- Stigma forces many LGBTQ+ Kenyans to avoid healthcare
- Grassroots groups serve vulnerable communities
- Confusion over U.S. AIDS funding may impact outreach
NAIROBI – Maria Okumu, a 29-year-old transgender teacher from the city of Kisumu on Lake Victoria, visited a local public health centre when she was diagnosed with HIV in 2023.
“They said they don’t serve people like me,” she recalled. “I felt invisible and helpless.”
She turned to Health Options for Young Men on HIV/AIDS/STIs (HOYMAS), a clinic based in the Nairobi suburb of Pangani, to receive antiretroviral therapy (ART) and counseling. Now she volunteers at HOYMAS, which serves sex workers, LGBTQ+ people, drug users, women and migrants.
The difficulty Okumu had starting life-saving ART illustrates how stigma, poverty and limited healthcare options can intersect to prevent some Kenyans from receiving help in the critical early stages following a diagnosis.
ART, which suppresses the virus and can slow its progression into AIDS, was made widely available in Kenya after the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) launched in 2003. The programme has invested more than $110 billion to fight the disease around the world and has helped reduce Kenya’s HIV prevalence rate among adults to 3.2%.
Now, President Donald Trump’s suspension of foreign aid has plunged PEPFAR into uncertainty. Although life-saving medicine received a humanitarian waiver, the World Health Organization has warned that services funded by PEPFAR have been disrupted in many countries.
In Kenya, the suspension has led to the closure of 15 clinics, the loss of 35,000 healthcare jobs and disruptions in HIV treatment for some 72,000 individuals, according to Nairobi-based Health NGOs’ Network.
‘Outright denial’
Before the pause in U.S. foreign aid, Kenya was set to receive about $300 million this fiscal year to treat 1.3 million people. This support reached at-risk communities like LGBTQ+ individuals through local organisations.
Community-led groups employ peer educators and outreach workers to serve patients who would otherwise struggle to get help from Kenya’s conventional healthcare system, where providers lack training in their specific needs, said Emma Hongera, an advocate at the Elite LGBTQI Safe House, an informal self-help group in the western city of Eldoret.
“Stigma isn’t just a social issue. It’s a structural one,” Hongera said. “When people face judgment or outright denial of care, they retreat, and this impacts not only their health but also public health outcomes.”
A government report in 2022 revealed that 45% of LGBTQ+ individuals avoided healthcare services due to fears of discrimination, according to human rights lawyer Carol Makana of the Centre for Minority Rights and Litigation.
That was the case for James Maina, a 32-year-old hairdresser from the town of Nakuru, who resisted treatment for four years after he was infected in 2020, fearful he would face reproach from his community.
A support group at HOYMAS “gave me the courage to start treatment after years of fear,” said Maina.
Finding the gaps
Limited official data make it difficult to determine how many Kenyans receive care at such community organisations. Most are affiliated with the LGBTQ+ rights umbrella group galck+, which is comprised of 18 groups, each with thousands of members.
Kenya’s ambitious goal to end AIDS as a public health threat by 2030 will require the government to ensure strong data collection to find more underserved individuals, said Ivy Werimba of galck+.
Government health surveys often exclude questions on sexual orientation, and fear of reprisals may lead to underreporting by LGBTQ+ individuals, Werimba said.
Groups like Ishtar MSM are well-placed to identify those gaps. The Nairobi clinic has served more than 7,000 gay, bisexual and other men who have sex with men (MSM), since it opened in 1997. Before the U.S. aid freeze, 365 people were receiving ART, and Ishtar MSM’s nearly 200 peer educators mentored about 50 men each.
“Our work isn’t just about numbers. It’s about saving lives and building resilient communities,” said Duncan Kioko, a healthcare provider at the clinic.
Already limited funding had restricted its ability to meet increased demand, Kioko said. Fear of police harassment and other legal barriers have also hindered access to care at the clinic.
Ishtar MSM received more than $80,000 from USAID in 2023, according to U.S. government data.
The suspension of that assistance means it will now look for alternatives, including crowdfunding, an official from Ishtar MSM said on condition of anonymity because of sensitivity surrounding the funding freeze. “The progress we’ve made in reducing HIV stigma and improving access to care for MSM is at risk of being reversed,” the official said.
At a health security summit last month, former president Uhuru Kenyatta said the cuts in U.S. aid should serve as a “wake-up call” for African nations “to help ourselves.” HOYMAS, where Okumu volunteers, receives funding comes from international groups, but it has diversified its sources and does not receive USAID money, said director John Mathenge.
It may not be immune to the freeze in U.S. assistance, as demand for other international funding now rises, but self-reliance is at the heart of the group’s model.
“Healing is not just about physical recovery, but also about giving back and making a difference in the lives of others,” Okumu said.
This story is part of a series supported by Hivos’s Free to Be Me programme.
(Editing by Sadiya Ansari and Ayla Jean Yackley)