Mx. Harrington met with their healthcare provider the very next day, and while the provider agreed to give them post-exposure prophylaxis (PEP) - a month-long regimen of medication taken after coming into contact with HIV - they denied their pleas to be put on PrEP, despite their being in a queer MSM serodiscordant (read: one partner has HIV) relationship. Now, Harrington helps all members of the LGBTQI community, as well as women of color, non-monogamous and polyamorous people, and sex workers, get access to PEP and PrEP for HIV prevention.
“As a provider, if one of my patients makes a case for starting PrEP, I believe them,” Harrington said. “I also do a risk assessment that’s significantly more comprehensive than most of my professional cohorts find necessary.”
Queer Sex and HIV
Both Harrington and myself agreed that one of the major healthcare system pitfalls still impacting AFAB folks today is a complete ignorance of how queer people have sex and, in turn, what risks they’re actually exposing themselves to. All too often a medical professional hears a patient identify as “lesbian” or say that the majority of their partners are “women and trans men” and subsequently makes an assumption that the patient is not a PrEP candidate based on their limited understanding of how AFAB people love and fuck. In stark contrast, Harrington tries to set an example for what providers should be asking their patients.
“When I take a sexual health history for a patient, I ask the exact same questions of each person regardless of their gender or sexual orientation: ‘How would you describe the genders of the people that you like to date and have sex with? When you engage in sex, what parts of your body do you use? When you engage in sex, how often do you use safer sex practices and for what acts?’, and so on and so forth.”
“When it comes to HIV, it’s less about who you’re having sex with, and more about how and where you’re having sex,” Harrington added. “For example, we see higher rates of transmission among African American populations in part because their communities and networks are more intertwined and have more members affected. Even though POC typically have fewer partners than whites, the larger pool of people affected means that any unprotected sex is riskier. Sadly, many don’t know they are HIV positive because stigma prevents folks from getting tested and linked into care.” Harrington went on to say, “Yet the fact remains, if we’re having unprotected sex and being exposed to our partner’s sexual fluids, it means we’re at risk. Period.” .”
This resonated heavily with me, as on a recent visit to my doctor’s office to obtain a surgical referral for a tonsillectomy, I somehow found myself demystifying queer sex for my nurse practitioner simply because I’d mentioned I have transgender partners. Sadly, this wasn’t an atypical experience. Queer AFAB patients are constantly being put in positions where they’re shouldering undue amounts of emotional labor to educate their own healthcare providers. It's a substantial burden to place on marginalized people, but in 2018, it’s also an embarrassment.
People with vaginas can be susceptible to HIV through both anal or vaginal sex, and not just in the ways one might think. HIV can be spread via blood, semen, pre-seminal fluids, rectal fluids and vaginal fluids, and while unprotected receptive penetration with a penis has been responsible for the highest transmission numbers, having unprotected oral or manual sex can also put you at risk. Let’s say that I decide to go down on my HIV positive, cis female partner’s genitals while I have an open cold sore on my lip. Or that I decide to put my fingers inside my HIV positive trans masculine partner’s vagina while I have an open cut on one finger. Again, the risk of transmission is smaller, but by no means is it insignificant. Add to that the that the vast majority of medical providers still define sex as limited to “penis in vagina” or “penis in anus,” and you can clearly see how queer AFAB are being made invisible when it comes to HIV transmission risk.
HIV Research and AFAB People
Fortunately, though, things are looking up in terms of increased research around HIV transmission and prevention within AFAB demographics. We’re seeing relevant epidemiological statistics becoming more accessible to women and trans men, and there’s also been a significant push to create more marketing and promotional strategies around advertising PrEP to demographics who historically have been convinced that they weren’t “high risk enough."
It's a start.