This Supplement aims to recognize ongoing research with MSM in Kenya, stimulate ideas for new research and support efforts by communities themselves.
Increasingly, research with MSM is informed by the views and planned with the support of Kenyan lesbian, gay, bisexual, and transgender groups. Although further behaviour change research may be useful in these very high-risk MSM, biomedical interventions, including preexposure prophylaxis and treatment as prevention, are urgently needed. Micheni et al. High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya.
PLoS One. HIV-1 infection in high risk men who have sex with men in Mombasa, Kenya. All of the work reported in this Supplement has been performed in a context wherein MSM are stigmatized and marginalized, and in which sex between two consenting males is illegal. PLoS Med. Washington: Population Council; A call to action for comprehensive HIV services for men who have sex with men. Adherence to antiretroviral therapy and clinical outcomes among young adults reporting high-risk sexual behavior, including men who have sex with men, in coastal Kenya.
In Nairobi, over male sex workers, most of them MSM, have been engaged in research and provided with HIV care and prevention services [ 1415 ], whereas counselling services targeting MSM have also been provided by the Liverpool Voluntary Counselling and Testing Programme [ 16 ]. In this population, alcohol abuse, other substance abuse, sexual stigma and childhood or recent sexual abuse were all correlated, but did not differ by HIV status. Challenges in providing counselling to MSM in highly stigmatized contexts: of a qualitative study from Kenya. For this reason, recruitment of MSM for research studies usually is done discreetly by word of mouth, through peer networks or with the help of LGBT organizations and other civil society groups.
J Acquir Immune Defic Syndr. Graham et al. The year anniversary of the Key Populations cohort studies in Kilifi prompted the idea for this Supplement. Clearly, MSM in Kenya are no longer a hidden population. Secor et al. Findings from the small pilot test conducted for this study show promise, as the intervention was found to be well tolerated, feasible and acceptable.
The main outcome measure was depression score, based on the Patient Health Questionnaire-9 instrument [ 23 ]. Sex Transm Infect. First, if the HIV epidemic among MSM has less transmission impact on the general population than what was ly thought, then the modes of transmission study estimates for Kenya should be adjusted [ 33 ]. Learn More. In addition to tackling health challenges, these LGBT groups and their leaders aim to address human rights challenges.
Kenya collects blood for its periodic AIDS indicator survey and has many ongoing clinic-based cohorts as well as key population cohorts led by the MSM consortium and others with the requisite data on estimated date of HIV-1 infection, biological sex and route of transmission [ 35 ].
Harper et al. The Shikamana intervention approach and data presented will be of great interest to other researchers and interventionists in deing programmes to promote appropriate, tailored services for African MSM living with HIV. Two articles offer a systems approach to the vulnerabilities common among MSM. Van der Elst et al.
Evaluation of WHO screening algorithm for the presumptive treatment of asymptomatic rectal gonorrhoea and chlamydia infections in at-risk MSM in Kenya. Earlier work demonstrated a reduction in homoprejudice [ 27 ] of healthcare providers who underwent an interactive eight-module training course now freely available online www.
Although MSM received late recognition in the African HIV epidemic [ 23 ], Kenya was at the forefront in recognizing the vulnerabilities of this highly stigmatized population that feared legal authorities and had virtually no access to health services [ 4 ]. Clearly, stigma reduction and comprehensive mental health services, recommended by the authors, may be needed to reduce barriers to care engagement in this and similar MSM populations.
Increased coverage with biomedical prevention interventions should be combined with approaches outlined in this Supplementincluding improved recognition of AHI, innovative peer support to promote medication uptake and adherence, engagement and collaboration with LGBT groups to strengthen social support and wider community stakeholder engagement, including healthcare workers trainings, to facilitate societal change. Among this group, problems including loneliness, lower perceived social support, reactions to trauma, low self-esteem, struggles with LGBT identity and internalized homonegativity adversely affected psychosocial well-being and uptake of preventive measures including condom use and HIV testing.
Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries — a systematic review. Kenya also has the potential to conduct a well deed population-based phylogenetic study to confirm the degree of mixing of HIVepidemics among MSM and the general population [ 34 ]. The study by Harper et al.
Rape incidence in MSM was similar to that reported in female sex workers FSWs and was associated with alcohol use, sex work and group sex. The MSM sensitization training offers an opportunity for providers to change, and van der Elst et al. Over the relatively short duration of follow-up, a median of 1. Reaching out to MSM who are not sex workers, may not identify as gay, or may be more socially privileged would broaden our understanding of what it means to be an MSM in Kenya, and could serve to reduce stigma.
See other articles in PMC that cite the published article.
The study population included many male sex workers, and almost half the participants were HIV positive. This relatively supportive environment set the stage for recruitment of MSM into a cohort study investigating the feasibility of HIV-1 vaccine research on the Kenyan coast [ 8 ]. However, the authors note several important study limitations. Despite legal challenges and largely negative public debates [ 6 ], the Kenyan Ministry of Health and National AIDS and STI Control Programme has recognized that MSM are one of the key populations in need of urgent attention and have demonstrated their willingness to work with them [ 7 ].
Thus, none of these studies is truly population based.
Save citation to file
References 1. In their study of MSM who sell sex, Smith et al.
The authors recommend that intervention components to foster resilience be incorporated to promote the success of HIV prevention programmes. Try out PMC Labs and tell us what you think. Susan M. Author information Copyright and information Disclaimer. The publisher's final edited version of this article is available at AIDS. Conversely, men who had higher perceived social support, higher self-esteem and acceptance of their gay or bisexual identity were more likely to take up preventive measures. Resilience has been defined as a process involving positive adaptation in the face of adversity and risk, and has received attention as a cornerstone of HIV prevention research for gay and bisexual men [ 21 ].
In addition, numerous operational research studies based in this cohort have informed HIV prevention and care programming for MSM in Kenya and beyond [ 10 — 13 ]. MSM who acquired HIV-1 in the cohort studies in Coastal Kenya informed the idea for this study, as many sought healthcare prior to seroconversion and were frequently treated for malaria [ 30 ]. Such a study would require sequencing of samples from recently infected persons from the general population, MSM and other key populations, with detailed analysis of sequence clustering. Although higher scores on the sexual stigma scale used [ 24 ] were associated with higher depression scores, being married to a woman was associated with lower depression scores.
Those with bisexual behaviour had a considerably lower HIV prevalence 8.
Nordling L. African academics challenge homophobic laws. Sanders et al.
AIDS Behav. Correspondence to Eduard J. Copyright notice. However, those with bisexual behaviour were not simply MSM who have sex with women; rather, they differed from exclusively homosexual men in important ways. As a result of this increased activity, researchers in Kenya have formed an MSM health research consortium, with the aim of improving healthcare for MSM and sharing findings with the Ministry of Health.
Of particular interest, HIV-infected men decreased their rates of insertive anal intercourse, whereas uninfected men reduced their rates of receptive anal intercourse.
Free sugar mummy dating site kenya
HIV infection and sexually transmitted infections among men who have sex with men in Senegal. These Supplement studies provide suggestions for new directions in research and prevention in Kenya. Although the study by Harper et al. Aug 13—18, ; abstr MOPE Heterosexual behaviours among men who sell sex to men in Coastal Kenya.
Third, the MSM health research consortium in Kenya has the opportunity to coordinate research efforts, align goals with both LGBT stakeholders and the Kenyan Ministry of Health and coordinate planning with partners on future intervention studies that hold the greatest promise to improve health for Kenya MSM. National Center for Biotechnology InformationU. Author manuscript; available in PMC Nov Eduard J. Graham a, g. This is an open access article distributed under the Creative Commons Attribution 4.
Men who are closeted or otherwise prefer to remain hidden are not reached easily by these approaches.