Beyond biomedical and comorbidity approaches: Exploring associations between affinity group membership, health and health seeking behaviour among MSM/MSW in Nairobi, Kenya

Abstract

We explored general health and psychosocial characteristics among male sex workers and other men who have sex with men in Nairobi, Kenya. A total of 595 MSM/MSW were recruited into the study. We assessed group differences among those who self-reported HIV positive (SR-HIVP) and those who self-reported HIV negative (SR-HIVN) and by affinity group membership. Quality of life among SR-HIVP participants was significantly worse compared to SR-HIVN participants. Independent of HIV status and affinity group membership, participants reported high levels of hazardous alcohol use, harmful substance use, recent trauma and childhood abuse. The overall sample exhibited higher prevalence of moderate to severe depressive symptoms compared to the general population. Quality of life among participants who did not report affinity group membership (AGN) was significantly worse compared to participants who reported affinity group membership (AGP). AGN participants also reported significantly lower levels of social support. Membership in affinity groups was found to influence health seeking behaviour. Our findings suggest that we need to expand the mainstay biomedical and comorbidity focused research currently associated with MSM/MSW. Moreover, there are benefits to being part of MSM/MSW organisations and these organisations can potentially play a vital role in the health and well-being of MSM/MSW.

“When you talk it out … you will feel like the burden has somehow gone down, you will feel light”: Social Support Received by Gay, Bisexual, and Other Men Who Have Sex with Men in Western Kenya

“…Participants described receiving emotional, informational, and instrumental support across these groups; we identified both similarities and distinctions among the ways each type of social support-emotional, informational, and instrumental support-was expressed by each group. Social support is known to have positive impacts on mental health and sexual health outcomes [26][27][28], and previous studies with GBMSM in Kenya have identified high levels of social support as protective [11,29,30,35]. Our findings are consistent with previous research and are also consistent with the concept of social integration, which finds that having a strong social network and multiple sources of social support facilitates positive mental health [27,36].…”

“…Harper and colleagues [29] found that higher perceived social support was correlated with sexual health outcomes including increased condom use and increased likelihood of HIV testing, as well as mental health outcomes including higher self-esteem and lower levels of both depression and anxiety; additionally, lower levels of loneliness were associated with lower levels of depression and anxiety, as well as a greater likelihood of intention to test for HIV in the next 3 months [29]. A recent study by Doshi and colleagues [30] with male sex workers (MSW) and other GBMSM in Nairobi found that those who were members of an organization that supported MSW and other GBMSM had greater quality of life, reported higher levels of social support, and were more likely to have ever accessed mental health services than non-members.…”

Sexual health among Kenyan male sex workers in a time of COVID-19

“…Poor mental health outcomes related to depression, traumatic experiences, stigma and hazardous substance use have been well-documented among men who have sex with men in Kenya (Korhonen et al, 2018). In Nairobi, however, our team found that male sex workers who were affiliated with community-based organisations showed significantly higher levels of social support and quality of life compared to those unaffiliated with community-led organisations (Doshi et al, 2020). In the time of COVID-19, HOYMAS is seeing new increases in mental distress brought about by financial insecurity, impending homelessness, food insecurity and anxieties around the risk of contracting SARS-CoV-2 among immunocompromised members.…”

Sexual Health and HIV/STI Risk in Gay Refugee Men in Nairobi, Kenya: A Qualitative Study

“…The review highlighted that sex workers' capacity to engage in HIV/STI prevention, and access sexual and reproductive health services are severely undermined by social and structural determinants, including widespread violence and human rights violations, the collapse of livelihoods, and traditional social structures. These factors thus increased sex workers' vulnerability to HIV and STI infection [19,20].…”