The Mental Health of Male Sexual Minority Asylum Seekers and Refugees in Nairobi, Kenya: A Qualitative Assessment

Authors

  • Lourence Misedah-Robinson The University of Texas Health Science Center at Houston, School of Public Health https://orcid.org/0000-0002-6528-1742
  • Vanessa Schick The University of Texas Health Science Center at Houston, School of Public Health
  • Michael W. Ross University of Minnesota Medical School https://orcid.org/0000-0002-5718-9989
  • Solomon Wambua Key Population Consortium of Kenya [KP Consortium]

DOI:

https://doi.org/10.25071/1920-7336.40935

Keywords:

MSM asylum seekers, MSM refugees, mental health

Abstract

Very little information exists about the experiences of asylum seekers and refugees who are men who have sex with men (MSM). Therefore, this study explores the psychological distress of MSM asylum seekers and refugees in the Nairobi metropolitan area. We collected data using in-depth interviews transcribed verbatim, coded using NVivo 12 Plus, and analyzed using the six-step thematic analysis framework. Four major themes emerged from the study: psychological distress, traumatic stress symptoms, mental health care access, and coping strategies. Although we did not use any diagnoses, the results indicate that MSM asylum seekers and refugees share mental health problems with other refugees. However, MSM have specific needs that derive from their persecution based on their sexual minority status. The results confirm extant findings, as seen in the discussion, and encourage more research. Further research will inform collaborative, culturally sensitive, and targeted interventions that decrease adverse mental health outcomes for MSM asylum seekers and refugees in the Nairobi metropolitan area.

Author Biographies

Lourence Misedah-Robinson, The University of Texas Health Science Center at Houston, School of Public Health

Lourence Misedah is a Postdoctoral Research Fellow at The University of Texas Health Science Center at Houston School of Public Health. He can be reached at lourence.misedah@uth.tmc.edu.

Vanessa Schick, The University of Texas Health Science Center at Houston, School of Public Health

Vanessa Schick, PhD, is an Associate Professor at the University of Texas Health Science Center at Houston School of Public Health. She can be reached at vanessa.schick@uth.tmc.edu.

Michael W. Ross, University of Minnesota Medical School

Michael W. Ross is a Professor of Family Medicine and Community Health at the University of Minnesota. He can be reached at mwross@umn.edu.

Solomon Wambua, Key Population Consortium of Kenya [KP Consortium]

Solomon is a National Coordinator at the Key Population Consortium of Kenya [KP Consortium]. They can be reached at solomonwambuad@gmail.com.

References

Alessi, E. J. (2016). Resilience in sexual and gender minority forced migrants: A qualitative exploration. Traumatology, 22(3), 203–213. https://doi.org/10.1037/trm0000077

Alessi, E. J., Kahn, S., & Van Der Horn, R. (2017). A qualitative exploration of the premigration victimization experiences of sexual and gender minority refugees and asylees in the United States and Canada. The Journal of Sex Research, 54(7), 936–948. https://doi.org/10.1080/00224499.2016.1229738

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5) (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Antebi-Gruszka, N., & Schrimshaw, E. W. (2018). Negative attitudes toward same-sex behavior inventory: An internalized homonegativity measure for research with bisexual, gay, and other non–gay-identified men who have sex with men. Psychology of Sexual Orientation and Gender Diversity, 5(2), 156–168. https://doi.org/10.1037/sgd0000292

Bentley, J. A., & Dolezal, M. L. (2019). Does time in migration exacerbate posttraumatic symptoms among internationally displaced east African refugees? Journal of Immigrant & Refugee Studies, 17(3), 371–388. https://doi.org/10.1080/15562948.2018.1480824

Bhalla, N. (2019, January 11). LGBT+ refugees in Kenya accuse U.N. of failing on protection, shelter. Reuters. https://www.reuters.com/article/us-kenya-lgbt-refugees/lgbt-refugees-in-kenya-accuse-u-n-of-failing-on-protection-shelter-idUSKCN1P51Q2

Bhalla, N., & Goldsmith, B. (2020, April 13). Investigation after gay refugee found dead at U.N. refugee office in Kenya. Reuters. https://www.reuters.com/article/us-kenya-lgbt-refugees-trfn/investigation-after-gay-refugee-found-dead-at-u-n-refugee-office-in-kenya-idUSKCN21V1Y9

Bhugra, D., Gupta, S., Bhui, K., Craig, T., Dogra, N., Ingleby, J. D., & Qureshi, A. (2011). WPA guidance on mental health and mental health care in migrants. World Psychiatry, 10(1), 2–10. https://doi.org/10.1002/j.2051-5545.2011.tb00002.x

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Cain, D. N., Mirzayi, C., Rendina, H. J., Ventuneac, A., Grov, C., & Parsons, J. T. (2017). Mediating effects of social support and internalized homonegativity on the association between population density and mental health among gay and bisexual men. LGBT Health, 4(5), 352–359. https://doi.org/10.1089/lgbt.2017.0002

Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2007). Psychological stress and disease. JAMA, 298(14), 1685–1687. https://doi.org/10.1001/jama.298.14.1685

Cope, D. G. (2014). Methods and meanings: Credibility and trustworthiness of qualitative research. Oncology Nursing Forum, 41(1), 89–91. https://doi.org/10.1188/14.ONF.89-91

Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1–4. https://doi.org/10.11648/j.ajtas.20160501.11

Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. The Lancet, 365(9467), 1309–1314. https://doi.org/10.1016/S0140-6736(05)61027-6

Ferrari, A. J., Charlson, F. J., Norman, R. E., Patten, S. B., Freedman, G., Murray, C. J., Whiteford, H. A. (2013). Burden of depressive disorders by country, sex, age, and year: Findings from the global burden of disease study 2010. PLoS Medicine, 10(11), Article e1001547. https://doi.org/10.1371/journal.pmed.1001547

Henrickson, M., Brown, D. B., Fouché, C., Poindexter, C. C., & Scott, K. (2013). “Just talking about it opens your heart”: Meaning making among Black African migrants and refugees living with HIV. Culture, Health & Sexuality, 15(8), 910–923. https://doi.org/10.1080/13691058.2013.790076

Hopkinson, R. A., Keatley, E., Glaeser, E., Erickson-Schroth, L., Fattal, O., & Nicholson Sullivan, M. (2017). Persecution experiences and mental health of LGBT asylum seekers. Journal of Homosexuality, 64(12), 1650–1666. https://doi.org/10.1080/00918369.2016.1253392

Hynie, M. (2018). The social determinants of refugee mental health in the post-migration context: A critical review. The Canadian Journal of Psychiatry, 63(5), 297–303. https://doi.org/10.1177/0706743717746666

International Lesbian, Gay, Bisexual, Trans, and Intersex Association (ILGA). (2017, May). State-sponsored homophobia. A world survey of sexual orientation laws: Criminalization, protection, and recognition (12th ed.). https://www.refworld.org/docid/59e615f64.html.

Jansen, S. (2013). Introduction: Fleeing homophobia, asylum claims related to sexual orientation, and gender identity in Europe. In T. Spijkerboer (Ed.), Fleeing homophobia (pp. 19–49). Routledge. https://doi.org/10.4324/9780203515723

Johnson, P. (2014). Making unjust law: The parliament of Uganda and the Anti-Homosexuality Act 2014. Parliamentary Affairs, 68(4), 709–736. https://doi.org/10.1093/pa/gsu021

Jones, K. T., Wilton, L., Millett, G., & Johnson, W. D. (2010). Formulating the stress and severity model of minority social stress for Black men who have sex with men. In D. H. McCree, K. T. Jones, & A. O’Leary (Eds.), African Americans and HIV/AIDS (pp. 223–238). Springer. https://doi.org/10.1007/978-0-387-78321-5_12

Kahn, S., Alessi, E. J., Kim, H., Woolner, L., & Olivieri, C. J. (2018). Facilitating mental health support for LGBT forced migrants: A qualitative inquiry. Journal of Counseling & Development, 96(3), 316–326. https://doi.org/10.1002/jcad.12205

Kenya Human Rights Commission. (2011). In Gitari E. & Waweru E. (Eds.), The outlawed among us: A study of the LGBTI community's search for equality and non-discrimination in Kenya. Kenya Human Rights Commission. http://www.khrc.or.ke/mobile-publications/equality-and-anti-discrimination/70-the-outlawed-amongst-us/file.html

Kenya National Bureau of Statistics (KNBS). (2015). Economic survey 2015. https://www.knbs.or.ke/download/economic-survey-2015/

Kubicek, K., McNeeley, M., Holloway, I. W., Weiss, G., & Kipke, M. D. (2013). “It’s like our own little world”: Resilience as a factor in participating in the ballroom community subculture. AIDS and Behavior, 17(4), 1524–1539. https://doi.org/10.1007/s10461-012-0205-2

Lavers, M. (2021, April 14). A gay man burned in a Kenya refugee camp dies. Washington Blade. https://www.washingtonblade.com/2021/04/14/gay-man-burned-in-kenya-refugee-camp-dies/

Laws of Kenya. (2014). Penal Code: CAP. 63. http://www.kenyalaw.org/lex/actview.xql?actid=CAP.%2063

Leiler, A., Bjärtå, A., Ekdahl, J., & Wasteson, E. (2019). Mental health and quality of life among asylum seekers and refugees living in refugee housing facilities in Sweden. Social Psychiatry and Psychiatric Epidemiology, 54(5), 543–551. https://doi.org/10.1007/s00127-018-1651-6

Li, S. S., Liddell, B. J., & Nickerson, A. (2016). The relationship between post-migration stress and psychological disorders in refugees and asylum seekers. Current Psychiatry Reports, 18(9), Article 82. https://doi.org/10.1007/s11920-016-0723-0

Lincoln, Y., & Guba, E. (1985). Naturalistic inquiry. Sage Publications. https://us.sagepub.com/en-us/nam/naturalistic-inquiry/book842

Malebranche, D. J., Peterson, J. L., Fullilove, R. E., & Stackhouse, R. W. (2004). Race and sexual identity: Perceptions about medical culture and healthcare among Black men who have sex with men. Journal of the National Medical Association, 96(1), 97–107. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594754/

McAdams, D. P. (2007). The life story interview. Northwestern University. https://cpb-us-e1.wpmucdn.com/sites.northwestern.edu/dist/4/3901/files/2020/11/The-Life-Story-Interview-II-2007.pdf

Merriam, S. B. (1998). Qualitative research and case study applications in education. Jossey-Bass Publishers.

Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36(1), 38–56. https://doi.org/10.2307/2137286

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674

Miller, A., Hess, J. M., Bybee, D., & Goodkind, J. R. (2018). Understanding the mental health consequences of family separation for refugees: Implications for policy and practice. American Journal of Orthopsychiatry, 88(1), 26–37. https://doi.org/10.1037/ort0000272

Minor Peters, M. (2016). “They wrote ‘gay’ on her file”: Transgender Ugandans in HIV prevention and treatment. Culture, Health & Sexuality, 18(1), 84–98. https://doi.org/10.1080/13691058.2015.1060359

Misedah, L (2021). A qualitative assessment of persecution experiences and health needs of sexual minority asylum seekers and refugees in Nairobi, Kenya [Doctoral dissertation, University of Texas, School of Public Health].

Misedah, L., Ross, M. W., Wambua, S., & Schick, V. (2021). Sexual health and HIV/STI risk in gay refugee men in Nairobi, Kenya: A qualitative study. Venereology, 1(1), 9–22. https://doi.org/10.3390/venereology1010003

Misedah, L., Schick, V., McCurdy, S., Wambua, S., Wilkerson, M., & Ross, M. (2021). Persecution experiences and related injuries of men who have sex with men (MSM) asylum seekers and refugees in Nairobi, Kenya [Manuscript submitted for publication]. University of Texas Health Science Center at Houston, School of Public Health.

Mulqueeny, D. M., Nkabini, S. M., & Pokiya, M. H. (2021). Mapping evidence of depression in HIV-seropositive MSM in sub-Saharan Africa: A scoping review protocol. Systematic Reviews, 10(1), Article 50. https://doi.org/10.1186/s13643-021-01604-w

National Immigration Forum. (2020, November 5). Fact sheet: U.S. refugee resettlement. https://immigrationforum.org/article/fact-sheet-u-s-refugee-resettlement/

Newcombe, R. (2003). From client to project stakeholders: A stakeholder mapping approach. Construction Management and Economics, 21(8), 841–848. https://doi.org/10.1080/0144619032000072137

Nicol, N., Gates-Gasse, E., & Mule, N. (2014). Envisioning global LGBT human rights: Strategic alliances to advance knowledge and social change. Scholarly and Research Communication, 5(3), Article 0301165. https://doi.org/10.22230/src.2014v5n3a165

Nilsson, J. E., Jeevanba, S. B., Molitoris, A., Stratmann, S., & Kubik, R. (2020). Sexual and gender minority refugees and asylum seekers: An arduous journey. In E. M. Lund, C. Burgess, & A. J. Johnson (Eds.), Violence against LGBTQ persons (pp. 231–239). Springer. https://doi.org/10.1007/978-3-030-52612-2_18

Ogden, S. N., Scheffey, K. L., Blosnich, J. R., & Dichter, M. E. (2019). “Do I feel safe revealing this information to you?”: Patient perspectives on disclosing sexual orientation and gender identity in healthcare. Journal of American College Health, 68(6), 617–623. https://doi.org/10.1080/07448481.2019.1583663

Onyango-Ouma, W., Birungi, H., & Geibel, S. (2005). Understanding the HIV/STI risks and prevention needs of men who have sex with men in Nairobi, Kenya. Population Council. https://doi.org/10.31899/HIV2.1031

Pincock, K. (2020). UNHCR and LGBTI refugees in Kenya: The limits of “protection.” Disasters, 45(4), 844–864. https://doi.org/10.1111/disa.12447

Porter, M., & Haslam, N. (2005). Predisplacement and post-displacement factors associated with the mental health of refugees and internally displaced persons: A meta-analysis. JAMA, 294(5), 602–612. https://doi.org/10.1001/jama.294.5.602

Poteat, T., German, D., & Flynn, C. (2016). The conflation of gender and sex: Gaps and opportunities in HIV data among transgender women and MSM. Global Public Health, 11(7-8), 835–848. https://doi.org/10.1080/17441692.2015.1134615

Refugee Consortium of Kenya (RCK). (2015). Myths and truths: The facts about refugee self-sufficiency and economic contribution in Nairobi. https://www.rckkenya.org/?media_dl=842

Ross, M. W., Kashiha, J., Misedah, L., Mgopa, L. R., Larsson, M., Agardh, A., & Venkitachalam, K. K. (2021). Addressing the healthcare needs of African men who have sex with men: Barriers to healthcare and promoting HIV and STI treatment in sub-Saharan Africa. East African Journal of Health and Science, 3(1), 59–77. https://doi.org/10.37284/eajhs.3.1.339

Secor, A. M., Wahome, E., Micheni, M., Rao, D., Simoni, J. M., Sanders, E. J., & Graham, S. M. (2015). Depression, substance abuse, and stigma among men who have sex with men in coastal Kenya. AIDS (London, England), 29(Suppl 3), S251–S259. https://doi.org/10.1097/QAD.0000000000000846

Semlyen, J., King, M., Varney, J., & Hagger-Johnson, G. (2016). Sexual orientation and symptoms of common mental disorder or low well-being: Combined meta-analysis of 12 UK population health surveys. BMC Psychiatry, 16, Article 67. https://doi.org/10.1186/s12888-016-0767-z

Shidlo, A., & Ahola, J. (2013). Mental health challenges of LGBT forced migrants. Forced Migration Review, 42, 9–11. https://www.fmreview.org/sogi/shidlo-ahola

Silove, D., Sinnerbrink, I., Field, A., Manicavasagar, V., & Steel, Z. (1997). Anxiety, depression, and PTSD in asylum-seekers: Associations with pre-migration trauma and post-migration stressors. The British Journal of Psychiatry, 170(4), 351–357. https://doi.org/10.1192/bjp.170.4.351

Sinnerbrink, I., Silove, D., Field, A., Steel, Z., & Manicavasagar, V. (1997). Compounding of premigration trauma and postmigration stress in asylum seekers. The Journal of Psychology, 131(5), 463–470. https://doi.org/10.1080/00223989709603533

Smith, A. D., Muhaari, A. D., Agwanda, C., Kowuor, D., van der Elst, E., Davies, A., & Sanders, E. J. (2015). Heterosexual behaviors among men who sell sex to men in coastal Kenya. AIDS (London, England), 29, S201–S210. https://doi.org/10.1097/QAD.0000000000000889

Steel, J. L., Dunlavy, A. C., Harding, C. E., & Theorell, T. (2017). The psychological consequences of pre-emigration trauma and post-migration stress in refugees and immigrants from Africa. Journal of Immigrant and Minority Health, 19(3), 523–532. https://doi.org/10.1007/s10903-016-0478-z

Steel, Z., Momartin, S., Silove, D., Coello, M., Aroche, J., & Tay, K. W. (2011). Two-year psychosocial and mental health outcomes for refugees subjected to restrictive or supportive immigration policies. Social Science & Medicine, 72(7), 1149–1156. https://doi.org/10.1016/j.socscimed.2011.02.007

Suen, L. W., Huang, H., & Lee, H. (2014). A comparison of convenience sampling and purposive sampling. Hu Li Za Zhi, 61(3), 105–111. https://doi.org/10.6224/JN.61.3.105

Tamale, S. (2014). Exploring the contours of African sexualities: Religion, law, and power. African Human Rights Law Journal, 14(1), 150–177. http://www.scielo.org.za/scielo.php?script=sci_abstract&pid=S1996-20962014000100011

Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042

Tongco, M. D. C. (2007). Purposive sampling as a tool for informant selection. Ethnobotany Research and Applications, 5, 147–158. https://ethnobotanyjournal.org/index.php/era/article/view/126

Ulanja, M. B., Lyons, C., Ketende, S., Stahlman, S., Diouf, D., Kouamé, A., & Liestman, B. (2019). The relationship between depression and sexual health service utilization among men who have sex with men (MSM) in Côte d’Ivoire, West Africa. BMC International Health and Human Rights, 19, Article 11. https://doi.org/10.1186/s12914-019-0186-6

United Nations General Assembly. (1951). Convention relating to the status of refugees. https://www.unhcr.org/3b66c2aa10

United Nations High Commissioner for Refugees (UNHCR). (2011, July). Resettlement handbook. https://www.refworld.org/cgi-bin/texis/vtx/rwmain?page=search&docid=4ecb973c2&skip=0&query=Resettlement

United Nations High Commissioner for Refugees (UNHCR). (2008, November 21). UNHCR guidance note on refugee claims relating to sexual orientation and gender identity. https://www.refworld.org/docid/48abd5660.html

United Nations High Commissioner for Refugees (UNHCR). (2012, October 23). Guidelines on international protection no. 9: Claims to refugee status based on sexual orientation and/or gender identity within the context of article 1A (2) of the 1951 Convention and/or its 1967 Protocol relating to the Status of Refugees. (HCR/GIP/12/01). https://www.refworld.org/docid/50348afc2.html

United Nations High Commissioner for Refugees (UNHCR). (2015, December). Protecting persons with diverse sexual orientations and gender identities: A global report on UNHCR’s efforts to protect lesbian, gay, bisexual, transgender, and intersex asylum-seekers and refugees. https://www.refworld.org/docid/566140454.html

Zomorodi, G. (2016). Responding to LGBT forced migration in East Africa. Forced Migration Review, 52, 91–93. https://www.fmreview.org/solutions/zomorodi

Published

2022-10-25

How to Cite

Misedah-Robinson, L., Schick, V., Ross, M. W., & Wambua, S. (2022). The Mental Health of Male Sexual Minority Asylum Seekers and Refugees in Nairobi, Kenya: A Qualitative Assessment. Refuge: Canada’s Journal on Refugees, 38(2), 1–21. https://doi.org/10.25071/1920-7336.40935