Prevention & protection

Harm Reduction for Ourselves & Others: Prevention, Protection, Preservation

Our vision for health justice is having all the tools and information we need to protect ourselves and our sexual partners, and build our families and kinship networks. Health justice is sexual self-determination including the freedom from shame, coercion, or violence. Health justice is having support to become pregnant, to prevent and end pregnancies, and parent our children with dignity. This vision builds on and with the reproductive justice movement.

We provide data about participants’ sexual partners to counteract dangerous myths that Transmasculine people do not need sexual or reproductive health information and services. We use this evidence to demonstrate the need to rethink binary gender concepts in sexual and reproductive health care.

1) Believe us when we say we are trans and straight or gay, etc. don't put us through the process of feeling like we need to prove this to you in order to get care; 2) our partners may also be trans; 3) work on language that focuses on needs not genders, and don't make assumptions about what we do and don't need. just ask casually and calmly as a matter of routine. Do you need birth control? PrEP?

TMSHRJ:LA survey participant​

Sexual Identity AND sexual partners

Sexual orientation / Identity terms

WE ASKED PARTICIPANTS ABOUT THE TERMS THEY USED TO DESCRIBE THEIR SEXUAL ORIENTATION OR IDENTITY. Participants could select multiple categories and/or write in terms.

0 %
identified as queer, pansexual, gay, or bisexual

 

multiple selection QUESTION

queer
70%
pansexual
24%
gay
16%
bisexual
15%
straight
15%
asexual
5%

About 4% of participants selected the term lesbian and 3% selected same-gender loving. Terms that participants wrote in included: demisexual, graysexual, fluid, Free spirit, Gray-asexual, grey-ace, Gynephilic, Heteroflexible, i don’t know, i dont even know at this point anymore!, I love everyone!, Kinky!, Lesbiqueer, mostly into dudes, Queer heterosexual, Quoiromantic, polyamorous, sapiosexual, Trans, Transsensual, and Unsure.

BIPOC

A smaller portion of BIPOC participant identified as bisexual when compared to white participants. 

IDENTIFIED AS BISEXUAL

BIPOC
9%
WHITE
24%
Instead of asking "men, women, or both?" they could say 'what gender(s) are your sexual partner(s)?' or something like that, to show me that it's safe to talk about my non-binary sexual partner.

TMSHRJ:LA survey participant​

Sexual PARTNERS BY GENDER

WE ASKed participants about the gender(s) of the recent and lifetime sexual partners. Participants could select multiple categories and/or write in Terms.

0 %

at least one sexual partner was trans, nonbinary, genderqueer, gender nonconforming, or two-spirit in their lifetime.

LIFETIME SExual partners

% of those who had a sexual partner in their lifetime.

trans men / trans masculine
36%
men who are not trans (cis men)
62%
trans women / trans feminine
21%
women who are not trans (cis women)
84%
non-binary, genderqueer, gnc
54%
two spirit
9%

RECENT Sexual partners

% of those who had a sexual partner in the Past six months (n=231)

trans men / trans masculine
19%
men who are not trans (cis men)
31%
trans women / trans feminine
12%
women who are not trans (cis women)
63%
non-binary, genderqueer, gnc
28%
two spirit
2%
Stop automatically looping us with women and truly understand that gender and genitals aren't the same thing. Stop cisnormativity and its direct assault on trans experiences.

TMSHRJ:LA survey participant​

Sexual FLUIDITY

We asked participants if they noticed changes in their sexuality after taking testosterone.

The majority of survey participants said they experienced changes in libido and sexual activity after taking testosterone. Many participants also experienced shifts in the number of sexual partners and their sexual orientation. Some said they had an increased desire to partner with men or masculine people, some indicated a stronger desire for women or feminine people, and some described being more open or interested in sexual partners of a variety of genders than they were prior to taking testosterone,

after taking testosterone, participants noticed:

Changes in libido
83%
INCREASED SEXUAL ACTIVITY
62%
shifts in sexual orientation
41%
increase in sexual partners
30%
I feel much more comfortable with my body, and so have been much more open to sex, and have let my sexuality blossom. I'm more interested in people of a diverse range of genders because I'm more interested in sex.

TMSHRJ:LA survey participant​

SeXUAL NETWORKING

We asked about whether participants used dating sites & hook up apps to find sexual partners and, if so, what platforms people were using. 

0 %
had a profile
0 %
recently used an app to hook up

 

Most popular sites/apps

among those with a profile

NEGOTIATING Pleasure, HEALTH & SAFETY

connection to self & otherS

We asked everyone if they were satisfied with their current sex life. WE then ASKED THOSE WHO HAD A RECENT SEXUAL PARTNER about how they were experiencing their sexual interactions.

I feel satisified with my sex life

Strongly agree
23%
somewhat Agree
30%
neither Agree nor Disagree
15%
somewhat Disagree
17%
strongly Disagree
15%

when I engage in sex with another person...

I feel free to be who I am

I experience shame about my body

negotiating Safer Sex with partners

We asked participants about their access to information about safer sex and factors influencing establishing safer sex practices with partners.

Safer sex and partner negotiation

I feel informed about how to have safer sex

I feel confident in negotiating safer sex with my sexual partner(s)

My current sexual partner(s) and I agree on how to practice safer sex

I have felt afraid to talk to my sexual partner(s) about safer sex

transactional sex

We asked participants if they had ever exchanged sex for things they needed, like money, food, drugs, or a place to stay. We recognize these as valid survival strategies and as forms of work. We also know that trading sex for survival can make some trans people more vulnerable to harm. Most participants who said they had recently exchanged sex said they did so for money.

EXCHANGED SEX For money, food, shelter or drugs

lifetime
23%
past six months
4%
It's super annoying when [providers] ask if you're having sex with women or men because there are obviously more than two genders and what they really want to know is what parts are going where and what sex looks like for the patient in order to determine risk factors.

TMSHRJ:LA survey participant​

access to testing & preventive medicine

screening in the past year

We asked participants about THE TIMING OF THEIR MOST RECENT PREVENTIVE HEALTH SCREENINGS. Preventive Pelvic exams are generally recommended every five years for those who have a normal PAP test & HPV Screening

A routine physical
64%
HIV TESTING
55%
STI testing
53%
A Pelvic Exam (Pap test)
35%

How comfortable were you when getting your most recent pelvic exam?

Template Pie chart 01: 30% very uncomfortable; 29% somewhat uncomfortable; 8% neither comfortable nor uncomfortable; 20% somewhat comfortable; 13% very comfortable

How likely are you to get a pelvic exam in the future?

Template Pie chart 02: 48% likely. 20% somewhat likely. 11% neither likely nor unlikely. 9% somewhat unlikely. 12% very unlikely.
I am concerned that my anxiety around pelvic exams will keep me from getting check ups and/or medical needs met.

TMSHRJ:LA survey participant​

HIV & STI testing

We asked participants about their most recent test for HIV and other sexually transmitted infections. We then focused on participants who had 2 or more sexual partners in the past six months to better understand gaps in access to care for those with current elevated risks of HIV and/or STIs.

RECENT HIV/STI TESTING AMONG ALL

 

HIV test

in the past 6 months
36%
6 months to a year
20%
over a year ago
31%
NEVER TESTED
14%

STI testing

in the past 6 months
36%
6 months to a year
18%
OVER A YEAR AGO
32%
NEVER TESTED
15%

 

RECENT HIV/STI TESTING AMONG THOSE WITH 2+ PARTNERS in the PAST SIX MONTHS

HIV test

in the past 6 months
60%
6 months to a year
18%
over a year ago
22%
NEVER TESTED
4%

STI testing

in the past 6 months
58%
6 months to a year
20%
over a year ago
22%
NEVER TESTED
4%

MOST COMMON testing siteS FOR THOSE TESTED IN THE PAST YEAR

We don’t need to be the next wave of the HIV epidemic... I think if we bring enough awareness quick enough then we can keep that from happening.

TM HEALTH JUSTICE RESEARCH INITIATIVE: Advisor

Access to PrEP for HIV prevention

we asked participants if they heard of prep, talked to a health care professional about Prep, or been given a prep prescription.  More than half said that they  might take PrEP it were available to them for free, while only 6% had spoken to a provider about PrEP.

has heard of PrEP
79%
meets criteria for PREP*
19%
had spoken to a medical provider about prep
6%
currently taking prep
4%

For a broader discussion of this how we determined criteria for PrEP, see our earlier report Addressing HIV Prevention Among Transmasculine Californians.

Do you know a provider you could ask for prescription for PrEP if you wanted one?

How likely would you be to take PrEP if it were available to you for free.

contraception, pregnancy & family planning

use of contraceptives

We asked about lifetime and recent use of contraceptive medicine for any reason.

About 20% of participants had used emergency contraception in their lifetime, a figure nearly double the estimated 11% of the general population.

Conversely, fairly few had ever accessed long-acting contraceptives such as an Inter-uterine device (IUD). This suggests a gap in access to contraceptive medicine and highlights the need to protect access to emergency options.

LIFETIME USE
hormonal birth control (pill, patch, etc)*
40%
interuterine device (IUD)*
7%
abortion
4%
emergency contraception (Plan b)
20%

* Use of hormonal birth control or IUDs may be used for contraception or other reasons, such as controlling menstruation.

PAST YEAR
hormonal birth control (pill, patch, etc)
11%
interuterine device (IUD)
4%
abortion
1%
emergency contraception (Plan b)
6%
condoms**
68%

** Among those who had the kinds of sex that can result in pregnancy, this is the % of participants who said they used condoms sometimes, frequently, or always.

“When I sit down and think about it seriously, there seems to be so many obstacles in the way of having kids. Not only financial resources, but also just the time to juggle it all. We need community to help with all of it."

TM HEALTH JUSTICE RESEARCH INITIATIVE: Advisor

Pregnancy & childbirth

We asked participants about if they had ever been pregnant and given childbirth. We also asked about access to and interest in future fertility treatment.  we also asked whether participants had recently talked about planning a pregnancy with a partner.

0 %
childbirth in their lifetime
0
birth in the past year
been pregnant
7%
terminated a pregnancy
4%
accessed fertility treatmEnt
2%
interested in fertility treatment in the future
11%
talked to a recent partner about wanting to get pregnant (Question did not specify whether self or partner)
24%
BIPOC

More participants who were Black, Indigenous, and/or People of Color (BIPOC) said that they might be interested in fertility treatment in the future than white participants.

INTERESTED IN FERTILITY TREATMENT IN THE FUTURE

BIPOC
15%
WHITE
7%
“We need to come together and discuss having and raising children as Transmasculine people. We need a vision for reproductive futures that includes us.”

TM HEALTH JUSTICE RESEARCH INITIATIVE: Advisor

key takeaways

0 %
had a sexual partner that was trans, nonbinary, or two spirit in their lifetime
5 %
had used emergency birth control in their lifetime
1 %
had talked to a provider about PrEP although many more were interested
1 %
had given childbirth, but many more were interested
OUr partners