Respectful and dignified care for LGBTQI+ people and youth in Kenya

Making health care more inclusive isn’t just the right thing to do—it saves lives.

A man making a heart symbol with his hands in Kenya.

Kenya 2023 © Nora Nussbaumer

No one should be denied access to medical and mental health care simply because of who they are or who they love. But in many of the places Doctors Without Borders/Médecins Sans Frontières (MSF) works, LGBTQI+ people are criminalized, discriminated against, and denied access to health care—even by health care providers.

These barriers can have serious consequences for the health of LGBTQI+ people, leading to increased rates of contracting and dying from treatable diseases. That’s why MSF is working to break down barriers to medical care through LGBTQI+ inclusion initiatives around the world. Making care more inclusive isn’t just the right thing to do—it saves lives. 

A group of MSF staff look over a town near Mombasa, Kenya.
MSF staff and a peer outside a church where outreach activities take place. Kenya 2023 © Nora Nussbaumer

Barriers to health care access for LGBTQI+ people and youth 

In November 2023, the photographer Nora Nussbaumer spent a week with an MSF project in Mombasa, Kenya that provides medical assistance to adolescents and youth, with a focus on vulnerable groups also known as key populations, or “key pops.”

When the MSF team in Mombasa discovered significant gaps in health care for adolescents and young people, they decided to do something about it. 

The aim was to launch a peer-led project that would help young people who are marginalized or excluded from health care get the advice and care they need. 

An MSF assessment conducted in May 2021 revealed that many adolescents and youth, aged 10 to 24 years old, had specific medical needs and were struggling to get basic health care. Several young people our teams met had experienced teenage pregnancies, unsafe abortions, and sexual and gender-based violence, yet they had not received appropriate counseling or treatment. 

“People with unique health needs often face challenges accessing appropriate health services,” said Marcos Tamariz, MSF project coordinator in Mombasa.

Portrait of a participant in MSF's "key pops" project in Kenya.
A former participant, now peer, in the inner courtyard of PEMA, a safe space for the LGBTQI+ community. Kenya 2023 © Nora Nussbaumer

What is a “key population”?

UNAIDS first defined key populations as groups of people at increased risk of HIV irrespective of the local context. In Kenya, however, other factors play a role, including socioeconomic status. 

“Key pops” include sex workers, people who use drugs, men who have sex with men, and LGBTQI+ people, including transgender and gender non-binary people. Members of these communities are not only at increased risk of contracting HIV, but also of being targeted with violence based on who they are. 

I mostly interact with young mothers who live on the streets. The youth-friendly center makes them feel comfortable, especially because the services are confidential.

KHADIJA, PEER EDUCATOR

The Mombasa project reaches other vulnerable groups such as children living on the streets and people with disabilities. People from these groups often experience a greater prevalence of health risks and mental health issues, while enduring marginalization and systemic discrimination in their own community. 

Together with the Mombasa County Department of Health and several community-based organizations, MSF launched the “key pops” project in 2021. It included opening Adolescent and Youth Friendly Services and conducting regular outreach activities to breach barriers to health. 

The aim was to launch a peer-led project that would help young people—including young key populations—who are marginalized or excluded from health care get the advice and care they need. 

Portrait of a man in a hat in Kenya.
Portrait of a woman in a leather jacket in Kenya.
Portrait of a man with glasses in Kenya.

Project participants and peers from the community. Kenya 2023 © Nora Nussbaumer

Safe spaces for care without bias or judgement 

“It is one thing to offer specific health care services, but quite another to convince people who live in fear of being stigmatized to go there,” said Agripina Toni, MSF health promotion manager in Mombasa. 

That’s why, in partnership with local associations, MSF has set up "safe spaces" where peers from the community lead health promotion activities and link patients to public health services. 

Safe spaces can be temporary or permanent meeting places identified by peers to reach target groups. These spaces have been set up in a variety of places including a local church, football club, theater hall, hotel backyard, a bar’s backroom, and the inner courtyard of a children’s home. All are considered safe places where young people don’t need to worry about seeking care, including confidential sessions and follow-up. 

A peer talks to a group of teenagers about sex education at a church for outreach activities in Kenya.
A peer talks to a group of teenagers about sex education at a church for outreach activities. Kenya 2023 © Nora Nussbaumer

Building understanding for inclusive care

In June 2023, MSF and the Mombasa Department of Health launched a study aiming to better understand the health and well-being of young people between 10 and 24 years old. The information collected is intended to improve available services and help design better and more effective health programs adapted to their needs.

Peers outside a designated safe space offering support for sex workers in Kenya.
Peers outside a designated safe space offering support for sex workers. Kenya 2023 © Nora Nussbaumer