We deserve healthy and fulfilling sex lives, writes Rory Finn, Health Promotion Practitioner at Terrence Higgins Trust.
Whether we decide to undergo a physical transition or not, sexual health resources need to be speaking our language. Globally it is thought that trans women are 49 times more likely to be living with HIV than cis gay men. It is not known how much risk trans masculine people are at because few studies have been made into the health and sex lives of trans men.
Of course, people in wealthy nations with access to universal public healthcare or who enjoy a better socio-economic quality of life, stand a far better chance of remaining HIV negative. Discrimination and prejudice affects our ability to get and maintain steady employment and creates barriers for accessing healthcare. If you’re having to sex work in order to pay for hormones, chances are you are not getting the healthcare you need.
But even in countries that offer free trans healthcare, access to the right kind of support can be lacking. Even the better clinics can make entry level errors that can be off-putting even to the most thick-skinned trans patient. It’s rather troubling when a doctor asks you if you have pain in a body part you don’t possess or fails to see where you ticked the ‘trans’ box on a form right in front of them.
So it’s no surprise that many of us don’t make it to a sexual health clinic and instead rely on information on the internet to guide us. Unfortunately trying to find good, relevant information is challenging. Typing ‘trans’ and ‘sexual’ often will return results that are suited for a different day of the week.
Since I began my transition more than 12 years ago, I’ve gone from identifying as a lesbian woman to non-binary to trans man, and now, gay trans man. Each of those steps have put me into different boxes of risk when it comes to sexual behaviour. As a lesbian, the sex I was having was perceived as low risk and I struggled to get an HIV test when I wanted one. Just by changing my name I immediately became higher risk in the eyes of service providers and suddenly I was offered HIV tests and vaccinations, despite the fact my sex life hadn’t changed.
In fact the first time I contracted an STI I was in denial; I didn’t even know what an STI symptom would look like on a body like mine and I hoped it would clear up by itself. When I was prescribed medication, I didn’t take it straight away.
Any information targeted towards the kind of sex I was having didn’t include people with bodies and identities like mine. I ended up having to look at sexual health articles published in women’s magazines to try and filter out what information would be useful for me and what was not.
The continued lack of knowledge and resources around trans sexual health made me feel like I didn’t matter, that my body was an oddity and that I didn’t deserve good health -all on top of the stigma of having an STI.
As trans people we are simultaneously changing and remaining the same. Often we don’t fit into the boxes that medics would like to fit us in. Frustratingly, it could all easily be avoided if healthcare professionals actively built up their knowledge on trans bodies. We need services that recognise that while our bodies and behaviours might change, we’re still the same person. And conversely, while our identities might change, our bodies may not. We shouldn’t have to rely on Google searches and outdated sexual health resources. We should be afforded the same information and representation that cis people have.
This is why I decided to feature in and co-write the Terrence Higgins Trust trans-specific sexual health resource. It is led by and celebrates us as trans, non-binary and gender diverse people. It features people from different cultural backgrounds with different body types and identities.
We used feedback from more than 200 trans, non-binary and gender diverse people who responded to our survey and a trans steering group. The survey gave us vital insight into the sexual health needs of trans and non-binary people. It showed that more than half (52%) of respondents said they didn’t feel fully in control of their sex life, with over 70% saying that feelings of negativity and low mood or depression were a factor in this. 45% had never tested for HIV, while 25% hadn’t heard of HIV prevention pill PrEP despite almost half (46%) having reported condomless sex in the previous year.
The survey also showed that 1-in-5 people from trans communities in the UK feels uncomfortable attending sexual health clinics for reasons including misgendering, encountering prejudice, and being given incorrect information. We also heard of trans people not being able to access emergency contraception, with pharmacies refusing treatment because of assumptions based on gender.
A lot of thought was put into the language we used. What words would capture a broad spectrum of people, with differing identities, experiences and bodies? It’s not a conundrum we have definitely been able to answer. We settled for the broad categories of trans feminine, which is intended to include anyone assigned male at birth, and trans masculine, which is intended to include anyone assigned female at birth.
The new webpages and leaflet are directed to our specific needs and provide up-to-date information and advice on everything from HIV to contraception. They include the impact of hormones and surgery, considerations when taking HIV-prevention pill PrEP, and how to navigate happy, healthy sex. The resources were peer reviewed by Dr Kate Nambiar, sexual health and gender identity clinician who is Clinical lead at the trans sexual health clinic, Clinic T, in Brighton.
It feels empowering to be able to do something proactive about something I care so deeply about. I want trans people to have good sex, good health and a healthcare system with as few barriers as possible. All trans and non-binary people’s bodies should be celebrated, just like everyone else. We have sex too, and we’re deserving of enjoyable and healthy sex lives.
It’s easy to test for HIV
Around 7000 people living with HIV in the UK don’t know they have it. The only way to know your HIV status is to get tested. When you know your status, you can get onto treatment and live a long, healthy life and not pass on HIV.
It’s quick and easy to test for HIV, whether in person at a clinic or by ordering a self test online. Find out more about HIV testing.
Try our free online HIV test finder to see what online testing is available in your area.
Visit THT's Sexual Health Page
This article first appeared in Issue 72 of Transliving Magazine.
