Confronted by growing evidence that sex between men is a significant driver of new HIV infections, the Kenyan government has shed a longtime refusal to acknowledge the existence of homosexuality and will launch a survey of gay attitudes and behaviors in its three biggest cities next year.
The project is considered a landmark because the government and the vast majority of Kenyan people have long refused to address homosexuality in the fight against AIDS. Sex between men is illegal in Kenya punishable by up to 14 years in prison and is seen by many as a Western-imported, morally wrong behavior that is limited to areas visited by tourists.
But officials say the country is in the middle of a full-blown HIV/AIDS epidemic, with about 7% of the population now infected and only 15% of those people even aware that they are HIV positive. While the vast majority of HIV transmissions are through heterosexual sex or intravenous drug use, research conducted in 2007 suggests that the spread of the disease through gay sex is far more common than skeptics believe. Fifteen percent of all new HIV infections each year are thought to be among men who have sex with men. And because some men who engage in gay sex are married and do not identify themselves as gay, it is seen as one way in which the virus crosses from "at-risk" categories to the general population.
"It will be a tricky issue that is likely to polarize everybody," Dr. Nicholas Muraguri, director of the National AIDS/STI Control Program, tells TIME. "But what we are saying is that we cannot as a country socially exclude these groups and hope that we will win the war against HIV at the same time."
Initial media reports said the project, which was announced last week, would be a gay census raising fears that gays could be exposed against their will and also questions about whether such a count could possibly be accurate. But Muraguri says all information collected by the government will be kept confidential and officials will not seek to contact all men who have sex with men in Kenya. The government will also seek to interview both male and female sex workers and intravenous-drug users.
While Kenyan attitudes toward homosexuality are considered more liberal than the rest of sub-Saharan Africa outside South Africa, gays say they still face overwhelming hostility in the country. The law banning sex between men is a holdover from colonial times but won't be repealed soon; one member of parliament, asked if a draft constitution in the works would enshrine gay rights, said recently that doing so would destroy the document's chances of passing.
Anti-gay attitudes have been on full display in recent weeks as the Kenyan media have breathlessly reported on the civil ceremony of two Kenyan men in Britain. They were dubbed a shame to Kenya, their parents were harassed and The Nation newspaper's website has been inundated with comments, most of them condemnatory.
Because of the stigma they face, gays rarely seek information about the dangers of having unprotected sex. One commonly held myth in Kenya is that HIV cannot be contracted via anal sex, when in fact that is one of the easiest ways to get it. Gays have trouble receiving treatment at hospitals, particularly if they show symptoms of sexually transmitted diseases that might lead doctors to suspect they had engaged in sex with other men.
"Some of us have gone to a public-health facility and if the doctor realizes we are gay, they will draw attention to us, even from the reception, calling people, 'Come and see a gay person, come and see a gay person,' " says Peter Njane, director of the Ishtar MSM gay-health-rights group in Nairobi. Muraguri's NASCOP group, which will lead the survey with funding from the U.S. President's Emergency Plan for AIDS Relief, says those beliefs must not be allowed to impede the country's efforts to fight HIV.
The researchers will ask a series of behavioral questions to men who have sex with men starting next year in Nairobi, the western city of Kisumu and the coastal city of Mombasa. They will also try to estimate the number of men who are HIV-positive or have sexually transmitted diseases. Such a widespread survey has never been attempted in Kenya before. In a 2004 study in Nairobi, 500 men who have sex with other men were interviewed about their health practices, and in Mombasa in 2006 and 2008, 400 male prostitutes were questioned as part of two different sex surveys.
"What we've primarily been slowed by is just not having the clear sense of where those populations are centered in the country and where socially and otherwise we can most effectively reach them," Warren Buckingham, Kenya coordinator for the U.S. President's Emergency Plan for AIDS Relief, tells TIME.
Much of the gay community has largely decided to abandon the fight for gay rights for now because the hostility they face is too intense. But they hope that initiatives such as the NASCOP research will help reshape Kenyan opinions about AIDS. "As a country and as an African culture, we live in full denial of the existence of homosexuality," says James Kamau, national coordinator of the Kenya Treatment Access Movement, which aims to increase the availability of all essential medicines to Kenyans. "Because of the cultural background, we shut our eyes, our minds and everything, yet it is happening every single day."