POSITION STATEMENT OF HEALTHCARE PROFESSIONALS IN GHANA AND GHANAIAN HEALTHCARE PROFESSIONALS IN GHANA AND THE DIASPORA ON “THE PROMOTION OF PROPER HUMAN SEXUAL RIGHTS AND FAMILY VALUES BILL 2021”

Africa Freedom of Speech gender equity Global Health Health Equity Healthcare Equity Human rights international relations LGBT Rights Sexuality society and health Womens Rights

Following the submission of the above bill known in some circles as the Ghana Anti-LGBT+ bill, to parliament several of us health professionals, in Ghana and the diaspora, have taken the opportunity to review the bill. We have come to a consensus that the proposed bill contains several provisions that raise significant medical, scientific, and public health concerns. On that account we believe the bill if passed can cause damage to the health and wellbeing of individual citizens and the public in general. Furthermore, while we reserve it to legal minds to determine definitively, we believe that many of the provisions of the bill are unconstitutional, violate individual liberties, and may indeed violate multiple international laws. As concerned healthcare professionals, we would like to bring these issues and concerns to your attention and to that of parliament as they deliberate the bill.

A former Chief Justice of Ghana, Justice Kweku Etrew Amua-Sekyi in a judgment of the case: New Patriotic Party vrs Inspector-General of Police [1993] 2 GLR 459 – 509 in 1993 wrote; “Most restrictions on our personal Liberty which, after years of repression, we have come to accept, are inconsistent with democratic norms. Except in times of war, or when a state of emergency has been declared, it cannot be right for any agency of the executive to suppress free expression of any opinion. However unpopular that opinion may be. The believer in absolutism and the anarchist, those who support and those who are opposed to abortion, those that favour equal rights for women – yes, lesbians and homosexuals too – are entitled to the free expression of their views, and the right to assemble and demonstrate in support of those views and to their propagate views…”  With the above clear and strong opinion, which is as valid today as it was then, expressed by one of our eminent past Chief Justices, it is strange and surprising that a bill such as the above, will be entertained in our legislature. 

The LGBTQ community that the bill targets is a very small minority group in the Ghanaian society, incapable of having a significant influence on the culture and way of life of most Ghanaians yet faces significant discrimination and difficulties in their day to day lives, including limited access to healthcare at various levels. This was well articulated in focus group interviews performed in Accra, Kumasi and Manya Krobo in 2017 [Kushwaha, Sameer, et al, 2017]. The bill proposed by the Honorable Member of Parliament for Ningo Prampram constituency Samuel Nartey George will make an already bad situation an almost impossible one. Many members of our group have significant experience in the care of individuals from the LGBT+ community and can attest to the profound way this bill can negatively impact the health of the community. Below is a point-by-point summary of some of our main concerns, with respect to the health implications of The Promotion of Proper Human Sexual Rights and Family Values Bill, presented with excerpts from the Bill.

If you a healthcare professional working in Ghana or a Ghanaian healthcare professional in the diaspora express your concerns on this proposed bill by adding your signature below.

Below are our listed concerns for your information

Duty to promote proper human sexual rights and Ghanaian family values (1) Each citizen shall promote and protect the proper human sexual rights and Ghanaian values specified in section 2 of this Act. (2) Without limiting subsection (1), the following persons or institutions shall, within the jurisdiction of the persons or institutions, promote and protect the proper human sexual rights and Ghanaian family values specified in section 2 of this act

This section of the bill implies that entities, such as, teachers, parents and guardians, the church, the executive, the legislature, the judiciary, and relevant bodies are required to promote the content of the bill. It is ambiguous enough to include healthcare professionals and, thus, will make individuals in the LGBT+ community even less likely to go to healthcare facilities for care, or, to speak honestly to their healthcare professionals. Many experts, including some Ghanaians have recognized these problems already and have documented these difficulties and their impact on health prevention in these communities. [Gyamerah, Akua O., et al, 2020]. This bill will push our citizens, who are LGBT+ even further away from our healthcare system.

Duty to report. (1) A person in whose presence an offence is committed under this Act shall report the commission of the offence to a police officer, or in the absence of a police officer to a political leader, opinion leader or the customary authorities of the community in which the offence is committed.   

Like the above section, this will make it difficult for community members to seek needed healthcare. Many of our members who have worked in the United States know of similar situations related to undocumented migrants in the US not seeking care for fear doctors and healthcare workers will give their names to immigration officials even though that is not the true (Berk, Marc L., and Claudia L. Schur, 2001). The bill will create a culture of mistrust between health professionals and the community. This is not how we should be relating to a community who are already less likely to seek services. This was seen in Senegal with criminalization of same sex relationships [Poteat, Tonia, et al, 2011]. As healthcare workers we hope our country will not close the doors of our health system on a community that has significant health issues requiring special attention.

Prohibition of LGBTTQQIAAP+ and related activities. (1) A person commits an offence if the person (a) engages in a (1) sexual intercourse between or among persons of the same sex; etc. …….. (f) provides or participants in the provision of (i) a surgical procedure for sex or gender reassignment; or (ii) any other procedure that is intended to create a sexual category other than the sexual category of a person assigned at birth except in the case of correcting a biological abnormality including intersex

This provision of the bill stipulates punishments for providing or participating in the provision of a surgical or other procedure that is intended to create a sexual category other than the sexual category assigned at birth except in the case of correcting a biological anomaly. If this bill becomes law, this provision will put the health of individuals requiring such services for medical reasons, whether in Ghana, when they are available, or elsewhere at risk. Thus, individuals requiring, for example, hormonal therapy will resort to unlicensed and unregulated facilities, manned by unscrupulous and untrained individuals as seen in other countries with similar policy barriers [Maschião, Luca F., et al, 2020]. It is critically important that the healthcare system is open non-discriminatory to allow all citizens to have access to healthcare, provided by trained qualified professionals.  

Prohibiting of funding or sponsorship for prohibited activities. Section 14 (1) A person who funds or sponsors an activity prohibited under this Act commits an offence and is liable, on summary conviction, to imprisonment for a term of not less than five years and not more than ten years.  Section 15, Disbandment of LGBTTQQIAAP+ groups, societies, and associations, club or organisation. Any group, society, association, club or organisation in existence before the coming into force of this Act, whose purpose whether, partly, overtly or covertly, is to promote, facilitate, support or sustain in any way an act prohibited under this Act is disbanded

These two provisions will close off all avenues of funding and other activities used by many organizations to develop HIV prevention programs for the community. We believe that these provisions of this bill, which, ironically, states an intent to reduce HIV will rather increase the risk.  This is evidenced by the fact that criminalization in several African and Caribbean countries appears to lead to increased HIV risk and made control more difficult [Hagopian, Amy, et al., 2017].

Access to medical help and treatment of the accused – A person who (a) upon arrest; (b) during police investigation; ( c) upon arraignment before court; (d) in the course of trial; or (e) at any time during incarceration for the commission of an offence under this Act recants and makes a voluntarily request to access an approved medical help or an approved medical treatment, shall be granted access to the approved medical help or approved medical treatment. (2) The cost for an approved medical help or medical treatment shall be borne by the person or any other person or any other person, including an approved service provider, on behalf of the person

A section of the proposed bill purports to offer voluntary treatment to LGBT+ individuals and to reduce their sentences. This provision should be irrelevant since these citizens are not criminals and their lifestyle should not be criminalized. We believe that criminalizing them will be a violation of their constitutional rights and a breach of international human rights laws. Such a provision will also result in significant psychological trauma to the impacted individuals, by subjecting them to unnecessary dubious, scientifically, and medically unproven “treatments” with doubtful clinical benefit [Meanley Steven et al, 2020]. There is a reported close to 2 – 2.5 times increase in psychological conditions in adult gay men exposed to these “treatments”. The mere mention of treatment for homosexuality pathologizes same sex relationships. In this context, we would like to emphasize that the Diagnostic Statistical Manual of Mental Disorders, 5th Edition (DSM-5) does not classify homosexuality as a mental disorder. In fact, the DSM has not classified homosexuality as a disease since 1973 [Drescher, Jack., 2015]. There are some who mention the high rates of suicide as a justification that homosexuality be classified as a mental disorder. These arguments however fail to state that the increased harassment associated with laws such as the one being proposed in Ghana, as well as the intense organized negative public antagonism against the community is driving these increased suicide rates [Marx, Robert A., et al, 2021]

Mr. Speaker, we have many more concerns with regards to this bill but will leave the overall assessment of the bill to our legal colleagues who are best qualified to do so. We hope with your support and influence these concerns will be addressed in a constructive manner.

We will also welcome an opportunity to discuss these issues further with yourself and with other relevant members of parliament sponsoring this bill. It appears to us that this bill was proposed to help address social issues of concern within the country. We can understand these concerns but believe these problems can be appropriately addressed outside the legal system. 

We will await your response and action on the issues raised in this letter.

Your Sincerely 

Dr. Leonard Anang Sowah

& Coalition of Ghanaian healthcare professionals in Ghana and the diaspora

holisticphysician

A physician providing primary medical care to patients across the lifespan

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