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.

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.”

TRANS-INCOMPETENT HEALTHCARE – A FATAL EPIDEMIC

View at HIV Equal

“Hi, could I speak with Brittany please?”

This phone call is not how I wanted to wake up today.

Excuse me??”

“This is Janet*, from your doctor’s office. Is this Brittany?” the nurse asked.

“My name has been legally changed for a year and a half. It has been updated on all my prescriptions, in my medical file, and on all my legal documents. When I became a patient at this LGBT-serving clinic, I was explicitly told that staff would make an effort to recognize people by their preferred names rather than their legal one. I tolerated these mistakes back then, but now I have jumped through all the hoops of legally changing my name. It’s more than a year later, and you are still not calling me Brandyn.

“Aren’t you the same person who left a voicemail for me three months ago when you made this same mistake then, too? Haven’t I already sent you two very politely-worded emails asking you personally to please check whatever medical records you’re looking at to see that they’re updated correctly?”

I might not sound so harsh if I weren’t certain that the answer was yes, that I had explicitly told this nurse twice before to stop calling me by the name I was assigned at birth… Or if I’d even had the chance to get out of bed first, before the burden of navigating a trans-incompetent medical system came bearing its weight down upon me once again.

“Oh. Uh, yeah, you know, this is the name that was in the email I’m looking at. I’m not sure who made that mistake. So, you’re, uh – your name is, uh,“ the nurse stammered without apology.

“My name is Brandyn. What can I do for you, Janet?”

“I’m just checking to see if you’re back from you winter trip. You’re due for a checkup with your doctor so he can continue to prescribe your Truvada for PrEP.”

“I’ve already made the appointment. It’s scheduled for next Wednesday. Is there anything else?”

What the nurse doesn’t seem to understand about her duty as a healthcare professional is this: She is a tiny, important piece of a very complex, oppressive system in which refusing to provide adequate care to transgender people is associated with a 60 percent rate of attempted suicide – 1.5 times higher than the already deplorable 41 percent rate when calculated independently of how our doctors treat us, and 13 times higher than the US national average of 4.6 percent. There is unambiguous, positive correlation between how carelessly medical professionals treat us and whether or not we give up on being alive.

When Janet called me, it wasn’t just one small mistake she made. That one mistake exponentially compounded my reality of being told every day that my identity is not legitimate, that I don’t really need to be represented in population samples for medical research, and that I just have to smile and nod when cisgender people are disrespectful toward me. Her phone call came on the heels of a brief leave of absence I’d taken from work because I felt sufficiently overwhelmed by the transphobia present in everyday conversation. So much so, that I could not safely interact with the outside world at all for a time. If I want to go a whole day without being subjected to some degree of transphobic comments, I pretty much have to go a whole day without talking to other human beings.

But I didn’t really feel like I had a choice to interact with this nurse, despite my discomfort about answering the phone for anyone at all. She called me, in my own home, as I lay in my own bed, where I had been trying for three consecutive days already to move past the persistent pain and exhaustion of being transgender in this society. I thought my health depended on answering that phone call. Instead, her trans-incompetent ignorance, without a hint of apology, sneaked into my vulnerable space cloaked inside the Trojan Horse of My Best Medical Interests.

Is it any wonder 54 percent of trans folks refuse to get checkups or preventive medical care in order to avoid the disrespect and discrimination we face from our healthcare providers?

We need this to stop. We need medical professionals to be more interested in lowering the transgender suicide rate than in soothing their wounded, defensive egos when their mistakes are pointed out to them. We need the people we entrust with our health to understand that if we can’t get them stop hurting us, we’re likely to stop the pain by removing ourselves from the equation altogether, exercising control over our suffering in the only way we see how.

Our lives depend on this – and it’s my understanding that healthcare professionals are supposed to be in the business of saving lives. First, do no harm.

I’d like to see us all celebrate National LGBT Health Awareness Week by stepping up to cultivate awareness about the existence and the struggles of transgender people. Can we take the extra few seconds to look at a patient’s file and make sure we have the right name? And take personal responsibility for our mistakes when we miss the mark? Can we acknowledge that every patient or client we encounter is living in some degree of pain we know nothing about, and that it is the responsibility of medical professionals not to add to that pain?

I think we can. You have the power to save countless lives. Let’s celebrate awareness of transgender health together by each of us doing our part to be the change we want to see in the world.

DEALING WITH THE BURNOUT OF HIV

View at HIV Equal

It took about 15 minutes before he asked what I do for a living. Scruff dates can be awkward at first, so I was content to forgive his incessant rambling until we got settled with our drinks and could begin to relax at the coffee shop.

“HIV prevention. Mostly educational outreach,” I said to him.

Five words were all I got out before he hammered the nail into his coffin with one stroke. This was surprising, because after I’d just spent five months out of the country with no physical affection at all, I had every intention of sleeping with this guy… Until he opened his mouth.

“Oh. I am so over that,” he scoffed, rolling his eyes dismissively.

Twenty-two years poz, apparently HIV is the very last thing he wants to think about. I would later learn that he had recently been double dipping from his insurance and has a 12-month stockpile of Stribild, which made his out-of-state move last month easy as pie. He has all the tools he needs to pretend HIV just doesn’t exist anymore. For him, it practically doesn’t. The biohazard symbol inked across his bicep is a relic, a useless artifact of a world in which he is no longer trapped. He’s so over that.

Privilege is an insidious thing. It’s the headache we don’t realize we don’t have. But the issue here runs far deeper than a mere overabundance of privilege: He lacks compassion.

Compassion is the thing that tells us to empathize with the people who do have headaches even when we don’t have one. Compassion is why we say, “I’m sorry you’re hurting. Can I get you some medicine? Is there something I can do to help you with your headache?”

We don’t stand there and say, “Oh. I used to have a headache, but I take medication for it now and don’t have to think about it anymore. I’m so over headaches.”

When we do that, we sound like jerks, especially to people are troubled by headaches. I’m still startled when guys who spent the 80s and 90s living with the persistent headache known as HIV feel entitled to roll their eyes and scoff at folks who are experiencing that headache now. And if you were a gay man during this era, regardless of your serostatus, HIV/AIDS was a headache you felt.

Just because that headache has eased up doesn’t mean HIV is a fad that came and went. It’s not some minor inconvenience that only matters until you get a once-daily pill to make the virus disappear from your consciousness. There are millions of people who do not have and cannot get that pill. People are still dying, just like this guy’s friends did two decades ago. This headache is still real.

I have fought damn hard to be alive today. The people in my community have, too. Even this guy sitting in front of me at the coffee shop, bitching about how he can’t be bothered to care about preventing HIV – or even be appreciative of those who do care so he doesn’t have to – has fought valiantly and successfully for his life.

But the fact is, we haven’t survived all on our own. Someone helped us. Someone who didn’t share our headache, who didn’t know our pain, who wasn’t trapped in the same hell at the same time. Someone came along at some point and showed us compassion. They empathized with us. They reminded us why life is worth living and encouraged us to keep fighting.

We survived because someone cared whether or not we lived. They cared about our headache even though they didn’t have one. Can’t we show a bit of gratitude for how they eased our struggle by taking some initiative to ease someone else’s? Can’t we lend our hearts now to those who are still fighting for their own survival, who aren’t “so over that” battle for privilege we’ve already won?

HIV treatment means so much more than a stockpile of anti-retrovirals and doctor’s visits. How about we make an effort to see that everyone receives from us the treatment they deserve: Compassion.

Misogyny in Fag Space: How to Have a Dick Without Being a Dick

View at BETA

“Oh, lordy have mercy! A vagina just walked in the room.”

“There goes the neighborhood,” Dustin1 snarked, scrunching his face in agreement with Eric’s comment before prancing off to the bar for another cosmo.

Sometimes they just forget. Or, if I’m standing around near a group of guys I don’t know well yet, they probably don’t know. Unless I’m wearing my Three-Holed Faggot shirt or am naked, it’s not like anyone can tell I have a cunt. I’m just one of the guys to them. Usually one of the guys people like hanging out with, even. They assume I’m cisgender, and I don’t go out of my way to correct them.

Once upon a time, I was a young fag disguised as a girl. Throughout junior high and high school, I consistently dated boys who eventually figured out they were gay and dumped me so they could instead date men. Rejection, being told my body isn’t desirable or legitimate enough for the men toward whom I’m attracted, has been part of my internal narrative for as long as I can remember. It’s gotten better for me over time, but dating in the world of gay men is far from struggle-free—for anyone, but especially a trans man.

Early in my transition, I felt as though gay men had every right and reason to proclaim their disdain for morphologically inward genitalia. I heard these assertions made with enough frequency that I became convinced this attitude was a given among all gay guys. I had grown as disgusted by my body as many gay men seemed to be, and I even participated in the practice of unabashed misogyny for a time myself, reinforcing my sense of belonging among men in the face of raw insecurity about my masculinity.

I came to learn that existing in Fag Space means being subjected to persistent shame. It’s not just vagina-shaming, either. Dick-shaming, size-shaming, hair-shaming, and slut-shaming are rampant as well. Fag Space often feels like a shame-saturated world where we exist equally and simultaneously as both object and objectifier. Since I already felt ashamed of my body and its purported inadequacy, since I wanted to be a good fag, since I wanted nothing more than social validation and love—for years, I said nothing.

But this past year or so, I’ve been savoring my new male privilege—my sense of entitlement to be in Fag Space without a speck of concern about whether I truly belong there. I know I do. It’s been a tough chore to get here from where I was, but I’m confident that this is where I belong.

Now that my attitude has changed, now that self-loathing isn’t a thing I’m caught up in anymore, I’ve really started to feel put off by the misogyny I witness among my peers.

I’ve been noticing more often when the gay men around me talk with casual cruelty about bodies. Often, if I hear a guy say “vagina,” it’s clear he means “woman,” despite the fact that some men have vaginas and some women do not. Reducing people to their body parts is a common practice for many in this culture of objectification.

“Oh, I wouldn’t say that to her face,” Eric explained dismissively as I called him out on his inappropriate, flippant remark. “I only say that here because it’s fine among us guys. You know I love you, sweetheart. Just not vaginas. Eww. This should be a place for cocks only. Nice, big cocks.”

The cisgender men around me either lift their drink in agreement or roll their eyes and say nothing.

He assumes, of course, that I have a penis. And, apparently, he also assumes that every man within earshot is either well-endowed, or at least agrees with him.

Is it really fine to talk this way? Even “among us guys”? I know there are cisgender men out there that are bothered by these types of remarks and even feel uncomfortable hearing them. Many times, though, they don’t speak up.

I tell this story not because one jerk in a bar annoyed me, but because I’ve been hurt by this brand of misogyny dozens of times now. I’ve seen poorly-planned announcements sent out for men-only events, where trans men were known and expected to attend, that read “anyone with an attached penis is welcome.” I’ve stood in leather bars while title holders who call themselves trans-inclusive yammer about how men whose dicks aren’t big enough are just a waste of air. I’ve heard size queens exclaim outright that any man with a two inch dick might as well just kill himself and end the shameful misery.

I see an opportunity for us to change how we talk about bodies. To prevent the shame and hurt caused by careless words and thoughtless remarks.

We all have the ability to pay attention to our words and stop making assumptions. We have the power to speak up—and speak out when we hear hurtful words from someone else. We have the option to acknowledge that we all have different bodies—and that unless you’ve seen someone’s genitals yourself, and talked with them about it, you can’t possibly know what’s between their legs or how they feel in their own skin. We have the power to be kind to everyone, even in the absence of this information. Our words and our voices are filled with power, in a community that has for decades so often felt powerless to prevent death.

Nearly half of all transgender men attempt suicide at some point in their life.

Have I been one of them? Flip a coin and tell me where it lands.

Does the coin land on the side where I feel solid and confident enough to tell myself that Eric is just an ignorant jerk who doesn’t know what he’s talking about? Where someone speaks up to say his comments aren’t okay? Or remind him that gay men have fought too long and too hard for survival to be tearing people down like this now?

Or did it land on the side where Eric’s words rip open a gaping wound that never really heals? Where a lifetime of self-hatred, of shame, of insecurity and inadequacy bubbles over? Did it land on the side where the word “vagina” was used one too many times in a way—unintentionally of course—that made me infer that my masculinity is inadequate and that I would never legitimately be recognized in my community?

Do I live? Or do I die?

You have the power to save my life. Is it worth it to you?

TRANS MEN: THE INVISIBLE BATTLE WITH HIV

View at HIV Equal

So there I was, sitting there in a room full of the world’s top HIV researchers, uncomfortably under-dressed in my Mr. Friendly t-shirt but not letting that stop me from asking the question I need answered.

“Dr. Molina, in your study on intermittent PrEP dosing among men who have sex with men (MSM), did you see or anticipate any differences in efficacy between the transgender gay men in your study versus the cisgender men? What have we learned about the 2+1+1 dosing for men who engage in receptive vaginal intercourse?”

I desperately need this information, you see, because every day I log into Facebook and respond to yet another question about HIV prevention from yet another trans guy who wants to protect himself from HIV and whose doctors won’t help him. I am a moderator of the PrEP Facts: Rethinking HIV Prevention and Sex discussion group where people from all over the world – research scientists, doctors, community organizers, and lay people alike – come to learn and digest the latest information about HIV prevention and safer sex strategies. There are a lot of trans folks and a myriad of gender identities present there. Many of us use this Facebook group as our primary source for medical information concerning HIV prevention because we cannot get adequate care from our doctors.

But then I ask the doctors why they’re failing us, and they say to me that they don’t have any data. They don’t know the answer. They can’t answer these questions without studies to back them up.

So I asked Dr. Jean-Michel Molina about the trans men in his study, with the naïve and unwarranted optimism that he would tell me something useful, something I could relay to the droves of trans men seeking me out as their last glimmer of hope for sexual health. He responded by telling me about the one trans woman in the study, with no mention of trans men at all. Another researcher in the room explained to me afterward that trans men were not included in this study. Dr. Sheena McCormack would later apologize to me that her PROUD study in the UK, about which I’d been on the edge of my seat for months to see results, also failed to include trans men.

I have been a participant in a PrEP research study at the University of Washington, as have many of my trans brothers in Seattle, so I know we’re showing up to do our part for medical science. Yet, even though we’re presenting ourselves, able and willing to offer our researchers abundant data about our bodies, at best these studies have not been designed to track the information we’re providing. Or, at worst, as was the case in both the IPERGAY and PROUD studies, the criteria for entry into the studies are designed in such a way that explicitly makes trans men ineligible altogether.

I want to let you in on a little secret: Transgender gay men are not heterosexual women. We do not have sex like women do. Our behavioral risk factors are the same as the behavioral risk factors of gay men, because – big surprise – we are gay men. Sometimes we have anal sex. Sometimes we have vaginal sex. We have sex in bathhouses, perhaps with 20 or more guys in one evening. Not all of us, but some. We cruise for hookups in the twilight hours at Volunteer Park. We meet guys on Scruff, Grindr, and Craigslist for casual one-offs. Some of us use poppers, crystal, and other drugs associated with the gay party-and-play scene. We are at high risk of HIV just like cisgender MSMs are, and we’re being ignored.

This cannot continue. We already have a 41 percent or greater rate of suicide attempts. For trans folks who survive society at large, we are then faced with incompetent medical professionals who use the wrong pronouns, who refuse to listen to us and who cannot or will not give us answers about how our bodies work. We have to fight for basic healthcare, fight for HIV prevention, and then ultimately fight for HIV treatment after we’ve been cast aside until it’s too late to prevent infection. Still, no matter how hard we fight, we cannot bypass our doctors to independently investigate research about the HIV prevention strategies that are optimal for us ourselves – because no such research exists. We are an invisible, dying group of gay men being left to face the threat of HIV with no one hearing our cries, no researchers taking notice and no public health officials acknowledging our plight.

The HIV epidemic of the 80s and 90s does not have to repeat itself. We have the tools and the knowledge to prevent HIV. We just need medical professionals, researchers and advocates to step up and make it happen now. Please, help us.