The last few years in Kenya have been quite interesting in matters sexuality. Historical evidence shows that homosexuality was practised in Greece, Rome and some ancient Celtic communities as early as 300AD. Same sex relations existed in society until the christianity era came in and the emperors passed decrees that condemned homosexuality, making it a crime punishable by death. Currently, approximately nineteen countries in the world have legalised homosexuality, thirteen of which are in Europe.
As early as the early eighties, the coastal region of Kenya was beginning to experience a new culture of homosexuality. The practice was viewed with great suspicion and contempt. It was seen as a rebellion by a cohort of young men who thrived on controversy to gain attention. Those who openly practised homosexuality were commonly in the prostitution industry. This perspective drastically changed after the diagnosis of the first case of HIV/AIDS in Kenya in 1984. The deceased is described as a homosexual commercial sex worker from Mombasa who succumbed to the 'slimming disease' as it was then described. His body was transferred to KEMRI headquarters wrapped up in plastic and handled as highly contagious. Suddenly the gay community had no peace and many withdrew from the public.
Fast forward to fifteen years later and the gay scene in Kenya and especially Nairobi, had undergone a transformation. Homosexuality almost became a fad with several gay clubs sprouting around the city and young men spotting what was viewed as a feminine look. Currently human rights groups are speaking up for this group as they struggle to be officially recognised as the Lesbian, Gay, Bi-sexual and Transgender (LGBT) community. The result has been a rise up in arms by the religious groups, politicians and a section of the community at large, condemning them.
Away from the media circus, we seek to address a poorly understood section, the transgender lot. This group encompasses persons who may have been born with ambiguous physical features that make it impossible to assign them a gender. It also covers those who have a clear physical designation of gender but feel that this designation is inaccurate. Whatever drives them is not within our capacity to discuss. What however cannot be wished away is the fact that this is an area of unique medical importance that cannot be disregarded and requires well thought out guidelines and legislation.
Sexual ambiguity is overall commonest in Africa but special attention is given to the south-east region of brazil. These infants are commonly assigned a female gender at birth. At puberty, it is recommended that they undergo surgery to take on a full female morphology. It is critical that as they grow, they are fully socialised as female to ensure that they adjust well in society. Research has shown that they generally tend to be well adjusted despite the fact that they will never be able to bear children.
In the case of individuals who desire to alter their gender, it is worth noting that it is a long tedious journey with heavy physical and psychological investment. The individual has to deal with the effect of hormones modifying their body and the attendant side effects, ranging from headaches, vomiting, constipation, mood swings, migraines, among others. The psychological impact is perhaps the most taxing. Loss of friends, family, identity and self esteem to name but a few. Open hostility and even outright violence marks their existence. One must re-learn routine activities such as using the ladies instead of gents in public and sitting in the toilet instead of standing at a urinal. One must adjust to wardrobe change and of course the years of agony when the voice box just won't produce the appropriate timbre of voice. The inner battle is probably consenting to permanent life-altering surgery to change the genitalia. The fact that there is no going back is a weighty matter that cannot just be brushed aside. These individuals may look tough as nails but deep inside they are fighting their own demons.
All world over, there are few countries that have legislatively approved gender reassignment surgery for individuals who opt for it with no medical indication. These include Sweden, Iran, Denmak and Hongkong. This however has not stopped individuals in countries that prohibit the surgery from having it. They will do what it takes to have the surgery done away from home. For instance, Thailand does not permit the surgery but one can have it done in Hong Kong and come back home. The government permits them to change their legal documents and names, including birth certificate.
Closer to home, Kenyan doctors have successfully performed gender reassignment surgery for medical reasons. It is a procedure fraught with anxiety for both the patient and the medical team, from psychiatrists, gynaecologists and urologists. The possibility that one could wake up from surgery with lifelong inability to control urinary function is real. The on-going court battles by our very own Audrey, formerly Andrew, is a clear indication that we as a country cannot bury our heads in the sand about the matter. She seeks to have her surgery done at Kenyatta National Hospital by our own specialists. This alone is the most powerful statement made to the judicial system and to the Medical Practitioners and Dentists' Board.
Our constitution does not expressly prohibit render reassignment surgery but clearly prohibits homosexuality. This law proves difficult to enforce as the same constitution strongly supports freedom of expression in the bill of rights. The medical practitioners and dentists' board is tasked with the hefty responsibility of coming up with regulation of this highly controversial matter. Whatever happens, this is not an easy process and will require input from all relevant stakeholders. The discussion around this topic must be sober.
As we engage in high profile media battles, it is worth noting that in a few years, our reality is set to change. Parents are likely to contend with their grown children introducing their same-sex partners and asking for their blessing in the union. More dramatically is that, asking a potential sexual partner what their genetic designation is prior to dating them, will be the norm rather than the exception!
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