SELLING PrEP, PART 3

CliniQ Seminar on Sex, PrEP, & HIV

Now that gender dysphoria is classified by the World Health Organisation as a sexual health matter, two sets of activists sit very comfortably alongside each other; the gender identity ideologists, and the HIV positive activists (pushing other gay men to have condom-free sex).

Last year CliniQ held a day long seminar, replete with a plethora of breakout workshops and full catering, on the topic of trans healthcare (see end of this article for my thread from last year*). It had been planned to have another day long event this year, but unfortunately the pandemic has put a stop to that. Instead we have had to make do with 90 minutes of shilling for HIV pharma instead.  

Michelle Ross (she/they), the chair of the meeting and Director of CliniQ, was supportive of the PrEP for all campaign but was annoyed that trans people had been described as ‘hard to reach’. It’s hard to disagree since they are very very easy to reach given the huge number of conspicuous political organisations across the English-speaking world.

Ross said there had been a lack of research into transgender healthcare and even more so of that carried out by trans people for trans people. For example, there was no data available for STIs for the trans-identifying population in the UK, the lack of research into ‘transmen’ was unethical and ‘black transwomen’ had a higher risk of HIV transmission.

The hysterical quote below was presented to demonstrate the importance of making PrEP available. (I’m not sure what protection the masks are giving in this scenario.)

Slide presented

Ross rehashed much of the information that was shared at the meeting last year, that HIV healthcare for trans-identified people is on par with general outcomes but that they are more likely to be under psychiatric care and more likely to be clinically complex. Just 123 trans people were recorded as accessing HIV care in England in 2017 (0.14% of all HIV positive people) if you want an idea of the minuscule numbers of patients we are talking about.

Slide demonstrating differences in mental health

On a brighter note, Ross informed us that CliniQ had won an award junket with the National Diversity Awards in 2019. The patrons of the National Diversity Awards include Peter Tatchell and three minor transgender celebrities, upcoming judges for 2020 include Jake and Hannah Graf. A brief look at the current shortlist reveals a huge number of LGBT people and organisations, many of whom must be having close to zero impact in the wider world. For example, the group below, Trans’pirational, has been nominated in the ‘Community Organisation Award for LGBT’ category – it’s a Facebook group. Just remember these people are being feted as experts.

The presentations

The HIV Activist

Gus Cairns described himself as a ‘cis bisexual man’ who had been involved in HIV activism since before 1998, after which he began working in the field and was HIV positive himself. He first heard about pre-exposure prophylaxis (PrEP) in 2002 and is staff editor at NAM (a charity providing information on HIV and AIDS).

Cairns explained to us that the phrase ‘men who have sex with men’ (MSM) was not an appropriate phrase to describe men who have sex with men (i.e. TW) since research had shown that men who have sex with (trans-identified) men didn’t regard such men as men. In fact, the study found that 85% of such men exclusively chose only trans-identified men for sex, when seeking sex with another man. So, not gay.

Furthermore a study in Peru reported that 97% of trans-identified males (out of a survey of 203) had had male partners who did not consider themselves gay, so nur. One hundred percent of these males had had sex previously with another trans-identified male. Again, this is totally not gay.

In recent times 6 out of 27 studies in HIV research had asked a question about trans and non-binary gender identities. It was difficult to establish the prevalence of HIV in trans-identified people and studies suggested that it may be falling but it was difficult to know. Rates of testing for HIV for trans-identified females was very high (71%) when compared to the statistic for men being tested (88%). (All part of confirmatory behaviour in their roles as ‘gay men’ I expect.)

Cairns also talked a bit about whether PrEP was effective for trans people. For men, there is some evidence to suggest that PrEP affects cross sex hormone treatment, causing oestrogen levels to drop (but testosterone does not rise). There was also a small drop in PrEP protection levels when taken in conjunction with oestrogen. Penile tissue levels had not been studied in trans-identified men (PrEP builds a protective shield in tissue).

He didn’t talk about drug interactions for females at all, but women on testosterone run the risk of kidney damage and liver damage, which are listed as side effects of PrEP, however it’s significant that he concluded that PrEP should only be given on-demand to bi and gay males ‘because we don’t know about the other holes’ (i.e. the protective shield in ‘neo-vaginas’ and vaginas). He also said that there were two very small studies which showed that between 10-20% of trans-identified females were on PrEP and that these were mainly women who were having sex with ‘gay-identified men’.

Cairns presented quite a few slides on the subject of what ‘trans people think about PrEP’ which included several ludicrous statements, but none more so than:

Quote 1:
Like when I went to a city sexual clinic they gave me a piece of paper that said are you a man that has sex with men/ trans woman. And I literally looked at them and was like: ‘Are you comparing a man and trans women on this piece of paper? This is completely ridiculous’.

Quote 2:
Like no doctor has really asked me if my dick still worked or if I could top with it, unless I bought something up about it.

Two quotes from Cairns’ slide

The Trans Activist

Erika Castellanos is Director of Programs at GATE (Global Action for Trans Equality), yet another NGO which is promulgating gender identity ideology and describes itself as ‘Trans, Gender Diverse and Intersex Advocacy in Action’. Its key areas are working with the United Nations, declassifying gender dysphoria as a mental illness, and HIV. They are currently seeking researchers to investigate ‘UK Radical Anti-Gender Organizing‘.

Erika talked a lot but didn’t have much to say that was of interest. Erika is HIV positive, doesn’t think that trans-identified males should be in the MSM category, not just because this affected PrEP uptake but also because of the gay thing, and that abnormal liver function tests as a result of the combined drug regime needed further data. (Ross said the nuance of this data needed to be ‘informed by trans people’.)

The Cos Player

Max Appenroth (they/them) is also involved with GATE, as Project Co-ordinator for Trans Men and HIV. The group is made up of 23 female activists and researchers from 18 countries who all identify somewhere on the spectrum of gender identity from non-binary to transman.

Max wasn’t happy because ‘transmen’ were not included in the MSM definition. The main barriers to research for trans-identified females were that there was no biomedical research due to lack of sufficient sample sizes. It was found that females had poor negotiation skills in asking men to use condoms and that no condom use was also used as leverage to recognising them as ‘real men’ (‘I will only have sex with you if …’).

Using testosterone can cause vaginal atrophy which leads to the development of small fissures. Thinning of vaginal tissue increases the likelihood of sexually transmitted diseases and infections. Males and females have different presenting symptoms with regards to STDs, meaning that women on testosterone could be misdiagnosed. The way PrEP works is to build up a shield in the tissue of the vagina/rectum. Any kind of thinning of the tissue means the protective effect of PrEP is reduced. The issue of vaginal tissue thinning of women on testosterone had not yet been studied.

Appenroth claimed that barriers to PrEP included not being given the right information, that trans people lived in poverty and couldn’t afford it, lack of access to health care and exclusion from trials. On the slide she did at least mention the drug interactions potential. No study into the tissue of neo-phalluses or neo-vaginas had been done.

The real meat of her presentation though was griping about gay men on Grindr and gave some examples of what men had said to women using the service. I haven’t been on Grindr so I can’t comment how typical the comments are. The one below is certainly not polite, but it’s fairly mild compared to what you might imagine.

So u have a vagina?
Ur not a man
Can’t stand trans idiots on here
Ur not a real man
U never will be
Yes I’m a mysoginist and proud of it
Get off this app

Comment from Appenroth’s slide

Appenroth told us on Instagram there is a hashtag #transmenongrindr, hinting there were horrors, so I went and had a look. Yeah sure, some of the messages aren’t nice, but given that Grindr is a sex app for gay men it could be so much worse. It’s notable that several are polite. It suggests that most gay men won’t allow themselves to be rude and aggressive when dealing with someone they perceive as female. The prim and proper responses of the women suggest that the rough and tumble of Grindr is just too much for them. It seems like people can’t really break out of their conditioning, even when their whole lives are based around non-conformity.

Appenroth also quoted a study (couldn’t read the small print of which one) that more than half of trans-identified females had experienced sexual violence.

The group is asking that treatment of trans people is based on physical needs (i.e. completely individualised), not biological sex or legal sex. Referring to men as ‘cis men’ would help with inclusion. Deconstruction of the patriarchy by gay and bisexual men was necessary. And, of course, the repeated demand that ‘transmen’ should be included in the definition of MSM.

The transman with HIV

A trans-identified female was on the call who was living with HIV. Eli told us that early in her transition her GP warned her against going on testosterone because of the drug interactions with anti-virals. She felt that not transitioning posed more of a risk to her and the GP finally agreed to do a shared care arrangement. She experienced ‘subtle transphobia’ at her first HIV clinic because they had recorded her sex as female, so found a new clinic which focussed on young people. Eli says that she has had to educate her doctors (yes, that old chestnut) on the potential interactions between testosterone and HIV drugs. Often trans people are too scared to go to clinics because of the fear of misgendering. She was not happy that health professionals asked probing questions about her sex life (which Appenroth agreed with).

It wasn’t the job of trans people to make themselves seen, it was the job of the rest of the world to notice trans people and make it known that they are wanted and that we should ’embrace’ them ‘in everything you do’. Eli finished on ‘please embrace trans people because we’re an amazing group’.


The battle for language

Honestly when I signed up for this seminar I thought it was about PrEP. It was only when I began to write it up that I realised that PrEP was the side issue. The real issue is the battle for language. The term ‘men who have sex with men’ (MSM) was coined so that men who had sex with men didn’t have to admit to a homosexual identity. This, apparently, made it more likely that they would seek health advice and testing for HIV. You can disagree with its inference but it is a factual sentence which neatly describes a reality.

There was no time for a Q&A but there was one question following Cairns presentation about the importance of accurate language in clinical situations. Cairns claimed that it was answered during his presentation but I didn’t hear it.

Of course there was no mention of condom use to prevent the spread of STIs, no discussion of the long term effects of taking PrEP, especially in conjunction with cross sex hormones. Quite simply the stated need for PrEP promotes the idea that transgender people have sex all the time and provides a reassuring note to those on the precipice of ‘transition’.

Gender identity activists want complete control of language so that ‘men who have sex with men’ phase would cover:

  • two women having sex if both identified as male
  • a man and a woman having sex, if the woman identified as male
  • BUT NOT two men having sex if one or both identified as female

So we can’t even say that the phrase is simply changed to ‘people who have sex’, it’s a complete and total mangling of language. It seeks to eradicate the language used to describe homosexuality but also covers up homosexuality. This could be funny but for the fact that the people involved on this panel are working for organisations which receive public money and are really influencing public health policy.


*My thread about last year’s event from Twitter.