“We must help them despite who they are…”: Healthcare providers’ attitudes and perspectives on care for tertiary student men who have sex with men in Nairobi, Kenya

Abstract

Abstract Background: Young gay, bisexual and other men who have sex with men (YMSM) face disproportionate burdens of sexual, mental and physical ill health compared to young men in the general population and older MSM. This disparity is occasioned by criminalization and stigmatization of same-sex relationships, YMSM’s limited access to non-judgmental and non-discriminatory health services, and challenges associated with healthcare delivery. We explored the attitudes and perspectives of tertiary academic institution-based healthcare providers (HCPs) in Nairobi, Kenya as relates to provision of services to tertiary student MSM (TSMSM). Methods: In September 2021, six in-person focus group discussions (FGDs) were held with 36 HCPs drawn from six public tertiary academic institutions within the Nairobi metropolis. HCPs were drawn from six cadres: front office staff, nurses, clinicians, counselors, laboratory technologists, and pharmaceutical technologists. Discussions were conducted in English, transcribed verbatim and analyzed thematically using NVivo version 12. Results: Analysis revealed three themes, namely: HCPs’ attitudes towards TSMSM, perspectives on service delivery challenges, and possible opportunities for improving care for TSMSM. Majority of HCPs articulated positive attitudes towards care for TSMSM, though some acknowledged having attitudes, beliefs and values that would hinder care for TSMSM. HCPs identified religious principles such as the golden rule of “treating others as one would want to be treated” as a facilitator of care for TSMSM. Criminalization of same-sex sexual behaviour did not hamper care for TSMSM. Healthcare delivery challenges included inadequate knowledge and skills, a desire to “convert” TSMSM’s perceived deviant homosexual to the normative heterosexual orientation/behaviour, secondary stigma from other HCPs, and failure of TSMSM to disclose same-sex sexual behaviour. Suggestions for improving care comprised sensitization and training of HCPs, encouraging more HCP interaction with MSM clients, providing TSMSM-friendly and inclusive services, and advocacy for MSM services. Conclusion: Despite their readiness and willingness to provide services to TSMSM, HCPs face challenges related to stigmatization of same-sex relations and inadequate knowledge on the health needs of TSMSM. There is a need to train HCPs on the unique health needs of TSMSM, encourage more interaction between HCPs and MSM, and advocate for improved health access for MSM.