by Alex Jacobs
“You’ve caused quite a debate in the office today,” the nurse tells me. Earlier, while she was taking my blood, I mentioned during our conversation that I am trans. Seeing my confusion, and worried that she might have offended me, she quickly adds “Oh no, not like that!” The nurse smiles sympathetically. “It’s just that, well, we don’t tend to see many patients like you.”
For trans people, this type of experience in medical settings is all too common. The absence of research about the specifics of our healthcare, plus a lack of training, often means that even the best doctors can be uncertain when it comes to our treatment. For me, accessing PrEP was no different.
PrEP (Pre Exposure Prophylaxis) is a drug designed to reduce the chances of getting HIV for people who are at a higher risk of exposure, including men who have sex with men (MSM), injection drug users, and sex workers. Thanks to the efforts of HIV activist groups, over the past few years, PrEP has become available on the NHS in the UK. Those who meet certain criteria can access it through a sexual health clinic. As a queer trans man, I felt that it was important for my health and peace of mind to get on PrEP. Moreover, studies have shown that the drug is safe for transgender people to take, and does not interfere with HRT.
Nonetheless, there are still obstacles to accessing PrEP as a trans man, trans masculine person, or non-binary person. The primary issue is the significant lack of research; there are no clinical trials that include us as a specific group, for example. This certainly influenced my experience: the “debate” that the nurse was referencing was about which form of PrEP was best for me to take as a trans man who doesn’t have front hole sex.
You can take PrEP in two ways: as a daily pill or using event-based dosing (EBD). The difference between these methods is similar to the difference between regular contraception and the morning after pill, except that with EBD you also need to take pills 2 hours before having sex. The staff at the clinic, including the head doctor, were unsure whether I would have a sufficient level of protection if I used event-based dosing. There is no official guidance from the NHS about EBD for transgender men, and information from other sources is often vague or conflicting.
The doctor therefore advised me to follow a daily dosing regimen, to be on the safe side. I mention this anecdote not as an indictment of the staff at this clinic (who were all extremely helpful, patient and kind towards me) or the NHS in general, but more to indicate how the lack of medical understanding and study of transgender people has considerable impacts on our lives and healthcare.
I walked out of the clinic with a bag of pills and condoms in my hand, feeling relieved and a little bit lighter. Despite the issues that came up, I would certainly recommend looking into PrEP for any trans person who feels like they might benefit from it. As well as feeling safer and more in control of my sex life, taking PrEP has made me feel more affirmed in my identity as a queer trans man. Below, I’ve offered some general advice for trans people who are wondering if PrEP is right for them, and some further resources on PrEP and trans people. (Disclaimer: I am not a doctor, so please speak to a medical professional if you have concerns, questions or want to find out more!)
If you are a transmasculine person who has sex with cisgender men (especially if you don’t always use condoms), it’s worth looking into PrEP. Although the numbers have fallen in recent years, MSM still make up one of the largest groups of new HIV diagnoses in the UK.
Doing your own research is important for any medical treatment, but especially for transgender people. Often (as many trans people are aware), doctors don’t have much experience in treating trans patients, so it helps to be prepared.
Having said that, more often than not, sexual health clinic staff are pretty good. In my experience, I’ve usually found that they are more open, sympathetic and non-judgmental than any other group of NHS practitioners that I’ve come across.
A reminder that PrEP will NOT protect you against other STIs, such as syphilis or gonorrhea, so it’s important to get regular sexual health checks. For some trans people, this can sometimes be a difficult or uncomfortable experience. It helps me to think of it as an act of self-care and self-preservation; try to find something that helps you. This webpage has some more information about taking care of your sexual health as a trans person.
Further resources:
A general guide to PrEP: http://bit.ly/PrEPiBase
CliniQ: https://cliniq.org.uk/pep-prep
Terrence Higgins Trust: https://www.tht.org.uk/hiv-and-sexual-health/sexual-health/trans-people/trans-masculine/prep-and-pep
Alex Jacobs is a Bristol-based writer and poet. He tweets at @its_alexj and writes at https://alexjacobs.substack.com