Strengthening HIV preventive services for transgender women and men who have sex with men in coastal Kenya

Men who have sex with men (MSM) and transgender women (TW), are at the highest risk for infection with the Human Immunodeficiency Virus (HIV). Globally, MSM and TW have higher prevalence of common mental disorders (CMD) including depression, anxiety and substance abuse. Finally, most of sub-Saharan Africa countries are rights constrained settings for both MSM and TW. The lack of legal recognition and protection for MSM and TW results in both internal and enacted stigma. Mental health challenges, stigma, lack of social protection and reduced access to healthcare services create a vicious cycle of increased risk for HIV infection. Pre-exposure prophylaxis (PrEP), could help prevent incident HIV infections in MSM and TW.
In the empirical chapters of this thesis the author present studies in this thesis address the challenges MSM and TW face in accessing PrEP. The studies demonstrate the PrEP provision cascade including PrEP knowledge, desire to take it up, adherence and retention in follow-up. Additionally, the author explores the prevalence of CMD in MSM and any association with HIV status.
In the discussion chapter, the author synthesises the findings from the studies against current literature. Finally, there are recommendations to improve HIV prevention for MSM and TW specifically in coastal Kenya. There are also recommendations addressing diagnosis and management of CMD in MSM. The author also gives suggestions for areas of further research especially in TW who are still underserved and underreached in sub-Saharan Africa.