Integrating Mental Health into HIV Prevention and Care Continua Services and Systems for Young GBMSM in Kenya: A Community-Led Participatory Approach

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Project Summary Young gay and bisexual men and other men who have sex with men (Y-GBMSM) are at elevated risk for HIV in Kenya, and are a Key Population in the Kenya AIDS Strategic Framework II (2020/21-2024/25). Y-GBMSM experience multiple barriers to accessing quality HIV prevention and care services, and report high levels of discrimination and violence perpetrated by healthcare workers. Criminalization of same-sex behavior and negative societal attitudes toward LGBTQ people lead to persistent experiences of stigma and discrimination. Y-GBMSM in Kenya also report disproportionately high levels of mental health (MH) challenges, in part due to persistent discrimination and violence. Associations between mental health challenges and increased HIV risk behaviors and negative HIV health outcomes have been documented among Y-GBMSM in Kenya. Conversely, positive mental health factors are associated with improved HIV outcomes for this population regardless of their HIV status. Given the multi-faceted associations between MH challenges and HIV prevention and treatment outcomes among Y-GBMSM in Kenya, researchers have recommended the integration of MH and HIV services, as such integration improves patient and service delivery outcomes. In this R-21 application, we will utilize a participatory action research approach to: a) explore how mental health challenges negatively influence progression through both the HIV prevention and HIV care continua for Y-GBMSM in Kisumu, Kenya; b) develop a framework for integrating MH promotion with HIV prevention and care continua services for Y- GBMSM in Kisumu; and c) develop blueprints for mental health promotion program components that could be integrated into HIV prevention and care continua services for Y-GBMSM at four socio-ecological levels: individual, group, clinic/organization, and community. This proposed study will take advantage of analyzing data already collected as part of an ongoing study currently testing an HIV prevention/psychosocial PrEP support intervention for Y-GBMSM in Kisumu [R34-MH-118950-01:Harper,M-PI], and will collect primary data in the form of community charrettes, individual in-depth interviews, and focus group discussions with both Y- GBMSM and service providers. We have a multi-disciplinary Core Research Team of mental health and HIV experts from Kenya and the U.S. that have worked together in Kisumu for 5+ years, and we will have active engagement from Y-GBMSM through our Community Participatory Development Team and from service providers through our Service Providers Development Team. The study builds on Harper's 15+ years working with Y-GBMSM in Kenya. We anticipate that results from this study will have high impact by creating both a framework that can be used to explore advantages/disadvantages of different models of mental health and HIV service integration for Y-GBMSM, and blueprints for mental health promotion components that can be integrated into both HIV prevention and care services at four different socio-ecological levels. Such data will have implications for similar work in other sub-Saharan African settings, as well as inform domestic efforts.