MSM/WSW and HIV
Dr Mary Wangari Kuria
Chairman Department of Psychiatry
MSM/WSW
• MSM are men who have sex with men
• WSW are women who have sex with women –
little is known about this population
• These are key population whose unique
physical and mental health issues requires
attention
Do they exist in Kenya?
Data[1]:
Nyanza has the highest number(2765 )
Nairobi (1702)
Coast(775)
Characteristics of MSM
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2/3 are single
Mean age 26 years
67% have secondary or college level of education
67.8% are paid to have sex with men
Payment for sex with women: 62.6% of
MSW/MSM reported that they also had sex with
women.
• Mean number of sex partners per week is 3.54
Challenges associated with
MSM/WSM
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HIV/AIDS
ADA(alcohol and drug addiction)
Reproductive issues(human extintion)
Rectal prolapse and stool incontinence
Anxiety and depression?
Is it act of terrorism?
Should it be legalized or criminalized?
MSM & HIV
• Men who have sex with men (MSM) in subSaharan Africa experience a high burden of
HIV infection [2].
• an estimated 18.9% of MSM are HIV-positive
[3].
• 15% of the new prison infections in year 2012
is related to MSM
MSM & HIV
• A very significant % of the clients of the MSM
are married men who keep their
homosexual/bi-sexual actions secret from
their heterosexual partners/wives.
• The possibility of HIV cross over infections can
be very high if they engage in unprotected
anal sex.
MSM/HIV/AUD TRIAD
As defined by AUDIT (Alcohol Use Disorder
Identification Test)
• 35% of participants who drink had
hazardous drinking,
• 15% harmful drinking and
• 21% alcohol dependence.
• Total with Alcohol Use Disorder (AUD):
71%
continued
• Compared with those who are abstinent,
alcohol dependence was associated with
inconsistent condom use, penile or anal
discharge, and two-fold higher odds of sexual
violence.
• Frequent drinking was associated with
inconsistent condom use and partner number,
while binge drinking was only linked with
inconsistent condom use.[4]
Role of mental health professionals
• Research (why?
• Involvement in policy formulation
• MSM often require psychotherapy but do not
know who turn to
• Training of health professionals
• De-stigmatization ? De-criminalization?
Which way
Why are MSM/ WSM?
• Parenting ignorance
• Childhood neglect(the presence of a man in
bringing up a child though minimal is
extremely important
• Poor socialization
• Cost of marriage initiation and maintenance
MSM/WSM
• Or Would this be just an insane world that is
coming to an end?
• We need to address all these issues and offer
leadership in providing solutions because we
will be held accountable here on earth and in
heaven
References
1. Geographic Mapping of Most at Risk Populations
for HIV (MARPs) in Kenya, NACC and NASCOP,
June 2012 )
2. Zimitat C. Designing effective on-line continuing
medical education. Med Teach. 2001;23:11722.
3. Beyrer C, Baral SD, van Griensven F, Goodreau
SM, Chariyalertsak S, Wirtz AL, et al. Global
epidemiology of HIV infection in men who have
sex with men.Lancet Infect Dis.
2012;380(9839):36777.
4. Luchters et al. BMC, Public Health 2011, 11:384