Project 456164

Early mischaracterization of HPV as a women's health problem-referred to as the 'feminization of HPV'-largely ignored high risk for anal HPV-related infections and cancers among men who have sex with men (MSM), especially those living with HIV. Although high prevalence of HPV infections in MSM populations have been found in African countries like Kenya where HIV prevalence is high, their HPV-related prevention and treatment needs are largely omitted in public health policy and interventions. In response to this gap, a local community-based organization serving MSM in Nairobi known as Health Options for Young Men Against STIs (HOYMAS) set up HPV clinical services. Their attempts at early detection, treatment and prevention of anal disease, however, failed to mitigate this emerging health problem, with men continuing to present at HOYMAS' clinic at extremely late stages of anal disease. These late-stage diseases frequently appeared as severely advanced cases of anal warts and anal cancers-both of which are likely caused by anal HPV infections coupled with compromised immune systems from HIV co-infections. Such delays in seeking treatment have resulted in invasive surgeries, accompanied by long recoveries, tremendous pain and suffering. The overarching goal of our project is to understand and confront, through a community-based program science study, homophobia and the role it plays in the late presentation of HPV-related and other anal diseases among MSM in Nairobi, Kenya. Our three-year mixed methods study builds on and contributes to an internationally renowned Kenyan-Canadian collaboration that has been studying STBBI and closely collaborating with marginalized communities since the 1980s. Our community-based program science approach will ensure that the evidence produced in this project is owned, understood, and can be mobilized by HOYMAS health activists, thereby aspiring toward the broader vision of data justice.