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Nguru Karugu is a public health consultant on LGBTI healthcare needs with 20 years experience working with vulnerable groups including LGBTI, MSM, incarcerated and injection drug users.

Avatar of Alessia Valenza

5th March 2012 10:53

Alessia Valenza

Nguru, as everyone calls him, worked with LGBTI and substance abusers at the height of the HIV epidemic in the South Bronx, USA in the late 1980’s and early 1990’s prior to the introduction of ARV’s.

Presently Nguru is a consultant with various regional entities including the Open Society Institute East Africa (OSIEA) where he is managing their LGBTI Initiative Portfolio. Nguru also serves on the Peer Grants Committee of UHAI which provides grants to LGBTI and sex worker groups in the East African region.

He spoke to Melissa Wainaina of Behind the Mask and the following are excerpts of the interview:

What are the key components the Kenyan LGBTI movement needs to pay keen attention to in seeking a holistic well being?

Stigma and discrimination have been proven to have an effect on one’s sense of wellness and wellbeing. The lived reality of many LGBTI persons is informed by the illegality of same-sex sexual conduct.

The struggle to come to terms of who one is under an environment which is hateful and oppressive is bound to have effect on one’s wellbeing. Therefore mental health is a major issue for the LGBTI community.

Where studies have been conducted, LGBTI communities have been found to have higher suicide rates than the general population. Substance use and abuse have also been found to affect this community in higher levels than the general community.

Besides these, other medical concerns like HIV/Aids, STI, various cancers (breast, cervical etc.) afflict the community. Due to stigma, discrimination and ignorance, accessing appropriate services within existing health sites tends to be difficult to impossible for the community and that further exacerbates the presenting medical issue.

HIV/ Aids is a huge issue in general, but it has a special significance within LGBTI communities. Why is this the case? How can we combat new infections and ensure treatment for those who test positive?

HIV/Aids is a huge issue for Kenya at large. The government’s response over the years was not necessarily informed by concrete data until 2008, when two key studies, the Modes of Transmission Study (MOT) and the Kenya Aids Indicator Survey (KAIS) conducted by the government with key stakeholders provided for the first time a clear picture of the HIV epidemic in Kenya.

Of significance was the indication that while HIV incidence was at about 7 per cent for the general population, it was at a staggering 33 per cent for some marginalized communities (MSM, IDU and sex workers). This made it clear that Kenya was experiencing a mixed HIV epidemic with characteristics of both a ‘generalized’ epidemic among the mainstream population and a ‘concentrated’ epidemic among specific most at risk populations (MARPS).

The data around MARPS remains incomplete, and while the modes of transmission study, 2008 indicated that MSM (Men who have sex with Men) and IDU (intravenous drug users) combined account for perhaps 15 per cent of new infections, the model for Nairobi places these groups contribution at 26 per cent and in Mombasa at 31 per cent, almost a third of new infections.

Currently, access to appropriate services for MSM communities continues to be a challenge. Stigma and discrimination at health service points continue to hinder the provision of much needed services to the community leading to undue suffering and death within the MSM community.

Stigma around HIV positive persons within the LGBTI community is another major problem that the community is experiencing. Openly HIV positive LGBTI persons are discriminated openly by their fellow LGBTI community members. This fear of stigma from the one community that accepts them as who they are has resulted in individuals being afraid to know their status.

Do you feel that attitudes are shifting in Kenya regarding stigma and homophobia around HIV/Aids both within and out of the community?

This is a hard one to answer. While I would like to believe there is some shift in attitudes, there is still a long way to go. Especially through the health and medical services ministries, the government has shown a significant shift and has prioritized work on MARPS including MSM.

NASCOP, under Dr [Nicholas] Muraguri has provided clear leadership on the need to reach MSM communities across the country. Both Ministers of Health have verbalized the need to reach out to men who have sex with men as has the Minister of Special Programs.

While these are important steps forward, community stigma and intolerance abound across the country. The recent flushing out [of] MSM peer educators from a HIV workshop in Likoni Mombasa is possibly the most visible example of this intolerance.

The coast region is now the leading inhospitable region in Kenya for LGBTI communities and that has a direct impact on how they receive HIV prevention, treatment care and other health services.

There is of course good news in other areas, and services providers in Nyanza have stepped up and the regional LGBTI Network there (Nyawek) continues to make significant inroads in ensuring a safe space for LGBTI communities as well as scaling up appropriate health services for them.