Sexual Health and HIV/STI Risk in Gay Refugee Men in Nairobi, Kenya: A Qualitative Study

Lourence Misedah,Vanessa Schick,Michael W Ross,Solomon Wambua

doi:10.3390/venereology1010003

Lourence Misedah, Vanessa Schick + Show 2 more

Open Access

https://doi.org/10.3390/venereology1010003

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Abstract

Refugees are often without financial support and some resort to survival sex. Some of these men are gay or bisexual who fled their countries because of actual or fear of death and other persecution, exacerbated by the criminalization of consensual same-sex practices by life imprisonment or death in extreme cases. We conducted qualitative interviews with 12 gay and bisexual men within a larger sample in Nairobi, Kenya, who engaged in survival sex. Thematic analysis indicated eight main themes: Physical dangers, sexual assault, lack of rights and recourse to justice; Emotional difficulties of sex work; Seeing treatable STIs as “normal”, but others like Hepatitis B and C as abnormal, and HIV as the most feared; Recognition of penile symptoms but concerns about sexual health including anal symptoms, such as fistulas and bleeding; good knowledge about HIV but confusions over PEP and PrEP, self-testing, health access to NGO clinics and some hospital clinics but concerns about stigma and discrimination in public clinics generally; and as a result of concerns about public healthcare settings, use of pharmacies for treatment. The data indicate that male refugees from gay repression, as found for refugees from other repressions, face many of the same issues with local variations.

Highlights

The National AIDS programs and frameworks recognize male sex workers in Kenya as Key Population (KP) because of their high risk of HIV [1]
The researchers conducted the formative evaluation with community partners and developed an interview guide adapted from the Life Story Interview (LSI) [12]
The experiences included multiple-layered discrimination and ostracization aimed at refugees, Ugandans reported in our larger study [8]

Summary

Introduction

The National AIDS programs and frameworks recognize male sex workers in Kenya as Key Population (KP) because of their high risk of HIV [1]. Gay and Bisexual male sex workers may belong to one or more stigmatized groups, which may increase their vulnerability to discrimination and extreme violence because of laws and policies that criminalize both consensual same-sex practices and sex work. These factors may contribute to high-risk behaviors, for example, unprotected anal intercourse (UAI), increasing the vulnerability to HIV and other Sexually Transmissible Infections (STIs) [4]. [6] interviewed 26 male sex workers within a sample of 136 sex workers in Kenya, South Africa, Uganda, and Zimbabwe They found violence, payment refusal, and fear of reporting abuse because of criminalization and police impunity. Sex workers have no recourse to law, suffer abuse from the community, including public attacks associated with religious fundamentalism, and are accused of being “not human.” The participants noted that this extends to health services and felt that no one wants to help sex workers

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Discussion

Conclusion