Written by Dalziel Leone, social justice advocate in Kenya
The following is a fictional example of what trans people in Kenya often face when presenting at a clinic for HIV testing:
“Are you a man or a woman?” the nurse asked him as she scanned him from head to toe.
Kaya is a transman who was recently a victim of violence and presents at a clinic for HIV testing.
“I am here for HIV testing,” Kaya replied with no regards to the question. The nurse kept talking to other nurses about how Kaya is a woman pretending to be a man and pointing out to him that he attracted the violence he experienced. This is a common experience for trans people when they seek health care services.
Although transgender individuals are recognized as key populations in other parts of the world, this is not the case in Kenya. As a researcher who studies trans issues and a member of the transgender community in Kenya, I add my voice to those advocating for greater recognition of transgender people in Kenya, especially for services designed to meet their unique needs.
Compared to other key populations (sex workers, people who inject drugs, and gay men and other men who have sex with men), I feel the transgender community is a forgotten population in HIV programming. In Kenya, other key populations have exclusive spaces where their holistic needs are integrated into HIV programming. Transgender people are sometimes asked to use these spaces, (i.e., clinics that offer HIV services to other key populations), but the damage this might cause to a transgender individual is not taken into consideration. Despite being at high risk of HIV infection, trans people tend to shy away from these exclusive spaces because their gender is not affirmed, and their needs are often left unmet.
Trans people have unique health service needs, including gender-affirming services, psychosocial support, and hormone replacement therapy. Also, many trans people consider transitioning to be more important than all other needs and most will do anything to get this need met.
Creating exclusive spaces where HIV services are offered in conjunction with gender-affirming services will likely increase the uptake of HIV testing and treatment among trans people.
Hormone replacement therapy is often taken for a lifetime, which makes it costly over time. Offering (free or low-cost) hormone replacement therapy in exclusive spaces will attract trans people because their holistic needs will be met in addition to HIV testing and treatment. Hormone replacement therapy also requires frequent visits to a medical center to monitor how the hormones interact with their body. If these medical check-ups were offered at trans-exclusive centers, trans people could also receive HIV services during their regular visits; this is especially important considering that medical transitioning requires one to be healthy and aware of one’s HIV status, and closely monitored if they are HIV positive. An exclusive space would also feel much safer for trans people because they won’t face discrimination and stigma or need to educate medical providers about what it means to be transgender. It is important for health care providers who work with trans people to create spaces that offer services to meet the holistic needs of trans individuals instead of trying to blend them into existing, unfit spaces that don’t meet their needs.
About this key population hero: Dalziel Leone is a young, avid, and exploratory social justice activist and blogger from Kenya who happens to be a trans man. He is committed to improving transgender lives in Africa. He is a former Open Society Foundation Fellow where he worked with Iranti-Org and Fahamu Network for Social Justice focusing on trans and gender nonconforming individuals across Africa. He has worked with FHI 360 under the LINKAGES project as a research assistant, focusing on transgender health research and with Pathfinder International, focusing on sexual reproductive health among students.