If you are a pre-op or non-op transfemale, substitute penis for vagina and estrogen for testosterone and read the above questions again, then think about your answers. Are we setting up our own barriers to proper HIV/AIDS prevention and treatment as well as other necessary medical care?
Certainly there are things that are nobody's business and, as trans people, we don't need to discuss every personal issue with everyone we talk to. But if we're not informing our health care and service providers about our bodies and what we do with them, we're creating a situation that could prevent us from getting adequate information about, and treatment for, various health-related conditions. Yes, we want our providers to be educated on trans issues, and yes, we are tired of doing some of that education, but we can't expect more from our health-care and service providers than we are willing to give ourselves. What kinds of things should we as trans people be aware of when thinking about protecting ourselves and others from the spread of HIV/AIDS?
First, let's look at hormones. The majority of transmen and many transwomen are using needles to administer testosterone and estrogen. Twenty cents may seem like a small price to pay for a sterile, fresh needle, but when you don't have it, there isn't much difference between twenty cents and twenty dollars -- hence, needle sharing occurs, which we all know can be a dangerous practice. If you are sharing needles, talk to your provider about getting a bleach kit, learn the correct way to use it, and use it every time you share a needle. Even if you're not sharing needles, if you are sharing a vial, make sure you don't stick a used needle back into the vial for any reason.
In order to protect your health, make sure you know where your hormones are coming from and who is administering them to you, if you aren't doing it yourself. Non-reputable people who are offering hormone shots are generally not concerned about how many times they use a needle or how many used needles might have been reinserted into a vial.
And we all know that some shots are gushers. If you are HIV positive, it's important to protect others who might be giving you a shot. Health care providers generally use protection, such as gloves, but partners, friends, or acquaintances who are helping you might not think about it. A few minor precautions can protect you and those around you when you're taking hormones by injection.
And when you're thinking about sex (don't lie, you are), think about the needs of your transsexual body. If you have a vagina and are using it, you need to be aware of the extra risk of tissue tears for certain vaginas. The use of testosterone can cause the vagina to become dryer, shorter, and less flexible, thus making it more vulnerable to tears, which can be an entry point for HIV or, if you're positive, a way for you to transmit the virus. Surgically constructed vaginas don't self-lubricate, also making them more prone to tearing. So whatever you're packing, pack some extra lube.
If you are factory equipped with a penis and you tuck, the skin of your dick can sometimes become chafed and cracked and even bleed, which provides an entry point for HIV or a way for the virus to be transmitted if you're positive. If you have a surgically constructed dick, be aware of infections that can cause blood or pus to form.
In reality, any of these risks can be significantly lessened with the use of protection -- a male or female condom. But some of us aren't using them. Why? There are a variety of reasons, none of which really stand up under scrutiny.
Internalized transphobia: "I don't deserve to stay healthy" or "I'm basically worthless, so who cares if I get sick and maybe die." This one is tough to deal with. If you're feeling worthless, if you're feeling self-hatred, if you don't think your life is worth saving, then professional help is definitely warranted. Ask your health care provider for a therapist recommendation, or call your local gender center or GLBT services center.
More internalized transphobia: "I finally found someone who doesn't care that I'm trans. I'm not going to screw this up by insisting on using a condom." This also stems from self-hatred -- as if you are darn lucky that anyone wants to have sex with you. But how lucky could you be if your potential sex partner doesn't care about your health or his or her own?
Validation as a gay man: I have heard some gay transmen say that becoming infected with HIV will validate their gay male identity. It will also necessitate coming out twice to potential partners -- as a transman and as an HIV-positive man. And because both testosterone and HIV medications (and most medications) are processed through the liver, if the liver is damaged, it can come down to a choice -- HIV meds or hormones. Do you really want to make that choice?
Problems with genitalia: In some cases, this is just more self-hatred, and in others, it simply goes along with being trans, but in either case, if it is difficult for you to acknowledge your genitals, you might also find it difficult to look at or touch them in order to protect yourself and others. Applying a male or female condom makes you that much more conscious of genitalia that you might want to forget. This is a tough one, and if it is preventing you from using protection, you may want to consult with a therapist or another provider.
Uneducated/untrained providers: Your provider won't know you're injecting hormones unless you reveal it. Your provider won't know you don't have a dick/vagina unless you tell him or her. If you have not come out as trans, and your provider is talking to you about body parts you don't have or discussing sexuality in a way that doesn't apply to you, the only way you can correct it is to be honest about who you are and what your needs are. Many HIV/AIDS centers are trans friendly and will give you the opportunity to identify yourself on an intake sheet or in an initial interview. But the majority of health care providers still don't do this. It's up to all of us to take responsibility for our own health and to make our providers aware of our needs. When we are honest, we are more likely to get the advice and the care that can keep us, and our sexual partners, healthy.
Matt Kailey is a female-to-male transsexual, an author, public speaker, and workshop facilitator focusing on gender and transgender issues. He can be reached at FtMatt@aol.com or through his Web site at www.mattkailey.com.
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