Ayden Scheim Western University & GBQ Trans Men’s Working Group, Ontario Gay Men’s Sexual Health Alliance TRANS-FORMING HEALTH CARE FOR TRANSGENDER MEN

We are meeting on the traditional and unceded territory of the Coast Salish Peoples, including the Musqueam, Squamish, and Tsleil-Waututh Nations. I have no conflicts of interest.

 Heterogeneity of trans health and HIV regionally  No seroprevalence data for trans people in Canada  Patterning of HIV epidemics  Care organized differently (single-payer public insurance in Canada)  Most provinces provide some coverage for transition-related surgeries  Explicit and implicit trans human rights protections CONTEXT

 Limited, low-quality data regarding HIV prevalence, risk, and sexual behaviour of trans men globally  In Ontario, 63% were gay, bisexual, queer or MSM (Bauer et al., 2013) ; similar findings in the U.S.  Only 1/3 of this group had sex with cisgender men, of whom 29% had high HIV sexual risk (Scheim et at., manuscript in preparation).  Primarily high-risk receptive genital sex  For those having sex with cisgender MSM, HIV prevention services required TRANS MEN & HIV

 Access to transition & primary care  Varies greatly by region; wait times; costs for uninsured services  Access to HIV/STI prevention & testing “I was like, ‘what do you do for cis gay men?’ And they were like ‘oh, well for men who have sex with men we do an anal swab and a urethral swab’… and I was like ‘why did you never offer any of those to me?’ and they were like ‘well, you’re not a man who has sex with men’.” --Trans MSM Sexual Health Study participant (quoted in Scheim et al., 2014)  Data to inform prioritization and delivery of services CHALLENGES & GAPS

PRIMARY CARE

 Gay, Bi, Queer Trans Men’s Working Group, Gay Men’s Sexual Health Alliance  Founded in 2006 to address trans men’s inclusion within provincial gay men’s prevention strategy  Published Primed sexual health guide  Carried out a needs assessment and initiated follow-up community-based research study  Developed a sexual health group for trans men with AIDS Committee of Toronto  Consultation re inclusive services & research HIV TESTING & PREVENTION

TRANS MSM INTERVENTIONS  TM4M, San Francisco, USA  Trans Men’s Group, AIDS Committee of Toronto, Canada  Lifeskills for Men, Fenway Health, Boston, USA

DATA  Community-initiated and community-based research  Trans MSM Health Study in Ontario  Intervention studies  Transmasculine Sexual Health Collaborative (HPV/cervical cancer screening)  Inclusion in MSM research studies  Momentum in Vancouver  Global Men’s Health and Rights  Capturing trans status in HIV test surveillance data

BURNING QUESTIONS  Trans MSM in the global south  Combination prevention for trans MSM -- access to PrEP, research on effectiveness  What would appropriate resource allocation to trans MSM HIV prevention look like? Mindful of:  Continued underfunding of response for trans women  Increasing integration in broader (cisgender) MSM communities  Reliance on HIV funding for other needed services and community development

THANK YOU  Organizers and sponsors  GBQ Trans Men’s Working Group  Trans PULSE Project  Research funders: Canadian Institutes of Health Research, Trudeau Foundation, Vanier Canada Graduate Scholarships Contact: