TRANS MEN: THE INVISIBLE BATTLE WITH HIV

View at HIV Equal

So there I was, sitting in a room full of the world’s top HIV researchers, uncomfortably under-dressed in my Mr. Friendly t-shirt but not letting that stop me from asking the question I need answered.

“Dr. Molina, in your study on intermittent PrEP dosing among men who have sex with men (MSM), did you see or anticipate any differences in efficacy between the transgender gay men in your study versus the cisgender men? What have we learned about the 2+1+1 dosing for men who engage in receptive vaginal intercourse?”

I desperately need this information, you see, because every day I log into Facebook and respond to yet another question about HIV prevention from yet another trans guy who wants to protect himself from HIV and whose doctors won’t help him. I am a moderator of the PrEP Facts: Rethinking HIV Prevention and Sex discussion group where people from all over the world – research scientists, doctors, community organizers, and lay people alike – come to learn and digest the latest information about HIV prevention and safer sex strategies. There are a lot of trans folks and a myriad of gender identities present there. Many of us use this Facebook group as our primary source for medical information concerning HIV prevention because we cannot get adequate care from our doctors.

But then I ask the doctors why they’re failing us, and they say to me that they don’t have any data. They don’t know the answer. They can’t answer these questions without studies to back them up.

So I asked Dr. Jean-Michel Molina about the trans men in his study, with the naïve and unwarranted optimism that he would tell me something useful, something I could relay to the droves of trans men seeking me out as their last glimmer of hope for sexual health. He responded by telling me about the one trans woman in the study, with no mention of trans men at all. Another researcher in the room explained to me afterward that trans men were not included in this study. Dr. Sheena McCormack would later apologize to me that her PROUD study in the UK, about which I’d been on the edge of my seat for months to see results, also failed to include trans men.

I have been a participant in a PrEP research study at the University of Washington, as have many of my trans brothers in Seattle, so I know we’re showing up to do our part for medical science. Yet, even though we’re presenting ourselves, able and willing to offer our researchers abundant data about our bodies, at best these studies have not been designed to track the information we’re providing. Or, at worst, as was the case in both the IPERGAY and PROUD studies, the criteria for entry into the studies are designed in such a way that explicitly makes trans men ineligible altogether.

I want to let you in on a little secret: Transgender gay men are not heterosexual women. We do not have sex like women do. Our behavioral risk factors are the same as the behavioral risk factors of gay men, because – big surprise – we are gay men. Sometimes we have anal sex. Sometimes we have vaginal sex. We have sex in bathhouses, perhaps with 20 or more guys in one evening. Not all of us, but some. We cruise for hookups in the twilight hours at Volunteer Park. We meet guys on Scruff, Grindr, and Craigslist for casual one-offs. Some of us use poppers, crystal, and other drugs associated with the gay party-and-play scene. We are at high risk of HIV just like cisgender MSMs are, and we’re being ignored.

This cannot continue. We already have a 41 percent or greater rate of suicide attempts. For trans folks who survive society at large, we are then faced with incompetent medical professionals who use the wrong pronouns, who refuse to listen to us and who cannot or will not give us answers about how our bodies work. We have to fight for basic healthcare, fight for HIV prevention, and then ultimately fight for HIV treatment after we’ve been cast aside until it’s too late to prevent infection. Still, no matter how hard we fight, we cannot bypass our doctors to independently investigate research about the HIV prevention strategies that are optimal for us ourselves – because no such research exists. We are an invisible, dying group of gay men being left to face the threat of HIV with no one hearing our cries, no researchers taking notice and no public health officials acknowledging our plight.

The HIV epidemic of the 80s and 90s does not have to repeat itself. We have the tools and the knowledge to prevent HIV. We just need medical professionals, researchers and advocates to step up and make it happen now. Please, help us.

On Service, Attachment, and Being in Love with Life

Welcome to my 100th blog post. I am celebrating this occasion by telling you how in love I am with Life. Oh, and why giving of myself to others is a good reason for me to wake up every day, too.

This week I scrubbed an oven. I don’t know when the last time was that it had been cleaned. It’s a good oven, in a good space, loved by good people who make good baked things with it. When it recently needed a minor repair, I was asked to come over and clean it before the technician would arrive the following morning. It started out like this:

It was 1100 hours, and this was my task. The pursuit would total 3.5 hours of cleaning all by myself while the oven’s owner was at work, during which I had plenty of opportunity for introspection. It is nigh impossible for me to sit through 15 minutes of casual introspection without purging my thoughts into text, let alone an entire afternoon of the relatively intense stuff. I call this Compulsive Writer Syndrome (CWS). It’s a very real thing that I suspect one day the DSM will recognize. Maybe I’ll write them about it….

I texted to let him know I was about to begin the project, and he gave me a specific set of instructions in response: “Do the oven first. If you have time after that, oven cleaner works well on the stove top, too. It could use it. But oven priority.”

I don’t have adequate words for describing the whole-body tingle I experienced upon receiving that message. “Yes sir,” I typed. No, I’m not supposed to say that. That’s… no, that’s a thing I shouldn’t say. Even though it’s the only thing I want to say. Even though everything in me feels compelled to say it. No. Backspace. I thought for a moment, trying to respond in a way that felt less… non-consensual. “Okay”, I tried to type. My fingers wouldn’t budge. “Will do”, I thought might be more appropriate. It felt gross to say such a thing in that moment. Ultimately, I said nothing at all.

I set the music on my iPhone to shuffle, took my pants off (I didn’t want them getting dirty), and dug in. There is a certain loveliness, I think, to performing deep cleaning in one’s underwear on a beautiful summer day. The thoughts I processed may sound now as incoherent or peculiar as a dream sequence, but they accurately represent the innards of my mind in these hours. It began with focused attention: What am I doing? Why am I doing it?

I was not merely cleaning an oven; I was improving the world. I was making life easier and more relaxed for someone about whom I care deeply. I was accomplishing, creating something with my own hands, the results of which indicate to me a successful undertaking in life. I was finding meaning in my existence. That’s what I was doing.

Why? Well, I’m on this relatively brief vacation from being dead, and as is the case with all vacations, there’s only so much fun I can cram into it. Might as well pack as much joyful adventure and pleasure as I can fit, right? Only, I don’t actually like cleaning. Yeah, I spent some time examining that fact as I tied rags around my face for a makeshift mask to protect me from the god-awful oven cleaner fumes. I don’t fucking like cleaning. The question remained.

The scouring pad knocked loose chunks of crisp debris. I imagined him there towering over me as I cleaned. “I’m so glad I don’t have to do this,” he might say. Yes. Yes, that was precisely it. I hate cleaning. That’s why I want to do it — because why would I want him to be bothered to do it himself? Knowing that the harder I worked, the less he’d have to do, I felt infinitely joyful about this task. In hindsight now I notice: it never occurred to me that I should do the job just well enough to satisfy the repair technician.

There was only one opinion I cared about, and whatever I did had to be good enough for his appraisal. That meant giving it everything I had in me, nothing less.

I told myself, attachment is destined to cause suffering. You know this. What you’re saying is that the value of your work is contingent upon a standard over which you have no control. This isn’t the way we give gifts, Brandyn. This isn’t the way we give gifts. We give them with no strings attached, no expectations. If he comes home today, sees the work you’ve done, and never says “thank you” or “good job”, that has to be acceptable. If he isn’t pleased, even though it’s your very best work, that has to be acceptable. If it isn’t, it’s time we reevaluate our priorities and our motives. Are you giving your service-gift freely, or are you not?

I hate it when I’m right.

So the next long while, as I scrubbed, was invested in the examination of my motives. I had this conversation with a friend in Mexico about doing things we don’t like in order to get things we want: I had once approached a sadist friend and asked him to beat me. One day he asked me why I wanted him to hurt me, and I replied, “I want the snuggles afterward.” He decided that beating me was not an option after I’d said that, and he instead sat me down on the couch with him and held me in his arms. I cried like hell; I felt fucking awful about it. Giving me snuggles without making me earn them? What was this heresy! It was in Mexico that I came to understand that when I want something specific, it’s best to ask clearly for what I want rather than asking for whatever suffering I think I have to do to earn it.

Are you scrubbing this oven because you want a certain response? Is there something you’re not asking for?

This is an important question. I made a list of applicable statements in my head, all beginning with “I want”, hoping to get to the core of my motives. I want him to be happy. I want him to think highly of me. I want him to have a good evening when he gets home from work. I want him to feel relief that this task is done. Alright, if we’re being entirely honest… I want him to let me do this for him more. I want him to validate my work. I want him to be proud of me. I want him to feel warm and fuzzy.

Well now. That’s an interesting set of attachments to sever, isn’t it? Most of my motives were indeed pure and without expectation, but not all of them, and that was a thing I needed to nip in the bud swiftly and mercilessly. I have no idea what time it was when I realized all of this. My hands were covered in grease, my fingertips abraded. The pain was arousing, but the cognitive dissonance trumped the pleasure. I paused, poured myself a cup of water, and embarked on a meditation I find quite reliable in circumstances such as these. I mentally explored other possible outcomes than the one in which he would be happy at the end:

This may be the only time he’ll ever ask me to clean his oven. When he sees the work I’ve done, he may be satisfied that I did my best, but it may still not be up to his standards. There will be no reward beyond the privilege of giving it to him. What I am doing for him is a gift, and there is no wrong way for him to respond. He doesn’t have to accept it or want more of it, and it is not a failure on my part for this to be the case. He could bring home a goose and leave it in this oven until it catches fire and explodes this evening, obliterating all the work I’m doing right now. This is okay. I am giving him a clean oven. What he does with it is up to him.

Typically, when I give someone a physical object as a gift, this process is much easier. I just imagine them throwing it in the trash can the moment I hand it to them. If I can’t handle them doing that, if I feel upset or angry about it, then I need to reevaluate my motives for giving them the thing. What someone does with a gift is none of my concern once it belongs to them. Since I haven’t spent much time giving service, it seems there may still be a good amount of assumption packed away in it that I’ll likely spend a few months or more ironing out. Maybe I’ll get it all sorted out this winter while I sit on the beach contemplating my life.

Detaching myself from the after-effects of gift-giving is a daily exercise I spend a lot of time practicing, in every opportunity I can find. Being conditioned in this way, it didn’t take long to make peace with the infinite number of possible outcomes for this experience. I would have breathed deeply, had it been safe to do so. Relaxed and content, I continued my mission.

My mind grew calm and blank, nothing in it outside of this moment in which I was crafting a treasure for him.

Amidst the serenity, my mind was startled to recognize an insidious suffering creeping toward the forefront of my awareness. Why aren’t I using gloves? Holy fuck, this is burning. Oh gods, burning! Burning! Ouchmotherfuckerouch, burning!

Naively, I had hoped that running my hands under the sink faucet would somehow improve my condition, but it was futile. The Brillo pad had torn away enough skin and pulled back my flesh from its attachment point under my fingernails. There is, in fact, no safeword for chemical burns under one’s fingernails.

In this moment, I felt quite fortunate to be alone. Pain-induced arousal can be a very difficult thing to work through when given the opportunity to be distracted. I sent him a text message to let him know that there was suffering in progress, and this communication served as a sufficient relief valve for the experience. It wasn’t until a bit later that I would begin to overthink this — Would he rather not have known? Am I being disruptive while he’s at work? Is it strange to him that I’m deriving this particular flavor of happiness and excitement out of cleaning his oven? Is it strange to me that I’m deriving this particular flavor of happiness and excitement out of cleaning his oven? — but none of these questions crossed my mind in that moment where my thought-free consciousness was candid and forthright. For much of the time I was engrossed in this task, I forgot how to overthink anything.

After my hands began their plea for reprieve, another hour of scrubbing passed before I at last afforded them their rest. The oven’s (and stove top’s) condition still wasn’t as ideal as I wanted it to be, but it was as good as I could make it. There were a few specks here and there which I simply hadn’t the fortitude to remove. This raised an anxiety I’d not touched in a while: safewording.

Safewording is a thing I hate doing. I hate ending my suffering when it’s to the benefit of someone I care for that I continue it. But I’ve spent years now actively cultivating my ability to do it, to recognize and communicate my boundaries, and to enforce those boundaries accordingly. Like it or not, this is where I needed to stop. I sat with myself for a few moments, trying to achieve acceptance of this fact.

From the beginning, I’ve known how he responds to gifts of service I offer him. I went out and worked on that project with him back in the Spring, and I took breaks just to see how he’d react when I didn’t work as hard as I could have, I reminded myself. Never, ever did he complain. He’s always been appreciative and grateful for whatever I give him, no matter how little it was or how much more I could have done. I know this about him, I thought. I know he’ll be pleased with what I’ve done, because it’s as much as I am able to do. ‘As you’re willing and able’, he says. I am no longer able. It’s time to stop. He would be terribly disappointed if I didn’t.

I sent him a text message to let him know I was finished, along with the following photo of his oven:

Feeling peaceful about this process was not easy, but it was certainly possible. It required some trust, not in his response, but in the fact that his response was irrelevant. This was the best work I could give him. It seemed unlikely that he would be displeased, simply because of that fact and because he’s a decent human being who doesn’t take people for granted. After a whole afternoon of breaking apart my own anxieties, my own insecurities, my own fears, and my own assumptions, I received this from him: “Wow. Good job. Thank you.”

Wonderful. That’s all I’d hoped (and more than I’d expected) to hear. I have found that when I make a conscious effort to detach myself from expectations or external validation, the experience of receiving praise is far more valuable than when I receive it with a feeling of having “earned” it. When we work hard in pursuit of a certain goal, the achievement of that goal can often feel like something to which we’ve become entitled. I’m really not a fan of entitlement. By the time he said “thank you”, I had already overcome my own entitlement hurdles and made peace with not hearing it. Those words felt far more valuable to me in that moment than they ever could have if I’d felt he owed them to me.

I vacuumed the kitchen floor, wiped down the counters, tidied up the cleaning tools, and took my leave. I went home to attend to the, erm, sensation that accompanied feeling the undersides of my fingernails on fire. I’m going through puberty; gimme a break. So I’m in my room, I’m decompressing from the last 3.5 hours of intense internal self-examination, and I get another set of text messages: “Ummm. Apparently you fixed the oven. It was just dirty. Something was gunked up that you cleaned and now it works again. You may have just saved us hundreds of dollars. Thank you. I’m thrilled. Very well done.”

One of the great things about living without expectations is that you’re rarely, if ever, disappointed. One of the surprisingly difficult things about living without expectations is that when you’re pleased, you’re really fucking pleased. Holy wow, pleased. OMG-squealing-because-I-can’t-believe-he’s-so-happy, I’m-so-excited-that-I-was-able-to-do-this-for-him, I-didn’t-imagine-that-I-could-feel-this-gleeful-right-now pleased. I reveled in it for a bit, high on joyfulness just as intensely as if I’d been beaten. It was beginning to sink in for me that the chemicals my brain enjoys in the context of physical BDSM are the same chemicals it was enjoying from spending the afternoon making that oven look as close to new as I could get it.

It was nearly 9pm when the final wave of text messages rolled in, this time more enthusiastic than before. I assume that he had perhaps only just arrived home to see the results in person. I had just spent a few hours coming down from the high of his lauding in the afternoon, and here was this even greater, more intense expression of gratitude coming at me without warning:

“The oven looks almost new. You exceeded my expectations. Would it be presumptuous to say ‘good boy’?”

I exploded. Boom goes the brain-splat, squish squish flop. Brain was even leaking out the corners of my eyes. Brains are 75% water, you know. My brain was dripping down my cheeks. The joy was so intense.

It’s a vicious cycle when I begin to feel grateful that one of my biggest “problems” is my exceptionally intense, perpetual experience of gratitude. I am so completely in love with life.

“I don’t think it would be too presumptuous at all. Thank you.” I don’t know if I was happier that he felt compelled to say “good boy” to me, or that he is so completely devoid of entitlement that he would ask permission to say it to me. He’s such a marvelous human being. This is why I cleaned his oven, I thought. It’s not about the praise at all; it’s about giving this human whatever I’m able to offer in the course of improving his life, because the example he sets just being in the world has so phenomenally improved mine.

“Well then. Good boy.”

I took a deep breath. The tears tasted salty as they landed in my giggles.

“I am ecstatic,” he continued to say.

As much as I am? I wondered. I do hope so. This much ecstasy comes with a certain amount of suffering, I know; it’s intense and jarring, often. But I wouldn’t trade any of it for the world. What better way to spend my life than to be wholly and emphatically in love with it all!

I Want to Die

The whole world seems filled with these people who are really quite afraid of death. Or, they think they’re afraid of death. I think they’re afraid of life. I don’t see how you can think you’re afraid of one but not the other. That doesn’t make any sense at all.

Alright, so you’re afraid of life, and you’re afraid of death, and you sit around watching television so that you don’t have to think about either of them, and that works just great as long as you never encounter anyone who challenges your assumptions in any way. Cool. It’s not what I want for myself. I’m glad you’re happy with it though.

Sure, the alternative has its own share of suck. But by comparison? Yeah, I’ll take the struggle of screaming at pan full of flan during an existential crisis, isolated in a remote village in Mexico, over the dreadful condition of walking around in a human body with no curiosity of what more exists than the suit its occupant wears. I’ll take the suckage that comes with living as fully as I can see how. It’s uncomfortable and difficult at times, and it’s beautiful and awe-inspiring, too.

One day, while life is being incredible and interesting, I’m going to die. There will be something fascinating happening at the exact same moment, although I may not know what it is or that it exists. In the moment that I cease to exist, there will be flowers blossoming. There will be creatures giving birth. There will be earthquakes stirring. There will be black holes vacuuming entire planets into them. There will be a grandmother sitting on a porch. There will be a human speaking her first words. There will be a couple breaking up. There will be a heart attack. There will be fish swimming. There will be children marrying. There will be boats sailing. There will be storytellers writing. There will be trees falling. All these things will be happening at the moment I die.

Life itself is happening, at all times. Paying attention to it is the choice we make, not whether it takes place around us. With all the things that are happening in this moment, you reading the words on this computer screen being only one of an infinite number of them, someone is dying. It’s as necessary a part of life as giving birth, sitting on a porch, speaking, breaking up, swimming, sailing, or sharing. If we cut from reality the moment death occurs, we lose everything else that exists in the universe with the erasure of the time in which death exists. We erase the joy, the beauty, the excitement, the pain, the confusion, the resilience. I think those things are pretty awesome and spectacular. I prefer to have them exist, and to see them.

I don’t spend my time dreading an inevitable death in the same way that I don’t spend my time dreading an inevitable sunrise. Sometimes I’m more excited about it than others, but mostly I just passively expect that it will happen all the same and go on about my business. Do I have my preferences about the matter? Sure, as much as I have my preferences about anything. At 13,000 ft on Mount Kailash, for example, my partner’s body atop my own against the ground, his hand around my throat as I bask in the alertness of my insignificance until I drift happily out of consciousness forever. Would it be a better way to die than being hit by a bus? No, but I would prefer it anyway.

I want to die. I don’t just tolerate that it will happen; I welcome it. It is in the welcoming of this inevitability that I am able to welcome all the other inevitable aspects of life to take place. Because I will die, I can smell flowers and armpits and saltwater. I can think and write and love. I can be infatuated and giddy. I can be disappointed and confused. Because I will die, everything exists.

How marvelous is that!

I died as a mineral and became a plant,
I died as a plant and rose to animal,
I died as an animal and I was Man.
Why should I fear? When was I less by dying?

– Rumi