Extreme Weather Events and Linkages with HIV Vulnerabilities Among Young Sex Workers and Sexually Diverse Men in Nairobi, Kenya: Qualitative Multi-method Insights.

Abstract

There is growing attention to the impacts of climate change and related extreme weather events (EWE) on HIV vulnerabilities, yet this research largely overlooks key populations such as sex workers and gay, bisexual, and other men who have sex with men (gbMSM). This is a critical knowledge gap in contexts that are greatly affected by climate change, EWE, and HIV, such as Kenya. To address this gap, this study examined the lived experiences of sex workers and gbMSM aged 18-24 in Nairobi, Kenya, regarding the relationships between climate change and EWE, resource insecurities (e.g., food, water), and HIV vulnerabilities. In 2023, we conducted a multi-method qualitative study in Nairobi, Kenya, including individual interviews using the SenseMaker web-based data collection tool and group digital storytelling workshops among 36 participants, including 21 sex workers and 15 gbMSM. Participant narratives aligned with the following themes highlighting the interconnections between EWE and HIV vulnerabilities: (1) EWE, specifically droughts and flooding, led directly and indirectly to resource scarcities and infrastructure damage; (2) participants enacted strategies to navigate resource scarcities, some of which increased HIV vulnerabilities (e.g., reduced condom agency, transactional sex engagement); (3) EWE and resource scarcities increased sexual violence risks; and (4) LGBTQ stigma exacerbated resource scarcities. Participants provided recommendations for multi-level strategies for HIV prevention, sexual health, and wellbeing for young sex workers and gbMSM in Kenya. Learning from young sex worker and gbMSM experiences can advance climate-informed HIV programming that addresses stigma, resource scarcities, and violence to advance sexual health and rights.