In response to mounting evidence of the prevention benefits of pre-exposure prophylaxis (PrEP) use by HIV-negative gay and bisexual men, a discussion recently emerged on social media about the perceived exclusion of trans men1 who have sex with men from PrEP research studies.
In fact, trans men participate in many HIV prevention research studies, whether or not they are identified as trans when results are reported. Some do not identify as trans, but rather as men of trans experience or transitioned men, and are happy to check the “male” box without qualification. Other studies have explicitly included trans men and allowed them to self-identify. Regardless, some were upset that when results were reported, PrEP effectiveness among trans men was not addressed. In response, a number of well-intentioned non-trans men voiced their support for greater inclusion of trans men in biomedical and other HIV prevention research. While these statements are a testament to the progress gay and bisexual men’s communities are making in embracing men of trans experience, I feel compelled to offer a reality check about the inclusion of trans men in HIV prevention research.
It’s cold in Thompson, Manitoba. The snow squeaks and the roads are nearly pure ice; everyone drives a truck up here. I’ve arrived here to do a three-day training alongside Gina McKay from Sexuality Education Resource Centre and Carrie Pockett from Play it Safer Network. With some resources from Keewatin Tribal Council’s Adele Sweeny, we’ll be spending time with 25 people from 16 First Nations communities in the area.
Recent developments in prevention are pointing to worrying gaps in the community-based approach to HIV prevention in Canada.
Perhaps we have been used to having only a single prevention technology on our books for so long – think condoms – that our ducks are not always in a row when new ones like PrEP come along. Thus potholes in our response become apparent – and none leap in to fix them.
After a series of somewhat inconclusive PrEP trials, whose results were marred by adherence issues, the results of more stringent trials like the PROUD and IPERGAY studies are in, and they are good. So good, in fact, that it would now be foolish not to put PrEP right at the front of the shelf that features ways to stay HIV-negative.
What happens when much of your life is built around a particular position or identity, and then that identity changes?
In 1993, while in the hospital having my daughter, I was diagnosed with hepatitis C. Three years ago, I did the ribavirin and pegylated interferon treatment and cleared the virus. It’s very cool to be living virus-free after 25+ years of being positive, but it is also kind of weird.
In Canada and in much of the Western world, thanks to the advent of combination antiretroviral therapy, there has been a clear improvement in health status and increased life expectancy of people living with HIV approaching that of the general population. However, despite these medical advances, negative public perception about HIV has yet to catch up to the reality that most clinicians encounter. The reality for the most part is of healthy and conscientious patients looking to improve their quality of life.
The CATIE Blog hosts the views and opinions of people and organizations working and volunteering in Canada’s response to HIV and hepatitis C.