Résumés
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.
Keywords:
- MSM asylum seekers,
- MSM refugees,
- mental health
Résumé
Peu d'informations existent sur le vécu des demandeurs d’asile et réfugiés qui sont des hommes ayant des relations sexuelles avec des hommes (). Par conséquent, cette étude explore la détresse psychologique des demandeurs d’asile et réfugiés dans la région métropolitaine de Nairobi. Nous avons procédé à la collecte de données en effectuant des entretiens approfondis dont les verbatims retranscrits ont été codés à l’aide de Plus 12, puis analysés suivant une analyse thématique en six étapes. Quatre thèmes principaux émergent de cette la détresse psychologique, les symptômes de stress post-traumatique, l’accès aux services de santé mentale et les stratégies d’adaptation. Bien que nous n’ayons utilisé aucun diagnostic, les résultats indiquent que les demandeurs d’asile et réfugiés partagent des problèmes de santé mentale avec d’autres réfugiés. Les ont cependant des besoins spécifiques qui découlent de leur persécution sur la base de leur appartenance à une minorité sexuelle. Ces résultats confirment ceux des travaux existants, comme le démontre la discussion, et appellent à davantage de recherches. Des recherches plus approfondies contribueront à l’élaboration d’interventions collaboratives, culturellement adaptées et ciblées afin de réduire les effets néfastes sur la santé mentale des demandeurs d’asile et réfugiés dans la région métropolitaine de Nairobi.
Parties annexes
Bibliography
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5) (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
- 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
- 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
- Im, H., Swan, L. E., Warsame, A. H., & Isse, M. M. (2022). Risk and protective factors for comorbidity of PTSD, depression, and anxiety among Somali refugees in Kenya. International Journal of Social Psychiatry, 68(1), 134–146. https://doi.org/10.1177/0020764020978685
- 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). (2015). 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
- United Nations High Commissioner for Refugees. (2008). https://www.refworld.org/cgi-bin/texis/vtx/rwmain?page=search&docid=4ecb973c2&skip=0&query=Resettlement
- United Nations High Commissioner for Refugees. (2012). 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. https://www.refworld.org/docid/50348afc2.html
- Zomorodi, G. (2016). Responding to LGBT forced migration in East Africa. Forced Migration Review, 52, 91–93. https://www.fmreview.org/solutions/zomorodi