“…Anecdotal reports from Ghana suggest that persons found to be engaged in sexual behaviours considered non-heterosexual have been arrested by the police for prosecution [28,29], some have been thrown out or disowned by their families [26,29], while students have been suspended or expelled by school authorities for 'coming out' as nonheterosexual [30,31]. A recent study on vigilantism in Ghana reports that some individuals have been labelled homosexual and assaulted by community members, because those individuals exhibited (sexual) behaviours that were considered stereotypically opposite to their sex [32]. This environment of criminality, social hostility, stigma, tension and strong heteronormativity, as found also in high-income countries [33,34], gives rise to increased vulnerability of persons identifying as sexual and gender minorities to negative health outcomes and risky health behaviours including alcohol and substance use and abuse, self-harm, and suicide [35][36][37][38].…”