The clinic door is not always a doorway to relief. For some male sex workers in Kenya, it can feel like an entrance into an ordeal, one marked by whispers, judgement and fear.
In Kisumu, Meshack Abur, not his real name, says the silence surrounding men who sell sex has left many unable to seek healthcare, including services for HIV, sexually transmitted infections (STIs) and other sexual health concerns.
“We are surrounded by denial,” says Abur, who lives in Kondele. “People do not want to acknowledge that we exist, yet we have health needs like everyone else.”
His experience reflects a problem reported by male sex workers in Kisumu, Nairobi and Mombasa. They say social stigma, discrimination and limited services tailored to their circumstances have pushed many into the shadows, where illness can go untreated and vulnerability grows.
In Nairobi, John Wekesa, another male sex worker, says government programmes need to recognise that sex workers are not a homogeneous group.
“Many interventions target female sex workers, but we are here too,” he says. “The government has to face the reality and acknowledge that male sex workers also exist in Kenya.”
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For Wekesa, recognition is not about seeking special treatment. It is about ensuring that health and protection services reach people who can’t get conventional programmes.
Research and community reports cited by advocates indicate that many male sex workers are young. Some have a low perception of their risk of HIV and other STIs, even as inconsistent condom use can increase their vulnerability to infection.
The contradiction is stark: the very people who may need healthcare most can be among those least willing to walk through a clinic door.
In Mombasa, Fumo Mbwana says the fear of being exposed can be more frightening than the illness itself.
“We are dying in silence,” he says. “If we walk into a clinic with diseases like gonorrhoea or syphilis, it becomes the talk of the town.”
That fear, he says, encourages some to self-medicate rather than seek professional help, potentially delaying diagnosis and treatment and increasing the risk of complications or transmission.
The problem does not end at the clinic. Male sex workers interviewed in Mombasa also describe difficult encounters with police, particularly when reporting harassment or abuse by foreign clients. They allege that some clients use money or influence to avoid accountability, leaving the local sex workers feeling powerless.
Advocates say the discussion must also avoid an often-made mistake: equating male sex work with homosexuality. A male sex worker is defined by the exchange of sexual services for money or material benefit. Sexual orientation, meanwhile, describes a person’s enduring pattern of emotional, romantic or sexual attraction. The two may overlap for some individuals, but they are not synonymous.
That distinction matters because policies based on assumptions rather than lived realities can miss the people they are intended to protect.
In coastal Kenya, where the sex industry intersects with tourism, advocates say some young men can be exposed to exploitation and abuse. The power imbalance can be severe when clients are wealthier foreigners or visitors with greater access to resources. Beyond physical health, there is another wound that is less visible: mental wellbeing.
Constant concealment, rejection and fear of discrimination can erode self-esteem and deepen isolation. Young people who disclose their sexuality or involvement in sex work may face rejection by relatives, homelessness, bullying and estrangement from their communities. For those already struggling financially, such rejection can leave few safe places to turn.
Walter Odede Nyakwaka, the chief executive officer at Africa Alive, Kenya chapter, says the response must begin by listening to the people programmes are intended to serve.
“To reach our target population, we must ensure that our audiences are fully involved,” he says.
Odede says urgent, appropriate programmes are needed to address HIV and STI prevention, healthcare access and the broader social pressures surrounding male sex work.
He argues that male sex workers remain largely hidden from mainstream interventions, making it difficult to measure the full scale of their challenges or design effective responses.
The proposed remedies are practical: train healthcare workers to provide confidential, respectful and non-judgmental services; strengthen peer education and counselling; expand HIV and STI prevention; and train police officers to respond appropriately to complaints of violence and abuse.
Community advocacy is equally important. Ending stigma does not require society to endorse sex work. It requires recognising that people engaged in it still have rights, health needs and human dignity.
For Abur, the first step is being seen.
“We are here,” he says.