The misconceptions that trans (transgender) men are predominantly heterosexual or otherwise not at risk for HIV have contributed to the historical absence of trans men in HIV research, and specifically research with gay, bisexual and other men who have sex with men (GBM). In fact, some trans GBM share risk factors for acquiring HIV with non-trans GBM according to a recent study by the BC Centre for Excellence in HIV/AIDS (BC-CfE). Based in Metro Vancouver, this is the first study in Western Canada to assess sexual HIV risk and related factors among trans gay, bisexual and queer men.
This qualitative research builds on growing evidence showing trans gay, bi and other men who have sex with men are at risk of acquiring HIV. By hearing directly from trans men who are gay, bisexual or have sex with other men, the study aims to understand their experiences of HIV risk within the unique context of BC’s HIV Treatment as Prevention¨ (TasP¨) programs. BC is the only province to offer immediate, universal access to HIV treatment upon diagnosis, under the implementation of TasP¨.
The trans men in the study were generally successful in accessing services to address their sexual health, despite experiencing trans-specific barriers. Routine testosterone therapy monitoring and transition-related care provided an entry point to regular HIV and STI testing for some. However, participants described having to advocate for themselves and educate health care providers on their sexual health needs as trans GBM.
Previous research from the Ontario-based Trans PULSE Study found that up to two-thirds of trans men identify as gay, bisexual or queer. Trans individuals often experience discrimination in accessing sexual and other health care services based on transphobic attitudes or lack of knowledge. Trans people have been found to face high rates of depression, suicide and to experience stigma or discrimination in health care settings.
The BC-CfE study-based on a cohort of GBM within the Vancouver-based Momentum study-found that:
¥ Trans GBM participants described engaging in a diversity of sexual risk behaviours, including receptive genital and anal sex and inconsistent condom use, with both trans and non-trans men partners.
¥ Generally, trans GBM participants expressed their own risk of acquiring HIV as low, although worry about HIV acquisition as high.
¥ Participants described access to regular testing for HIV and other STIs, despite having to overcome trans-specific challenges in accessing this type of service, such as health care providers using birth names, insisting on undesired pap testing and making assumptions about their sexual practices. Most trans GBM participants consumed alcohol and some used marijuana and poppers during sexual encounters to facilitate connection with partners, bolster self-esteem and increase social enjoyment and physical pleasure.
These experiences show that, even in urban settings like Vancouver, trans people are often invisible in terms of health research, programming and delivery. Trans men who are gay, bi or who have sex with other men are often overlooked in health care and other services and programs for gay, bi and other men who have sex with men. Their presence and needs-both trans-specific and those shared with non-trans men-should be acknowledged in order to better reach them through HIV and STI prevention.
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The Momentum Health Study is a BC-CfE sexual health study of gay, bisexual and other men who have sex with men in Greater Vancouver. Momentum aims to report new estimates of HIV prevalence among men who have sex with men (MSM) in the region. The study is supported by grants from the U.S. National Institutes of Health and the Canadian Institute for Health Research.