Abstract
Background: Sexual and gender minority (SGM) people in Kenya face pervasive socio-cultural and structural discrimination. Persistent stress stemming from anti-SGM stigma and prejudice may place SGM individuals at increased risk for negative mental health outcomes. This study explored experiences with violence (intimate partner violence and SGM-based violence), mental health outcomes (psychological distress, PTSD symptoms, and depressive symptoms), alcohol and other substance use, and prioritization of community needs among SGM adults in Western Kenya. Methods: This study was conducted by members of a collaborative research partnership between a U.S. academic institution and a Kenyan LGBTQ civil society organization (CSO). A convenience sample of 527 SGM adults (92.7% ages 18–34) was recruited from community venues to complete a cross-sectional survey either on paper or through an online secure platform. Results: For comparative analytic purposes, three sexual orientation and gender identity (SOGI) groups were created: (1) cisgender sexual minority women (SMW; 24.9%), (2) cisgender sexual minority men (SMM; 63.8%), and (3) gender minority individuals (GMI; 11.4%). Overall, 11.7% of participants reported clinically significant levels of psychological distress, 53.2% reported clinically significant levels of post-traumatic stress disorder (PTSD) symptoms, and 26.1% reported clinically significant levels of depressive symptoms. No statistically significant differences in clinical levels of these mental health concerns were detected across SOGI groups. Overall, 76.2% of participants reported ever using alcohol, 45.6% home brew, 43.5% tobacco, 39.1% marijuana, and 27.7% miraa or khat. Statistically significant SOGI group differences on potentially problematic substance use revealed that GMI participants were less likely to use alcohol and tobacco daily; and SMM participants were more likely to use marijuana daily. Lifetime intimate partner violence (IPV) was reported by 42.5% of participants, and lifetime SGM-based violence (SGMV) was reported by 43.4%. GMI participants were more likely than other SOGI groups to have experienced both IPV and SGMV. Participants who experienced SGMV had significantly higher rates of clinically significant depressive and PTSD symptoms. Conclusions: Despite current resilience demonstrated by SGM adults in Kenya, there is an urgent need to develop and deliver culturally appropriate mental health services for this population. Given the pervasiveness of anti-SGM violence, services should be provided using trauma-informed principles, and be sensitive to the lived experiences of SGM adults in Kenya. Community and policy levels interventions are needed to decrease SGM-based stigma and violence, increase SGM visibility and acceptance, and create safe and affirming venues for mental health care. Political prioritization of SGM mental health is needed for sustainable change.
Highlights
Sexual and gender minority (SGM) people in Kenya face pervasive socio-cultural and structural discrimination
A comparison of the sexual orientation and gender identity (SOGI) categories indicated that gender minority individuals (GMI) and sexual minority men (SMM) had nearly identical levels of clinically significant psychological distress (12.7% vs. 12.3%, Table 3) indicating a score of 62 or more
When examining elevated rates of depressive symptomatology, in the current sample we found that 13% of participants reported moderately severe or severe depressive symptoms (PHQ-9 ≥ 15), which was slighter higher than that found among GBMSM in a similar region in Western Kenya (10.5%) [64] and in the three-region dataset (12.2%) [5], but lower than that found among GBMSM on the Coast (23.2%) [4]
Summary
Sexual and gender minority (SGM) people in Kenya face pervasive socio-cultural and structural discrimination. Kenya is home to an increasingly more visible sexual and gender minority (SGM) community, as can be seen by the growing number of civil society organizations (CSOs) and national advocacy efforts focused on improving the health and human rights of lesbian, gay, bisexual, transgender, and queer (LGBTQ) people [1]. This activism and advocacy is especially important considering the non-affirming, and in many ways hostile, social and public policy environment for LGBTQ people in Kenya [2]. Research has shown that SGM people report experiencing harassment and denial of care from health care workers, and report frequently avoiding seeking physical and mental health services for fear of discrimination and even violence [9,10]
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