Sharing Research, Building Possibility: Reflecting on Research with Men Who Have Sex with Men in Kenya

Abstract

Sharing our research with participants and communities is a standard and critically important ethical practice in anthropology, but do we use such opportunities to their full potential? In this article, I reflect on the possibilities generated by a community dissemination event to share my research with men who have sex with men and engage in sex work in Kisumu, Kenya. Drawing on Arjun Apaddurai’s concept of an “ethics of possibility” that pushes beyond ordinary ethical practice, I reflect upon engagement with participants in the research process and advocate for greater emphasis on research dissemination events as a strategy to make research more meaningful to communities. Although my project was initially framed around HIV, what emerged were men’s desire for spirituality, belonging, and new possibilities of inclusive citizenship that better attend to men’s health and well-being. Research dissemination creates a critical space to generate ethnographic insight and guide theoretically rich applied health research.

On a beautiful Saturday morning in Kisumu, Kenya, more than fifty people gathered under the covered patio of a health services organization for a community dissemination event on our research with gay, bisexual, and other men who have sex with men (MSM). My two Kenyan Research Assistants and I carefully planned the event and invited all of our participants, key community stakeholders, and allies of queer communities¹ to provide feedback on our qualitative study with MSM who engage in sex work. Like many global health research projects in Kisumu, my work was funded under the auspices of HIV prevention and care. Specifically, we examined how substance use and violence interacted to shape HIV risk and engagement in care among men who sold sex to other men. The dissemination event was organized as a way to assess the validity of our analysis and elicit feedback. We wanted to ensure that we understood the unique issues that men face and identify service gaps to address their health needs.

While the event generated lively discussion, we scarcely mentioned the word “HIV” all morning, nor did we come away with focused ideas for tailored HIV services as our original grant application had promised. Strictly speaking from a global public health perspective, our efforts could be considered an abject failure. But from an anthropological perspective, I argue that critically important theoretical and applied insights emerged from creating a mutually constituted space to discuss important issues in men’s lives.

In this paper, I reflect on my ongoing ethnographic research with MSM in Kisumu and use our community dissemination event as a platform to pose broader questions about the potential for anthropological approaches to generate what Arjun Appadurai (2013) calls an “ethics of possibility.” My approach to such an ethical project is twofold: first, to turn the gaze within to reflect on our research practices, and second, to illustrate that research dissemination events are one such strategy to make research more meaningful to communities. Specifically, I am interested in how practices of dissemination can generate meaningful theoretical insights as “a tool for making a difference in people’s lives” (Harrison 2016:165).

By way of outlining the paper, I first provide background on the HIV epidemic in Kenya and how donor-driven priorities have shifted toward “key populations,” including MSM. I next consider the role of ethnographic data in informing a theoretical understanding of issues that matter to socially marginalized communities. To examine the potential for more radically collaborative courses of action beyond HIV agendas, I offer two examples of topics raised during our dissemination event: the “emotional and spiritual” dimensions of being a sexual minority and the meaning of “human rights” discourses in the local context. Although my project focused on MSM who engage in sex work who have specific health needs, the insights drawn here are applicable for applied anthropologists working in diverse contexts of global health.

The Making of HIV Epidemics in Kenya

Kenya has been at the center of an ongoing HIV epidemic across East Africa and remains a significant site of biomedical intervention driven by Western donors. In contrast to the early United States epidemic, which largely focused on MSM, the early African epidemic was framed almost exclusively around heterosexual transmission, which obscured other groups at risk. Much of this focus was driven by Western priorities, including the United States President’s Emergency Plan for AIDS Relief, better known as PEPFAR. Created by George W. Bush’s administration in 2003, PEPFAR is touted as a “compassionate effort to deliver lifesaving services in countries hardest hit by HIV/AIDS” and represents the largest commitment by any nation to address a single disease in history (PEPFAR n.d.). However, it has also promoted what Ida Susser (2009:49) has called “imperial moralities” that tied sexual relations to sin and morality while reinforcing gender and sexual subordination. Early prevention efforts promoted ABC approaches (abstinence, be faithful, use condoms) while restricting funding allocation to groups outside of normative heterosexual practices. This failure to provide comprehensive programming has been critiqued as a violation of human rights, as all individuals have a right to know about their bodies and risks (Susser 2009:49). Yet, funding commitments have remained strong, and in 2018, funding from PEPFAR totaled nearly $445 million to Kenya alone (PEPFAR n.d.).

In a new variant of imperial morality, PEPFAR, other global health organizations, and United States government grant funding initiatives have begun to prioritize HIV prevention and programming for so-called “key populations” across Africa, defined as MSM, sex workers, people who use drugs, transgender persons, and prisoners. PEPFAR’s key populations website used to feature a quotation from Archbishop Desmond Tutu: “HIV prevention, treatment, care, and support are a human rights priority…for vulnerable populations,” a point that responds to Susser’s critique and a key focus I return to later in the paper.² Kenya’s shift in HIV priorities reflects, in part, broader global health discourses and actions recognizing that “key populations” have been neglected in the epidemic and have a right to HIV services, even as their political rights and social needs often remain unfulfilled (Moyer and Igonya 2018).

Kisumu, Kenya, offers a rich case study of how broader HIV policies and discourses play out ethnographically and generate social change. Located on the shores of Lake Victoria in western Kenya, Kisumu was established as a port town and major railroad station in the early 20th century. Although its history is marked by periods of prosperity, political neglect and economic decline worsened in conditions of fiscal austerity in the 1980s. Structural adjustment and privatization devastated the health sector, creating shortages of medicines, crowded and crumbling health facilities, and overworked providers, which contributed to sub-optimal care. This was exacerbated by a devastating era of HIV/AIDS that has gripped this region to the present day and shaped its modern course of development. In contrast to the early days of the epidemic in which a colleague told me how the coffin business was booming in Kisumu, in 2004, PEPFAR and the Global Fund began to fund HIV care and services. The number of clinics have not only rapidly grown, but their ample supplies, superior equipment, and adequate support for services rendered HIV as a form of development in Kisumu that reflects how inequalities are both addressed and produced by donor priorities (Prince 2014a). Donor focus on HIV and the United Nations recognition of Kisumu as a “millennium” city in 2001 helped it transform into an “NGO economy” as a massive influx of global donors, NGOs, and foreign research entities have continuously poured into the region to address health and social issues (Prince 2014b). Kisumu has thus become a critical site of HIV knowledge production, including hosting seminal HIV clinical trials that have transformed global policy (Bailey et al. 2007).

In part driven by the constant and ever expanding influx of multinational government and contract workers, foreign researchers, students, development specialists, and others, Kisumu has witnessed a recent surge in foreign economic investment that is also altering the social landscape. The region is now experiencing the rapid development of roads and infrastructure, shopping malls, restaurants, and multi-story housing developments alongside an unchecked expansion of informal settlements that circle the city (Geissler 2013). With a population of over 400,000, it represents one of the fastest growing cities in East Africa. However, prosperity is not evenly distributed, and entrenched social inequalities, poverty, and poor health outcomes are exacerbated by its persistent HIV epidemic. Despite sustained, focused attention to the HIV epidemic, Kisumu County continues to have the third highest HIV prevalence in Kenya, reaching an astounding 16.3 percent in the general population compared to a national prevalence of 4.9 percent (NASCOP 2018).

Since 2013, I have conducted ethnographic fieldwork on HIV prevention and care among “key populations” in Kisumu, during which time the focus on these groups has intensified. I have thus witnessed the on-the-ground effects of broader pushes for HIV services for groups who until recently have been shrouded in denial and secrecy. While my applied work has generated practical knowledge to address health concerns (Syvertsen et al. 2015),³ just as importantly long-term ethnographic fieldwork opens the door to engage with communities and critique the social changes that biomedical interventions and policies produce, which often get lost in the daily urgency of global health work.

Where is the Ethnographic in the Theory?

In his reflection on long-term fieldwork in Brazil, Joao Biehl (2013:575) writes about his interest in “how ethnographic realities find their way into theoretical work.” Not only do we need to pay attention to what unfolds on the ground but how we interpret the folds. He asks: “…what if we broadened our sense of what counts as theoretical and methodological innovation and left aside, even if for a moment, the need for central discursive engines—the modus operandi that shaped much of anthropology in the twentieth century?” (Biehl 2013:575). In other words, why not look beyond the canon of predominantly European male philosophers who have shaped our field in favor of more seriously considering how the complexities of the people’s lives with whom we work can generate new theoretical insights? A key strength of an anthropological approach is embracing new forms of knowledge outside of boundaries already drawn. However, all too often this does not seem to apply to social theory in which disciplinary proscriptions keep us tethered to elitist influences.

Raewyn Connell (2014), whose definition of theory as “a way of seeing and speaking beyond the given” is brilliantly simple, has written extensively about the need to incorporate multiple voices into projects of the social sciences. Connell’s (2014:539) work on gender and masculinity argues that “transforming” and “revolutionizing” unequal gender relations “absolutely requires postcolonial, decolonial, Southern theory…to create spaces of theoretical discussion with many more voices and wider and deeper agendas” beyond traditional social science.

Faye Harrison (2016) has similarly called for the “democratization and decolonization of epistemic space” to facilitate greater participant inclusion in theoretical discussions. She notes that some progress has been made:

More than in the past, anthropologists’ theorizing practices involve more diverse conversations. Some of those participating in these conversations would not traditionally be expected to make theory. Rather, they would more likely be viewed as sources of raw data that more privileged northerners mine and cook into refined forms of explanation.

(Harrison 2016:162)

Even if anthropologists are making some progress, those of us working in global health settings know that power relations remain asymmetrical and research is too often an extractive process without genuine, sustained collaboration (Crane 2010). In this context, it takes rethinking what it means to practice a “critically applied medical anthropology,” including its key proposition to radically reclaim health research as “a tool for human liberation” (Scheper-Hughes 1990:194). In relation to conducting research on sensitive, criminalized, and stigmatized issues in Kenya, this has meant reflecting on my own complicity in global health agendas driven by Western donor and grant funding priorities, including HIV.⁴ Can research ever be “liberation” if directed from the outside? Although some scholars argue that such reflexivity in anthropology is a passing trend, I follow Allen and Jobson (2016:136) in contending that “the reflexive project was not capacious enough” but rather “requires an openness not simply to questions of identity and positionality vis-à-vis research sites and subjects but to a political economy of knowledge production….”

My focus herein lies in decolonizing anthropological knowledge production within contexts of applied global health research. At the center of an ethical anthropological practice should be the very individuals who help generate new forms of knowledge in the first place so that more communityoriented research agendas, theoretical interpretations, and forms of dissemination are advanced throughout the research process. To do so, I draw on Arjun Appadurai’s (2013:295) call for an “ethics of possibility” as a framework to think about how we conduct ethical research and what this means for the communities with whom we work. Beyond an ethics of the ordinary, an “ethics of possibility” refers to the “ways of thinking, feeling, and acting that increase the horizons of hope, that expand the field of imagination…and that widen the field of informed, creative, and critical citizenship” (Appadurai 2013:299). Specifically, Appadurai (2013:299) calls on anthropologists to be “mediators, facilitators, and promoters of the ethics of possibility.” This conception of ethics challenges anthropologists to practice anti-oppressive forms of research (Strega and Brown 2015). While this can take many forms, my reflection centers on how a dissemination event can serve as a platform to generate ethnographicallyinformed theoretical insights into the social effects of global health initiatives.

MSM Experiences in Kenya

Although I did not originally set out to work with MSM, I followed the data: based on themes that arose in my initial studies, I obtained funding to conduct a qualitative study of how substance use and experiences of violence shape HIV risk and engagement in care among female sex workers. When women began telling us about their increased competition for clients from men selling sex in Kisumu, we decided to speak with some of these men.

While we do not have any hard data to substantiate women’s claims, nevertheless piecing together epidemiologic evidence suggests that MSM sex workers are an important group to consider from a public health perspective. A recent MSM cohort study in Kisumu found a 10.5 percent HIV prevalence (Kunzweiler et al. 2017b), while studies of male sex workers from Nairobi have estimated HIV prevalence among this group to be 26.3 percent (Muraguri et al. 2015) and as high as 40.0 percent (McKinnon et al. 2014). Work with MSM and female sex workers in coastal Kenya also documented high levels of rape and physical and emotional violence, and selling sex was associated with a higher incidence of all forms of violence (Micheni et al. 2015).

The practice of sex work, which is prevalent and tolerated even if technically illegal in Kenya, heightens vulnerability to HIV, sexually transmitted infections, and other health and social harms (Shannon et al. 2018). Sex work is all the more stigmatized and risky in the context of same-sex relations (Baral et al. 2015; Okal et al. 2009; Padilla et al. 2008). Men not only have to contend with sex work but bigger issues around tolerance of same sex behaviors. I found that in explaining the new direction of my study, some people in the community found it shocking that men sold sex to other men and not women. Until relatively recently, this has been a blind spot in global health work as well.

Visibility and understanding of sexual minority health across Kenya is unfolding as a dynamic process. Scholars have noted that over the past decade or so, queer populations across diverse African contexts have become increasingly visible and active in society even as same sex behaviors continue to be criminalized and homophobia persists. Sokari Ekine (2013) has pointed out two common and interrelated myths that dominate and confuse discussions about African queerness. One myth is that any forms of queerness—sexual identity, expression, or any experience outside of hegemonic heterosexual norms—are Western and thus “un-African.” A related discourse revolves around an African “obsessive homophobia” that universalizes a Western metanarrative of non-heterosexual experience (Ekine 2013).

Building on these ideas, I suggest another increasingly common stereotype in light of donor-driven pushes to target key populations: that African queerness is a site of HIV risk and infection requiring Western “intervention.” Indeed, Ekine questions the motivations of international interventionists. Drawing on Massad’s concept of the “Gay International,” Ekine notes the proliferation of “‘LGBT,’ white, Northernbased NGOs and activists with an almost obsessive interest in searching for homophobia across the global South” (Ekine 2013:85). Although it is unclear if the Gay International always have Africans’ best interest at heart, or if they wish to justify their own involvement in a foreign space, such intervention has raised awareness and drawn attention to queer health. Yet, as Ekine and other scholars point out, “queerness in Africa” needs to be understood in context-specific and local terms.

Kenya represents one fluid and contradictory space for MSM that is much more complex than blanket discourses of homophobia. Kenya adopted a new constitution in 2010 that proponents say enshrined protections for all citizens, while critics note that specific language around sexual minority rights is purposively absent (Macharia 2013). At the same time, the colonial-era Kenya penal code continues to prohibit “unnatural offenses” of same sex behaviors that carry prison terms of five to fourteen years. Cultural and religious tensions and homophobia also represent challenges for sexual minorities, who often fear violence, discrimination, and shaming if they disclose their sexuality. In Kisumu, there is a proliferation of MSM organizations working toward health and social justice issues, yet a recent media report of youth being “recruited into homosexuality” triggered community backlash (Mbenywe 2018). Although this newspaper article caused a prominent MSM health services organization in Kisumu to temporarily close and relocate for safety concerns, it also sparked new forms of activism and a broader conversation about sexual rights.

Within this dynamic social context, HIV research and programming efforts have intensified to reach MSM in Kenya. I recall that during my first trip to Kisumu, I attended the launch of a new study and toured the clinic of the first organization in the region devoted to MSM health where a Dr. Seuss quotation adorned one of the walls: “Be who you are and say what you feel. Because those who mind don’t matter and those who matter don’t mind.” Over the past several years, Kisumu has become an increasingly significant site of research and health programming activities for MSM, and there is a growing network of scholars collaborating on projects (Harper et al. 2015; Kunzweiler et al. 2017a; Kunzweiler et al. 2017b; Okall et al. 2013). This visibility has created changes in the health care system while also shifting the sociopolitical landscape and demanding social attention to previously taboo health topics.

Research and Dissemination Activities

For the current study, my research team and I began building contacts with MSM health services organizations, where we held informal discussions to present our research ideas and garner feedback. We also worked with peer educators, or MSM who were members of the sex work communities, to refer potential participants for the study. We asked enrolled men to refer their peers to the study in a process of snowball sampling that helps reach deeper into men’s social networks, including individuals who are not linked to services. We also conducted participant observation during field outreach in places where sex work occurs, community meetings about key populations, and other activities at MSM health organizations, which I have informally continued to do since.

In total, we interviewed twenty-eight MSM sex workers about topics including their early life experiences, social relationships, sexuality, how they became involved in sex work, patterns of substance use, experiences of violence, and use of and perceived needs for HIV prevention and care services. Although their life experiences were often difficult, I found the men generally eager to participate, and more so than the women with whom we worked, they often asked questions about the purpose of our study and to what it might lead. As with my previous research, I organized to return the following summer and hold a dissemination event to share our study results with the community as a way to respect their right to access their own data and to help us better understand their experiences.

We arranged to hold the dissemination event at Anza Mapema (“start early” in Swahili), an MSM health clinic and research center that is friendly and well-known to queer communities. We personally invited all twenty-eight participants as well as key stakeholders and allies from other organizations supporting queer health in the community. We held the event on a Saturday so as not to interfere with work schedules and catered it with snacks of mandazi (delicious Kenyan donuts) and tea.

Our presentation included plentiful photographs, rainbow colors, and interactive discussion prompts. But more importantly, rather than a traditional didactic summary of our results, we used an experimental format: after reviewing the background and objectives of our study, we posed our results as a series of questions that were meant to spark participation and debate.⁵ Specifically, we posed six questions from our research (e.g., “why do men engage in sex work in Kisumu?”), one question per slide. With a click, text then appeared of what we identified as the primary themes from our data to answer the question, and a final click offered a de-identified quotation or two to illustrate the themes. We presented the questions and our preliminary analyses one at a time and opened up the floor to discussion and debate, creating an ongoing dialogue throughout the event.

I was not anticipating the results. The discussion organically veered away from the study’s explicit framing around HIV and into a broader conversation grappling with the biblical history of same sex practices, the meaning and universality of human rights, Kenyan legal protections, and the process of community acceptance of non-heteronormative sexual expression. Sometimes, we are too caught up in the ethnographic moment to realize that we are in the midst of making future possibilities. But upon further reflection, this kind of forum represents an ideal space in which to test the confines of Western-driven HIV research priorities and stereotypes about a singular, intolerant, homophobic Africa.

Our approach to the event was admittedly imperfect, and the boundaries can be pushed further, but it represents an initial participatory effort toward fostering new possibilities for MSM research in Kenya. The event generated lively debate and engagement, and, as I argue in the remainder of this paper, it provided ethnographically-grounded theoretical insight towards an “ethics of possibility.” In creating a collaborative experience, the event became a productive space to rethink the ethical imperatives of research and men’s lived experience in relation to broader political and global health ideals.

To begin, I offer a brief sketch of the men in our study to situate the research and segue into two examples of topics discussed in the dissemination event.

The Life of “Moses”

Our sample was young (median age: 25; range: 19–41) and self-reported HIV prevalence reached 29 percent (n=8; two men did not disclose their status).⁶ The men’s experiences were complex and shaped by the broader sociocultural environment, which is illustrated through the story of “Moses,” a composite character and pseudonym that protects participant confidentiality. The themes in Moses’s story were commonly raised and foreshadow key issues that animated our dissemination event.

Moses is in his early 20s and self-identifies as gay after many years of struggling with his sexuality. He grew up poor in a village on the outskirts of Kisumu, where he completed his schooling and was often teased for being different. From an early age, he felt attracted to other boys, but for years he ignored it because his strict Christian upbringing instilled strong expectations to get married and bear children. After his father abandoned the family and his mother passed away from HIV, Moses left for Kisumu to earn money to help support his younger siblings. However, the economy was unstable and like many other young men, he turned to cheap local alcohol to cope with his stress. One day at a local bar, an older man named Salim approached him with the extraordinary opportunity to go back to his hotel room and earn money. Moses was confused: he needed money but this proposition also stirred up sexual feelings that he had long buried. He took the risk and went with Salim.

Moses’s first sexual experience with a man was transactional in nature, but it also provided an opportunity to explore his sexuality. Moses started to regularly engage in sex work, which alternately provided exciting new experiences and placed him at physical risk for HIV and violence as well as social risk of discrimination and humiliation. In the course of his work, sometimes Moses was not paid and beaten up by clients, some of whom also refused to use condoms. The ongoing stress and having to hide his work often exacerbated his drinking and depression. He has also been harassed, called names, and threatened by community members who now suspect he is gay. He dares not report his experiences to the police, whom he fears.

Moses has not been able to talk to many people about his sexuality or the risks involved in sex work. When his sister suspected and confronted him, she grew angry and told him that God would send him to hell for his lifestyle, and he has not been able to attend their home church ever since. But how could he be destined for hell, he wondered? He has tried his entire life to not feel attracted to men, but he has come to the conclusion that he was born that way.

One day he met Peter, a peer educator for a local NGO that was recently funded to provide HIV testing and support services for MSM. Peter was fully public about his sexuality and had ambitions to expand the NGO beyond HIV to “empower” MSM and hold events to “sensitize” the community. At first, Moses was terrified to attend a group meeting, but when he arrived, he found other men like him, some of whom also engaged in sex work. Some men were even married and had children. At the NGO, Moses found a supportive staff, free health care, and numerous social activities to attend, like movies and even a church service for MSM. Although Moses has not come out to all of his family and friends, he has found a safe space where he is gradually learning to become “empowered” in his life. He hopes that the community will also accept him for who he is and that the new promises for “human rights” in the constitution that he keeps hearing about will somehow change not only his life but society more broadly.

This sketch of Moses illustrates that although our study was about HIV, it is clear that men’s lives include but transcend this concern in ways that were further explored in our dissemination event below.

An “Emotional and Spiritual” Experience

Globally, men have diverse reasons for engaging in sex work (Baral et al. 2015; Lorway, Reza-Paul, and Pasha 2009). To get at this complexity at our event, we posed the following question: “why do men enter into sex work in Kisumu?” We identified several key themes in our data, which we summarized as economic and material needs at a basic subsistence level and as a process of self-discovery of one’s sexuality. For men in the latter category, being propositioned or introduced to sex work helped many men recognize their desire; men often described situations in which not only were they able to express themselves sexually, they found a way to earn a living. We presented two quotations to represent these different experiences:

…[A friend] asked me why I was toiling with the fish business yet there was a well-paying job…. He told me that it was about being gay. At first I dismissed it, but later because of poverty, I agreed.

…[A] certain boy seduced me…the way he was behaving meant that he wanted me. I accepted his advances and he said that he would pay me. I accepted…. That is how I realized my orientation. Immediately I got the money and I felt like doing it again and again.

We selected these quotations for their complex configurations of sexual subjectivity, behavior, and desire that typified men’s stories. Immediately, a participant in the audience volunteered that the man represented by the first quotation “is not really gay, he’s someone just doing it for money.” The economic situation in Kisumu is indeed dire for a majority of the population, and poverty and lack of viable opportunities push individuals into the informal economy. None of the participants denied that some men, and maybe even an increasing number of men, sell sex in Kisumu for purely economic reasons. Unfortunately, there are no data on the numbers of MSM sex workers in Kisumu, nor a breakdown of their motivations for engaging in such work. In our qualitative study at least, a minority of men were driven by purely financial motives, but we did not want to ignore the outliers in our discussion. The majority of participants self-identified as gay and practiced sex work for complex reasons shaped not only by financial reasons but by desire, pleasure, and emerging sexual subjectivities, reflecting the complex experiences of MSM sex workers globally (Lorway, Reza-Paul, and Pasha 2009).

The first quotation about “being gay” as a “well-paying job” also reflects local understandings that some men are “recruited” into becoming “gay.”⁷ In a place like Kisumu where individuals are grappling with increased visibility around same sex identities, behaviors, and new forms of sexual subjectivity, emerging categories of “gay” and “MSM” are often conflated or reimagined in ways that produce new forms of sociality (Lorway and Khan 2014). Indeed, a flashpoint in our event came when one man stood up and said that what many people outside of queer communities fail to understand are the critical “emotional and spiritual” dimensions of what it means to be gay.

Spirituality was a particularly salient theme throughout our discussion and interviews, even though we never directly asked about it. In interviews, when we asked the men about their sexual orientation, several invoked God and spirituality as part of their very being:

God brought me to this world. He wouldn’t have done so if at all he didn’t want me to come to this world. He brought me here and I found myself with that sexual orientation. I was born like this. Even if people don’t like me, God loves me. Jesus did not discriminate against anyone.

I am comfortable because I know I am not abnormal, I am just a normal human being and God created me this way and God loves me the way I am.

I cannot reject God’s plan for me.

Like many African countries, religion plays an important role in social and political life in Kenya (Chitando and Van Klinken 2016; Van Klinken 2015). In western Kenya, forms of charismatic Christianity are prevalent, and based on my observations, it is not uncommon to start meetings and government events with a prayer. Church-based worship is an important spiritual and social event for much of the population. Given its significance, why would religious practice and spirituality be outside of MSM, sex worker, or queer experiences more broadly?

Ellen Lewin (2018:26) has argued that scholars have largely ignored the spiritual needs of queer communities, but that groups who have been marginalized from mainstream religious movements share a “yearning for spiritual wholeness and rectitude.” While Lewin’s work focuses on radically inclusive Pentecostal groups in the United States who embrace those who have been socially rejected, including queer communities, such movements also have global momentum and speak to broader issues of social justice and tolerance.

Scholarship focusing on spirituality as a way to contest homophobia in African contexts is a very new but promising area of research (Chitando and Van Klinken 2016). In his work with gay men in Zambia, Adriaane van Klinken confronts the “surprise” and “contradiction” that many Western scholars have suggested about the links between spirituality and same sex behaviors. He identifies the need for work “challenging the emerging (but contested) body of queer studies in Africa to take religion seriously, not only as a tool of homophobia and a force of oppression…but also as key to agency and empowerment” (van Klinken 2015:948). Van Klinken and Phiri (2015), in separate studies, found potently similar themes in their research with gay communities in Zambia in which men frequently evoked their connection with God not only as a strategic tool to resist conceptions that their sexuality was a lifestyle choice, but “based on a deeply religious sense of the self: a sense that they, like other human beings, have been created by God, and in the image of God” (van Klinken and Phiri 2015:46). The authors suggest that a powerful grassroots African queer theology “is possible and timely—but only if it takes cognizance of the social, cultural and political specificities and sensitivities in African contexts, and gives an epistemological privilege to queer communities living in these contexts” (van Klinken and Phiri 2015:45).

The voices from our dissemination event in Kenya contribute to this emerging conversation to demonstrate the possibilities for new, inclusive visions of a future that recognizes and supports the role of spirituality in men’s lives. These ideas speak to global religious movements whose visions include the broadest understandings of Christianity possible (Lewin 2018). Reclaiming spirituality is critical to men’s emotional well-being. MSM sought safe spaces to cultivate their spirituality (including church services specifically for MSM offered by an NGO), but spiritual wellness in this context transcends religious settings to bigger ideas about accepting themselves for who they are and feeling a sense of belonging.

Research framed around an “ethics of possibility” gives men the “epistemological privilege” to define their own humanity and connection to God’s love. The dissemination event enabled such a conversation to happen in a safe space as a step toward broader change. If we succumb to dominant narratives about religious intolerance and incompatibility, Western scholars become ethically culpable in the “destruction and devaluation of intellectual, spiritual, and cultural resources” (Strega and Brown 2015:6) through erasing and re-interpreting experiences in ways that pathologize queer communities. Spirituality is central to the rights, freedoms, and inclusive citizenship that MSM desire, as explored below.

Human Rights

A second example from our event opens up questions about to what extent, if any, Western, donor-driven narratives reflect the on-the-ground experiences of MSM in Kisumu. After discussing several other topics relating to sex work and substance use (reserved for another analysis), the final question in our forum posed an explicitly applied inquiry: “what kind of support is needed for MSM who engage in sex work in Kisumu?” Based on our data, men gave standard answers about health services and economic support, and some suggested broader efforts such as drama and radio programming to disseminate information and available resources. But more striking was how the majority of men organically mentioned the need for community “sensitization” and “empowerment” to understand the multiple, interconnected issues at stake for MSM and queer communities in Kisumu. We offered the following quotation in our presentation as an example of this sentiment:

…[T]he general public should be empowered and they should be sensitized to know that we have people in society who are different from them. But it is not like they are sinning, they are there and they were made like that. The general public should know that when you meet a gay person you should not lambast him or do mob justice. God made him like that.

Not only does this quotation reinforce the inseparability of spirituality and gay experience as detailed in the prior section, it opened up discussion about values in Kenyan society more generally and how everyone fits into its broader social fabric, or what some queer activist groups have described as a shared “Kenyanness” (National Gay and Lesbian Human Rights Commission n.d.). The group discussed how some sectors of Kenyan society were beginning to acknowledge queer experiences, yet “culture” and “religion” continued to complicate ideas around sexual tolerance, and there was still a lot of “sensitizing” to be done. In particular, participants looked to Kenya’s new constitution for guidance. As described earlier, this version of the constitution is celebrated by many Kenyans for whom it invokes a broad citizenship, including what many view as increased protection of “human rights” for all Kenyans.

On the surface, the logic of human rights appears as a given. But looking “beyond the given” (Connell 2014), the concept of human rights becomes deceptively tricky terrain, particularly in application to sexual equality across African contexts. The concept has its origins in the political philosophy of liberalism, which is based on individual notions of sovereignty that reject medieval ideas about community and society under ultimate divine authority (Cobbah 1987). As a codified concept, human rights were introduced to the world in a United Nations universal declaration in 1948. Although the idea has been embraced as revolutionary, scholars have also pointed out that the concept was declared in Europe by a cabal of Western dignitaries, even as much of the continent of Africa remained colonized by European powers (Cobbah 1987). Thus, as a largely Western construct, and one that could be perceived as hypocritical at that, scholars have worried that homophobic and otherwise intolerant constituents could reject human rights approaches as Western and “un-African,” thus backfiring in protecting MSM and other queer communities.

Several examples illustrate potential quandaries surrounding human rights approaches. Even well-intentioned initiatives tying international aid provision to human rights can appear imperialist (Ekine 2013) and part of a longer history of donor-driven “imperial moralities” (Susser 2009). Although concepts of rights, dignity, and justice clearly existed across African contexts prior to colonialism, this is largely lost in human rights debates in which these notions have been co-opted as “new” European ideas. However, human rights discourses can alienate activists from broader communities who associate rights-based discourses as demands for special rights above heterosexual communities, thus reinforcing cultural arguments that queerness is alien in Africa (Dearham 2013). This framing can also exacerbate tensions among different social movements in which groups vie for rights and recognition. MSM and other queer Africans are not just queer; they have multiple struggles and stigmas to overcome that would be better served by aligning with other social justice movements rather than pursuing separate causes (Ekine 2013). All of this is not to say that we should necessarily abandon human rights language entirely or that is not a valuable step in the right direction, but such ideas need to be analyzed in terms of their meaning, interpretation, and strategic deployment on the ground.

Although “human rights” has seeped into the local vocabulary in Kisumu, and I have heard it with increasing frequency even since the dissemination event, simply adopting this framework at face value is an incomplete version of what is currently transpiring. Speaking to some of the concerns raised by scholars above, the participants at our event explicitly stated they did not want special treatment or to be considered any different from other Kenyans. As one participant rhetorically asked the group: “why do we need to be special?”

Kaitlin Dearham (2013:192–193), who worked with a queer women’s movement in Nairobi, similarly found “the perception that queer Kenyans want to be ‘special’ or ‘different’ from other Kenyans serves to reinforce the cultural argument that queerness is alien and has no place in African communities.” However, she goes on to note that even though the women did not necessarily relate to the concept of “human rights,” they often invoked this concept because international donors understood it (Dearham 2013).

We found a similar occurrence in Kisumu, where men strategically adopted this kind of language, including notions of desiring their full “rights.”⁸ Like in the dissemination event, men invoked rights-based language in their interviews to signal their desire for fair and equal treatment:

We also need our rights to be recognized, at least the community should be addressed that sex workers are also human beings…. It is only that the way people get money is what differs here, so we wish if there could be a campaign or focus about healthy society, healthy community.

The police harass the MSM seriously, they think we don’t know our rights, advocacy should be done to them, and they should be told that these people are human beings. The [sex work] clients should also be informed and do the right thing at the right time.

Even if men’s deployment of rights-based language was a strategic response to global health programming, the importance of their ultimate goal remains the same: in everyday life, men wanted their “right” to act as Kenyan citizens, not as members of a sexual minority group marked by difference. These conversations reject what Joan Ablon (2002:S4) has called “master stigmas,” or the social and health conditions that are used to “define a person, discounting his or her other more relevant-to-the-context characteristics.”

In this sense, men were not just “MSM” or “HIV-positive,” they wanted a version of life often taken for granted by heteronormative communities. They were “made that way” by God just like anyone else and thus did not deserve judgement, harassment, and intolerance from the broader community for being themselves. They deserve constitutional recognition and “rights” but warrant no special privilege. This is not just about the individual; it is a collective endeavor. This fundamental shared “Kenyanness” calls for rethinking conceptions of rights and citizenship more broadly.

Toward New Possibilities of Citizenship?

In critically reflecting on fieldwork, interviews, and conversation at the dissemination event, I want to circle back to Appaduari’s idea of a “critical citizenship” and the kinds of possibilities it can unlock. There is a burgeoning anthropological literature on citizenship, which includes classic notions of the relations between an individual and the state but also extends well beyond that to invoke an embodied sense of belonging (Lazar 2013). Innovative ways to think through citizenship necessitates active and meaningful participation of those who have traditionally been marginalized from these social processes (Appadurai 2013). As a project, rethinking citizenship has critically important implications for anthropological work in global health settings.

The discussion from our event offers an important opportunity to juxtapose an abstract, universal ideal of citizenship that is called upon in Kenya’s constitution relative to the actual lived experiences of MSM. Constitutional protections and promises of human rights in Kenya are important but remain incomplete without greater involvement of groups who have been marginalized. Without acknowledging the importance of spirituality and attendant conceptions of “radical inclusivity” (Lewin 2018), citizenship projects do not go far enough. As a result, men like Moses and others like him will continue to risk stigma, discrimination, and social death if they open up about their sexuality, even as some social ideas are changing.

As anthropologists, our work should facilitate conversations that center men’s ethnographic realities in theoretical debates. However, much of the extant citizenship literature bearing relevance to MSM who engage in sex work and are at high risk of HIV can be found at the intersection of sexual subjectivity and biopower. Sexual citizenship literatures theorize exclusion and belonging through the lens of heteronormative sexuality and sexual practice (Richardson 2017). Medical anthropology scholarship has largely drawn on Foucault’s notions of biopower to inform theoretical conceptions of citizenship in relation to health as a tool of discipline and control; in this context, shared health conditions become the basis for making citizenship claims while generating new subjectivities and social relations (Biehl 2004; Nguyen 2010; Petryna 2013; Rose and Novas 2005). Across diverse contexts, individuals perform citizenship to gain access to material resources and sociopolitical forms of capital while subversively resisting neolcolonialist global health and development programming.

However, the enthusiastic discussion during our event outright veered away from a focus on HIV, suggesting that men want to move beyond narrow, imposed categories to reclaim a broader vision of possibility. This reflects the view of other anthropologists working in East Africa who have found that biological categories of citizenship based on health conditions “did not quite work” in this context, as these concepts fail to address the “vitality” of lives beyond biology (Marsland and Prince 2012:454). Furthermore, as Susan Reynolds Whyte (2009:13) has cautioned, “Focusing narrowly on relations among people with the same health condition excludes all the other relations and domains of sociality that actually fill most of their daily lives.”

Perhaps it is unsurprising that men refused to be confined to a donor-prioritized illness and largely avoided the topic. It may be that HIV remains deeply political and stigmatized, and thus, people prefer to avoid discussing it. However, HIV programming is also a ubiquitous part of life in Kisumu. The men picked up global health buzz words (e.g., rights-based language) from the myriad donor-funded programs in Kisumu, but they also pushed beyond this to evoke their “rights” in relation to the same God that all Christian Kenyans revere.

Similar projects are happening elsewhere, including Mimi Sheller’s (2012) work on a “citizenship from below” that reconciles political personhood with gendered, sexualized, and racialized dimensions of experience among queer populations in the Caribbean. Particularly insightful and applicable to the Kenyan context is her assertion that “it is necessary and urgent to encompass religion and spirituality in any discussions of freedom and citizenship…only with such expansive understandings of the spiritual realm are we equipped to address citizenship from below” (Sheller 2012:46). This aligns with van Klinken’s (2018) recent claim that grassroots artistic expression and queer activism hold radical potential to counter homophobia and hate in Kenya. He senses that Kenya is on the brink of a “citizenship that is yet to come, that is, a pan-African, Christian and queer citizenship of love…[that] feeds into a political commitment to diversity, inclusion, solidarity and justice in society…rooted in God’s radical love which puts any form of hatred and injustice in society under critique” (van Klinken 2018:662–663).

The seeds of a radical citizenship were already being sown before our event, but community dissemination facilitated a safe space to further transform the process. As our event made clear, the further engagement of MSM, other queer Kenyan communities, and diverse allies are vital for a grassroots conceptualization of an inclusive citizenship that is ethnographically grounded in local struggles while in dialogue with other global communities. Over the past several years, I have been heartened by the proliferation of queer-friendly organizations in Kisumu and how these groups are employing creative strategies like art, drama, and community debates to move toward a more inclusive society. As illustrated in the sketch of Moses, the radical figures emerging locally as proudly out peer educators and leaders of organizations have begun to make a difference in the lives of MSM who might otherwise remain isolated. However, I am equally worried about how funding opportunities and support is often tied to pre-determined priorities, like HIV, that can constrain the creativity of such groups. As one director of an organization told me, his group was only interested in future research collaborations if it worked to “change the narrative” from donor-driven priorities to enabling men to write their own stories.

The juxtaposition between broader discourses and men’s ongoing experiences of marginalization and struggle for acceptance speaks to the disjuncture between universalist human rights claims and ethnographic realities. There is certainly hope and progress toward community tolerance in Kisumu, but it will remain on uneven ground if queer communities do not own the process. A different kind of citizenship is becoming, but it is not up to the anthropologist and observer to create this. A more productive role is to facilitate ongoing grassroots efforts toward the possibilities for a radically inclusive citizenship yet to come.

Closing Reflections

This paper has considered decolonizing anthropological knowledge production within contexts of applied global health research. Specifically, there is underappreciated value in engaging with communities to share our study results. Beyond standard ethical practice, Appadurai’s (2013) concept of an “ethics of possibility” is a useful framework to reflect on our research practices and turn a critical lens to our ethical practice. This concept also challenges us to undertake collaborative research processes, including constructing dissemination events as mutually constituted spaces for open dialogue and new possibilities.

Appadurai (2013:300) is clear that our ethical commitments “must begin at home: our institutions, disciplines, and our methods.” Although there are clarion calls for anti-oppressive approaches (Strega and Brown 2015), research remains typically resigned to the realm of elite Western institutions and has been critiqued in global health as extractive. There is no natural reason for these inequalities to exist. Achieving a “critical citizenship” requires the capacity of individuals everywhere to make inquiries into the critical topics that shape their lives (Appadurai 2013:270). There is also no reason that critical social theory needs to remain an elitist endeavor. The communities with whom we work are quite capable of engaging in meaningful conversations that lend interpretive power to their lived experience.

Our research and dissemination event with MSM who engage in sex work went beyond the project’s initial framing around HIV and toward a more complicated understanding of what is meaningful to the men themselves. HIV is a concern to the men with whom we worked but clearly not the only one. Rather, very different priorities emerged around men’s desire for spirituality, belonging, and inclusion that supersede individual sexual orientation or HIV status. The men joined a growing chorus of global voices calling for radical forms of inclusion, or the ability to “be who you are and say what you feel.” This is not the path I expected to take in my work in Kenya, and it has required a fundamental reconsideration of what it means to practice a critically applied medical anthropology and how to subvert global health priorities to better align with local concerns. But therein lies the beauty and power of ethnography: its endless possibilities for becoming.