Using innovative outreach and targeted counselling, peer educators have helped bring about a nearly 30 percent drop in HIV infection rates among Ghana’s sex workers over the past six years. Thanks to effective campaigns by groups like The West Africa Program to Combat AIDS and STI (WAPCAS), HIV prevalence among female sex workers in Ghana fell from 37.8% in 2006 to 25% in 2009, then further to 11.2%, two years later, according to the National AIDS Commission. Because sex work is illegal in Ghana, females engaged in the trade are vulnerable to exploitation and abuse which they cannot report because they have little legal recourse. While HIV prevalence among the general population in Ghana is 1.5 percent, that among sex workers is much higher, around 11 percent, according to the National AIDS Commission. WAPCAS offers preventive services, counseling, free testing and referrals to hospitals or public health care for sex workers and other people defined as key populations - or at higher risk of HIV exposure. Key populations include people living with HIV, men who have sex with men and people who inject drugs. Peer workers empowered to practice safer sex Educators say they take the keep “sex safe” message right down to the street - sometimes even between their own clients, handing out condoms and lubricants to their fellow sex workers. “We dress up like a for a normal night out. Do our hair, wear heels and makeup,” said a peer educator who requested to be identified as Aba. “There’s no problem because we are peers. They know we understand and have their interest at heart,” Aba said. Another educator spoke of the new confidence WAPCAS had given her to understand and practise safer sex. “I use female condoms if my clients refuse to wear them,” said Tina who also chose not to be identified by her real name. “I always insist. Money can’t buy back your health if you contract a disease,” she added. Men who have sex with men Another group that WAPCAS works with is men who have sex with men. The prevalence rate among this group is 25 percent. Gay sex is illegal in Ghana and homosexuality carries a deep social stigma. As a result, WAPCAS and other groups must strike a delicate balance. Taking steps to reduce HIV among this population while respecting the laws and cultural norms of the country. “Our job is to protect the practise without popularizing the activity,” said Nii Akwei Addo, head of the government’s National AIDS Control Programme. Cultural and religious norms in Ghana make it very hard for homosexuals, lesbians and men who have sex with men, who face entrenched hostility against their lifestyle choice. “Men who have sex with men are more even more vulnerable than sex workers and face the worst violence, “ Selasi Dzomeku, a coordinator for WAPCAS said. Dzomeku said the group has seen an increase in numbers of men having sex with men throughout the country and is working to make sure they are included in testing, counseling and curative services. “If they go underground they will not access treatment and we will have a real problem,” Dzomeku said. According to The Ghana Centre For Popular Education and Human Rights, increased access to antiretrovirals along with testing, counseling and education programs has led to a decrease in the number of deaths of men who have sex with men (MSM) in Ghana. Mac-Darling Cobbinah said deaths in the capital among MSM members of the group had fallen from about 12 a year to only about two over the past four years. Cobbinah said a peer educator program similar to that by the sex workers has also been successful in promoting safer sex practises within the community. The Centre seeks to promotes the rights of the lesbian, gay, bisexual, transgender and intersex communities in Ghana. Because of stigma, funding for the Centre is almost entirely dependant on foreign and donor aid, Cobbinah said. “In Ghana “our” issues are still very sensitive. People find it difficult to identify or help us,” he said. Non paying partners at risk Despite a general high level of awareness about safe sex with paying clients, a sex worker’s relations with her boyfriend, spouse or non-paying partner is where there is potential for the spread of sexually transmitted infections and the HIV virus, experts warn. Many sex worker’s partners are former or regular clients. If couples want to have children, they forego condoms, increasing their risk of becoming infected with HIV if their partners are untested. With MSM’s the issue is compounded by the fear of disgrace or shame which leads many to take heterosexual partners to cover up their their sexual preference. The need to encourage safe sex becomes even more crucial, said Akwei Addo. “We need to move out and bring services closer to them, make condoms available,” AkweI Addo said. Creating awareness about HIV-AIDS and sexually transmitted infections and teaching people how to avoid them is what groups like WAPCAS say they are all about. “When I first came I didn’t practise safe sex or use condoms. Now, I have educated my boyfriend,” said Charlotte another peer educator(real name not used).