By: Ann K. Avery, MD, Infectious Disease Physician at MetroHealth Medical Center
Being at risk for HIV is less about what or who you do and more about how you do it. If you’re not sharing needles and you’re not having sex without condoms, PrEP, or other forms of protection, then you are not likely at all to get HIV.
Sounds simple, right?
But it isn’t always simple for people because life isn’t always that simple, especially if you’re transgender. Being trans in the U.S. sometimes means you have to face a lot more hate, pressures, and barriers in life than other people. Because of these challenges, trans people may turn to risky behaviors — like sex work or drug use — that increase their risks of HIV.
If you’re trans, we want you to know that you are beautiful and loved for who you are. Because we love you, we want to share with you seven key ways you might overcome those pressures that can put you at greater risk for HIV.
1. Get some allies and supporters
Having people in your life who love and support you for who you are is worth more than any amount of gold. You might be able to meet like-minded people by joining a support group for transgender people. It’s good to have people who can counsel you and help you to face the emotional ups and downs of life.
Not being accepted can make people feel isolated and ruins their self-esteem. When you’re all alone, it’s like going through life wearing glasses that are fogged over. Friends, allies, and supporters clear off that fog and help you see your own value.
2. Transition out of sex work
If this doesn’t apply to you, by all means, skip this one and keep reading below! Transgender people often have a hard time finding a job, so sometimes they become sex workers because they need the money.
You gotta do what you gotta do to get by, of course. But just keep in mind that every time you have unprotected sex for money, housing, food, or anything else, you’re increasing your risk of getting HIV.
Nobody’s saying you have to quit right now — but we like you and encourage you to start looking for safer ways to earn a living and take advantage of them when you find them. Did you know that MetroHealth, in Cleveland, Ohio, has an annual Transgender Job Fair every spring?
There are other ways to make money, honey. If you need help finding the right fit, turn to your allies, friends, social worker, or other supporters for guidance and ideas. Sex work isn’t your only option. You are strong and capable. You got this!
3. Insist on condoms
This is a very tough call (especially for sex workers). If you’re the receptive partner, you might not feel safe or able to ask your partner to use a condom. Sometimes this means less money, and we get that.
But if you’re engaging in condomless sex, the risk to your health goes way up. A simple condom will go a long way in protecting you.
Insisting on a condom says your right to exist outweighs somebody else’s preference for bareback sex.
Come join our private, stigma-free, supportive community.
Health management tools with medication & appointment reminders.
Social networking in a community conversation & private chats.
4. Prioritize health over hormones
There is nothing wrong with hormone therapy. You have every right to have your outward appearance match with who you are and how you see yourself inside. But sometimes people go about it the wrong way by sharing or reusing needles. When they do this, they could expose themselves to HIV or other health problems in the process.
We know you need and deserve your hormones, but buying them off the street can be shady and sharing needles is super dangerous. We hope you’ll consider seeking out a doctor who can help you start and manage your hormone therapy so it’s safe and effective. If you’re looking, MetroHealth has an excellent Pride Clinic with providers who are well versed in every aspect of trans health.
5. Get on PrEP
PrEP is short for pre-exposure prophylaxis — it’s a once-daily pill that can prevent you from getting infected with HIV.
Its side effects are minimal, and it’s fairly easy to get. If you need help finding the right PrEP doctor or want to learn more, check out the Cleveland PrEP page or click your way on over to Ohio PrEP.
If you’re trans, it is a good idea to make sure your doctor knows if you’re on any kind of hormone therapy before you start taking PrEP.
6. Get tested regularly
It’s easy for somebody to tell you: “Just take an HIV test.” It’s harder to do when you already have so many pressures in your life.
Maybe you don’t want to know you have HIV. But that just makes things worse. The sooner you know your HIV status, the sooner you can get on with your life.
Not sure what testing is like? Read our blog on what happens in an HIV test.
7. Keep putting yourself first
You know it’s important to BE yourself, but sometimes it’s hard to PRIORITIZE yourself.
A lot of the pressures that elevate HIV risk come down to other people thinking they have a right to define who you are — or to disrespect you because you’re different.
If they want to be that way, that’s on them. Once you make up your mind that you and your health comes first, you’ll be in a better place. Don’t be afraid to stand up for yourself and avoid (or at least reduce) the pressures to do risky things. Not sure you can do it alone? Reach out for help, we got you! Try the Trevor Project’s 24/7/365 hotline. There’s always someone to talk to.
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