“Heavy Drinking” and HIV Vulnerability Among African Male Sex Workers: Narratives from a Community-Based Participatory Study in Nairobi, Kenya

Abstract

With growing attention to the vulnerability of men who have sex with men in African contexts to HIV, public health scientists and others have begun to draw connections between alcohol use in this population and the transmission of HIV and other sexually transmitted infections. In this chapter, we consider the role of the global health discourse in shaping the meanings, experiences, and subjectivities of male sex workers in Kenya with respect to heavy drinking, referred to locally in Kiswahili as kulewa (getting drunk). Employing a community-based participatory research approach, we conducted in-depth interviews with male sex workers (n = 41) in Nairobi, Kenya. Our findings illuminate how drinking narratives are influenced by regionally based HIV interventions. Global health discourse, we contend, (1) constructs the sexual health of male sex workers as continually ‘in jeopardy’ while it (2) compels male sex workers to reflect on and enact ways to improve ‘community health.’ We describe how male sex workers rework reigning global health discourses that reduce problem drinking to ‘poor’ individual decision making. Instead, their narratives depict heavy drinking as tied to multiple overlapping oppressions faced by a wider community of male sex workers.