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I Am Transgender and on PrEP: Navigating HIV Prevention as a Trans Man

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By Ryan M. Leach
Photo by Eric Edward Schell Photography

Lou Weaver decided it was time to get on PrEP, or Pre-Exposure Prophylaxis. He called the Legacy Community Health’s Montrose location and made an appointment with a patient navigator—his first step toward making sure he was doing everything he could to prevent the spread of HIV. Weaver is a transgender man, and he wants you to consider getting on PrEP, too.

PrEP is a drug regimen that was approved for distribution in 2012 by the Food and Drug Administration. The brand name for the once-a-day pill is Truvada, a combination of two types of medications that traditionally help fight HIV after infection. However, doctors found that if taken as prescribed, PrEP is over 90 percent effective at preventing transmission of the virus from one person to another.

Although all doctors can prescribe PrEP, many are unaware of the drug or the potential it has to help curb the transmission of HIV. Also, for many people, gaining access to PrEP presents an additional challenge because some insurance providers do not cover it, and without insurance it can cost upwards of $1,300 per month. These hurdles can prove to be insurmountable for many people living under the best of circumstances, meaning they have a job and access to health insurance. For underserved populations like transgender people and the economically challenged, these hurdles are almost impossible to overcome—an unfortunate circumstance, considering these are the people who are most in need of access to PrEP.

Weaver is one of the lucky ones with a job and health insurance. However, he went to Legacy Community Health in Montrose because, through their grant with Gilead, Legacy can provide PrEP to clients at low or no cost. Legacy serves clients who are either with or without insurance. Weaver also wanted to go to a clinic that provided services specific to the unique needs of transgender patients.

Weaver is also lucky because a large percentage of transgender men and women face regular discrimination in housing, employment, and healthcare access. Frequently, transgender women must resort to sex work simply to survive from day to day. These circumstances put this particular population at a much higher risk of contracting HIV and spreading the virus. It is a cycle all too familiar for many underserved populations. Part of Legacy’s mission is ensuring that everyone in the community has access to healthcare, including access to PrEP.

Weaver’s experience at Legacy was similar to the experience most cisgender men and women have. He met with a patient navigator who gathered general information about him, and the reasons he wanted to get on PrEP.

“I wanted to learn more about PrEP for my own personal use and information,” he says, “but I also wanted to go through the experience at Legacy so that I could share what it was like with others interested in learning about PrEP. As a transgender man, it is necessary that I have a doctor who has a clear understanding about how to treat and diagnose transgender patients. Legacy was able to connect me with a trans-affirming physician’s assistant. This made the process much more comfortable.”

When asked about some of the differences a transgender person may expect to encounter (as opposed to a cisgender person), Weaver says, “Well, one major factor is how I talk about my body. I am a man, and my body is unique and different. Some people will use terms like ‘vagina.’ I don’t identify with that word. So when transgender men, for instance, talk about their bodies, they might use terms like ‘front hole’ or maybe ‘bonus hole.’ Conversely, transgender women may refer to their body as having an ‘enlarged clitoris.’ It varies among individuals, but it is a part of how we identify ourselves and our bodies. It is important that a doctor respects and understands that.”

Weaver, like every other patient trying to access PrEP, went through a long and thorough series of blood tests. The tests make sure that Weaver does not currently have HIV or any other infection that might compromise the effectiveness of PrEP. If a person who is HIV-positive takes the Truvada PrEP regimen, it could cause the virus to become resistant to treatment. Weaver also consulted with his doctor to make sure that PrEP would not have a negative interaction with his other medication. In Weaver’s case, there was nothing to worry about.

“Going to the doctor and talking about your sex life is never a comfortable conversation,” he says. “But it was important to me to get all of the information I could to make sure that I am as protected as possible from contracting HIV.”

PrEP is not 100 percent effective in preventing HIV. Doctors recommend that patients using PrEP continue to use condoms. There has only been one documented case, so far, of a man in Toronto who contracted HIV while properly adhering to a daily regimen of PrEP. In that particular instance, he had been exposed to a strain of HIV that the drug did not block. Although his case was rare, it does demonstrate that there is still no perfect cure or prevention for HIV.

PrEP is available for everyone, regardless of gender, gender identity, or sexual orientation. Weaver identifies as queer. When asked what that term meant, he explains that “I am a man who is primarily interested in sex with men, but I don’t identify as a gay man. That feels so limiting. I identify as queer. ‘Gay’ and ‘lesbian’ are gender-specific terms that create a clear binary. To say that I am ‘gay,’ to me, disregards the 38 years of my life that I spent as a woman. I am open to dating anyone. ‘Queer,’ to me, is an umbrella term that describes how I identify in regards to sexual orientation without forcing me to choose to be ‘gay’ or ‘straight.’ I can just be me.

“I want to help make access to PrEP, as well as other health services, more available to the transgender community as well as other underserved communities,” Weaver adds. “More often than not, these are the communities that need the most outreach because they are the most at risk due to circumstances beyond their control. With transgender people, the daily discrimination we face can make simple things others take for granted much harder. Healthcare should not be an insurmountable hurdle. I hope that by getting on PrEP I can help educate others about why it is important and how they too can get help.”

Despite all the apparent positives that PrEP can provide to the community, there are still a large number of people who oppose PrEP as a preventative treatment. They claim that access to PrEP can cause people to become complacent in their safe-sex practices and thereby increase the transmission of not only HIV, but other secondary infections. Since PrEP was approved, terms like “Truvada Whore” or “Truvada Slut” have been used to describe folks who choose to get on PrEP. Weaver responded to that claim: “I am not getting on PrEP because I want to have unprotected or dangerous sex. That part of my life is very much the same as it was before PrEP. PrEP is more about prevention and taking ownership of my own sexual identity in an empowering way.”

For more information about PrEP and how to access it, you can contact Legacy Community Health at 832.548.5221 or legacycommunityhealth.org.

Ryan M. Leach is a community activist, lawyer, professor, writer, and humorist. You can email him at [email protected]

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Ryan Leach

Ryan Leach is a frequent contributor to OutSmart magazine. Follow him on Medium at www.medium.com/@ryan_leach.
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