Redneck Solidarity

Redneck Solidarity: Black lives matter!

1999: I was 11 years old, and the Dixie Chicks‘ opening act was Ricky Skaggs. I already owned his album ‘Soldier of the Cross’, but apparently the rest of my generation didn’t know him so well. Before the Dixie Chicks began singing, Natalie explained:

“We asked Ricky to share the stage with us for this tour because the music industry has for so long stripped us of our historic roots in the name of profit. We are Bluegrass artists who happen to have a hit-selling Country album. To appreciate our music, you have to understand where we come from. We want our younger generation of fans to learn where you come from, too, and what role this music and its history have played in shaping who you are and the media you’re buying.”

The following year, their careers were effectively destroyed over speaking out against George Bush, and they sealed that coffin further by denouncing the Iraq war.

Tonight though, they took the stage with Queen Bey in perhaps the boldest statement of their careers: Redneck Solidarity with Black Feminist empowerment.

Daddy Lessons couldn’t have been more perfect an anthem for that solidarity.  It is the story of every poor Southern girl clawing her way toward Liberation from within the gun-totin’ Patriarchy. Ain’t make no difference her skin color.

My Daddy said shoot.

Praise the Lord and pass the ammunition,

Because Earl had to die. 

At a point in our country’s history, before the Plantation Owners frightened us into hating one another’s voices of freedom and silencing one another’s songs of liberation, we sang them together.

When I read that white country music fans were protesting the CMA awards show because it was “Diluting its country brand by allowing a pop star to take the stage…”, my first thought was “WHERE WERE THESE PEOPLE WHEN I WAS CRYING ABOUT KIDD ROCK STEALING AIRTIME ON MY COUNTRY MUSIC CHANNEL???”

But the performance that was allegedly diluting the value of Country music then happened, and I understood:

The protestors/whiners weren’t upset about compromising the integrity of Country music. They were upset about compromising the country music brand. Their White Supremacy exists to reinforce Capitalism.

Real Country music is the Dixie Chicks and Beyoncé singin’ about their daddies teachin’ ’em to shoot asshole men in self-defense.

Together.

🦄💕

Evolution

I am growing.

In past, I have written and been paid
and written when I wasn’t paid;
Payment governed my choice to speak freely.

I am one person.

Today, I still write and still am paid
and I still write when I’m not paid;
I will no longer restrict my speaking.

I am merging
with myself
here.

 

When we speak we are afraid our words will not be heard or welcomed. But when we are silent, we are still afraid. So it is better to speak.

Audre Lorde

Privilege in Transition: PrEParing to level the playing field among gay men

View this original publication on HIVEOnline.org

“What do you mean?” my researcher asked with bated breath. From across the room, I could hear her heart stop and sink to her stomach.

Four months earlier, I had enrolled in a PrEP [Pre-Exposure Prophlyaxis, brand name Truvada, is a once a day pill that can prevent HIV aquisition] study at the local gay clinic. The doctor hadn’t expected trans men to enroll, but when I showed up in her office arguing that I, too, was a high-risk gay guy who needed PrEP, she conceded that I was right. She gave me a pregnancy test, as was required by IRB (institutional review board) regulations for anyone possessing a uterus, and she drew a couple vials of blood to check for HIV and proper kidney function. A week later, with an offer of free condoms and a reminder to use them consistently, she handed me my new prescription for Truvada, the pill that prevents HIV.

I used condoms more consistently with PrEP than without it. Completing the survey about my recent sexual behaviors at each clinic visit felt like earning a gold star with my perfect adherence to both Truvada and condoms. Some people asked why I bothered taking PrEP at all, consistent as I was with rubbers. Sometimes their questions seemed strangely accusatory.

Why bother obeying the speed limit if you always wear your seat belt? Why bother having airbags? Does having them prove you’re lying about always buckling up? Does someone else have the right to judge my choices even if I didn’t buckle up? No. I’m being responsible and maximizing my safety by taking PrEP every day.

The third clinic visit was the first time I had to give my researcher a different answer:

“Have you had condomless sex since your last visit?”

“Yes.”

Her eyebrows went up involuntarily. She asked, “Do you know his HIV status?”

“No.”

She looked shocked, but not judgmental. This was so unlike the answers I’d given her in the past. My eyes were fixed toward my fidgeting left foot, and I waited impatiently, hoping the conversation would move on quickly.

“Okay. So you had condomless sex with someone who didn’t know his own status, or…?”

“I don’t know. I don’t know his name. I don’t know who he is. I don’t know anything about him,” I snapped at her matter-of-factly. “If I knew, the management at the bath house and the police probably would, too. But I don’t know.”

I instantly felt awful for having told her about my mishap. I could see her mind racing, flooded with emotion, and I couldn’t tell which she was going to do first: hug me, or cry, or call the IRB to tell them that a research participant had been sexually assaulted while enrolled in her sexual health study. She tried to offer me some “help” and said she’d get me referrals to mental health and trauma recovery resources right away. She did not cry in front of me.

“It’s okay. I’m on PrEP,” I told her.

“No, it’s more than that. It’s not just about HIV. You need other kinds of support, too. Rape is a big deal, a big experience, with big feelings that are about more than just HIV.”

After all those years of unenthusiastic sex in a female shell; the evangelical upbringing that told me I existed just to satisfy men; and the countless nights I’d laid awake in my bed, hating my body but terrified to accept who I truly was, because I so strongly equated gay sex with death and I didn’t want to die – how could I explain to this cisgender woman, with her very best of intentions, that I really felt okay? That I didn’t feel traumatized from this the same way that I’d felt from similar experiences in my past? How could I explain to her that I move through the world as this man’s equal now, and that although it was wholly inappropriate for him to have put his dick in me without a condom after I had explicitly said no, it felt more like rudeness to me than violence?

“This pill changes things, you know? I mean, yeah, I’m pissed that the guy did it. It was messed up. I wish I knew who he was so maybe it wouldn’t happen to others,” I told her. “But I’m not afraid. When this happened to me as a woman, I was overwhelmed and fearful. I felt like it would always keep happening, like I didn’t have any control. I felt like the consequences were always mine to face; if I got pregnant or got HIV, that was something I would have to live with. I didn’t have that control over my own body, and that was frightening.”

She drew a deep breath, cautiously trying to find her own words while processing mine. Biting her lower lip, she reminded herself to breathe, and I continued:

“This guy screwed up. It was his fault, not mine. It happened, and it’s over now. I’m not afraid, and I don’t need to see a counselor to deal with it. It’s amazing. I never thought I could go through something like this and not feel afraid of the HIV test afterward, but I don’t. I feel like I have so much power over my own body now, even when someone else tries to take that power from me. He tried, but he couldn’t take it. He couldn’t hurt me, because now I protect myself, on my own terms. His cooperation was not required.

“I’m still adjusting to what it means to move through the world feeling like men’s equal. I didn’t learn that growing up, and it’s not an easy process. But at least it’s feeling like a safe one right now. The stakes don’t feel so high, and removing HIV from the equation has made the transition infinitely easier.

“Thank you,” I said, “for helping me make being gay something I can live with.”

Where do I fit in? PrEP and Transgender Men

View original publication on BetaBlog.org

When I read results from clinical trials about PrEP—or other HIV prevention tools or strategies for that matter—I’m often left wondering: Where do I fit in?

There aren’t guidelines about Truvada-based PrEP use for transgender men who have sex with men because there haven’t been any studies specifically looking at how the drug works in our bodies. In fact, major PrEP clinical efficacy trials have not included transgender men in any of their study populations to date. Robert Grant, MD, MPH, the principal investigator of the first successful randomized controlled PrEP trial with human subjects, iPrEx, confirmed this, saying, “to my knowledge, no trans men have been included in PrEP research.”

Grant says that it’s challenging to get study protocols that include transgender men approved. “The study sponsors will often ask that trans women and men be excluded if there will not be sufficient recruitment for a separate analysis. We had to argue to include trans women in iPrEx. We wanted to include trans men too, but we did not have estimates of HIV incidence among trans men that were required for inclusion in an efficacy trial.”

Because the majority of transgender men have reported condomless anal or vaginal sex with cisgender (non-transgender) men, it makes sense from a public health standpoint to include us in studies in order to capture the role we play in HIV prevention and transmission as a part of the MSM population.

Studies that present their findings as applicable to all MSM but do not include transgender MSM in their data fall short of having representative samples. This gap in our research agenda, evidence-based recommendations, and knowledge of PrEP has important clinical, ethical, and practical implications. Not knowing how PrEP can, and will, work for transgender bodies means that we’re left to wonder—are we truly protected?

“The lack of information about PrEP in trans men is a real problem,” said Grant.

The PrEP CDC guidelines tell us that it may take different amounts of time for people to achieve full protection based on whether they’re exposed to HIV rectally or vaginally. Many PrEP providers tell male patients that they will be adequately protected against HIV after seven consecutive days of adherence, with the assumption that their patients will be exposed to HIV only during anal sex.

Providers may fail to note, however, that Truvada takes longer to accumulate in vaginal tissue—and that transgender men often do not engage exclusively in anal intercourse. The best available information suggests that transgender men who have receptive vaginal intercourse will be protected after 20 consecutive days of dosing, when Truvada reaches its maximum concentration in the body.

Everything known about how PrEP works during vaginal sexual exposure is based on studies of cisgender women—but transgender men have different biological and physiological considerations than cisgender women. Transgender men oftentimes experience vaginal atrophy as a result of testosterone use. Might this condition significantly change the effectiveness of Truvada as PrEP?

Many men are unable or unwilling to use condoms for receptive vaginal intercourse because of the tearing and bleeding that often occurs during sex with vaginal atrophy. Does PrEP provide better HIV protection in combination with condoms despite the damage caused, or counterintuitively, does PrEP provide better protection without condoms since they may exacerbate tissue damage?

PrEP providers may reassure male patients that it’s not a big deal to miss a single dose once in a rare while1, based on the iPrEx OLE study which found no seroconversions among MSM who took Truvada at least 4 times per week. Because no transgender men were included in the iPrEx study, however, we can’t say for sure if this also holds true for transgender men. Cisgender women need to have nearly perfect adherence in order for PrEP to provide full protection against HIV. Is this the case for transgender men who engage in receptive vaginal intercourse, too?

It will be some time before PrEP research is able to fill in the missing data for trans men and answer these questions, but it is critical that efforts begin immediately. Transgender men are currently experiencing a watershed moment of visibility in the larger gay community. Casual bath house sex, cruising, and hooking up using phone apps are increasingly commonplace.

“The field desperately needs HIV and STD prevalence and incidence data, as well as information on demographics, comorbidities, and risk behaviors. In concert with epidemiologic characterization, at-risk trans men should be included in HIV prevention studies based on the type of exposure being investigated—that is, trans men who engage in receptive rectal intercourse should be included with other populations who have receptive rectal intercourse, and trans men who engage in receptive vaginal intercourse should be included in studies of others who have the same sexual practices,” said Raphael J. Landovitz, Associate Professor of Medicine in the Division of Infectious Diseases at UCLA.

Despite the gaps in clinical knowledge of how PrEP works for transgender men, all evidence supports the idea that Truvada provides a high degree of protection in people who take the pill consistently as prescribed—with no reason to believe that it is ineffective for transgender people. Even if there is a slight reduction in effectiveness, which has not yet been tested and is thus unknown, PrEP isrecommended for anyone HIV-negative at substantial risk for HIV infection.

PrEP may well be a life saver for transgender people who are disproportionately affected by HIV risk factors like poverty, unstable housing, discrimination, survival sex work, and disconnection from health care. We can’t give up on including transgender people in medical research. The urgency with which this minority population needs evidence-based guidance on sexual health care recommendations is an opportunity to improve the humanity of science moving forward.

A Trans Man Discusses PrEP and Condomless Casual Sex

View original publication on The Body, 8/3/15

In bed with a casual hook up, I said: “I realize that when we’re already naked is probably not the best time to have a discussion about condoms, but it’s not exactly the worst time, either.”

“I’m happy to use condoms. No problem,” he replied.

“Well, um, how do you feel about not using condoms?,” I asked sheepishly.

And then he said it: “Are you clean?”

John (not his real name) would tell me later that I looked like I was about to punch him when he asked me this question. Instead, I continued grinding steadily and rhythmically against his cock as I told him about pre-exposure prophylaxis (PrEP), treatment as prevention (TasP) and how people living with HIV are just as “clean” as anyone else. I explained that it would be much safer for him to have sex with someone who is HIV positive and on treatment than for an HIV-negative person to have sex with someone like him. I explained that those who most often transmit HIV to others are unaware of their status. They may get tested and sincerely believe themselves to be HIV negative. But many, like him, are vulnerable because they’re not on PrEP and rely solely on their partners’ claims to be negative in deciding whether or not to use a condom.

I’d been on PrEP for a little over 13 months. In that time, I’d had a penis inside me without a condom twice — once with a trusted partner after we’d both just received our sexually transmitted infections (STIs) test results, and once during a non-consensual encounter at the bathhouse when a guy took the condom off when I wasn’t looking.

My encounter with John was the first time I’d come close to condomless sex with a casual hookup. I’d been thinking about the possibility for months, but I’d been too afraid to follow through. You see, I learned this past February that transgender men like me have been excluded from every clinical efficacy trial of PrEP to date, which means there’s no data about how well Truvada (tenofovir/FTC) works to protect me from HIV compared to cisgender (non-transgender) men or women. There’s good reason to believe that it will prevent HIV infection, but there’s also good reason to believe that it may not be as efficacious for people who have receptive vaginal sex. Is PrEP efficacious enough to reliably prevent HIV in trans men? Probably yes. But it’s a question researchers haven’t yet fully answered.

The rational decision I arrived at was to have condomless sex only with guys who are on antiretrovirals — either PrEP or treatment. John was neither; he was about as risky a hookup as I could have picked for my first time barebacking. But he was a nice guy (which is not an effective STI/HIV prevention strategy) and this was the first time I had felt even the slightest bit comfortable letting down my defenses enough to push through the fear. If we’re being honest, I was just too exhausted to keep those defenses up any longer.

I’d been waiting years for this moment.

You see, I was raised with abstinence-only education and grew up believing that condoms didn’t work — but that I had to use them anyway, because otherwise I would surely die. This lifetime of programming became especially problematic after I divorced my husband, with whom I hadn’t used condoms during our marriage, and began taking testosterone.

Like nearly all trans guys on testosterone, I developed vaginal atrophy — a condition that also commonly affects post-menopausal cisgender women and causes deterioration of the vaginal walls. Sex with condoms grew increasingly painful, and I consistently experienced bleeding and tearing every time I had sex. My doctor gave me localized estrogen to treat the condition, which helped, but my vagina is most definitely not the same as the vaginas of the healthy, pre-menopausal cisgender women who were included in PrEP research studies. I’m also not having sex with the same kinds of guys as those women are, because their partners were heterosexual cisgender men, and my partners are almost exclusively gay cisgender men.

Two months ago, while lying around in a sling at the bathhouse entertaining myself between suitors, I discovered a new bump inside of me. It was painful, and frightening. I scheduled an appointment with a gynecologist to have it looked at, and I refrained from sex for the next five weeks while I awaited her insight.

It turned out that condoms were the culprit. Not a latex allergy — just a normal consequence of the friction from condoms rubbing against my fragile tissue, which was already prone to tearing and inflammation. The pain I’d gotten used to tolerating, which I’d learned to associate with “safer sex,” was actually something my body didn’t want me to ignore. Sex with condoms consistently hurt, but I had chosen to disregard the discomfort because my fear of condomless sex was more intense — until it wasn’t anymore.

Over the few weeks following my doctor’s visit, I had extensive private conversations with some of the world’s top HIV researchers and educators about my struggle to decide whether I would continue using condoms. There’s no scientific evidence available to give me any greater assurance than what I already know: PrEP will probably work, but possibly not as well as it works for cisgender men. It’s obviously a safer alternative for me right now than condoms, which I need to stop using because they’re putting me at higher risk of infections than barebacking does.

At last, there I lay, naked and hungry for the touch of the man situated between my body and a 400-thread-count blanket. He thanked me for telling him about PrEP and said he’d look into it. My hips bucked gently against him, impatiently awaiting the decision to which I had not yet committed myself.

He said, “We can use condoms if you want, you know. It’s okay to use them.”

So much of this story he doesn’t know. And how could I tell him? He’s a hookup, not my boyfriend. My struggle to find freedom from the confines of my transgender body is not an erotic tale. My pain, both physical and emotional, is not welcome in his bed. We do not have that kind of relationship. I cannot tell him what it would mean to me to use condoms. I can’t tell him how this would reinforce a life-long narrative that sex is about his pleasure to the exclusion of my own; that I would have to suppress my own pain while he uses my body for his own enjoyment; that I would feel helpless and sad. This is what it means to me to use condoms. He didn’t need to hear all that.

So I decided: “I’m on PrEP. Neither of our HIV statuses will change from this sex. Let’s just enjoy it.”

OP-ED: WHY I IDENTIFY AS A FAGGOT

View original publication on HIV Equal

In my younger years, I was called a faggot. I did not consent to this. A kid in gym class swung a three-foot metal pole at my head, and the teacher didn’t care when I reported being bullied. I grew older and connected with mentors who’ve since passed on their own lessons to me about moving through the world being irremediably and obviously gay. Being a faggot is not synonymous with being a gay man, however. Many gay men do not identify as faggots – and some faggots do not identify as men. We’re a diverse bunch like that. But regardless of our internal identities, it’s a word we’ve all heard.

“I was called faggot growing up. I hated it because I knew those jocks were right. I hated they could see the thing I was trying so hard to hide,” a friend shared with me early in my transition. “Calling someone faggot, for me, is basically saying, ‘I can see what you really are. The thing you’re trying to hide.’”

Isn’t that why we hate the word? Because people see us, and sometimes they hate what they see, so we try harder than anything not to be seen at all? Because being called “faggot” means we’re failing to convince our oppressors that we’re their equal? Because invisibility feels safer, and we’re exhausted from living in constant fear?

There are certain images the word “faggot” evokes – images of brutality, of discrimination, of vitriol; images of disease, of stigma, of suffering; images of loneliness, of brokenness, of heartbreak.

In those same images though, I see something more.

Survival. Perseverance. Strength. Determination. Triumph. Authenticity. People who call themselves faggots exhibit courage beyond measure. We have stared Death in the eyes and refused to blink. We are more than deviant sex behind closed doors. We are a tribe in which membership has nothing to do with our genital configurations or our blood, and everything to do with the capacity of our ever-expansive hearts to love one another in the face of great and divisive adversity.

In embracing my faggotry, I embrace my resilience. Owning this aspect of my identity is an expression of gratitude – both toward my former self for making my way through Hell alive, and toward those strong-willed fighters who came before me for the contributions they’ve made to the world I live in today.

Being a faggot means living in a way that feels right to me as a priority over what’s expected. It means being seen for the rawness of my humanity rather than the mask I so often wear. It means taking struggles and obstacles by the horns and hacking my way through them without reservation. It means surviving a part of my identity I once believed could only result in my death. It means being a whole human being whose sexuality, whose existence, requires no apology.

This word holds the same meaning regardless of who is saying it. It is the intent that changes. The intent is what we respond to. The intent is where its power comes from.

Jocks in high school: “I see what you really are. I hate you. I don’t want you to live, faggot.”

My partners: “I see what you really are. I want you. Don’t hide from your authenticity, faggot.”

Me: “I see what you really are. I love you. There is nothing shameful about being a faggot.”

BRUCE JENNER AND THE DIFFERENCE BETWEEN GENDER IDENTITY AND SEXUAL ORIENTATION

View at HIV Equal

You may have heard that Bruce Jenner came out last week as a woman. This was a watershed moment for transgender visibility. Many folks have expressed confusion, though, about Jenner’s sexual orientation and lack of attraction to men. Some don’t seem to understand that Jenner isn’t a gay man, while others insist on calling Jenner a lesbian.

For years, like Jenner, I postponed transition because I mistakenly believed in a rigid set of ideals about how gender should be performed. I didn’t understand the difference between gender identity (who I am) and sexual orientation (who I do). I was pressured into believing I must be female even though it didn’t feel right – because obviously, only women can be attracted to men. I was told that I must be straight; my attraction to men was used without my consent to define my identity for me. I succumbed to that pressure for a while, and I wasn’t a very happy person during that time. Eventually, I stopped thinking about my identity in terms of the male/female binary altogether and just began to identify as a faggot.

From the age of six, when I first learned that gay men existed, I knew beyond a shadow of a doubt that I belonged among them in this audacious community of strong-willed fighters who seemed to have broken themselves free from society’s sexual shackles. Being a “fag” is a completely different experience from being a straight woman, even though people of both identities tend to have sex with men. Our sexual partners do not define who or what we are.

My gender is non-binary, neither male nor female, like many in our community. I’m not a special snowflake; transgender eunuchs, nullos, and other non-male people have quietly occupied gay social and sexual space for as long as gay culture has existed. I also know cisgender men who identify strongly as very masculine men, yet desperately wish they had a vagina. I am one of countless gender non-conforming people in our community who pass as men attracted to men.

Discovering ourselves and finding the right language for our identities is not an easy or fast process. There is no flowchart that leads us to all the right terms for our convenience. We have to discover language that suits us in the same way we discover our favorite foods, by trying them one at a time and contemplating how they make us feel from within our own bodies. This cannot be dictated or assigned to us by others.

Jenner is still in the process of discovering himself and blossoming into the woman he’s been keeping hidden for decades. He was unmistakably clear about how his identity is in flux and he doesn’t have all the answers. Yet there is an exceptional amount of social pressure for him to commit to labels – “lesbian”, “gay”, “he”, “she” – that he hasn’t had time to contemplate or digest yet. In the interview, he defaulted to saying “I’m asexual,” which was clearly a last-resort defense against the pressure to provide an answer he hasn’t found within himself just yet.

The need for labels is a reflection of us as individuals. It demonstrates the limits of our capacity to embrace reality as it is rather than accepting only what we wish reality were. Coming out as transgender is hard enough in its own right. Let’s not add to that struggle by pushing people into ill-fitting boxes for our own convenience. There is only one label for Bruce Jenner with which we need to concern ourselves: Human.