EP33 LGBTI Health, Queer Migration and Refugees with Michael B. Clark

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I AM GPH EP33 LGBTI Health, Queer Migration and Refugees with Michael B. Clark

EP33 LGBTI Health, Queer Migration and Refugees with Michael B. Clark

Alexandra Arriaga: Hello and welcome back to I AM GPH. My name is Alexandra Arriaga and today, we're going to chat with Michael Clark. Michael is a current NYU student. He is completing his Master's in Public Health and he defines himself as an international advocate and researcher on health and stigma. He is a Fulbright scholar, which led him to Kenya where he researched HIV, sex work, LGBTI health, queer migration, and refugees. Hi Michael, how are you doing today?

Michael Clark: I'm good. How are you?

Alexandra Arriaga: I'm great. Thank you so much for joining us today. I'm very excited to have you here.

Michael Clark: Thank you.

Alexandra Arriaga: Can you please tell us a little bit about yourself?

Michael Clark: I am an older student. I just recently did my undergraduate, and I originally was in the military in 1991 through 2000 and I was a combat medic, which kind of really turned me off to being a military combat medic. But I was still very interested in health. And so at that point I was like, “Well, what else can I do for health?” And that's when I ended up becoming a personal trainer and fitness coach, which I did quite successfully for about 10 years. But I kind of got burnt out on helping rich people live better lives. And that's when I just kind of reevaluated what it was that I wanted, that would bring me happiness. And that's when I outlined I wanted to do public health. At that point, I was like, okay, if I get a Master's of Public Health, I need to actually get my undergraduate first, which I had never completed. And so I went back to school. I went to CUNY and was in school there and just recently graduated with a Bachelor's of Science in Health and Human Rights, and that's what led me to going into this.

Alexandra Arriaga: So while you were on your undergrad, you did a really great fellowship, correct?

Michael Clark: Yeah. Well, I did a study abroad. In my junior year, I went to Uganda and Rwanda. I picked a program specifically so that I could work in refugee camps. It was through the school, the international training, SIT, which does amazing study abroad programs. But the really great part about it is that they do this independent study project, and it's kind of a month where you just go off on your own and you do your own research. And my research, I knew going into it, what I wanted to do my research on and it was refugees based on their sexual orientation or gender identity. So people that have been displaced from their home country because they were LGBTI. And there is actually quite a bit of them in Uganda. And so for a month, I lived in a refugee camp and did interviews with about 40 different LGBTI and kind of talking about how they left. Some people were telling me that they got chased out of their village with machetes from the villagers, or their family kicked them out, or all sorts of different reasons. And they come from Central African Republic, Rwanda, The Democratic Republic of Congo, Burundi, and they all kind of converged in these refugee camps in Uganda, and some also in Kampala too. So there's a little bit of a difference between a refugee that lives in a camp and a refugee that lives in an urban environment. But I did interview both, and it was just really interesting. My main question was, what are the main barriers to accessing healthcare for them. And it came out being really that it was stigma, whether it was stigma that they perceived themselves, that they weren't good enough, or they were concerned about what other people would say if you didn't present as male when you were born as a male. So if you are transgender or something like that, they had a lot of stigma. And there were people who were even HIV positive who were scared to go to clinics to get their medication, or the doctors would tell them, “I don't have medication for you.” I mean story after story after story was like this. A lot of them have to rely on doing sex work. You combine sex work in addition to not getting HIV meds or not getting HIV prevention, then you have a real public health crisis for everyone. For multiple reasons, it's a problem for their community, but it becomes a real problem for a lot of people because of that.

Alexandra Arriaga: And it's a health risk in the community.

Michael Clark: Yeah, completely. And it's interesting too because traditionally refugee communities have a lower risk of HIV than their surrounding communities. In a way, it's protective. Being displaced is protective for HIV for a lot of reasons. There's a lot of research that shows that, but I don't think that's necessarily the case for LGBTI refugees. And so that's kind of been a continuing question that I've been exploring, is displacement a risk factor for LGBTI? And it seems for a lot of reasons, it can be. Maybe not just HIV, but maybe there's a lot of other things that you have a higher risk for. And that's what I've been continuing to explore.

Alexandra Arriaga: And as an American citizen, what drew you to go abroad as opposed to just doing something here at home?

Michael Clark: So I'm Native American. My family was displaced early in the century and I know that that affected my grandfather. My grandfather was the one who was displaced, and I know that that displacement really affected my father. In turn, that also affected me. I don't know, it was just really interesting how this trauma of displacement was a generational thing. That combined with hearing Uganda being in the news so much in 2014 about this Kill the Gays Bill was really kind of what interested me in the situation. I think I read this one news story when I was looking at study abroad programs about refugees that are in Beirut. In Beirut, the refugees live around the city and so a lot of times they would go into the town and these were guys that were doing sex work, and they would get HIV or they didn't want to test because the only place that they could access healthcare was in the refugee camp. And everybody knows that this big building in the middle of the camp is where people go. And so if you're seen going there then it would raise a lot of questions. Even though people felt that they were HIV positive, they weren't going to get tested because they didn't want everyone else to know.

Alexandra Arriaga: The stigma, right?

Michael Clark: Yeah, it's just this whole aura of how stigma affects how you can access your healthcare and it was really, really fascinating for me. And me as a person who’s HIV positive, it was really interesting that ... It kind of just showed that it doesn't matter how much money you put at a problem, you can put all of the equipment and all of the medicine you want, but if you're not addressing the core issues surrounding stigma, then the problem's never going to get solved. Like we have the biomedical means right now to completely stop HIV. We can put people that are at risk on preventative prophylaxis called PrEP, Truvada and that kind of stuff, and it stops them from getting HIV. Plus, we can take people that are HIV positive and we can make sure that they're adherent to their medication and there is absolutely zero chance that a person who's HIV positive can infect somebody who's not HIV positive. It's zero chance. Studies have shown that if you are positive and on medication and have an undetectable viral load, there's zero chance that you can infect somebody. So we have the tools to solve it, but it's because the stigma still exists in these people that are highest at risk, it's never going to be solved until we address the stigma. The core issue is, how the stigma affect all of this and how does displacement work into that?

Alexandra Arriaga: So that's where you've become such an essential part of this puzzle because we need people like you to bring light to this issue.

Michael Clark: Yeah, exactly. I mean, and that's why I'm like, the problem is not going to be solved by epidemiology and healthcare. It's going to be solved by examining the social-behavioral factors that go into these programs. And that's why I came to NYU to study social-behavioral health.

Alexandra Arriaga: And I mean, I think that it's a great thing that at NYU there's this open-mindedness and just acceptance of everyone and everything, which I think it's conducive to you feeling comfortable to doing the best work that you can.

Michael Clark: Yeah, thank you. I agree.

Alexandra Arriaga: And what are some lessons that you learned while working abroad?

Michael Clark: Well, when I did my study abroad, I was also applying ... I was like, I want to keep doing this. And so that's when I applied for a Fulbright fellowship. So that I could go to ... Because I noticed that people were in Uganda, but then when all of this Kill the Gays Bill happened in 2014, LGBTI were moving from Uganda and going to Kenya. And that's what I applied for my Fulbright. I wanted to see what effect did that have and did it cause their HIV vulnerability to increase or what were these communities like. My plan was to go to Kenya and to study HIV and do some surveys on refugee communities in Kisumu and in Kakuma, which is the refugee camp in the north of the country. The biggest issue I had is when I was awarded the Fulbright and I went to Kenya, I arrived to Kenya right at a time that there was unprecedented political violence going on because it was a really contested presidential election. And the town that I was going to be based in, Kisumu, was the center of this violence. It was kind of some ethnic violence between the Lua people and the predominant tribe, the Kikuyu. And so when I get to Kenya, the US Embassy tells me, “You can't leave your apartment.” For a month, I couldn't leave my apartment. And I'm like, “No, I want to ... ” Because you have a short period of time, you have nine months. It seems like a long time, but it's not a long time. It was like I couldn't go and do the work that I wanted to do. By the time I was able to leave Nairobi and go to Kisumu, then it was towards the end of the year, and all of the community organizations that I was working with had broken up and were doing their end of the year retreats and all this kind of stuff, and so no one was able to really host me when I arrived. I started to get really kind of depressed. I'm like, I came here to do this project and I feel like I'm really just wasting my time. I mean I really felt like I was wasting my time. I mean I watched all seasons and episodes of Game of Thrones from start to finish.

Alexandra Arriaga: That's a lot.

Michael Clark: Exactly. I was just like ... And every single episode of RuPaul's Drag Race from start to finish, every single season. It's just like, why am I here in Kenya just watching TV? At that point, I was like, “Okay, you gotta get out, you got to do something.” So I knew a couple of different little refugee groups that hosted LGBTI, and I just reached out to them and said, “I'm really interested in what you're doing. Can you just like show me around?” And so I went and I met some, and this is when I started to really understand the way that the LGBTI refugees from Uganda had come to Kenya, and in Nairobi, they had created these houses. They were community-based organizations, but they had a leadership structure, they had goals that were unique from each other. And here in this house, there would be 10 to 30 people, they were like their own family. And you had several of these in Nairobi. I went around Nairobi and interviewed a lot of them and did a little bit of a health survey to try to understand what is the issue. And so these little community groups, they provide the food, housing, and a lot of the medical needs. But there were other like kind of abstract needs that they knew they needed, that they didn't really have the ability to do themselves. That was like how can we stand up for our human rights when somebody is arrested or unlawfully detained or fired from their job because of them being LGBTI or there are these kinds of things because there was a lot of animosity between ... Animosity is not the right word. There's a lot of xenophobia in the gay community in Kenya towards these refugees because they are not Kenyan, and people kind of felt like they were coming here to take advantage of the liberal ways of Kenya. So there's no integration of the LGBT refugee community within the greater LGBT community in Kenya, which is making great strides. Kenya is moving along and doing really great things for human rights, but it's this group of the most vulnerable, the most persecuted that are not really getting to see any of those benefits. And so that was kind of one thing. The other thing was that there's a lot of times when there's doing research on the health of these groups of people, these refugee groups are excluded from that research just based on simple questions like, you know, are you a citizen? Or have you lived here for more than five years? You know these kinds of things. And also there's a lot of lost follow up on some of the research, and so a lot of times researchers just excluded them out of their broader findings. But when I was there, I got to meet up with this really great researcher from Oxford, Adrian Smith, who does fantastic work. We really started to talk a lot about what ...He included some of these questions so that he was then able to extract his data and look at what the health was like for an LGBTI refugee. It was absolutely astounding to see some of this data of incidences of stigma and discrimination, like blackmail and sexual assault and physical assault, gossip from healthcare workers and stuff like that, where it's in the low 20% for most Kenyans, for most LGBTI Kenyans. But if you're a refugee, it goes up to like 80% and 90% of people have experienced those things. I mean anybody's experiencing sexual assault is a horrible thing. And the prevalence rate in the LGBTI community in Kenya was I think 16%. but if you're a refugee, it's 45%. It's just outstanding to see some of this data. And so that kind of really propelled me to like, okay, I need to study this more and there needs to be a much more in-depth study. We need to be able to come up with a way to do that. And so that's when I helped the refugee groups come together and create a coalition of all of their groups with this being one of their goals. The goals of The Refugee Coalition of East Africa is what it ended up being called, is to do advocacy for human rights, to do strategic planning for like ... Because every refugee is there in Kenya for three to five years. It's not like you come to Kenya, you claim asylum and then you get sent off to Iceland. You're there for many, many years and you kind of have to think beyond. They’re such in a crisis mode that they don't really think beyond two or three days ahead of time. And so the coalition can kind of address these long term strategic problems. They can work on fundraising and then they can also advocate and facilitate research. And so that's the main goals of The Refugee Coalition.

Alexandra Arriaga: And so you right now are involved with The Refugee Coalition of East Africa, correct?

Michael Clark: Yes.

Alexandra Arriaga: And so what efforts are being made to help this group?

Michael Clark: So The Refugee Coalition of East Africa is the only refugee-led group that is working on those issues of strategic planning, fundraising, and research. Some of the things that we're working on ... Like we have a fundraiser ... And when I say me, I mean I'm an advisor helping them facilitate their things, but it is completely all run by them, by the refugees. One of the things that we're planning on doing is in December, we're having a kind of an economic empowerment initiative because some of the research we did shows that each refugee has anywhere from 10 to 15 dependents, people that depend on them for their money because a lot of these people can't get jobs. All of the support from the government and from the refugee organizations has been cut off so they have no money, and the only way that they can really make money is to either do sex work or come up with their own sort of underground businesses. And what the coalition is planning to do is create kind of like a Shark Tank competition in a way where each refugee group can present a business idea and they're writing out a business plan. And we have mentors that are working with them to develop their business ideas and to do strategic analysis to find out what are the competition and how ... A robust business plan. And then we are going to put them all online and have a big publicity campaign and people are going to be able to contribute to the businesses that they feel are most viable. And then all that money is going to go to the refugee businesses and we're going to kind of follow them throughout the year. I think when we get talked about it, we had hoped that people would be able to get a return on their investment, but it ends up the technology was really difficult in doing that. It should come in December, and we're really, really excited about it.

Alexandra Arriaga: And if we wanted to help right now, is there a place where we can and donate?

Michael Clark: Yeah, you can go to refugeecoalition.com and there is a GoFundMe attached to it. You can watch some of the videos that we produced when we were there, or you can also go to the GoFundMe, which is it's RefCEA, R-E-F-C-E-A, which is Refugee Coalition of East Africa. It's all on the website, refugeecoalition.com.

Alexandra Arriaga: Perfect. I am sure everyone will go check it out. And shifting to present day, what drew you to the MPH at NYU specifically?

Michael Clark: During this time, when I was sitting in Nairobi, just contemplating my existence is when I started to apply for programs and I applied to all of the top tier programs and I got accepted into most of them. There were other schools in New York that I was really kind of excited to go to and just talking to them, it was like I don't feel very comfortable in this situation. I had reached out to some professors that I was interested in working with, and one of them was Dr. Stephanie Cook. And she was amazing. She was so warm and welcoming. She wrote me back and she's like, “Let's have a web chat.” I'm like, okay. I'm thinking it's going to be a 15-minute like, “Here's what you're doing, here's what it's like.” She talked to me for like an hour and a half. I was amazed at that. It just felt so ... Like the attitude wasn't there. And even dealing with afterwards, when I was dealing with financial aid and talking to some people, I got quick response rates. I just got a much better feeling with NYU, which is why I chose it. The other reason was for HealthRight, which is what I'm doing in internship. Dr. Peter Navario has an organization called HealthRight, which is kind of doing health and human rights in nations like Kenya and Uganda and stuff like that. And that was kind of something I was like, “Well, if I go to NYU, you know, HealthRight would be a great place for me to continue to do what my interests are.” And I was really, really happy and excited to interview there and to get an internship. Hopefully, I can do my summer practicum back in Kenya through HealthRight.

Alexandra Arriaga: That would be amazing.

Michael Clark: Yeah. So that's what we're working on right now.

Alexandra Arriaga: And is that what you see yourself doing as a specialty just working with LGBT communities abroad?

Michael Clark: Yes, definitely. Since we launched the Refugee Coalition and published this video about the coalition, I've had groups from all around the world contact us. The same week that we launched, we had groups from South Africa, Malawi, Uganda, Turkey, Pakistan, Ghana, and Costa Rica. And people are saying, “There are groups of LGBTI here. There's 200 of us in this town in Turkey that we feel so alone.” There's a group of 80 that live in Costa Rica, in a village in Costa Rica because they were escaping Venezuela and Panama and stuff like that, and on their way to the US and they stopped in Costa Rica and they're like, “We feel so alone and nobody is advocating for our rights, and we want to be a part of your coalition.” And I was like, “Holy crap!” I did not realize that this was such a big issue. And that's really what I plan to continue to do is to work to empower these local groups to be better suited to fight for their own equality and their own rights, and their own health and that kind of stuff, and show that there's power in coming together as a group and to voice these concerns in mass. Because it's easy to ignore a group of 10 people and 30 people and all that kind of stuff that have a separate message and have their own agenda and stuff like this. But when this group comes together in mass saying the same thing, it becomes really, really hard to ignore. I think that as LGBTI rights spread around the world in places like India, decriminalize it, and Kenya is talking about decriminalizing it, it's going to cause those places to become magnets for places that are more oppressive around them. I think that if and when Kenya decriminalizes homosexuality, possibly this year, it is going to cause places like Uganda to become more aggressive and more anti-gay, which in turn is going to cause a lot more refugees because people are going to be escaping that, and they're going to want to go to place where they can be authentic and free. And so there needs to be a mechanism to address this, and there has not been because UNHCR is ineffective, and a lot of these refugee groups don't address LGBTI necessarily. It's more of like, “Eh, you know, we don't necessarily know how to deal with it.” I also don't think that the solution should come from a multinational organization based in New York City or something like that. I think that these solutions should come from the communities that are experiencing it. And that's what the coalition is working to do, is to ensure that they have the ability and the funds to come up with their own solutions.

Alexandra Arriaga: That social context is extremely important.

Michael Clark: Yes.

Alexandra Arriaga: Well, I'm glad that you are looking into the future and you're coming up with the solutions in the hopes that when all these things are eradicated, there will be a plan that can be implemented.

Michael Clark: Exactly.

Alexandra Arriaga: That's extremely relevant and I'm glad you're doing it.

Michael Clark: Yeah. Thank you.

Alexandra Arriaga: And Michael, is that where you think we'll find you in 10 years? Somewhere in Africa working on more and more health solutions?

Michael Clark: Somewhere. It probably is not going to be the United States. I will say that. I won't say it's necessarily Africa. I know that the Middle East and the region around the Mediterranean has a lot of these issues, and that's kind of a bigger, more structural thing. I mean I will say that my heart is in Uganda, definitely. I spend my holidays there and I have family of sorts there, so that is always going to be a place that's very, very close to my heart. But I mean I'm going to take it to wherever the need is at because my mission is to empower and protect the most vulnerable people in the world and that's always going to be where there are LGBTI, transgender, sex workers, people that are HIV positive, and wherever those communities are is where I will be.

Alexandra Arriaga: Would you say that's your biggest motivation, helping these vulnerable populations?

Michael Clark: Definitely. Definitely.

Alexandra Arriaga: I'm so glad that they have you on their side. You seem like such a prepared, determined individual and I know that you'll achieve great, great things. So thank you so much for coming, Michael.

Michael Clark: Thank you.

Alexandra Arriaga: I've enjoyed talking to you.

Michael Clark: I really, really appreciated being able to come and talk about this.

Alexandra Arriaga: Of course. And hopefully, maybe at some point, we'll have a Skype interview, where you'll be somewhere else around the world.

Michael Clark: Yes. Definitely.

Alexandra Arriaga: All right. Well, thank you so much, Michael.

Michael Clark: Thank you.