Earlier this year, I met Eugene and Dominique at a drop-in center for men who have sex with men (MSM) outside Nairobi, Kenya.
Eugene, 23, comes to the center regularly to get condoms, lubricants and HIV counseling and testing, and has brought other gay men to the center. So far, he is HIV-negative.
Dominique, 26, also frequents the center. He was treated for a sexually-transmitted infection, and gets tested there every month. He, too, is HIV-negative.
In Kenya, most gay men are very much in the closet, due to the strong stigma against them. Many of these men would not have access to health services if not for the handful of drop-in centers in Nairobi, Kisumu and other urban centers for the simple reasons that most health facilities are not gay-friendly. Quite the contrary. Thus, most MSM have no access to gay-friendly services.
This is in a country where 40% of all MSM are HIV-positive, according to the Kenya AIDS NGO Consortium, and where “MSM and prisoners” make up 15% of all new HIV infections (the fact that MSM are put in the same category as prisoners is revealing in terms of how society views them). HIV prevalence in Kenya on the whole is 5.6%.
Key populations like MSM, people living with HIV, people who sell or buy sex, transgender people, people who use drugs, young people, migrants displaced people and prisoners are especially vulnerable to or affected by HIV and AIDS. Therefore, they are key populations to reach for HIV services.
“The paradox is that because these are the most criminalized populations in most countries, they are some of the most difficult populations to reach with HIV programs,” said Enrique Restoy, senior advisor on human rights at the International HIV/AIDS Alliance. “And when we do, we have difficulty in these populations not being able to continue, to have ready access to services, because of this constant discrimination which drives them away from these services and towards more dangerous and risky practices.”
As we approach next week’s 20th International AIDS Conference in Melbourne, Australia, we need to place these key populations at the center of the conference deliberations.
And we must not forget young women and men who are often forgotten and marginalized. Just like other key populations, young people most at risk are even more likely to experience discrimination and be refused or excluded from services due to their age, or the need of parental approval. Projects like LinkUp are fighting for the rights of young people to ensure that they get the health services they need.
Unfortunately, it’s still a crime to be gay in 77 countries. Just in the last few months, Uganda, Nigeria and India have all imposed harsh penalties merely for being gay. Other countries are considering such legislation. Inexplicably, a few months after banning gay sex, India recognized transgender people as a third gender.
In stark contrast, the Government of Kenya is actually taking a public health approach to most at-risk groups, including MSM, people who use drugs and female and male sex workers. They are doing this because they have examined the evidence and determined that it serves the public health interest to connect these people with health services and not drive them underground.
In 2010-2011, the Integrated Biological and Behavioral Survey among Key Populations in Nairobi and Kisumu, Kenya, the first population-based survey on HIV and STIs among key populations including MSM, people who inject drugs, and female sex workers, was conducted in Kenya. It found that:
- Only 13% of MSM in Nairobi visited an MSM-friendly clinic or drop-in center in the past 12 months.
- MSM receiving services at one of these clinics or drop-in centers most often receive condoms (70%), water-based lubricant (61%) and information on HIV/STI prevention and transmission (81%).
- Condom use during anal sex is relatively low.
- Only 40% of MSM use a condom consistently with paying partners in the past month.
The report determined that HIV prevention interventions need to focus on partner reduction and condom use for both male and female partnerships, and that existing programs that target MSM sex workers must strengthen condom promotion programs among this very high-risk group.
The Melbourne Declaration, released by the organizers of AIDS 2014, states that:
"We affirm that all women, men, transgender and intersex adults and children are entitled to equal rights and to equal access to HIV prevention, care and treatment information and services."
Until the human rights of all people are respected, we will not achieve an HIV-free generation.
The International HIV/AIDS Alliance has just published a new toolkit “HIV & human rights” that you can access here. To learn more about the Gates Foundation's HIV Strategy, click here.