarantees personal liberties of all persons. Article 17 (2) and (3) go further to protect citizens that
may be “discriminated against on the grounds of gender, race, colour, ethnic origin, religion, creed or social or
economic status”. The constitutional protection appears to cover both the economic underclass, i.e. the poor and
aged, but social underclass as well, i. e. homosexuals and lesbians. Sexual groups constitute social classes. This
position is further strengthened by Article 17 (3) of the 1992 Constitution which states:
… “discriminate” means to give different treatment to different persons attributable only or mainly to their
respective descriptions by race, place of origin, political opinions, colour, gender, occupation, religion or
creed, whereby persons of one description are subjected to disabilities or restrictions to which persons of
another description are not made subject or are granted privileges or advantages which are not granted to
persons of another description.”
A liberal reading of this suggests that different sexual groups such as homosexuals and lesbians should be ac-
corded the same status as heterosexual groups since they fall into the “persons of another description” and are
not to be subjected to disabilities or restrictions to which persons of another description are not made subject
to…” Each sexual group has compelling and different sexual and medical health issues (Horowitz et al., 2001;
Kuyper & Vanwesenbeeck 2003; Smith et al., 1987).
In this study, we have demonstrated that homosexuality is part of the sexual mores of Ghanaian society de-
spite its level of material and industrial progress and it included respondents among various classes and age
groups (Table 1). The declaration of sexual autonomy and independence would become more common as the
Ghanaian society as well as those in Sub-Sahara Africa move from agrarian and parochial communities and set-
tlements into the more urbanized, semi-industrialized and commercial entity within the globalized world. Sex,
sexuality and their related activities have also morphed into a more modern form, which renders traditional
I. D. Norman et al.
21
views on sex, sexuality and activities antiquated; and the age of commencement of sexual activities also varies
(Figure 1) in the Ghanaian society.
It appears Ghana seems to be evaluating its thinking about the potential cost to culture if it allowed a complete
overhaul of the antediluvian views of sex and sexuality of society, as it entrenches its status as middle income,
urbanized society. Whiles long ways away from being accepted, male homosexuality is gradually but slowly
being considered and discussed in mainstream media by Ghanaians. Perhaps, it should be allowed to remain as
anomalous to the nature of heterosexuality but not to nature itself. On some level, there is an unflinching desire
on the part of the population to maintain ‘the embodiments of hegemonic masculinity, or its imitations’ and to
permit homosexuality and lesbianism to co-exist and to operate alongside heterogeneity how be it, secretively
(Ozbay, 2010: p. 659; Friedman, 2001; Prest & Keller, 1993). This is perhaps why in Ghana, lesbianism (or in
local language, “Supi” or otherwise something more superior to the norm) is not as frowned upon as much as
male homosexuality. To do otherwise, is to deny the statistics: where 179/415 (43%) of single individuals de-
scribe themselves as bi-sexual, (p-value = 0.000), and 77/184 (42%) of those married with children describe
themselves as bi-sexual and with (5%) admitting that they are homosexual, (p-value = 0.090) (Table 3), with
Table 4 comparing other demographic and social factors which increases likelihoods of homosexuality, bisex-
uality or heterosexuality. It appears but for the fear of being lynched or even killed, those describing themselves
as bi-sexual would have probably identified more with straight out homosexuality. Whether bi-sexuality or ho-
mosexuality, more and more Ghanaians seem to be engaging in anal sex, or have had an experience with homo-
sexuality (Figure 3) and are willing to report it, although anonymously. This is a good sign that the society is no
longer as reticent about discussing sexual proclivities as initially considered. Although 73% of males said they
had never had anal sex, the rest of them have had anal sex at least once; more females have had anal sex than
males, like their male counterparts, 70.2% of females said they had never had anal sex (Figure 2). Figure 4 also
proves that there is experimentation with multiple partners proving the fact that some respondents in the Gha-
naian population are becoming more and more exploratory when it comes to sex as shown in Table 2. These
phenomena have tremendous effect on public health policy and programs.
4.1. Study Limitations
In looking at the sexual habits of people, it is difficult to audit the true nature of the information provided by
respondents. As far as Ghana is concerned, this is the first of its kind where a cross-sectional study of this nature
has been carried out. Our study surveyed all the regions in the nation, though not a longitudinal study, it offers
the best option to understanding the trends in sexuality in Ghana thus far. Admittedly, the sample could be bi-
ased. The return rate was a hundred percent although not all the questions were answered by all the respondents.
This could be attributable to the youthfulness of the research assistants, who established a rapport with the res-
pondents. The respondents could have been waiting for an opportunity to share their knowledge about their sex-
ual behaviours and thus were probably happy to participate in this study. Due to the self-reporting nature of the
questionnaire administered, it is possible that respondents might not be truthful, or have difficulty in expressing
the true nature of their sexual proclivities and thus leading to poor characterization. There is no other alternative
method for such surveys, however. Therefore, despite the limitations, we believe the study still contributes to
knowledge on sexual trends and groups in Ghana and the in Sub-Sahara Africa and the world. Each sexual group
has compelling and different sexual and medical health issues, which needs the attention of all.
4.2. Conclusion
Communication about sexuality between patients and doctors is strained or self-censored in the face of HIV and
AIDs and associated high risk behaviours such as men-on-men sex and other practices such as anal sex between
men and women. The trends identified by this study within the Ghanaian sexual mores are interesting and im-
mense. The public health implications are unimaginable. It is therefore imperative to encourage open and honest
discussion of sex, sexuality and sexual activities in order to identify the gaps in the socio-cultural framework as
well as in the legislative framework and address them.
Acknowledgements
We are grateful to Dr. Akwasi Osei, CEO, Ghana Mental Health Authority for his insightful contribution to im-
prove the quality of this paper.
I. D. Norman et al.
22
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Appendix
STROBE Statement—Checklist of items that should be included in reports of cross-sectional studies.
Item No. Recommendation
Title and abstract 1
Homosexuality in Ghana (Page 4).
This paper investigated the incidence and prevalence of homosexuality and lesbianism in Ghana.
Assessment was done on association between psychosocial background, sexual attitudes and
homosexuality; including the use of paraphernalia in the sexual lives of the people.
The study revealed that the national attitudes towards homosexuality in general are changing from
ambivalence to focused activism and agitation against homosexuality on one hand and acceptance on the
other hand. Homosexuality and lesbian practices are prevalent in all socio-economic classes and ages of
society (Page 2).
Introduction
Background/rationale 2
Explain the scientific background
The rationale for conducting this research is that, homosexuality is a crime in Ghana yet, it is observed to
be still practiced among all social classes of individuals in the population, yet these practitioners are not
able to openly declare their sexual orientation because of the fear of opposition and agitation (Page 4).
Objectives 3 This paper investigated the incidence and prevalence of homosexuality and lesbianism in Ghana.
Assessment was done on association between psychosocial background, sexual attitudes and
homosexuality; including the use of paraphernalia in the sexual lives of the people (Page 7).
Methods
Study design 4 Present key elements of study design early in the paper
This is a cross-sectional study. It consisted of questionnaire survey, desktop and internet review (Page 7).
Setting 5
Describe the setting, locations, and relevant dates, including periods of recruitment, exposure,
follow-up, and data collection
The study targeted the general population of Ghana but looked at only people who were at least 16 years
old. The study was purely exploratory and did not test any hypothesis (Page 7).
Participants 6 a) Give the eligibility criteria, and the sources and methods of selection of participants
The study targeted the general population of Ghana but looked at only people who were at least 16 years
old (Page 7).
Variables 7 N/A
Data
sources/measurement 8*
For each variable of interest, give sources of data and details of methods of assessment
(measurement)
Obviously each variable of interest came from the questionnaire used and measured appropriately. The
attachment might help with this.
Describe comparability of assessment methods if there is more than one group
Chi-square tests were used to compare categorical variables initially for independence or homogeneity;
continuous variables like age were categorized into age ranges for this. Logistic regression was further
used to compare unadjusted odds ratios where the Chi-square test results were significant.
Bias 9 Describe any efforts to address potential sources of bias
Due to the sensitive nature of the study, respondents were interviewed out of their homes (Page 7).
Study size 10
Explain how the study size was arrived at
The sample consisted of (N = 1068) respondents. Sampling selection was of random, pre-stratified by
gender and region, which was based on the population survey by the Ghana Statistical Service for 2009
(Page 8).
Quantitative variables
11
Explain how quantitative variables were handled in the analyses. If applicable, describe which
groupings were chosen and why
Data entry was done using the Statistical Package for Social Sciences (SPSS). Descriptive and exploratory
analyses were carried out using SPSS to assess if there are trends in the sexual mores of a conventional
society (Ghana); and to assess if there is association between psychosocial background and sexual
attitudes. Analyses were also carried out to find the demographic characteristics of respondents as well as
their sexual attitudes and behaviors. Further analyses using SPSS and STATA (Chi-square tests and
logistic regression methods) were also carried out to explore if there were associations between
respondents’ background, sexual behaviours and orientation (Page 8).
I. D. Norman et al.
26
Continued
Statistical methods 12
N/A
N/A
a) Explain how missing data were addressed
Missing data were excluded from each analysis, hence the use of subtotals with varying values.
b) If applicable, describe analytical methods taking account of sampling strategy
Although sampling was stratified according to sex and region, analysis only took into account differences
in sex, one of the primary objectives. The use of region was only to give proportionate selection across the
country.
N/A
Results
Participants 13*
a) Report numbers of individuals at each stage of study—e.g. numbers potentially eligible, examined
for eligibility, confirmed eligible, included in the study, completing follow-up, and analyzed
The return rate was a hundred percent although not all the questions were answered by all the respondents
(Page 19).
N/A
N/A
Descriptive data 14*
a) Give characteristics of study participants (eg demographic, clinical, social) and information on
exposures and potential confounders
The response rate to the questionnaire developed for this purpose was 974/1068 (91.2%). This may be
attributable to those who decline to associate with a particular age group or perhaps did not know their
correct ages. There were 484 females and the rest were males (Page 9).
b) Indicate number of participants with missing data for each variable of interest
See attachment
Outcome data 15* Report numbers of outcome events or summary measures
The respective Chi-square tables show this and should be used in conjunction with the logistic regression
table.
Main results 16
a) Give unadjusted estimates and, if applicable, confounder-adjusted estimates and their precision
(e.g., 95% confidence interval). Make clear which confounders were adjusted for and why they were
included
The logistic regression models were unadjusted and confounders not taken into account.
b) Report category boundaries when continuous variables were categorized.
This was done for age (years) as follows:
16-20, 21-25, 26-30, 31-35, 36-40, 41-45, 46 and over.
c)
If relevant, consider translating estimates of relative risk into absolute risk for a meaningful time
period
Relative odds were used instead of risk in the study.
Other analyses 17 Report other analyses done—e.g. analyses of subgroups and interactions, and sensitivity analyses
These were not done.
Discussion
Key results 18
Summarise key results with reference to study objectives
About 27% of the respondents have had either anal sex or have had homosexual experience before.
The curiosity of Ghanaians in sex appears to be quite extensive. They seem ready to try multiple
configurations of sexual activities, including having sex with multiple partners, (ménage-a-trois) at the
same time. More than 24% of the males and (19%) of the females said they would like to try to have sex
with three, four or five persons at the same time (Page 9).
Limitations 19
Discuss limitations of the study, taking into account sources of potential bias or imprecision.
In looking at the sexual habits of people, it is difficult to audit the true nature of the information provided
by respondents. As far as Ghana is concerned, this is the first of its kind where a cross-sectional study of
this nature has been carried out (page 19).
Discuss both direction and magnitude of any potential bias
Admittedly, the sample could be biased. The return rate was a hundred percent although not all the
questions were answered by all the respondents. This could be attributable to the youthfulness of the
research assistants, who established a rapport with the respondents.
Due to the self-
reporting nature of the questionnaire administered, it is possible that respondents might not
be truthful, or have difficulty in expressing the true nature of their sexual proclivities and thus leading to
poor characterization (page 19).
I. D. Norman et al.
27
Continued
Interpretation 20
Give a cautious overall interpretation of results considering objectives, limitations, multiplicity of
analyses, results from similar studies, and other relevant evidence
From the study, the national attitudes towards homosexuality in general are changing from ambivalence to
focused activism and agitation against homosexuality on one hand and acceptance on the other hand.
Homosexuality and lesbian practices are prevalent in all socio-economic classes and ages of society. The
study revealed that pornography and other sex media are accepted as part of the sexual repertoire of
Ghanaian society.
This is confirmed by findings by Parker & Bhugra (2000), which indicated that, there are homophobic
tendencies among medical professionals, and the fact that communication between patients and doctors are
strained in the face of HIV and AIDs (pages 4 and16).
Generalisability 21 Discuss the generalisability (external validity) of the study results.
Other information
Funding 22 Dr. Ishmael Norman financed the collection of the data with his own private funds. There is no conflict
with other parties in terms of funding.
