Nguru Karugu is a Kenyan public health consultant. He recently spoke about why there is very little research on LGBTI except the MSM in Kenya’s National Aids Programmes.
“The HIV pandemic in the global north was viewed as an epidemic affecting MSM community while in the global south it was erroneously understood as solely heterosexually driven.
It is now clear that there are significant pockets of the non-heterosexual population that are key drivers as well and their invisibility from the national responses has an effect in combating HIV holistically.
Kenya has not had research carried out around HIV among the LGBTI communities. For MSM communities some studies have been conducted but it only managed to reach the male sex worker cohorts.
The Kenya government together with various stakeholders including Population Council, CDC (Centres for Disease Control and Prevention), Galck (the Gay and Lesbian Coalition of Kenya) and others managed to conduct the first full MSM study in 2010 which attempted to reach a wider reach of MSM and hopefully it will provide valuable information on the MSM communities in Kenya.
I mention ‘communities’ because the MSM tag represents a wide and diverse grouping of men from gay and bisexual identifying men to married and other bisexually involved men.
No studies or surveys have been carried out on [the] LBT communities. There is an erroneous belief that there is limited HIV transmission among lesbian and bisexual women and therefore no need to conduct studies to ascertain the HIV reality among these populations.
Why I say erroneous is that it assumes that lesbian and bisexual women have never had sex with men and in our Kenyan context, just like married men who have sex with men, there are many married women who also have female sexual partners.
Additionally, young lesbian women still trying to discover themselves may engage in sexual activity with men where they are placed at risk for infection.
Further, unfortunately there have been no prevention interventions or programming targeting the Trans and intersex communities in Kenya.
There has at times been a flawed collapsing of MSM and transgender communities when it comes to the development of HIV prevention messages and programming. This is wholly inappropriate since transgender communities are diverse communities and are not men having sex with men (or gay men as they are often assumed to be).
In Kenya therefore there are no HIV prevention programming targeting these two communities.
Trans Education and Advocacy (TEA) has been at the fore front creating voice for this community and was able to present transgender HIV concerns at the third Kenya National Aids Strategic Plan (KNASP III) validation meeting in 2010 and at the first ever MSM Symposium hosted by the government in 2010 as well.
At the validation meeting held at [Nairobi’s] KICC (Kenyatta International Conference Centre), Dr [Nicholas] Muraguri of NASCOP was open at the limited knowledge base that the government had around transgender related concerns.
In terms of HIV risk, there are specific risks that are unique to these communities. While unprotected sexual activity also applies to Trans and intersex communities, the use of hormones for transgender individuals puts them at added risk of infection.
Shared needles while using hormones by some transgender who do not feel they can receive appropriate care services at health sites puts them at added risk for infection.
For those who are HIV infected or living with Aids and are on ARV’s there is additional concern of the interaction of the various hormones they may be using with the HIV medications.
Since the individuals do not feel safe going to health centres for care, any complications are dealt by the individuals themselves sometimes with devastating results.
Additionally the intense stigma and discrimination experienced by transgendered individuals from a young age has meant many have dropped out of school with some winding up as sex workers which again provides for additional risk of infection.
Even less is known about the HIV risk for intersex individuals and there has been no focus on this community from any quarter in the country to date.
During the development of the KNASP III, these issues of exclusion were presented to the government and they indicated a willingness to try and figure out how to include LBTI related HIV needs into the larger discussion around MARPS.
The LGBTI activists must ensure that this conversation is carried through as the KNASP III activities are rolled out.
Government and other stakeholders’ efforts around HIV prevention for the last two decades were devoid of information pertaining to same sex activities for both men and women.
This means that the LGBTI community has never been provided with appropriate information on safer sex activities as it pertains to their sexual behaviour.
This has led to a lot of misinformation around HIV transmission among these communities.
Various studies carried out in the country show for example that many people believe that unprotected vaginal intercourse is the highest risk sexual activity and that unprotected anal intercourse is a low risk activity.
This is however not true and unprotected anal intercourse is the highest risk factor for HIV transmission.
Male sex workers have reported that married male clients have told them that they will not use a condom for anal intercourse because they think it is not risky.
As a result of the modes of transmission and the Kenya Aids Indicator Survey studies, the government in December 2009 reviewed KNASP II and it developed KNASP III (2009/10 – 2012/13) which clearly outlines prevention, treatment, care and support guidelines that integrate MARPS (most at risk populations) throughout its various thematic areas.
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