Integrating Anogenital Health Care Into HIV Programs for Queer Men in Kenya: A Project Ethnography of Lateralizing Community-Led Health Service Delivery

Amid shifting political and funding landscapes for HIV prevention, how do we recognize the localized knowledges and skills accumulated at the grassroots, and which undergird community-led health service delivery for “key populations”? Lateralization advances an alternative implementation approach for a new generation of HIV programs that not only meets the global health policy direction of “integrative health” but also centres community insights that ground and move to democratize HIV prevention science. We argue that innovations in community-led HIV care can be leveraged towards addressing other health needs of populations who are often left behind due to criminalization and stigmatization. Gay, bisexual, and other men who have sex with men (“queer men”) have only recently begun to be included in human papillomavirus (HPV) screening and vaccination programs. However, in settings where queer men are criminalized, they continue to be left out of HPV interventions. In Nairobi, Kenya, queer men are presenting for care at extremely late stages of HPV-related anal diseases. In response, Health Options for Young Men Against STIs (HOYMAS), a community-led organization serving queer men including those who sell sex, lateralized lessons learned from their HIV program towards integrating comprehensive HPV care into their services. Beginning in 2022, HOYMAS, in collaboration with the Universities of Manitoba and Maryland and Partners for Health and Development in Africa, worked to: (1) strengthen anogenital health services in their community-run clinic through clinician assessment, treatment, and referral; (2) raise awareness on anogenital health through community discussion groups; (3) share knowledge and experiences with clinicians working in community-led organizations across the country; and (4) develop standard operating procedures and clinical reporting tools. Decades of investment in community-led infrastructure and “know-how” in responding to the HIV epidemic hold valuable lessons towards lateralizing community-led health services to address other health needs of criminalized and marginalized populations.