Misanet.com / PlusNews, 1 December - "Some clients would infect your behind with sexually transmitted diseases and you would suffer silently because how do you explain to the doctor how you got the infection?" This recent disclosure to a leading Kenyan confessional magazine by a former male sex worker illustrates the double stigma suffered by men who have sex with other men.
After seven years of turning tricks for a mostly expatriate clientele - during which he suffered intermittent bouts of sexually transmitted infections - Patrick Mutisya is now HIV positive. Because of his status, he has lost the regular job he took after witnessing the slow and painful AIDS deaths of some of his "professional colleagues" in the sex industry.
HIV/AIDS activism in Kenya has been growing in recent years, with more and more people coming out to declare their HIV status and to demand access to antiretrovirals and the right to employment. But, it is rare for men who have sex with men to come out of the closet while also coming clean about their HIV status.
They suffer in silence because talking - even to health professionals - about sex between men, let alone indulging in it, is widely considered to be taboo in Kenya. Society in general shuns same sex intercourse as un-African. The church views it as the height of immorality, and the state pretends that it does not exist because the constitution is silent on the issue.
And it is still not an issue that the government is willing or able to tackle, judging by the deafening silence about this high risk group in literature and official activities planned by Kenya's National Aids Control Council (NACC) to mark World AIDS Day on 1 December.
This is despite the fact that in line with UNAIDS' two-year campaign to focus on the role of men in the AIDS epidemic, the NACC is focusing on encouraging behaviour change in men. This is because, for a variety of social, cultural, economic and physiological reasons, it is men - both heterosexual and homosexual - who who drive the epidemic.
UNAIDS estimates that sex between men accounts for the transmission of at least 5-10 percent of HIV/AIDS cases and although most sex between men is hidden, surveys show that up to a sixth of all men report having had sex with another man.
A report by the London-based Panos Institute entitled 'AIDS and Men: Taking Risks, Taking Responsibility' says widespread hostility and discrimination prevents many men who have had sex with men from admitting that they are at risk.
UNAIDS recommends that governments, particularly those in denial about the incidence of male sex or those who refuse to back interventions for such men, should stop criminalising and stigmatising the practice. Instead they should create awareness about the dangers of man-to-man sex, train health personnel to be more sensitive to the needs of this group, and include a category for men who have sex with other men when collecting epidemiological data.
According Dr Sam Kalibali, a medical associate at the Nairobi-based East and Southern Africa Regional Office of the Population Council, the first step towards including men who have sex with men in HIV/AIDS interventions is to get facts and figures about them.
- If we do not have facts, if we do not have information, we cannot sensitise even the governments, Kalibali told PlusNews. "Just talking without scientific data is like knocking our heads against a brick wall."
With a view to filling this gap, the Population Council has recently initiated a programme to profile Kenya's gay community, a task Kalibali admits will be difficult considering the clandestine nature of sex between men. "We know that in other countries where such studies have been done, the subjects have been sceptical because in many African countries the activity is considered illegal and the men are afraid to give information that may end up in the hands of the police," he noted.
However, Kalibali said a similar study done by the Population Council in Senegal last year yielded fruit. Researchers went to gay bars and sought out men who have sex with men and won their confidence to the point where they participated in the design, implementation and data analysis of the research.
He said the Kenya project was still at the advocacy stage and it would take the efforts of both the media and scientists to bring to the attention of the public, and policy makers, the special needs of men who have sex with other men - including male victims of male rape and prisoners.
Kalibali said using the same methodology as the Senegal study, initial contacts had already been made with individuals from the gay community in Kenya, who expressed concern about HIV/AIDS and would like to access voluntary counselling and testing. However, he declined to give a timeline for the project.
- We need them to develop confidence in us before we can begin a study. They are a very sensitive and difficult group to work with, he said. "If we rush, we lose out so we go by their pace."
- We want to reach the level where we can put a similar report to that of Senegal on the table of Kenyan officials and say: 'Okay. These are are the facts. What can be done about it?', he added.
The official silence and lack of reliable data on male sex is particularly dangerous in Kenya, as in other African countries where the stigma of being gay is so great and a high premium is traditionally placed on marriage and having children.
A good number of men who have sex with men tend, like Mutisya, to marry and lead a "normal" family life while still engaging in sex with other men for money or love. Now, as he tries to come to terms with his status, Mutisya says his greatest fear and regret is that he may have infected his wife and 11-month-old baby boy with the virus.
- I am advising everyone to take care. Those who are married and still practice homosexuality should stop for a moment and think about their families, if not themselves. I regret what I have put myself and my family through but it is too late now. I can only hope others can learn from my mistakes, Mutisya is quoted in the magazine as saying.