Fear of stigma and homophobia keeps gay people off treatment

NAIROBI: A discussion on the ruling by the Supreme Court of USA allowing same-sex marriages seriously challenged my otherwise still conservative views on our society.

The discussion went from what the Kenyan courts might decide then to the medical and public health implications especially as regards to HIV and Aids. Being a renowned HIV disease control expert with extensive experience in this aspect, I could not avoid the subject completely. I felt an opportunity to perhaps pass on the correct message.

Men who have sex with men (MSM) are not a single homogenous group, but represent a wide variety of people, lifestyles and health needs. From middle class gay men, to homeless runaways to injection drug users and incarcerated men, MSM have many different identities and associated risks for HIV and other infectious diseases. MSM refers to any man who has sex with a man, whether he identifies as gay, bisexual or heterosexual.

Despite success in changing sexual behaviours, MSM continue to be disproportionately affected by HIV and Aids. MSM account for the largest percentage of persons with Aids in the US (53 per cent), even as the percentage of Aids among  heterosexuals (10 per cent) has increased. In 1997, the prevalence rate of HIV for MSM in four urban communities was 17 per cent.

HIV is not an issue that exists by itself, but is woven into many aspects of men’s lives. Risk for HIV is embedded in many other core issues such as dating and intimacy, sexual desire and love, as well as alcohol and recreational drug use, homophobia, abuse and coercion, racism and self-esteem. HIV prevention programmes must be informed by these elements.

Research has shown that lesbian, gay, bisexual and transgender people are significantly more likely than heterosexuals to avoid or delay medical care. The fear of stigma and homophobia can also keep them from seeking care. And many are afraid to disclose their sexual or gender identity to their physicians, which also impacts on the quality of care they receive.