Participatory development and initial pilot run of the Shauriana program to integrate sexual health and mental health support for young gay and bisexual men and other men who have sex with men in Kenya

Abstract

Gay and bisexual men and other men who have sex with men (GBMSM) are at elevated risk for HIV, especially in rights-constrained settings such as Kenya, where stigma and discrimination have impeded access to HIV prevention. This article describes the development and pilot run of a theory-based and culturally relevant peer-led program called Shauriana (“we counsel each other”), which combines health education and integrated Next Step Counseling (iNSC) to promote sexual and mental health and well-being. Shauriana was developed using participatory methods in collaboration with GBMSM community members using the ADAPT-ITT framework and tested through an initial pilot run with 10 participants to refine and finalize program materials and procedures. The team monitored attendance and obtained participant feedback through quantitative evaluation and in-depth exit interviews that were thematically analyzed. The majority of participants (90%) attended all 4 core sessions and completed study visits on time. All participants completed an exit interview, providing feedback on program content and format, challenges/barriers, recommendations, impact, and recommending Shauriana to others. We identified key elements for positive engagement with the program, including being peer-led, maintaining privacy and confidentiality, using iNSC to provide guidance while maintaining autonomy, and taking a holistic approach by focusing on mental health and issues affecting GBMSM’s lives. We share modifications made in response to feedback and an overview of the final program sessions and structure. Pilot participants reported positive experiences engaging in Shauriana and shared that the program was highly relevant to their lives. Refined intervention procedures and materials are being tested in a subsequent randomized controlled trial. Lessons learned throughout the participatory development process and confirmed in exit interviews center on the importance of community engagement, local GBMSM leadership, and holistic, autonomy-supporting programming for young GBMSM in Kenya.