“What if I get sick, where shall I go?”: a qualitative investigation of healthcare engagement among young gay, bisexual and other men who have sex with men in Nairobi, Kenya

Abstract

Abstract Background Globally, young gay, bisexual and other men who have sex with men (YMSM) experience a disproportionate burden of disease compared to young men in the general population and older MSM. However, YMSM experience major inequities in access and use of healthcare services. There is a paucity of knowledge on the healthcare engagement experiences of YMSM, including tertiary student MSM (TSMSM) in Kenya. We sought to gain a detailed understanding of TSMSM’s healthcare engagement experiences across public, private, institution-based and MSM-friendly health facilities in Nairobi, Kenya. Methods In September 2021, in-person qualitative in-depths interviews were conducted among 22 TSMSM purposely drawn from among 248 TSMSM who had previously participated in a respondent-driven sampling integrated bio-behavioral survey. Interviews were done in English, transcribed verbatim and analyzed thematically using NVivo version 12. Results Participants were 18–24 years old, all identified as cisgender male, three-quarters as gay and a quarter as bisexual. Themes that emerged from the analysis included: TSMSM’s experiences during healthcare seeking in the various clinical settings, priority healthcare needs, desired healthcare provider (HCP) characteristics and the potential role of digital health interventions in improving access and use of healthcare services. Participants relayed experiences of prejudice, stigma and discrimination when seeking services in public and institution-based health facilities, unlike in community pharmacies, private and MSM-friendly health facilities where they felt they were handled equitably. Healthcare needs prioritized by TSMSM centered on issues around sexual and mental health. Participants desired to have HCPs who were empathetic, non-judgmental and knowledgeable about the unique healthcare needs of MSM. Participants highlighted the usefulness of digital media in offering telehealth doctor consultations and health education on subjects such as prevention of HIV and sexually transmitted infections. Conclusion During engagement with healthcare, TSMSM experience various barriers that may prompt them to postpone or avoid seeking care hence resulting in poor health outcomes. These findings underscore the need for equipping HCPs with knowledge, skills and cultural competencies to enable them offer equitable services to TSMSM. Considerations should also be made for use of digital interventions in reaching TSMSM with the much needed sexual and mental health services.