Sexual Health and HIV/STI Risk in Gay Refugee Men in Nairobi, Kenya: A Qualitative Study
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Participants
2.3. Recruitment
2.4. Data Collection and Analysis
3. Results
3.1. Refugee Status and Lack of Income
We used to get 6000 [shillings] a month from HIAS [HIAS Refugee Trust of Kenya]. In 2018, HIAS decided to cut the funds. There is no more assistance for LGBTI. You had to pay rent and other fees. It was very hard. I decided to involve myself in sex work. I did that in Nairobi here. But it was very dangerous.(Participant 01, 26 years)
This is the thing because I’ve tried my level best too. Cause they were giving us some financial assistance, but it reached the extent when they told us that they were no longer giving out financial assistance. So, for us to stay in Nairobi, we had to sustain ourselves. You must pay rent, you have to eat, you have to dress, you have to drink water. So you have to end up in sex work in that I’ve tried several types of tips here.(Participant 05, 26 years)
So, providing food and other essential needs in the house is really a tug of war. Personally, sometimes I go to the clubs, going to the streets around Nairobi trying to look for men. I mean men who can have sex with me, and I earn a living. So, I became a sex worker, not because I wanted, but because I needed to live. I need to make a living in Nairobi. I don’t have any other income. I don’t have money to buy anything, especially the essential ones.(Participant 06, 41years)
3.2. Physical Dangers
I decided to involve myself in sex work. I did that in Nairobi here. But it was very dangerous. You go there. You can get a client. You go with him, you bargain, I’m going to get this amount reaching there as they are blackmailers, they beat you. They take everything. As you get another one [he] takes you to his home, they stay two or three in the house, but they all want to use you. But since you are already in the house. You cannot do anything. If you do anything, they say we are going to kill you. You agree. Then they do everything they want; they end up not paying you like that.(Participant 01, 26 years)
I got a client, we agreed about the money and then he sent me the money for transport. He told me to use the money I had, and he would give it back to me. I told him I had no money, and he told me to look for the money from some friends. So, I found the money and went. What I found there, they used me [had sex with me], three guys and they say that they won’t pay me, I am in their country. They can do whatever they want. They said we were not going to pay you. Do whatever you want. We are not going to pay you. Then they started beating me.(Participant 06, 41 years)
3.3. Lack of Rights and Justice
He fucked me at night, and he did not want to give me my money. He told me, “I’m a Kenyan.” So, he tried to [not to pay] when we were talking. So, he went out, and he locked me inside. So, I was there. I saw the police; he came with the two guys who took me to the police [station]. They told me that I was a thief who had just gone and broken into someone’s house. I told them this guy was the one who called me. They didn’t want to help me, they told me I was bad, and because I am Ugandan, we will take you back to Uganda, ugh! Like that.(Participant 11, 26 years)
It happened to me. It was in Kasarani. I was beaten. You cannot go to the police here in Nairobi that you are reporting such a thing. You cannot. I used to cry even in my house. I said, no, I’m doing this. I can’t do this.(Participant 01, 26 years)
3.4. The Emotional Difficulty of Sex Work
I go on my phone and look for someone who can give me some money. I go we have sex, and he [client] gives me something to eat. It sounds like crazy it sounds like I am a sex worker; I don’t want to use that word like I am a sex worker; I feel bad. I should be doing sex for happiness. I should not be doing sex to get what to eat. Sometimes, you don’t know the challenges you will get; you even force yourself even when there is no love so that you can make something to eat.(Participant 09, 36 years)
The first challenge, you may find a customer or a client or customer. First of all, you do not have any feelings for him. But when you have to have sex with him because you need the money, you know?(Participant 13, 24 years)
But then I really, really, really needed rent. So, I hooked up on Grindr. And then I told the person, you know what, I want money. Because I want to pay my rent and could you please. So, I said the person before I even met the person. So, it’s something I’ve really tried to erase from my mind, but I know I’ve never done it. I should just own it. And I would want to disclose to the boyfriend. Yeah. Like to say things, like I did this or something. Yeah. I’m like less proud. But it saved me.(Participant 17, 24 years)
3.5. STIs and HIV
The ordinary STIs. Our biggest issue is that Hepatitis that is eating us Hepatitis B and C. Listen, KAVI tried to help us get vaccinations, but now I don’t know whether their project is on. But you see, they have their studies, and only the people involved can benefit.(Participant 02, 35 years)
The normal STIs I have been diagnosed with syphilis at some point diagnosed with gonorrhea. Some of us were so much scared of STIs (Sexually Transmitted Infection). The normal STIs HIV was my biggest worry now at that time.(Participant 02, 35 years)
3.6. STI Symptoms
So, when I went to the toilet, I saw some white thing coming out when I was peeing. It scared the hell out of me. And then I was getting all this knowledge about it. But then it showed me the same thing with HIV, so I had to get tested.(Participant 17, 24 years)
You can’t refuse because he paid you so that you could do sex. From there, it can harm you or your life. And then another thing. It can bring sicknesses such as anal fistula, HIV, STIs, yeah! … But about, um, this sickness of anal fistula, they said they cannot help me. I’m still looking for somewhere or another organization to help me because it’s also a huge issue.(Participant 08, 21 years)
So, it’s like gonorrhea, some of them like syphilis because when you reach here, you just do sex work. And you just get diseases. And even my ass, I told you they raped me, so even now, I don’t know if it will be okay. I don’t know. So sometimes, if they fuck, it can become bloody, things like that.(Participant 11, 26)
3.7. HIV Prevention (Testing, PrEP, PEP, Condom Use)
3.7.1. Condom Use
Then another one, we went, we had agreed that we should use condoms, he said yes. Reaching his apartment, he was like, Okay, let’s have sex. Then I was like, crazy. And he said no because he needed to pay me, so he didn’t need to use a condom. And I was like, no, but we agreed. So, I try to be polite to the people most of the time, but they can’t understand, they are not, this is my money that you are joking with. So, I was already in his apartment, and he had a lot of dogs outside, so he was like, if you try to go out of that door, my dogs will kill you. So, I ended up having sex with him.(Participant 06, 41 years)
Not many times would I be prepared. Sometimes we would not use condoms. You just have sex with a person, and you don’t know his HIV status and sometimes take a PrEP medication. So, you find that I’m unsafe if the person is HIV positive or probably blood contact. And aside from that also, there are times where we could use the condoms, but it’s not a must because you find that there are some clients who tell you that me, I don’t want a condom, but I’m giving you this much, and we look at it, it’s almost what you earn per month. So, I would easily give in cause I know how to do it cause these what you call a PEP medication.(Participant 04, 26 years)
3.7.2. PrEP
It was actually in August last year; now, it is like five months that I have been taking PrEP. When I started taking them, I was not feeling okay. I felt like I needed to take a lot of water, and I wanted to vomit; they were not good for my health, but they told me to keep on keep on you will get used. I got used now life is normal. I take my PrEP very well, and I hope I will keep on. I get PrEP from Hoymas, but I was advised, but in case they get finished, I go to a nearby hospital, and that is what I do.(Participant 09, 36 years)
I went to HOYMAS (HOYMAS is a MSSW led community-based organization (CBO). They have a clinic that offers HIV/STI prevention (testing, PrEP, PEP) and anti-retroviral for their clients with HIV.) [Health Options for Young Men on HIV/AIDS/STI], they told there if you fall sick, have any sexual disease, you can come and get it, you can be treated here. So, I used to go there. Then they also told me about PrEP. They said if you are sexually active, you can use PrEP, but you have to also condoms. Yeah. So I used to go for PrEP since 2016, the time I started survival sex here in Nairobi.(Participant 01, 26 years)
3.7.3. PEP
We have clinics like HOYMAS. We have LVCT, Sokoni arcade, and other hospitals. Like Kawangware SWOP clinic. So just in case of such cases, they can meet with the peer educators that can lead them up to the doctors. The peer educators can also follow up on their patients to see if they were really sexually violated. Uh, with the help of the medical doctors, they can be given what we call the PEP medication to suppress the virus in their body just in case they were sexually violated.(Participant 04, 26 years)
I’ve been trained to use lubricants, but right now, they’re no longer available; the lubricants. So you have to use condoms, and if you have any condom burst, you have to be there. This thing, cause they, that’s when I don’t know how to verify this because they say PrEP and PEP. PEP, this is the thing that when you’re at risk of getting HIV, and it helps, when you know you have got any condom burst with the person that you don’t know their status, then you have to take it for a whole month so from there, yeah.(Participant 05, 26 years)
3.7.4. Testing
I used the self-kits. So, then I tested myself. I actually told everyone; I’m going to test myself with the self-kit. And then, when I checked the result, they were positive. So, I fidgeted. And then I had to run very fast because the doctor told me, like when I was removing the Swipe, I touched where you’re supposed to rub in the gums, so I contaminated it. So, yeah. So, I got scared.(Participant 17, 24 years)
3.7.5. Healthcare Access
But now, here you are, even Hoymas might be scared of looking after someone not registered with UNHCR (United Nations High Commission on Refugees) because they feel they might be blacklisted for helping someone who is not registered to be in the urban center. So sometimes they will not touch that person. That is the biggest one I would tell people. Where is your alien card? Where is your asylum seeker pass?(Participant 02, 35 years)
No, you see, when I got Hepatitis, I thought I had got a normal disease that could be handled because the problem at times I do self-medication. The problem was because when I feel my dick is itching, I know maybe it is candidiasis, so I get cream, and sometimes it goes. Once I feel some kind of discharge, I get I just go out to the pharmacy or wherever it is.(Participant 02, 35 years)
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Description | n | % |
---|---|---|
Age | ||
18–24 | 4 | 33% |
25–34 | 5 | 42% |
35–44 | 3 | 25% |
Country of origin | ||
DRC | 1 | 8% |
Uganda | 11 | 92% |
Status | ||
Asylum seeker | 1 | 8% |
Refugee | 11 | 92% |
Duration in Kenya (in years) | ||
1 | 4 | 33% |
4 | 2 | 17% |
5 or more | 6 | 50% |
Education | ||
Primary or lower | 1 | 8.33% |
Secondary (O-level) | 2 | 25% |
Secondary (A-level) | 4 | 33.33% |
College or higher | 5 | 33.33% |
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Misedah, L.; Ross, M.W.; Wambua, S.; Schick, V. Sexual Health and HIV/STI Risk in Gay Refugee Men in Nairobi, Kenya: A Qualitative Study. Venereology 2022, 1, 9-22. https://doi.org/10.3390/venereology1010003
Misedah L, Ross MW, Wambua S, Schick V. Sexual Health and HIV/STI Risk in Gay Refugee Men in Nairobi, Kenya: A Qualitative Study. Venereology. 2022; 1(1):9-22. https://doi.org/10.3390/venereology1010003
Chicago/Turabian StyleMisedah, Lourence, Michael W. Ross, Solomon Wambua, and Vanessa Schick. 2022. "Sexual Health and HIV/STI Risk in Gay Refugee Men in Nairobi, Kenya: A Qualitative Study" Venereology 1, no. 1: 9-22. https://doi.org/10.3390/venereology1010003
APA StyleMisedah, L., Ross, M. W., Wambua, S., & Schick, V. (2022). Sexual Health and HIV/STI Risk in Gay Refugee Men in Nairobi, Kenya: A Qualitative Study. Venereology, 1(1), 9-22. https://doi.org/10.3390/venereology1010003