LGBT and the Social Pitfalls of their Vulnerability to Covid-19

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When the body of the gay Ugandan refugee was found hanging on a tree outside the Nairobi offices of the United Nations refugee agency (UNHCR) on the morning of April 13, 2020, it was as shocking as it was unexpected.

The promising 25-year-old was a well-known member of the estimated more than 750 LGBT+ refugees in Kenya. Some of them were aware all was not well with him.

“He was upset,” Mbazira Moses, of the LGBT+ group Refugee Flag Kakuma who knew the deceased, told Reuters.

“His monthly financial assistance from UNHCR had stopped two months ago and he was depressed about the fact that he had not got resettlement.

“The coronavirus made things worse,” Moses explained. “He wasn’t able to move around and find work as transport costs have gone up, and there was no hope of immediate resettlement as there is a freeze on processing asylum applications … this depressed him.”

Health experts recognise that mental health issues such as increased stress have arisen as a direct result of the coronavirus disruption, compounding life’s pressures. It was regrettable the young man should take such a drastic and final action.

It is in the nature of things, however, that something came of the incident. It not only thrust the LGBT+ again in the public consciousness, but the refugees might have it a bit easier now.

In expressing deep concern in a statement, the UNHCR said it would do all it could to support refugees during the pandemic.

The abbreviation LGBT+ describes the community of those who identify as Lesbian, Gay, Bi-sexual and Transgender people. The plus sign denotes the inclusion of the Intersex and those who identify as Queer, among dozens other identities.

While there aren’t exact figures as to their numbers in Kenya, their geographical spread in the country is one of the surprising facets of the community.

Aside from the economic hardships in the country that many LGBT+ persons suffer from as many other people do, stigma and discrimination constitute some of the major risk factors, making the gay and transgender community among the most vulnerable to COVID – 19 pandemic.

A sense of their geographical spread, including factors making them vulnerable to Covid-19, may be gleaned from insights in the recently concluded project, Towards Universal Comprehensive Health (TOUCH) Plus.

Implemented between 2017 and 2019, the TOUCH-Plus Project sought to integrate HIV and sexual and reproductive health (SRH) services for men who have sex with men (MSM) and the lesbian, gay, bisexual and transgender persons in 27 public health facilities in four counties — Mombasa, Vihiga, Kakamega and Bungoma Counties.

Another of its objectives was to reduce harmful social outcomes, resulting from documented challenges including stigma and discrimination, violence and sexual abuse faced by the LGBT+ community, who also record some of the highest HIV prevalence rates.

At the close of the project, it had approximately 13,000 MSM and LGBT persons enrolled in HIV prevention cohorts in the public health services facilities where they received comprehensive services.

This was an unexpected number. As a health care provider from Vihiga County was quoted saying, “What actually surprised us is that we had MSM in our community, we thought these things belong to big cities like Mombasa, Nairobi and maybe Kisumu but not in Vihiga County. But when we went for the sensitization we realized that they were in the community.”

If one was to extrapolate, and this is only a guess, 13,000 LGBT+ persons in four “rural” counties suggests there could be a significant number in the other 43 counties combined.

Getting to grips with the numbers is important, as they give an idea of the scale of the problem to deal with, in addition to LGBT+ people being categorised as some of the most vulnerable populations to Covid-19 in Kenya and around the world.

Factors such as HIV make them vulnerable. According to the TOUCH-Plus Project, men who have sex with men (and other key populations including LGBT+ sex workers and drug users) contribute significantly to the HIV epidemic.

HIV prevalence among MSM is quite high in Kenya at an estimated average of 18.2 per cent compared with 5.6 per cent in the general population.

While the impact of COVID-19 on people living with HIV is currently unknown, research suggests that those with certain chronic medical conditions are at increased risk of serious illness associated with COVID-19.

People with HIV are more likely to possess these conditions which include older age, cardiovascular and chronic lung disease, and immune suppression.

In addition, despite the high number of HIV positive people in these key populations, gaps remain in reach, coverage and responsiveness of available services in efforts by government and other players to provide services to the MSM and the LGBT+ populations in Kenya.

This is not to discount the important government efforts. However, factors that consistently compromise LGBT+ persons’ wellbeing are rooted in our communities.

The project’s findings are pertinent as they reveal coincidences in multiple barriers that could hinder access and uptake of Covid-19 services. These barriers include social exclusion, stigma and discrimination.

Recent newspaper reports, for instance, show how “the government is grappling with how to put a lid on the stigma that is devastating the lives of those who have recovered from the virus, as well as their families.”

Stigmatisation poses a serious challenge. Some people have been choosing not to get tested for the virus, or have been hiding their illness rather than seek treatment because this could expose them to discrimination. There are no indications LGBT+ persons are among them, but it would not be surprising if they were.

So far there has not been any information of infection among LGBT+ persons; which is a good thing. Being infected would not help matters. Letting it out would probably amount to double tragedy because of the stigma and discrimination LGBT+ already live with.

Something remains to be said about age. Older LGBT+ people face unique challenges, which could be exacerbated by the virus.

First, for older LGBT+ people, there is a general absence of data, which means they are largely invisible in research and surveys.

Indications worldwide however show their rates of family rejection and isolation are higher than any other population within the LGBT+ community, which can be a strong traumatising force, potentially exacerbating discrimination and stigma.

Some studies show that they are twice as likely to be living alone, which means that older LGBT+ people are especially at risk to lack care or support from family.

LGBT+ youth, in the meantime, are more likely than their straight counterparts to experience homelessness or unstable housing, often due to family rejection. This puts them in the line of danger of Covid-19 infection.

All told, focus has been on buffering them and the other LGBT+ groups from the pandemic.

Various LGBT+ rights organisations have been offering advice tailored to the community, in addition to measures in the general population to social distance, wash hands, watch for symptoms and get tested.

LGBT+ people have been urged to safeguard their mental health. The gay Ugandan refugee’s mental health may have been affected for him to go to the extent of taking his own life. 

Aside from lack or lost source of income, experts acknowledge that social distancing and quarantining have the potential to negatively impact individuals’ mental health, especially among LGBTI people, LGBTI people who use drugs, and LGBTI sex workers who already experience marginalisation and ostracisation.

They have been urged to take the necessary steps to protect their mental health by reaching out to their friends and family, and lean on their local community through phone calls and SMS, social media and other platforms.

By the same token, they have been urged to “look out for your family and your community”. They are reminded that many lesbian, gay, bisexual, transgender and intersex people including LGBT+ people who use drugs and LGBT+ sex workers have limited access to shelter, food and other basic needs.

They are asked to lend a helping hand and find ways to be supportive. They are also reminded to keep an eye out for their elders and people with underlying conditions.

They have also been urged to adamantly fight stigma in all its forms with information and education. They are asked to draw from their many strengths and experiences as they fight this epidemic together with the world at large.

Lessons could also be drawn from the TOUCH-Plus Project, which might inform Corvid-19 strategies. Among the project’s lessons learned was that LGBT+ integration is feasible and acceptable in the communities it was implemented.

Buy-in and leadership of the integration by the county authorities is key in ensuring sustainable service delivery systems. This is in addition to meaningful involvement of LGBT+ communities, which is important as it ensures their voices are heard in determining the most appropriate service delivery model.

In addition to strengthening the policy environment, there is a need to undertake research on costs and effectiveness of the integration model to inform future strategies post-Covid-19.

Gitura Mwaura is a development journalist and writer.

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