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Advocacy actors play a unique role in promoting changes in policy, legal, and social environments for sexual and gender minorities in sub-Saharan Africa (SSA). However, their efforts may be hampered by limited incorporation of evidence because there is a massive gulf between what researchers focus on and what evidence users need. Together with fifty key stakeholders across SSA, we—a team of researchers and policy engagement specialists—co-created a research agenda and identified policy goals and research priorities to support evidence-informed policy and advocacy that can foster social inclusion of sexual and gender minorities in the region. We identified six research priority areas: (1) The history of lesbian, gay, bisexual and trans people and people whose identities do not conform to typical binary notions of male and female, or identify themselves using other categories to describe sexuality (LGBT+) in Africa and their lived realities; (2) Cost of non-inclusion and benefits of inclusion; (3) Strategies fostering inclusion; (4) Challenges and needs of LGBT + people; and (5) Implementation science on the effectiveness of provisions in sexual and reproductive health and HIV strategies or guidelines; and (6) Understanding the existing policy and legal architecture. This co-created research agenda can guide the generation of policy-relevant evidence, increase collaboration between researchers and policy actors, and increase research uptake to support efforts toward inclusion. [ABSTRACT FROM AUTHOR]

Methadone, as part of Medically Assisted Therapy (MAT) for treatment of opioid dependence and supporting HIV prevention and treatment, has been recently introduced in Kenya. Few low income settings have implemented methadone, so there is little evidence to guide ongoing scale-up across the region. We specifically consider the role of community level access barriers and support. To inform ongoing MAT implementation we implemented a qualitative study to understand access barriers and enablers at a community level. We conducted 30 semi-structured interviews with people who use drugs accessing MAT, supplemented by interviews with 2 stakeholders, linked to participant observation in a community drop in center within one urban area in Kenya. We used thematic analysis. We developed five themes to express experiences of factors enabling and disabling MAT access and how community support can address these: 1) time, travel and economic hardship; 2) managing methadone and contingencies of life, 3) peer support among MAT clients as treatment ambassadors, 4) family relations, and 5)outreach project contributions. Crosscutting themes address managing socioeconomic constraints and gender inequities. People who use drugs experience and manage socio-economic constraints and gender inequities in accessing MAT with the support of local communities. We discuss how these access barriers could be addressed through strengthening the participation of networks of people who use drugs in drug treatment and supporting community projects working with people who use drugs. We also explore potential for how socio-economic constraints could be managed within an integrated health and social care response. [ABSTRACT FROM AUTHOR]

The availability of free antiretroviral treatment in public health facilities since 2004 has contributed to the increasing biomedicalization of AIDS care in Kenya. This has been accompanied by a reduction of funding for community-based care and support organizations since the 2008 global economic crisis and a consequent donor divestment from HIV projects in Africa. This paper explores the ways that HIV interventions, including support groups, home-based care and antiretroviral treatments have shaped expectations regarding relations of care in the low-income area of Kibera in Nairobi, Kenya, over the last decade. Findings are based on 20 months of ethnographic research conducted in Nairobi between January 2011 and August 2013. By focusing on three eras of HIV treatment – pre-treatment, treatment scale-up, and post-crisis – the authors illustrate how family and community-based care have changed with shifts in funding. Many support groups that previously provided HIV care in Kibera, where the state is largely absent and family networks are thin, have been forced to cut services. Large-scale HIV treatment programmes may allow the urban poor in Nairobi to survive, but they are unlikely to thrive. Many care needs continue to go unmet in the age of treatment, and many economically marginal people who had found work in care-oriented community-based organizations now find themselves jobless or engaged in work not related to HIV. [ABSTRACT FROM AUTHOR]