University of North Texas

Sociologist Ami Moore listened carefully as Philippe, a male college student in Togo, Africa, explained to her that he regularly receives money from a married man in exchange for sex.

“I use his money to pay for my college tuition and take care of myself,” said Philippe.

Philippe’s story is an all too common but hidden reality among young adult men who have sex with other men (MSM) in resource-poor countries such as Togo where jobs are scarce, said Moore, a native Togolese and associate professor in the Department of Sociology. MSM is a term coined by the Centers for Disease Control and Prevention in the early 1990s to describe behavior of men who have sexual affairs with other men regardless of their sexual identification.

Moore has spent countless hours interviewing and documenting the sexual histories of Togolese MSM for her research of sexual risk behaviors that could lead to AIDS, sexually transmitted diseases such as syphilis and hepatitis, and other physical and social health repercussions, such as beatings, ridicule and ostracism from peers and family. Togo has one of the highest rates for HIV/AIDS in West Africa, affecting 3.6 percent of the population, Moore said. For some of these young men, trading sex for cash from tourists or others in order to put food on the table or pay the bills outweighs the risks; it comes down to survival.

Another man confided to Moore, “When I am hungry, I go with people who can give me money to buy food.”

A 2012-13 Fulbright research grant award supported Moore’s travel residency to Togo in the fall of 2012. She is extending this research to include Ghana, a West African nation bordering Togo, using a 2013 grant received from the College of Public Affairs and Community Service. For this study Moore conducts phone interviews with subjects and recruits participants with on-the-ground help from a sociology colleague at the University of Ghana in Legon.

In both Togo and Ghana, Moore examines a range of contributing risk factors, including sex exchanged for money or goods, having multiple sex partners and inconsistent use of condoms. The two countries present nearly identical risk profiles. She said the situation is made dire due to a lack of free or low-cost sexual health services available to MSM and HIV/AIDS patients, in general. Many health non-governmental organizations that had provided free contraception and sexual health and family planning counseling closed or withdrew services during the last decade due to budget cuts and waning financial aid from foreign countries such as the United States. 

Religious mores exacerbate the problem. Togo and Ghana are predominantly Christian and Muslim countries, and sexual health services — especially those geared to help MSM — are often viewed as endorsing promiscuity and perversion. Neighbors and family members commonly reject MSM as sinners. Public health officers, sociologists such as Moore and other MSM are often the only support network for these men. In Ghana the stigma is so great that clinics may offer services but not advertise them. Consequently, MSM might not know that resources are available, or they might fear reprisal for seeking help. 

Shame gives rise to secrecy, and the problem spreads. MSM is a reality that affects every sector of society. Moore explained that many MSM will have sex with heterosexual women, for example, to avert family members’ suspicions, or they might sleep with heterosexual male partners who have girlfriends or wives. The situation is a health and also a human rights issue. 

“The prevailing attitude among community members and leaders is that these risks are confined to deviants and not the dominant society,” said Moore. “This denial is part of the problem. Studies show that sexual health services are critical for raising awareness and curtailing spread of HIV/AIDS and related sexual diseases.”

Moore believes that advocacy and research can help expose the high-stakes issues associated with MSM — not only so that MSM can get the help they need for counseling and treatment, but so that policy makers, politicians and community leaders might prioritize and invest in sex health education.

- Julie West, News Promotions