title: How intersectional constructions of sexuality, culture, and masculinity shape identities and sexual decision-making among men who have sex with men in coastal Kenya.
abstract: Men who have sex with men are increasingly recognised as one of the most vulnerable HIV risk groups in Kenya. Sex between men is highly stigmatised in Kenya, and efforts to provide sexual health services to men who have sex with men require a deeper understanding of their lived experiences; this includes how such men in Kenya construct their sexual identities and how these constructions affect sexual decision-making. Adult self-identified men who have sex with men (n = 26) in Malindi, Kenya, participated in individual interviews to examine sociocultural processes influencing sexual identity construction and decision-making. Four key themes were identified: (1) tensions between perceptions of 'homosexuality' versus being 'African', (2) gender-stereotyped beliefs about sexual positioning, (3) socioeconomic status and limitations to personal agency and (4) objectification and commodification of non-normative sexualities. Findings from this analysis emphasise the need to conceive of same-sex sexuality and HIV risk as context-dependent social phenomena. Multiple sociocultural axes were found to converge and shape sexual identity and sexual decision-making among this population. These axes and their interactive effects should be considered in the design of future interventions and other public health programmes for men who have sex with men in this region.
authors.affiliation: a School of Public Health , Brown University , Providence , RI , USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Midoun
authors.affiliation: a School of Public Health , Brown University , Providence , RI , USA.|c School of Public Health, College of Health Sciences , Moi University , Eldoret , Kenya.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Shangani
authors.affiliation: b Centre for Geographic Medicine Research-Coast , Kenya Medical Research Institute , Kilifi , Kenya.
authors.forename: Bibi
authors.initials: B
authors.lastname: Mbete
authors.affiliation: b Centre for Geographic Medicine Research-Coast , Kenya Medical Research Institute , Kilifi , Kenya.
authors.forename: Shadrack
authors.initials: S
authors.lastname: Babu
authors.affiliation: a School of Public Health , Brown University , Providence , RI , USA.|e Department of Women's, Gender, and Sexuality Studies , Emory University , Atlanta , GA , USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Hackman
authors.affiliation: b Centre for Geographic Medicine Research-Coast , Kenya Medical Research Institute , Kilifi , Kenya.
authors.forename: Elise M
authors.initials: EM
authors.lastname: van der Elst
authors.affiliation: b Centre for Geographic Medicine Research-Coast , Kenya Medical Research Institute , Kilifi , Kenya.|d Nuffield Department of Medicine , University of Oxford , Oxford , UK.
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.affiliation: d Nuffield Department of Medicine , University of Oxford , Oxford , UK.
authors.forename: Adrian D
authors.initials: AD
authors.lastname: Smith
authors.affiliation: a School of Public Health , Brown University , Providence , RI , USA.
authors.forename: Don
authors.initials: D
authors.lastname: Operario
mesh_terms: D000293:Adolescent; D000328:Adult; D001727:Bisexuality / Q000208:ethnology / Q000523:psychology*; D003469:Culture; D003657:Decision Making; D015658:HIV Infections; D018451:Homosexuality, Male / Q000208:ethnology / Q000523:psychology*; D006801:Humans; D007630:Kenya; D008297:Male; D057228:Masculinity; D008875:Middle Aged; D026684:Personal Autonomy; D036301:Qualitative Research; D012306:Risk; D012725:Sexual Behavior / Q000208:ethnology / Q000523:psychology*; D012923:Social Class; D013240:Stereotyping; D055815:Young Adult
keywords: HIV; Kenya; intersectionality; men who have sex with men; sexuality