Definition of prevention
the action of stopping something from happening or arising.
As I move into 2022 my work has taken me deeper and deeper into the realm of HIV work and what that looks like for our transmasc community. The frustration and irritation I have experienced when when I pose the question “what about the transmasculine community? (with respect to PReP, HIV research, and prevention treatment methods)” in some of these healthcare spaces because of the response is deep! I have written about this before and I feel its worth revisiting. Repetitively I have heard “there isn’t enough data to suggest that the transmasc community is at risk for HIV”. Wrong there are plenty of data and factors that put our community at risk. Let take look at a couple, shall we?
First there some Trans men and transmasculine individuals that are situated within the gay community, one of the highest risk communities for HIV, yet there has been little research regarding the experience of risk for these transmen and transmasculine folks. The failure to include transgender men in past HIV prevention efforts is due, in part, to an assumption that transgender men have sex exclusively or primarily with cisgender women and are therefore not at risk of HIV. Stop assuming! Such assumptions fail to acknowledge the diversity of sexual attraction, behavior, and expression among transmasculine individuals. The limited research that has engaged transmasculine populations in conversations about their sexuality and sexual heath finds that many transgender men report attraction and sexual contact with cisgender men.
A recent study by Professor Sarit Golub of the City University of New York released September 2019 states that out of a sample size 1808 Only 9.5% identify as straight and 7.9% identify as asexual or demi sexual the other 82.6% of the participants identified and is either gay, bisexual, queer, pansexual, or non-labeled identities with relationship to sexual orientation. Additionally 45% identify in monogamous relationships and 14% identified being in open or polyamorous relationships.
Now let’s look at something not very many are chatting about, stigma!
Partner related factors such as gender affirmation sexual minority stigma and internalized stigma are factors. Trans MSM are a stigmatized subpopulation at the complex intersection of both gender and sexual minority statuses. Dual exposure to gender and sexual minority and stress pathways increase risk of acquiring HIV. Socialization stressors are relevant particularly to gay identified trans MSM who experience gay community norms about sexual behaviors and sexual risk. Stigma from cis male partners can activate social and stress pathways around gender norms and HIV risk. Some transmasculine individuals may experiences pressure from their cis male partners and/or partners that produce semen to engage in risky sexual activities to prioritize gender validation and/or affirmation from these partners.
A 2019 study conducted by The Fenway Institute and released in the Journal of the International AIDS Society, with a sample size of 843 transmasculine MSM identifying individuals, found 45% experienced moderate to high stigma from their partners and 42% experienced moderate to high stigma that is internalized. Also 83.7% were in non-monogamous relationships, 79% of participants had no had bottom surgery and 49.5% had condomless receptive sex, with 9.6% of those folks having sexual relations with an HIV+ partner.
A substantial proportion transmasculine individuals meet eligibility CDC based PrEP criteria but few are receiving adequate PrEP services. Enhanced efforts should be made by providers, programs, as well as systems to assess HIV-related risk in transmasculine patients and engagement in comprehensive Sexual Health Care to include PrEP usage. Tranmasc folks who have sex with cis men (TMSM) may be just as likely to have condomless penetrative with people who are living with HIV or people whose HIV status is unknown as cis men who have sex with other cis men. If cis men are a priority for HIV prevention and sexual health care, so too should TMSM.
High percentages of prep eligible transmasculine individuals saw a healthcare provider at 64.9% and only 32.3% of PrEP eligible participants actually received information from the doctors and additionally only 10.9% of those eligible were actually given a prescription for PReP. Further a substantial portion, 24% of the sample reported receptive sex with cisgender male or transgender female partners and more than 18% of the sample report condomless insertive sex in the past 6 months
Now let’s talk about PrEP, hmmmm. In 2012 Travada (PrEP) was approved by the FDA for use for both for both trans women and trans men with the caveat that 2-1-1 dosing which is also called event-driven dosing it’s not conducive to efficacy for Transmasc folks, however, studies are inconclusive about the efficacy of PrEP with testosterone. So there’s that! There studies currently taking place to figure that out.
There needs to be more done to include our community in this and so many more conversations around sexual, mental health, and reproductive justice.
Have a different opinion or perception? Have you experienced this? Join the conversation and comment below and let’s talk about this.
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Further Reading (research they say doesn’t exist):