Background : Sexual health research with transgender men and people on the trans masculine spectrum has generally focused on risk reduction within existing disease prevention paradigms, particularly HIV. While trans masculine inclusion is crucial to a comprehensive HIV response, emerging categorizations tend to narrow the frame of inquiry and reassert gender binaries. As “transgender men who have sex with [cis] men” and “gay and bisexual trans men” increasingly enter the epidemiological terrain of HIV prevention, how might we leverage resources for holistic and social justice approaches to sexual health? This presentation draws on findings from the Transmasculine Sexual Health and Reproductive Justice Research Study (TSHRJ-LA) survey, part of a community-based participatory action research project in Los Angeles County, to reflect on challenges and potential directions within and beyond disease prevention.
Methods: The TSHRJ-LA survey was a collaboration between Gender Justice Los Angeles, the City of Los Angeles AIDS Coordinator’s Office, and the University of California, Los Angeles, Department of Social Welfare. The survey was created through a community engagement process and conducted online in July–August 2017. The 309 participants were trans masculine adults who lived, worked, or received services in Los Angeles County. They were ages 18 to 67, a majority low-income and people of color, and diverse in gender and sexual identities. We used descriptive findings to explore the adequacy of common proxies used to assess sexual behavioral risks tied to HIV transmission (e.g., sexual orientation, partner gender). We further examined sexual health-related risks that may be eclipsed by the emphasis on disease prevention, such as sexual violence, and then used bivariate tests to examine factors associated with a positive sexual health outcome.
Results: Sexual risks for HIV did not adhere to participants sexual orientation or partner gender, and more than 40% described one or more partner in the past six months was trans, nonbinary, gender non-conforming, or two-spirit. Among other sexual health-related outcomes examined, participants reported profound rates of experiencing sexual violence over the life course (71%) and in the past year (12%). About half of participants were satisfied with their current sex life (52%), and a greater portion of these participants were confident negotiating safer sex, agreed with their partners about safer sex practices, felt freer to be themselves during sex, and had better self-rated general health.
Conclusions: Diversity and fluidity in sexual partnering among trans masculine people pose an exciting challenge for sexual health research frameworks both within and beyond disease prevention efforts. We offer lessons learned toward holistic sexual health research and practices, highlighting the need to better coordinate HIV and violence prevention and response strategies including culturally-responsive survivor advocacy by and for trans masculine people.