KENYA: New survey to inform HIV programming for MSM

NAIROBI, 9 November 2009 (PlusNews) - A planned national survey of men who have sex with men (MSM) will be the first step in the government's plan to incorporate this high-risk group into the country's HIV programme, a senior government official has said.

"We have continued to ignore this group of people yet they are responsible for a big chunk of new HIV infections; we have resolved as a government that we cannot sit back and wait for things to get out of hand," said Nicholas Muraguri, head of the National AIDS and Sexually transmitted infections Control Programme (NASCOP).

There have been few studies on HIV among MSM in Kenya; a survey of 285 men in Mombasa in 2007 found an HIV prevalence of 43 percent among men who had sex with men exclusively, compared with 12.3 percent among men who had sex with both men and women. Kenya's national HIV prevalence is 7.4 percent.

HIV programming for MSM is extremely limited despite the country's national strategic plan for HIV/AIDS classing them as a “most at-risk population”.

"We cannot do this [provide HIV programmes for MSM] without knowing roughly how many they are and what special needs they require; I hope the survey that we will embark on will help us answer some of these questions," Muraguri said.

He noted that the survey - due to start in December and last six months - will attempt to discover information such as the specific sexual health risks and needs of MSM, MSM “hot spots” around the country, and the number of MSM-friendly health facilities available.

It will use respondent-driven sampling, recruiting openly gay men to reach out to other MSM who may not be out of the closet, and using existing MSM-friendly facilities to help conduct the research.

High hopes for better services

Joshua* is a male commercial sex worker in Nairobi who recently received training from NASCOP on reaching out to his peers with HIV/AIDS messages.

"Today I talked to 75 male commercial sex workers - 40 of them are HIV-positive but they do not know what to do," he told IRIN/PlusNews. "Many are homeless after being kicked out of their homes due to stigma."

Joshua hopes the survey will enable the government and NGOs to provide more services to MSM.

"Currently at a clinic in Nairobi, we are given one bottle of [water-based] lubricant to last three months but you know as a commercial sex worker, you finish it in a week," he added. "So it means for the remaining time, you engage in sex without the lubricant, putting yourself at great risk."

He noted that there was also a lack of sufficient knowledge about the risks associated with HIV and anal sex in the general population. "Many women [clients] approach us for anal sex wrongly believing that it lowers their chances of getting infected," he said. "Everybody should be educated on the dangers of this kind of sex because it seems people have the wrong perception."

However, not all MSM are as enthusiastic about the prospect of being counted and questioned by a government that has thus far shown little support for the rights of MSM.

Not everyone on board

"People in this country are still very homophobic and we are stigmatized a lot; who will want to come out to agree that he is a homosexual? Let them address issues of stigma first," said Donald*, who has not come out of the closet. "How do you convince me to come out and say I am a homosexual yet the same government that is asking me to do this criminalizes what I am engaged in?"

"I would rather they offered the services without going into the business of knowing who we are and trying to count us," he added.

I would rather they offered us the services without going into the business of knowing who we are and trying to count us

Proof that homosexuality remains taboo in Kenya was not hard to come by on the streets of Nairobi: "To say they want to offer services to people who are engaged in acts that do not conform to the law is taking this issue of human rights too far," said Lynette Moseti. "That money can be used to help children who are living with HIV."

Homosexuality remains illegal in Kenya, punishable by up to 14 years in prison. According to Muraguri, however, the urgency of the problem necessitated ignoring the law. "Rigidity will only make our situation worse," he said.

Muraguri stressed that the government's survey did not intend to stigmatize MSM.

"We appreciate the stigma these people face and that would be [the] last thing we would want to do; even in other mainstream HIV services that the government offers we use data to offer services, so I do not think there is anything unusual about the survey," he said.

Lorna Dias, MSM coordinator at Liverpool VCT (voluntary counselling and testing), Care and Treatment, one of the only organizations in the country that provides services to MSM, says the planned survey shows that the government is serious about tackling the epidemic among most at-risk populations.

"It is a positive step and a clear indication that the government is ready to open up to the reality that men who have sex with men pose a great risk to the war against HIV unless they are integrated within mainstream HIV and AIDS programmes," she said. "The next step should be to de-stigmatize them and see them as normal people who need services like everybody else."

*(not their real names)

ko/kr/cb

Theme (s): Care/Treatment - PlusNews, Education, Gender Issues, Health & Nutrition, HIV/AIDS (PlusNews), Prevention - PlusNews, PWAs/ASOs - PlusNews, Stigma/Human Rights/Law - PlusNews,

[This report does not necessarily reflect the views of the United Nations]