Jason Nagata, MD, sat in a wooden pew in the church in Kenya, listening to the pastor thunder away at the "abomination" of homosexuality. He began to sweat profusely, his face dripping and his palms wet. Flanking him in the church pew were members of his Kenyan host family, who had no idea he was gay.
"It was clear all the people in the church had similar viewpoints, as they were nodding in agreement with the pastor," Nagata told me. "I think I was just trying as hard as I could not to let anything show on my face."
In a new commentary written while he was a pediatric resident at Stanford, Nagata describes the challenges of being gay and doing global health work in countries where homosexuality is a crime. The issue came to the forefront in 2010 while he was doing research in Kenya on nutrition issues in the HIV community. The country then was considering protections for LGBT individuals, who under Kenyan law may be punished with up to 14 years in prison. Nagata wondered: Should he be open with his collaborators and host family there?
"It's a challenge I have grappled with a lot, now that I'm completely out locally," said 30-year-old Nagata, now a fellow in adolescent medicine at UCSF. "I wondered to what extent it would be safe or practical to come out to colleagues whom I would be working with internationally. Because coming out is a very big deal. I was still hiding a big part of myself from others, like my host family."
In his commentary, he weighs the value of being open about one's sexual minority status with the possible risks and dangers of exposure. He says U.S. clinician/scientists working abroad may open up the conversation on the issues by revealing their status to people who might not otherwise interact with an LGBT individual.
"People's opinions of LGBT rights and same-sex marriage might be changed if they experience solidarity with a LGBT family member or friend," he writes.
He says U.S. scientists also may have the opportunity to advocate for change in their host countries by working with local activists who are experienced and understand the risks. At the same time, however, they have to be cognizant of the risks they may face, including physical violence. "Not everyone can be a martyr and put their lives in danger for a cause," he writes.
Michele Barry, MD, director of Stanford's Center for Innovation in Global Health, told me that she advises medical residents working abroad to be very cautious on issues of sexual identity. The center is a sponsor of the Johnson and Johnson Global Health Scholars program, which sends residents abroad for rotations of up to six weeks.
"I talk to the residents about really being very circumspect and suggesting that they not share their sexual orientation," she said. "I think it can be very charged information. I give residents an opportunity to opt out of the program if they don't feel comfortable in not being open about their sexuality.
"I completely empathize with the urge to show solidarity, but it's not the time to endanger yourself," she added. "It's a conundrum."