Purpose: To better understand the lives and experiences of sexual and gender minority (SGM) adults experiencing homelessness relative to their cisgender heterosexual (non-SGM) counterparts. Methods: A modified time-location sampling strategy was used to reach a diverse sample of individuals with experiences of homelessness. Interviewer or self-administered paper-based surveys were administered to participants on location. Results: SGM and non-SGM participants reported significant differences in the age at which they became homeless, their current housing, and experiences of violence over the past year. SGM participants reported poorer mental health than their non-SGM counterparts. Conclusion: SGM adults may be uniquely impacted by their experiences of homelessness.

Barriers to healthcare for men who have sex with men (MSM) in sub-Saharan Africa (SSA) are rooted in stigma and discrimination against MSM fuelled by the criminalization of homosexuality. These barriers are influenced by factors involving MSM and the healthcare workers (HCWs). MSM are uncomfortable disclosing their identities and conceal symptoms of sexually transmitted infections (STIs), especially those in areas associated with homosexual behaviour to avoid stigmatization. MSM experience ill-treatment and abuse by HCWs and have concerns regarding HCWs maintaining confidentiality and privacy. This forces MSM to seek care from pharmacies/drugstores or resort to self-treatment, which may not be effective. This, coupled with increased HIV- and STI-risk behaviours resulting from depression and internalized homophobia, result in further spread of STIs. Further, barriers in HIV testing lead to exclusion of MSM from treatment cascades. Insufficient sexuality training of HCWs leads to discrimination or denial of treatment for MSM, particularly in government-run clinics. The criminalization of homosexuality deters HCWs from offering treatment to MSM. The prevailing discriminatory environment that accompanies the criminalization of homosexuality forces HCWs to don the role of moral and legal enforcers, making them the perpetrators of forced anal examinations that continue to be prevalent in SSA. Nevertheless, there is evidence to show HCWs in SSA recognize their lack of training in sexuality and have welcomed educational opportunities to better understand the healthcare needs of MSM. Pilot educational interventions for HCWs in SSA have been received enthusiastically, and have resulted in significant changes in HCW knowledge and attitudes and dealing with MSMs with STIs. This work reviews existing literature on barriers to STI-related healthcare for MSM in SSA. By drawing parallels to barriers that were overcome in the HIV epidemic in the 1980s, suitable solutions focusing on HCW education are suggested.

Introduction: Sexually minoritized men in the East, Horn, and Central Africa continue to flee from their countries, because of actual or feared persecution, to neighboring Kenya to seek protection and safety. However, there is limited research on their experiences and needs. Therefore, this study aimed to describe the persecution experiences of gay and bisexual asylum seekers and refugees in the Nairobi Metropolitan Area. Methods: We adapted McAdam’s Life-Story Interview (LSI) to develop a semi-structured interview guide. We used the interview guide to conduct one-time anonymous in-depth interviews with 19 gay and bisexual men recruited by purposive sampling. The study also included a photovoice component and written reflections. We transcribed the interviews verbatim, uploaded them to NVivo 12 plus, and analyzed the data using Braun and Clarke’s six-step thematic analysis framework. Results: The mean age of the participants was 26, with the largest age group being 18–24 (n = 9, 47%). We found six major themes: (1) The Anti-Homosexuality Act, (2) death punishment, (3) physical abuse, (4) sexual violence, (5) discrimination, and (6) injuries. Conclusions: Continued multi-layered discrimination across borders may have adverse physical health outcomes for gay and bisexual asylum seekers and refugees in the Nairobi Metropolitan Area. Further collaborative strategies may help to understand and develop culturally sensitive interventions to improve their health and well-being.

Refugees are often without financial support and some resort to survival sex. Some of these men are gay or bisexual who fled their countries because of actual or fear of death and other persecution, exacerbated by the criminalization of consensual same-sex practices by life imprisonment or death in extreme cases. We conducted qualitative interviews with 12 gay and bisexual men within a larger sample in Nairobi, Kenya, who engaged in survival sex. Thematic analysis indicated eight main themes: Physical dangers, sexual assault, lack of rights and recourse to justice; Emotional difficulties of sex work; Seeing treatable STIs as “normal”, but others like Hepatitis B and C as abnormal, and HIV as the most feared; Recognition of penile symptoms but concerns about sexual health including anal symptoms, such as fistulas and bleeding; good knowledge about HIV but confusions over PEP and PrEP, self-testing, health access to NGO clinics and some hospital clinics but concerns about stigma and discrimination in public clinics generally; and as a result of concerns about public healthcare settings, use of pharmacies for treatment. The data indicate that male refugees from gay repression, as found for refugees from other repressions, face many of the same issues with local variations.

Very little information exists about the experiences of asylum seekers and refugees who are men who have sex with men (MSM). Therefore, this study explores the psychological distress of MSM asylum seekers and refugees in the Nairobi metropolitan area. We collected data using in-depth interviews transcribed verbatim, coded using NVivo 12 Plus, and analyzed using the six-step thematic analysis framework. Four major themes emerged from the study: psychological distress, traumatic stress symptoms, mental health care access, and coping strategies. Although we did not use any diagnoses, the results indicate that MSM asylum seekers and refugees share mental health problems with other refugees. However, MSM have specific needs that derive from their persecution based on their sexual minority status. The results confirm extant findings, as seen in the discussion, and encourage more research. Further research will inform collaborative, culturally sensitive, and targeted interventions that decrease adverse mental health outcomes for MSM asylum seekers and refugees in the Nairobi metropolitan area.