South Africa’s first plan to fight HIV, sexually transmitted infections (STIs) and tuberculosis in lesbian, gay, bisexual, transgender and intersex (LGBTI) communities was recently launched during the national Aids conference in Durban. The plan aims to reduce new HIV infections in these communities by 63% in five years.

But activists say the framework fails to acknowledge the specific health needs of transgender men — those who identify as male but were born with female genitalia — and particularly those who have sex with men.

At least three public hospitals offer transgender men testosterone as part of hormone replacement therapy: Groote Schuur in Cape Town, Steve Biko Memorial in Pretoria and Johannesburg’s Chris Hani Baragwanath.

Testosterone use has been shown to contribute to the thinning of the vaginal wall as well as drying and inflammation — which can increase a transgender man’s risk of contracting HIV. A 2017 report published by the Centre of Excellence for Transgender Health found vaginal dryness to be one of the effects of masculinising hormone therapy.

Dr Elma de Vries, who does training for Gender DynamiX, says: “Vaginal atrophy increases the risk of tears in the lining of the vagina [during sex], which increases the risk of HIV infection.”

Zachary Shimange, the community mobilisation officer at trans rights organisation Gender DynamiX, says that anecdotal evidence suggested that, because trans men on hormone replacement therapy also have to inject themselves with testosterone — and some some may share needles — it puts them at further risk of being infected with not only HIV but also hepatitis B and C.

Transgender rights activist Estian Smit says the plan assumes, as do many health workers, that transgender men only have sex with women. But this is false, with one report — by trans organisation Transgender and Intersex Africa — saying more than half of trans men surveyed (55%) have had sexual contact with men. Read more via Mail & Guardian