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PrEP in transmasculine people

We need more studies on unique challenges facing trans men

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(Photo by Bowonpat/Bigstock)

A new article in “Physician’s Weekly” titled, “Q&A: Improving PrEP Access in Transgender Men, Other Transmasculine People” interviewed two leading HIV doctors on a study they conducted to assess how HIV prevention can best be implemented in the transmasculine population. Strangely — or maybe not so strangely — HIV prevention is not examined enough in transgender men and other assigned-female-at-birth (AFAB) individuals who choose to masculinize and decide to have sex with men. But it’s important, and crucial, to study how the HIV prevention medicine PrEP can best be administered to make sure that all genders are feeling its full and successful effect. 

Historically, as mentioned, PrEP has been used to treat cisgender gay men, especially in light of the HIV crisis of the 1980s and 1990s. Since then, groundbreaking treatments have been introduced to lessen HIV loads in patients and prevent transmission of the disease. 

Also known as pre-exposure prophylaxis, PrEP was approved in 2012 by the FDA as a leading anti-HIV medication going by the brand name Truvada. It quickly became a popular medicine among gay and trans folk. 

As a transgender man myself, there are three things to note when thinking about how PrEP can be better administered and studied in individuals like me. 

The first is barriers to care. Many transgender men might feel a barrier to accessing PrEP because they are unsure how to be prescribed it, who to turn to, and whether it’s socially acceptable to take among their friends. PrEP was traditionally made for cisgender gay men, so its use among that subpopulation is far more varied and spread than its use among transgender men. The happy truth, though, is that PrEP is cheap, if not totally free, and that blood tests required to go on it are also now federally mandated to be free as well. 

Currently, there are outstanding health centers like Whitman-Walker in D.C. that serve as almost free clinics to provide drugs like PrEP and other HIV treatment. Places like Whitman-Walker should continue to thrive without limits. 

The second issue concerning PrEP in transmasculine people is the fact that the drug was initially designed to treat cisgender men, and transgender men were female at birth. There are enough studies that prove or disprove how more effective or less effective PrEP is in individuals who were assigned female at birth. The effectiveness of certain medications on any individual does, sometimes, become affected by what gender they were born with. More studies need to be done to show the efficacy, or any lack of efficacy, in PrEP in gay transgender men versus gay cisgender men. 

Another issue to note is the epidemic among trans men of embarrassment surrounding being on PrEP and talking about gay issues. Currently, it is entirely socially acceptable for transgender men to date women, but some transgender men — if not many sometimes — shame others into being attracted to men. It’s perfectly OK to be a gay trans man, or to be gay in any way, shape, or form for that matter. 

Scientists should consider the above issues when studying transmasculine people who want to go on PrEP. They should study how hormone replacement therapy — including the injection of testosterone — could interfere with the effectiveness of PrEP. They should study how many of us are embarrassed to go on PrEP but still need it to protect our health. They should study how trans men choose to socialize with other gay men and have sexual encounters with men — be it through Grindr, Tinder, or some other dating platform. 

While PrEP was designed for those assigned male at birth, its implications vary widely across all genders and even sexual orientations. New research has even indicated that HIV is sometimes more prevalent, or exists at the same rate, among the straight population in Washington, D.C., and nationwide. As a result, studying PrEP is all the more important. PrEP should be designed and investigated as a non discriminatory drug that benefits people from all walks of life. 

Isaac Amend is a writer based in the D.C. area. He is a transgender man and was featured in National Geographic’s ‘Gender Revolution’ documentary. He serves on the board of the LGBT Democrats of Virginia. Contact him at [email protected] or on Instagram at: @literatipapi

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‘Are you on PrEP?’

Md. lawmakers considering bill to expand access to medication

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From left, FreeState Justice Executive Director Phillip Westry and Maryland state Del. Ashanti Martinez (D-Prince George's County) (Courtesy photos)

When we’re out with friends, we ask a question that sometimes surprises people: Are you on PrEP?

PrEP is a medication that reduces the risk of getting HIV by about 99 percent when taken as prescribed. We’re both on it. And we both talk about it openly because too many people in our communities still haven’t heard of it, can’t access it, or have been made to feel like asking for it says something about who they are.

It doesn’t. Taking PrEP is about taking control of your health. It’s that simple.

But getting there wasn’t simple for either of us. Our paths to PrEP looked different.

Del. Martinez learned this firsthand. When he asked his primary care doctor about PrEP, the response wasn’t medical — it was judgment. Instead of a prescription, he got a lecture. He had to leave Maryland entirely and go to Whitman-Walker in D.C. just to get basic preventive care. He serves on the Health Committee and sits on the public health subcommittee. Even he couldn’t access HIV prevention in his own state. That reality was soul-crushing, not just for him, but because he immediately thought about every person in his community who doesn’t have the resources to find another way.

Phillip came to PrEP through his work at FreeState Justice, where he was learning about HIV transmission rates and the gap in PrEP access for queer people of color. Black Marylanders account for 65 percent of new HIV diagnoses but only about 35 percent of PrEP users. Latino Marylanders account for nearly 19 percent of new diagnoses but fewer than 8 percent of PrEP users.

Seeing those numbers, he had to ask himself why he wasn’t on it. When he walked into Chase Brexton’s HIV Prevention clinic in Baltimore, the experience was easy and affirming, exactly what it should be for everyone. No judgment, just care. That’s the kind of experience every Marylander deserves.

A proposed bill would make it the standard in Maryland. HB 1114 would let people walk into their neighborhood pharmacy and access PrEP without waiting months for a doctor’s appointment, remove insurance barriers that slow things down, and connect them to ongoing care. 

Our stories are not unusual. When we talk to friends about PrEP — and we do, regularly — we hear the same things. People who didn’t know about it. People who tried and gave up. People who assumed it wasn’t for them. People who couldn’t afford it or couldn’t find a provider. There’s still misinformation out there, and there’s still stigma. Among women in Maryland, most new HIV diagnoses come from heterosexual contact, but PrEP is still rarely part of the conversation from their doctors.

When we talk to our friends about PrEP, we lead with honesty. Here’s what it does, here’s what it costs, here’s where to go. We talk about the different options: daily pills or long-acting shots. Generic options are available, and in many cases, free. If you’re sexually active, it might be right for you. It’s not a morality question. It’s a health question.

We try to make it feel approachable, because it should be. We answer every question, because sometimes we’re the first person someone has had this conversation with. It’s a conversation between people who trust each other. And it works, but it can only go so far when the system itself is still in the way.

We have the medical tools to virtually end new HIV transmissions. What we need now are the policies to make sure everyone can reach them. At a time when the future of federal HIV prevention programs is under attack, Maryland has both the opportunity and the responsibility to lead.

We’re asking our friends to take charge of their health. We’re asking Maryland to make it possible.

If PrEP sounds right for you, talk to your provider. If you know someone who could benefit, share what you know. And if you want to see Maryland get this right, tell your legislators to support HB 1114.

State Del. Ashanti Martinez represents District 22 in Prince George’s County in the Maryland House of Delegates, where he serves as Majority Whip and sits on the Health Committee. Phillip Westry is the executive director of FreeState Justice, Maryland’s statewide LGBTQ+ advocacy organization.

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A dream: Democrats focus on candidates who can win

Defeating every Republican has to be the goal in 2026, 2028

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(Washington Blade photo by Michael Key)

I know this is just a dream, but I am a dreamer and continue to hope Democrats can get beyond Black or white, gay or straight, man or woman; to look at who can win in 2026, and then in 2028. It’s often said each election is the most consequential in our lifetime. The next two actually are. 

The reality is without change; we face losing our democracy. We have a racist, sexist, homophobic, lying felon, in the White House. He has a Cabinet of vile incompetents, and a cadre of fascist advisers, controlling our government. They threaten our freedoms, and even our health. They think the military is theirs to use at will, without restrictions. Again, my dream for elections in 2026 and 2028, is we put our personal desires aside, for the good of the nation.

Everyone is being hurt by Trump. Black women being fired in huge numbers. Transgender people literally having their lives threatened. The LGBTQ community facing new threats. Civil rights are being undermined, and the Latino community across the country is targeted. Women are losing the right to control their bodies. Our voting rights are being threatened, and all this is happening with the consent of the Republican sycophants in Congress who are either in complete agreement with the felon, or threatened into submission by him, and his fascist cohorts. This is what we are facing in the next two election cycles as we try to take back our country. As the opposition party, we must first take back Congress in 2026. If we succeed, we must replicate that success as we work to reclaim the White House in 2028. 

I believe we must all be represented in our elected officials. For years I felt comfortable looking at the equality issue in choosing a candidate, as even in the worst-case scenarios, when losing meant the election of the likes of a Richard Nixon or Ronald Reagan, I never believed my country’s existence was threatened. They, and others like them, may have been vile, but none professed wanting to be king. They didn’t go to court seeking full immunity for anything they did and getting it from judges they appointed. 

I am a proud gay man but will not automatically vote for an LGBTQ candidate in the next elections. In 2024, I worked hard, and proudly, to see two strong Black women elected to the United States Senate. In the 2008 primary I was proud to stand with Hillary Clinton, then support Barack Obama when he won the nomination. In 2016, I again stood with Hillary. In 2020, I proudly supported Kamala Harris as vice president and then supported her for president in 2024. 

Today, I am looking at the next two election cycles differently. I have written the only way to win back my country is to look at which Democrat can win in a particular race. I will support a Democrat committed to voting for the Democratic leadership in the House and the Senate, and in their state legislature, even if they don’t support fully everything I want. Because when Democrats win the leadership, they set the agenda. The Democratic platform has been about the same for many years. It stands for equality in every area. Have we accomplished all we stand for, clearly NO. Have we made progress, clearly YES. 

In these upcoming elections each Democrat may win their race with a different set of issues at the forefront. I have suggested in the morning they go to the diners in their district, and in the evening to the bars, to find out what people are talking about, and concerned about. Then respond to that by running on those issues. If there is a primary, demand each candidate pledge to fully support the winner. Think about what is said about Democrats and Republicans, “Democrats fall in love; Republicans fall in line.” Well in the next two election cycles, Democrats need to fall in line with every Democrat on the ballot in the general election willing to say, “if elected I will vote for, and support, the Democratic leadership.” 

If we don’t commit to doing that in the next two election cycles, we may actually not have future elections. It is the only way we can stop the felon, and his fascist government, from winning. Defeating every Republican in 2026 and 2028, has to be the goal for all who care about our country, and moving on to the next 250 years. Not winning is not an option.  


Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.

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Capital Pride must be transparent about sexual misconduct investigation

More questions than answers after two board members resign

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A scene from last year's WorldPride Parade organized by Capital Pride. (Washington Blade file photo by Michael Key)

We are living through some very difficult times in our country. We have a felon in the White House who has surrounded himself with incompetent sycophants and fascists. A Congress that bows down to him, often based on his threats. Things have gotten so bad that his supporters are beginning to wake up to the fact that he cares not a whit for them. They are demanding he stop hiding his involvement with the convicted sex trafficker, Jeffrey Epstein, and come clean. So, to distract them from this, he began a war in the Middle East in which members of the American military have already lost their lives. He says more lives will be lost. He hopes this war of distraction will have Americans forget his failed domestic policies and the Epstein scandal. 

But at the same time that all of this is happening, I am forced to look around at organizations I support and ask if they are being open and honest in the way we are demanding of the felon in the White House.

Recently, I have received calls about an organization I have the utmost pride in: Capital Pride. The calls are about Capital Pride’s internal investigation of “a claim” made against a former board chair, who resigned and no longer has any role with the organization. There has been no public proof of any wrongdoing. At the time, Capital Pride announced it had retained an “independent firm” to investigate the complaint. Now, more than four months later, a second board member has resigned sharing her letter of resignation with the Blade. 

Taylor Lianne Chandler, a member of the Capital Pride board of directors since 2019 who served as the board’s secretary, submitted a letter of resignation on Feb. 24 that alleges the board has failed to address instances of “sexual misconduct” at Capital Pride. 

“This board has made its priorities clear through its actions: protecting a sexual predator matters more than protecting the people who had the courage to come forward. … I have been targeted, bullied, and made to feel like an outsider for doing what any person of integrity would do – telling the truth,” Chandler wrote in her resignation letter. 

The Blade reported the organization announced, “As we continue to grow our organization, we’re proactively strengthening the policies and procedures that shape our systems, our infrastructure, and the support we provide to our team and partners.” 

Again, it is four months later, and there has been no information from Capital Pride regarding that investigation.

Chandler said a Capital Pride investigation identified one individual implicated in a “pattern” of sexual harassment related behavior over a period of time. She added she was bound by a Non-Disclosure Agreement that applies to all board members and she cannot disclose the name of the person implicated in alleged sexual misconduct or those who came forward to complain about it. She added, “It was one individual, but there was a pattern and a history.” 

Again, reading that letter from Chandler and because of the news being full of the Epstein scandal, it makes me want assurances that no organization representing my community will ever think it can cover up issues like this. Capital Pride leadership must be totally transparent. 

Capital Pride is a wonderful organization with so many incredible people working and volunteering there. They make our community proud. I never want to see a blemish on the organization. So, I am calling on them to be open and transparent about the investigation they themselves announced, and let the community know what they found, in detail. More important even than the entire community knowing, is for their staff and volunteers to know what they found. No one should be bound by an NDA, which leads to people thinking something really bad is going on.

I thought twice, even three times, before writing this column. I don’t want it to be seen as casting aspersions on all of Capital Pride, or anyone who may have worked there, or volunteered there. But again, because of the focus on the Epstein scandal, and my writing about the felon and his Cabinet officials involved in it, my calling for them to come clean and tell us all they know, I feel compelled to say the same to the organization I have supported over the years, which even honored me as a Capital Pride Hero in 2016. I want them to move forward and be a beacon of light for our community for many years to come. The work they do makes a difference for so many. 

I wrote in my memoir that coming to a Pride event helped me to come out, and I am sure it has done the same for so many others in our community. What Capital Pride does is important and it must be as transparent as we demand of any other organization.


Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.

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