A trans man is a person who was assigned female at birth but has a male gender identity. Many choose to undergo surgical or hormonal transition to change their body appearance and alleviate gender dysphoria.
Several participants in the qualitative study discussed experiencing sexual violence or threats. They also described experiences with STIs and HIV.
Stigma
Many trans men face discrimination and prejudice in their daily lives, including being denied access to healthcare. For example, in May 2018, reports emerged of a trans man who was refused treatment at an emergency room for severe abdominal pain when he told staff he was undergoing hormone therapy and sex reassignment surgery. He died as a result of the delay in seeking care.
The study combines data on health seeking behavior, gender identity disclosure in health care, and experiences of discrimination among participants in the 2012 European Union Lesbian, Gay, Bisexual and Transgender Survey with country-level structural stigma measures, consisting of population attitudes towards sexual minorities and national laws on recognition of gender. Results indicate that structural stigma interacts with individual-level risk factors to influence health outcomes.
Stigma contributes to a wide range of health inequities for the transgender community, especially for those who are most marginalized such as people of color and those with lower socioeconomic status. In addition, the impact of stigma on a patient’s experience with their clinician is unique and must be considered in designing effective interventions to reduce this health disparity.
Sexual violence
As this Transgender Day of Remembrance draws to a close, HRC continues to track the deaths of people murdered due to anti-transgender bias. These victims were loving partners, family members, friends and community members. They worked, went to school and attended houses of worship. They did not deserve to have their lives taken away from them.
TGNC people were at high risk of state violence, with 1 in 4 respondents having experienced physical assault from police (rates stable across gender, region and income). 29% had faced legal accusations for not disclosing HIV status, soliciting sex or loitering or being a nuisance. These findings are robust across demographic breakdowns, with rates higher for low-income and racial minority participants.
Individualized stigma and social exclusion resulted in psychological distress, leading to self-harm, substance abuse and suicidal thoughts, which further exacerbated HIV/STI vulnerability. Structural stigma impeded access to gainful employment, resulting in survival sex work. Fear of being exposed to stigma and discrimination hindered uptake of healthcare, including HIV testing services and STI treatment.
HIV
Transgender men often have sex with male partners and are at risk for HIV infection. They also face stigma and discrimination, which can make it more difficult for them to access services that help them stay safe. However, there are now two HIV prevention medications approved for trans people — PrEP (Pre-Exposure Prophylaxis) and Truvada — which can be taken as prescribed to prevent transmission of the virus.
Research into sexual risk and prevention among transgender men has been limited, but this is starting to change. It is important for health care providers to be aware of the risks and challenges of transgender sex, and to understand how to deliver services that are appropriate and affirming.
SELPHI recruited a modest but diverse sample of 118 trans people who have sex with men – 60/40 were randomised to receive baseline HIV self-testing with Biosure(tm) (BT) and 50/50 to 3-monthly HIV self-testing without (nBT). STI testing uptake at 3 months was similar between BT and nBT.
Gender-sensitive healthcare
Medical professionals can help ensure a trans man’s well-being by providing gender-sensitive healthcare. Seemingly small steps, such as using a patient’s preferred pronouns and including gender in intake paperwork, can have a profound impact on a person’s health outcomes. This person-centered approach requires a physician to not pathologize transness and be truly invested in patients.
Having access to affordable, high-quality healthcare is vital for a trans man’s physical and mental wellbeing. However, barriers to care remain. For example, a trans man who has legally changed his gender may be denied a pap smear because the procedure is typically covered under the “women’s health” category.
Padula likens this situation to paying for cystic fibrosis treatment, which isn’t cost-effective individually but makes sense collectively because society has decided it is worth the expense out of compassion. Fortunately, some insurance plans are starting to remove gender-specific exclusions. Those who don’t have private insurance can enroll in state-run safety net programs, such as Medicaid.