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Jess Bradley and Francis Myerscough write about trans time, transition, and demands, as part of Action for Trans Health’s series on trans mental health and activism.


Time works differently for trans people.

And its not because we are always late to things. (Although this might be a factor).

Cis people might not notice it, but we live in a different time zone. To them, our words, behaviours, our actions all happen in the present tense. To us, though, cis people sound… glitchy. Like hearing a CD skip ever so slightly or catching the delay between audio and video on an old laptop.

Trans people are time-travellers. (This explains why we never look, nor act, our age).


Everytime I cross the road I expect to be run over. I’ve never been run over before, and “rationally” I know its unlikely to happen in the future. But still I find myself either sprinting across the road when its quiet, or waiting to cross the road with the pregnant lady so no-one ploughs me over. My obsession over road crossing is just one area in which my anxiety from living in a transphobic society coalesces outwardly into something which other people might recognise as weird.

For most trans people I know, anxiety is a constant companion. Sometimes it comes over us like the photo-negative of a sugar rush, intense, whilst other times it sits quietly but presently in the background. And when its not there, we anticipate its arrival.


We live in a time of anticipation.

We anticipate misgendering, perplexed looks, ignorance, transphobia. Even when what we anticipate does not occur (yet), we act as if it has, and it becomes an inevitability.

I think it has something to do with waiting lists. My whole life seems to be about waiting lists nowadays (even if I am not on one yet – I am waiting to be on one). We are kept in a constant state of anticipation: waiting for a letter or phonecall from the GIC, a prescription, a surgery date…

We are used to waiting, orientated towards the future like iron filings lining themselves up towards a magnet. We are focussed on the future whether that’s the future where we have already had access to healthcare treatment, or the future where the (seemingly inevitable) acts of transphobia have already taken place. Because we are always waiting for this future the present seems compressed somehow, like our lives are in limbo.


But looking to the future can also be positive.

Creating change requires us to live in a state of anticipation. It seeks to build a politics of hopefulness rather than of dread, preparedness rather than an anxiousness. Its not a naive hopefulness that ignores the very real harm that can come to us, but a strategic hopefulness. One that recognises that the way we think about the future has an impact on the present.

This isn’t about positive thinking or some individualistic bullshit. Its about the importance of making collective and radical demands. Demands are anticipatory. They stretch out, open palmed to the multitude of possible futures ahead of us and beckon them closer. They turn the ambiguity of anxious anticipation into a foundation that can be built upon.

What are your demands?



We can now accept donations!

Help us to provide access to essential healthcare today.

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As part of Action for Trans Health’s work, we raise money to give small grants to UK-based trans individuals in order to help facilitate their access to health care. As demand for grants will always outweigh supply, grants will be allocated to those with the greatest need. We are looking to recruit three people to sit on our funding panel whose job it will be to allocate grants from our solidarity fund to applicants.

The successful candidates will be organised, work well with others, and be able to demonstrate an understanding of systemic oppressions such as racism, ableism, and trans-misogyny. We are particularly keen on hearing from women, people of colour, disabled people, non-binary people, working class people and people from other marginalised groups within the community. We are only looking for applicants who define as trans or have a trans history.

The panel will meet remotely via skype/google hangouts to allocate funds to applicants a 1-4 times a year (dependant on how much money we manage to raise). It is expected that these meetings will take approximately 3-5 hours. For this time, you will be remunerated at £10 per hour. Each term of office lasts one year.

If successful, it is expected that you will not be applying for a grant from the solidarity fund. It is also expected that you will declare any conflicts of interest (for example, if you know that friends or family members are applying to the fund) before each meeting. We will not be publishing the names of people elected to the funding panel and we will keep your application details for this role confidential within Action for Trans Health’s board of trustees.

Please fill in this application form to apply for the role.

Application Deadline: Monday 23nd of March 2015 at 9pm.
If you have any other questions about the role please contact

We can now accept donations!

Help us to provide access to essential healthcare today.

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A few months ago we asked you to help us out with some important research looking into the experiences of non-binary people accessing healthcare. Since the survey ended, hospital we have tallied up your answers, site coded them, about it and started making some preliminary recommendations for a non-binary protocol. We wanted to ensure this process is as open and accountable as possible, so we are making the preliminary results available now and opening up a period of consultation to crowdsource recommendations for policy. If you have thoughts about what needs to go into the non-binary protocol, please get in touch by filling in this form or emailing info[at]

content note: discussion of medical transition, some quotes discussing transphobia and non-binary erasure, some transphobic slurs mentioned

A note on methodology and statistical significance: the participants for this piece of research were recruited from Action for Trans Health through social media and personal contacts. This is not a random sample and as such should not be seen as representative of the entire nonbinary community, but instead as a useful piece of research into the dominant narratives underpinning non-binary peoples experience(s) of accessing healthcare services. The results are shown below.

If you find the images in this post difficult to read, you can download the results in powerpoint and spreadsheet formats. All data is anonymous.

number s nbs gender identity nbs


specific id nbs sex at birth nbs healthcare nbs concerns nbs denied treatment nbs service used nbs out nhs nbs nhs exp out nbs experiences nhs nbs out private nbs experiences private nbs experience private out nbs self med nbs self med exp nbs self med reasons nbs self med exp quotes nbs campaign ideas nbs campaign quotes nbs conc 1 fin nbs conc 2 nbs


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I just walked out of a talk by Peter Tatchell at the LGBT History Conference in Manchester. He was talking about colonialism, page and I was hoping to ask him some uncomfortable questions about his own colonial attitude to working with LGBT groups in the global south (many prominent LGBT African activists refuse to work with him because he is so paternalistic), what is ed and about his views that many people consider islamophobic*. Unfortunately I didnt get that far, hospital because he started off his talk with a lengthy discussion of the recent transphobia scandal he has been embroiled in, and how trans people were making him so anxious because they have been tweeting about the open letter. As one of the few openly and visibly trans people in the room, I felt eyes shift to me, and I got up and left.

Peter Tatchell had recently signed an open letter to the Guardian condemning student’s unions no platforming trans- and sex worker- exclusionary feminists such as Julie Bindel. The letter is littered with mistruths of recent “no platforming” scandals, such as suggesting that the comedienne Kate Smurfwaite being cancelled by Goldsmiths uni comedy society has more to do with institutionalised silencing of feminists than the fact they only managed to sell 8 tickets. This and the other claims of the letter are quite successfully debunked by Sarah Brown’s blog on the matter.

For students unions and societies, no platform is literally the equivalent of saying “hey, we arent going to invite you to speak, and we’re not going to speak at the same event as you”. This is not a free speech issue, no-one is stopping Julie Bindel et al. from speaking in general, they literally are just not inviting her to speak at events in their own building. Its like me turning up to a complete strangers houseparty and being offended that I wasnt invited. No-one owes anyone an invitation or a platform.

Most of the people signing that letter are academics or activists who frequently get platforms to speak at conferences and events in universities and students unions, and no doubt found it easy to get their open letter in one of the countries largest newspapers. As people who are familiar with the university world, all of the signatories will know the difference between students unions and the university itself. Yet the letter seems to imply that its the university institutions who are silencing feminist critique, rather than the student body organising to make universities a safer space for students who are trans or engage in sex work. This is a convenient way of implying that trans people have a lot more power than we actually do.

Tatchell had been invited to speak at two sessions across the weekend of the LGBT history conference.  Across the whole conference, the T seemed to fall off end of the acronym a fair bit and very few sessions seemed to address trans history. Tatchell decided to use his platform at the conference to talk about how trans people, by tweeting about the letter, were making him anxious. He positioned himself as a defender of free speech, against a hoard of nasty trans people. But the thing is, Peter, free speech works both ways. It applies just as equally to our tweets as it does about your access national newspapers or big conferences.

*I would word this more strongly but unfortunately Peter Tatchell is notoriously litigious. He loves free speech, that guy.

– Jess Bradley


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In the first of our series on mental health, Jess Bradley talks about trans people, anxiety, and the need for democratic trans healthcare.

[Content note: general discussion of mental health. anxiety, violence, medical gatekeeping, and family stuff. No in-depth discussion of experiences]

Trans people are anxious. We are anxious at home, we are anxious at work, we are anxious at school. We are anxious on the bus, anxious at the Job Centre, anxious when praying. We are anxious in case our friends mispronoun us, anxious whether the presence or lack of stubble might affect how we are seen, anxious if strangers will shout at us in the street, or worse.

Anxiety dominates our lives and we are anxious about that. We are anxious about seeking help for our anxiety because it might impact on our ability to access healthcare. We are anxious about being not being “trans enough” when we don’t fit the neatly packaged medical narrative set out for us because it might impact on our ability to get healthcare. We are anxious about explaining our lives to medical gatekeepers who have the power to refuse us healthcare and we are anxious that our anxiety about that will give them reason to.

We are anxious because we live precarious lives. When we work we are one transphobic customer away from “causing a fuss” and losing our jobs. When we are on benefits we are one incident away from a sanction. When we live at home we are one angry reaction to a mispronouning from being out on the streets. When we are out on the streets we are one dickhead away from being beaten up. When we go to the psychiatrist we are one misplaced answer from being refused treatment. When we are in the closet, it feels like we are one decision away from either starting an an amazing authentic life, or ruining the one we have. When we are out of the closet, we are one bad reaction from a ruined day / week / year. When we are stealth we are one “curious” person away from potentially destroying the life we have built for ourselves. When we are disabled, queer, a woman, nonbinary, or a person of colour, we have to contend with our anxiety as a result of transphobia and the anxieties from others projected onto us through ableism, queerphobia, misogyny, nonbinary erasure, and racism.

We are anxious and we are taught that that is our fault. That we are too sensitive for being upset when a friend accidently misgenders us, too irrational when we are scared to leave our house for fear of strangers reactions, and too unreasonable for being angry about it. That it’s our fault for choosing this lifestyle, for messing with the natural order of things. If only we could pass better; if only we answered questions more politely; if only we had more money for treatment.

We need to recognise the reality of these problems: that they are systemic and not individual. We are anxious because we live under an economic system that treats everyone as disposable, and trans people as even more disposable. We are anxious because our healthcare system keeps our lives on hold for indefinite periods of time because the current project of dismantling the NHS and welfare system are overlaid on a wholesale disregard for our lives.  We are anxious because transphobia is deeply entwined with patriarchy and capital and because corporations profit from our anxiety.

As trans people we need to create a machine which fights anxiety. One which allows us to connect our personal experiences to the way in which society is structured. One which allows us to tell our stories; produces theories and practices based on our experiences of survival. One which creates unalienated, empowering spaces from which we organise for a better world for trans people and for everyone else.

But what do we fight for? What demands do we have, and to whom are we making these demands?

It’s clear that for many trans healthcare is an issue that causes our anxiety, either directly through our precarious access to treatment, or indirectly due to the effects that hormones, surgeries, and mental health treatment can have on the way we are allowed to operate in the world. Do we ask nicely for more money, less waiting time, less intrusive questions, from the people who represent and benefit from those systems of oppression? Or do we take a principled stand, refuse to engage with those in power and organise new systems and structures amongst ourselves?

It is clear that only asking nicely from those in power gives them a legitimacy they do not deserve. It is also clear that organising wholly outside the established structures would leave many behind, because our resources are unlikely to match the resources of the state and we can’t put our liberation on hold til after the revolution.

We need a demand which speaks both to those in power and to those at the grassroots. “Democratise Trans Healthcare Now!” is that demand. It demands the state changes its structures, to provide more funding, to stop acting as gatekeepers. But it also acts as an incitement to action for trans people, an incitement to shape the future of what healthcare could be – for and by ourselves.

“Democratise Trans Healthcare Now!” is a broad and unifying call to action. It can mean different things to different people. For the trans person lobbying Parliament it can mean the call to secure more funding so that all trans people, regardless of how rich we are or how well we fit within certain narratives, can get access to treatment. For the trans person of colour, the disabled trans person, the non-binary trans person, and the queer trans person, it can be a call to ensure that the organisations and campaigns which speak for trans people are representative of all of us and not just the most privileged in our communities.  For the trans community organiser, it’s a call to make sure that our community is robust enough to ensure that no trans person is left behind when the “official” structures fail them, a call to organise solidarity funds for trans healthcare, and for community responses to anxiety. For all of us, it’s a call to imagine what a world where trans people’s healthcare happens on our own terms would look like, and to take small steps towards creating that world.

“Democratise Trans Healthcare Now!” offers a paradigm shift in the way in which we do trans activism. By demanding what to some might seem impossible, we make possible what before was improbable.

[Props to the Institute of Precarious Consciousness and Plan C for the inspiration for this article.]

If you are interested in writing about the intersections of trans and mental health, please get in touch! 

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An open letter to Rupert Read, nurse by Loz Webb on behalf of Action for Trans Health

[content note: discussion of transmisogyny and TERFs]

Earlier this year, dosage I marched alongside Green MP Caroline Lucas at Trans* Pride Brighton, search and spoke to her briefly about the importance of improving trans healthcare, a point on which she seemed to heartily agree. I have been impressed with Lucas’ seeming commitment to the trans community, from her presence at Trans* Pride to her consultations with trans constituents, to her awareness of the dire state of trans healthcare in the UK currently.

The Greens have made a real show of their membership surpassing that of UKIP this week, and well they should – this is an impressive achievement. Unfortunately Rupert, you seem single handedly determined to use your platform as a Green Party candidate to attack trans people’s right to exist.

This problem is much larger than a few dodgy comments on Twitter, so let me first address your rejection of the term ‘cis’. You write that the notion of people being forced to use the word cis troubles you, and that some feminists share those concerns. Firstly, let me say that no-one is forcing anyone to use any particular language. It is simply that words mean things, and if you refuse to use certain neutral descriptive terms, don’t be surprised when no-one understands what you’re talking about. However, if your issue is that you believe that cis people should be called normal and trans people should be called trans, then the problem isn’t that you have a problem with random adjectives, the problem is that you think that cis people are normal and trans people aren’t. The problem is transphobia. I want to be very clear, because I can tell from your tweets that you struggle with the definition of words. The problem is not that you are plainspoken, nor that you self-identify as a philosopher. The problem is that you have a problem with transgender people.

I was intending to be a lot more polite when I started writing this open letter but, unfortunately for me, then I discovered your blog. Which, unfortunately for you, is full of transphobic hate speech. I had thought, prior to discovering your blog, that perhaps you were a bit ignorant, perhaps you’d never bothered to educate yourself about trans people, perhaps new words and concepts frightened you, similarly to how new words and concepts frighten middle age wealthy Tories in the Home Counties who estrange their LGBT children in order to punish them for coming out. In other words, I thought you were unintentionally harming trans people because of your narrow, ill-considered viewpoint.

However, it is clear in your blog, where you refuse to accept that trans women are women, and also refuse to accept that women who don’t have periods (thus including young, elderly, disabled, and intersex women) are women, and also refuse to accept that women who aren’t brought up as women (a category that includes women from other cultures where women and men have slightly or vastly different meanings, cisgender girls who are tomboys, children bought up gender neutral, survivors of abuse, and intersex children) are women. In fact, for a cisgender man (sorry mate, it’s nowt personal, it’s just that meanings of words thing again), you seem incredibly concerned with who is and who isn’t a woman. You don’t get to decide who is and who isn’t a woman. In fact, no-one except the woman in question gets to decide whether she is a woman or not. And that’s not based in some bizarre identity politics, it’s simply that no-one else knows, no-one else can possibly know – that’s how being a person works.

It seems to me that your particular brand of transmisogyny is actually about something far darker. It seems to me that you share trans-exclusionary radical feminists’ aims of seeking to refuse lifesaving transition treatment to trans people, that you sympathise with those who assault trans women for ‘deceiving’ people by not disclosing their trans status, and that you wish to deny trans people the right to be who they are. From your blog, and your adherence to trans-exclusionary radical feminism, it is clear that you oppose the rights of trans people. And until the Green Party do something about it, they must be considered a transphobic party.

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Who’s the odd one out?: Alexander the Great, case Frida Kahlo, web Virginia Wolff, Alan Turing, Paris Lees.

All of these famous LGBT people featured on posters around my campus in recent years to celebrate LGBT History Month. Although I would hardly call Paris Lees and her contemporaries Laverne Cox, Chaz Bono and Janet Mock historical figures, at least not yet! I was always quite confused about why famous LGB were found from all periods of history whilst we can only think of trans people who are alive today or in very recent history, despite ample evidence to suggest that people who don’t identify with the gender they were assigned at birth exist in all contemporary and historical societies. It creates the impression that trans people are a recent phenomenon, and divorces us from the historical struggles we have been a part of.

A major problem with compiling trans history is that the way that we talk about gender identity and sexuality now is a relatively recent thing. For much of history, what we know now as LGB and trans identities have not been considered as distinct. This has led to significant tracts of queer history – our history – being retrospectively claimed by cis LGB people alone.

Radclyffe Hall, the author at the centre of an obscenity trial for their novel The Well of Loneliness, is a case in point. Hall identified as being a congenital invert. Sexologist Kraft-Ebing defined AFAB inverts as having a “masculine soul, heaving in the female bosom”, whilst another contemporary sexologist, Havelock Ellis, defines AFAB inversion as something more similar to what we understand as lesbianism today. We don’t know which definition Hall would have preferred, or if Hall would have seen these two definitions as mutually exclusive. However, we do know that Hall chose to publish their work using their gender-neutral middle name, Radclyffe, rather than their more female-coded first name, and that Hall was called John by their closest friends and lovers. We also know that Hall pretty much exclusively dressed in clothes that would be considered masculine at the time. Yet Hall has been pretty much exclusively claimed as part of (cis) lesbian history and not trans history. Likewise we can see a similar dynamic happen with the Stonewall Riots, a riot led by trans women of colour and homeless queers, yet being claimed almost exclusively on behalf of white cis LGB historians.

When trans and gender non-conforming people are talked about, they are understood in cis-centric terms. I’ve lost count of the amount of times I have heard cis historians talk about people who were assigned female at birth dressing in men’s clothing in order to become a doctor, soldier, pirate or similar. This understanding frames their gender presentation as a means to accessing a profession, despite the fact that often there is evidence to suggest that many of these individuals dressed in male clothing much before taking on the occupation they were famous for. Chances are, these individuals were simply trans people doing what for the time was a gender appropriate profession, rather than being particularly opportunistic cis women.

Likewise a significant amount of people who pop up in the historical record as being convicted for being male sex workers may well could be understood differently from a trans perspective. In many of these cases, people were convicted on the basis that they looked to the police like men dressed in women’s clothes, and this was used as ‘proof’ of those individuals being sex workers. The understanding was that those individuals would dress as women in order to become sex workers, rather than simply being women who may or may not be involved in sex work. This framing results in those individuals being remembered as gay male sex workers, rather than as trans women.

Part of the problem is that history has been written, recorded and disseminated by cis people – the vast majority of which do not have much contact with trans culture. Cis historians are currently not equipped to recognise when a historical event of figure is of significance to the trans community. And as trans people are discriminated against today, most cis historians do not feel it valuable to learn about trans histories. This creates a vicious cycle: the less historians writing about trans histories, the harder it is to learn about them.

As such, Action for Trans Health’s resident historian, Greta Williams-Schultz, has created a short guide to historical trans figures from the UK. Within the guide you can read about historical trans people whom you might not have heard about. Some lead ordinary lives, such as Mary Mudge who worked as a dairymaid in Devon, and others were remembered as doing extraordinary feats, such as Jan Morris, a member of the first British team to climb Everest.

Many of these individuals lived before the term ‘trans’ or ‘lesbian’, ‘gay’ or ‘bisexual’ existed. There is always going to be a debate whether it is appropriate for us to claim people as trans when the concept didn’t exist when they were alive. But LGB people don’t seem to have an issue with claiming Alexander the Great as bisexual when he died approximately 2200 years before the term was invented. The fact is, cis people are seen as the default, so if we don’t claim these historical figures as our own, cis people will only do it for us.

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We know that transitioning usually has a very positive effect on trans people’s mental health. Providing care appropriate to their transition is the single most effective thing at reducing the rate of suicide attempts amongst trans people. However, some aspects of transitioning may have a negative impact on mental health, as well as being made more difficult by existing mental health problems.

A big part of this is related to how difficult it is to navigate medical care without your mental health declining. Medical professionals are poorly educated when it comes to trans people and mental illness even when the topics are completely separate, so when the two intersect it’s often impossible to find a doctor who is understanding of this and all it entails. The pathologising of trans people’s experiences makes it often dangerous to “admit” you’re mentally ill in a trans healthcare context – mental illness and trans status are often conflated and used as an excuse to not treat one or the other, which makes it hard to be open about how both are affecting you. A doctor who acts insensitively is often the best case scenario, with some people (especially those with “unstable” disorders like borderline personality disorder, bipolar or schizophrenia) being denied care altogether because their self-evaluation isn’t trusted. 
Even in the best case, the interrogation and long waiting times involved in GIC care have a negative impact on most people’s mental health. We believe that people with mental illnesses are valid narrators of their own experience and that they deserve help in navigating a system hostile to everyone, but especially to them. A helpful thing in these scenarios is hearing about what those who went before you did, whether or not they deemed it successful, and learning how this affected their experience. If you’ve dealt with the trans healthcare system while mentally ill, we’d like to hear how you navigated it, what you encountered and what wisdom, encouragement or solidarity you have for others in your position. 
We’re interested in hearing things about:
  • Self care tips
  • How you accessed counselling without it reaching GIC services or your GP 
  • How you dealt with hormonal changes affecting your mental health
  • How you dealt with invasive questioning regarding your mental illness affecting your trans experience
  • Post-surgical depression
  • Anything that helped you get through the adverse effects of doctors’ treatment of you
  • Intersections of mental health, trans, and other oppressions such as race, transmisogyny, sexuality, disability, drug use, survivorship
If you write something up and email it to we can collate them and present them as a resource. Feel free to email us submissions for our blog/website at anytime, but we are setting a deadline for inclusion in the print volume for 1st March 2015. Please share! 

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News that the Gender Recognition Panel is delaying and possibly denying legal gender recognition for a trans person because they had children whilst trans is deeply concerning. The Gender Recognition Act does not require a trans person from abstaining from sexual activity, side effects reproductive or otherwise. This news represents a potentially unlawful and clear violation of trans peoples reproductive rights.

The reasons giving for this action can be seen below:



We have a long way to go to achieve reproductive justice for trans people. Most European countries that have an equivalent to the Gender Recognition Act require the trans person to be sterilised in order to have their gender legally recognised. Although this is not the case in the UK, this move by the Gender Recognition Panel to delay and potentially deny recognition could seen as part of a move towards the de facto requirement for sterilisation. This is particularly concerning in a time when trans people are finding it increasingly difficult to access reproductive technologies such as gamete storage and IVF through the NHS or privately. Reproductive justice for trans people needs to be central to our agenda, and crucially needs to be picked up as a key issue for feminists in the UK to be working on.

It just so happens that today (Dec 5th 2014) the Gender Recognition Panel are meeting. As far as I can tell from here, the Gender Recognition Panel has its administrative offices in Leicester, presumably at the Crown Court, but meets in London. If my information is up to date, the panel is chaired by Judge Jeremy Bennett who has an office in Sutton, London: Copthall House, 9 The Pavement, Grove Road, Sutton, SM1 1DA. It might be worth locals in Leicester or London popping down and letting the Gender Recognition Panel know what you think. (Please let us know if any of this information is incorrect).





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Today is World Aids Day, a time to remember those lost to HIV/Aids and to reflect on our responsibilities to those living with HIV/Aids and to educate ourselves and our communities about safer sex and harm reduction. Jess Bradley writes:

<content note: sex, sex work, drug use, medicalisation, injections, mental health, sexual assault>

Like a lot of trans healthcare issues, the research simply has not been done to solidly say how many trans people are living with HIV/Aids. This is a huge problem because without these statistics it essentially means we are invisible to service providers. Where people do want to carry out trans specific HIV/Aids work, the lack of empirical evidence means that there are less likely to be able to secure funding for their work.

It is possible to pick out a few studies which investigate the stats regarding HIV in the trans community. In a study of trans women across 15 different countries, Baral et al (2013),  the global average HIV prevalence for the trans women studied was 19.1%, rising slightly to 21.6% in high income countries. In another international study, Operario et al (2008) found that the crude average HIV prevalence for trans women sex workers who had sex with men was 27.3%, compared to 14.7% for trans women in general, 15.1% in male sex workers, and 4.5% for female sex workers. Neither of those studies looked at data from the UK context. However it does suggest that UK trans women, especially those who engage in sex work, are likely to be at greater HIV risk than our cisgender peers. I have yet to find any specific prevalence data specifically looking at trans men or non-binary people, which is concerning.

Before my involvement in Action for Trans* Health, I used to work for Students for Sensible Drug Policy UK and Youth Organisations for Drug Action Europe. Primarily my interest in drug policy and harm reduction came from the higher incidence of drug use and drug harms within the LGBT community. Statistics for drug use in the trans community are scarce, particularly UK specific statistics. But for people such as myself who were working on LGBT drug use, the prevalence of drug use within the trans community, in particular types of drug use which are associated with more harms, was a red flag. Its worth noting here also that self-medicating trans people are also at risk of related harms with semi-legal supplies, access to needles, and inconsistent knowledge about safe injection practices.

There is very little data about HIV prevalence for trans men. However in a US study, Kenagy and Hsieh (2010)  found that whilst trans people in general had much higher likelihood of engaging in risky sexual practices then their cisgender peers, the trans men in their study exhibited riskier sexual health practices than the trans women studied.

The trans community has higher risk factors for HIV. This is due to the higher rates of sex work, IV drug use within the trans community, and riskier sexual practices. Stated simply, this seems to locate the risk factors within the trans community itself. However, I think it is important to look at structural factors in place which are so often missing from the analysis when talking about these issues.

Trans people face significant discrimination in the workplace and as such are an under-employed population. At the same time we face significant objectification and fetishisation by cis people. Trans people’s higher engagement in sex work can be explained by the interaction between those two factors. As a former sex worker, I know its reductive to deny trans peoples agency in the face of structural issues in a way which argues that trans sex workers are forced into that line of work. Yet these structural factors are not irrelevant, we can only choose from the options available to us. It is clear that the trans community needs to build strong links with those fighting for sex workers rights, and that the voices of trans sex workers need to be raised up within our community. Building these links of solidarity between these communities can yield results in terms of HIV harm reduction. As Shannon et al. (2014) suggest, global decriminalisation of sex work is likely to cut 33-46% of HIV infection over the next decade, something that will certainly make an impact on the trans community.

Similarly, trans drug use and self-medication does not happen within a social vacuum. The stresses of living in a transphobic society can lead trans people to develop problematic drug habits, and the lack of trans- or even LGBT-specific drugs services can leave trans people out in the cold. The barriers to access services such as drugs counselling, mental health provision, or needle exchanges has a big structural impact on our lives. Similarly, long waiting times for transition related healthcare and inconsistent support from GPs lead many down the path of self medicating hormones and/or other substances. Whilst it is possible to responsibly manage the risks of self-medication and illegal drug use (either recreational or medicinal), the lack of official guidance and support doesnt help. Funding for trans-specific harm reduction work desperately needs to be found and put to good use, and the trans community needs to support calls for drug policies which are shown to reduce the health and social harms of drug use.

Trans people often engage in riskier sexual practices. I don’t know of anyone who has ever been taught about trans specific sexual health issues who hasn’t been at a workshop that we at Action for Trans Health have offered. Part of my role in Action for Trans Health involves talking to sexual health service providers about how to improve their services for trans people. Sometimes, I am pleasantly surprised by the doctors, nurses and administrative staff’s prior knowledge of trans issues (ie. knowing what a trans person is). Other times, its a uphill struggle simply starting a conversation. I have yet to go to a sexual health clinic where anyone working there has the knowledge of trans specific sexual health issues I would expect from those who will be working with trans patients on a regular basis. Clearly this lack of information and education is a significant contributing factor to why we engage in riskier sexual practices. Work in this area is urgent, and whilst us and other organisations are doing work in this area, it simply isnt enough to cover the work that needs to be done. You can help by doing a sexual health audit of your local service, or getting in touch with us at info[at] to book us in for trans sexual health training (either for medical professionals or for trans people themselves).

However, I dont think that access to sexual health services is the only thing that should be considered here. Because of systemic transphobia in all areas of life, trans people often have low self esteem and low social equity. Sex and sexuality can be difficult for everyone to talk about, but particularly for trans people as sex is so gendered by society. Negotiating our sexual needs, especially discussions about safer sex, can be extremely difficult, something that many of our sexual partners may not realise. As a result, we often end up in situations where risky practices take place. Our partners need to be aware of our needs. The trans community needs to open itself up to a frank discussion of how we can negotiate for safe, consensual, and empowering sex. These discussions need to be had within a broader challenge to systemic transphobia.

Further Reading: 

An Open Letter to Stonewall from The Sex Worker Open University

Debating Drugs: How to make a case for legal regulation – Transform Drug Policy Foundation

Sexual Health Guide for Trans Women – Terrance Higgens Trust

Sexual Health Guide for Trans Men – Terrance Higgens Trust