By Stellah Bosire
One day, a young man walked into my medical clinic in Nairobi, Kenya. He was accompanied by almost a whole village — mother, uncle, brothers. I asked him how old he was. He said twenty-one. I told the rest of them to get out of my consultation room. They seemed uncomfortable.
He had come in because of a boil which, after examination, I informed him was a fistula that would need surgical intervention. It was only after speaking to him at some length that he shared that he was gay and HIV-positive. The reason this group of relatives accompanied him, he said, is because they did not want him to disclose that information and disgrace the family.
Before I was able to finish the examination, his mother barged in, asking, “Why have you stayed so long with him?” I responded that I get to decide how long I stay with my patients, not her. She grabbed him and left. I slipped my card to the young man and told him to call me, but he never did. I lost that patient. I lost him completely.
But it got me thinking: how many more people do we lock out of healthcare because of their sexual orientation?
WWhen we think of healthcare for sexual minorities, we often think of things directly related to sex and sexually transmitted diseases — like condoms, lube, PrEP. But that’s hardly it.
Health needs are vast: the World Health Organization defines health not as the absence of disease but as physical and social well-being. We fixate so much on sexually transmitted, communicable diseases like HIV that we neglect the other issues LGBTQ+ individuals face that prevent them from accessing healthcare in the first place, or those that push them to engage in risky sexual behavior. Like that young man, who could not even sit down with a physician to talk about a boil without being torn away because of his family’s fear of stigma.
It wasn’t until I started doing work with sexual minorities that I realized we are looking at LGBTQ+ healthcare in the wrong way. Yes, there are serious health consequences from HIV, and HIV is spread by risky behavior, but what is the risky behavior itself caused by? Human rights violations. Loss of income. Lack of opportunities to get jobs.
Take, for example, a trans woman in Kenya. Let’s say she cannot afford over-the-counter estrogen for hormone therapy. Say she changed her identity after she reached 18 years of age and moved out of her home so her ID card doesn’t match her identity anymore. Because of this, she’s never been able to get a meaningful job. So what options does she have? She has to look for other work; she has to survive. With no economic or social power, she may well be pushed into transactional sex or sex work. And she won’t have meaningful power to even have a conversation with clients about condom use.
Mainstream health programs then come in and focus on this “high-risk behavior” for contracting and spreading HIV—but how did it all begin? It began with her inability to afford hormones. We are trying to solve the problem from the middle, not the roots.
Here’s another example. Say the same trans woman enters a health facility to be seen by a doctor for a cough, or some other illness unrelated to her sexuality. Because the doctor will want to do a chest examination, she may be asked to remove her clothes. Here in Kenya, a doctor’s first reflex often may be to go and call their colleagues and ask why she has a penis. She will likely be refused healthcare, or worse, face social or legal repercussions.
So why would LGBTQ+ people even seek medical services when these sorts of hostile situations happen everyday?
Once I began working with LGBTQ+ people, I began to get lots of calls about very ordinary, routine health needs. People would call and ask for prescriptions for simple illnesses. I began to wonder why so many insist on calling me, this one doctor, in a country with over 7,000 doctors. It’s because medical service providers have not made it safe for them to access healthcare.
This isn’t an easy discussion in a highly transphobic and homophobic society. But we need to shift the conversation to the point where, if a physician is not comfortable treating a patient, they ought to refer the patient to someone else.
When we ignore the holistic well-being of LGBTQ+ people — which includes social acceptance, mental health, income, nutrition, housing — and instead focus exclusively through the tiny pinhole that is HIV, we miss all the other factors that make getting healthcare impossible or dangerous.
Article 43 of the Kenyan Constitution is clear: everyone has a right to the highest standard of health, which includes sexual and reproductive health. So these universal rights to healthcare are guaranteed in law. The problem now is implementation, which comes from a lack of political goodwill.
The other day, I heard Kenyan President Uhuru Kenyatta speaking about sexual minorities on TV on an interview with CNN. He dismissed it as a non-issue.
But if you are the father of a nation and you have children who are segregated away, it is an issue. Are LGBTQ+ people in Kenya not Kenyans? It is an issue if they can’t go to school or even walk into a gas station. It is an issue if they are turned away from doctors or remain afraid to access healthcare like others around them. It doesn’t matter if they are a drop in the ocean; it is an issue.
I look forward to the day we have some form of commitment from government — from any public-facing official, really — to come out and say, “We are all Kenyans, we all have a right to well-being.”
In an ideal world, we are not supposed to have “trans clinics” or “clinics for men who have sex with men.” We should just have clinics where everyone can be treated with respect and privacy. In the same way that a cisgender, heterosexual man feels safe walking into a “normal” clinic, LGBTQ+ people — like the young man who was dragged out of my consultation room — should not need to choose between health and safety.
Dr. Stellah Bosire currently serves as the Chief Executive Officer of the Doctors Professional Association of Kenya and the Vice Chairman of the HIV/AIDS Tribunal of Kenya. She is also a board member of Carolina for Kibera and the National Gay Lesbian Human Rights Commission of Kenya.
