Sex & Substance Use Among Transgender Gay, Bisexual & Other Men Who Have Sex with Men

Gay, bisexual and other men who have sex with men (GBMSM) make up over 50% of new HIV infections in British Columbia, as well as almost half of those living with HIV in the province. Despite up to two-thirds of transgender men identifying as gay, bisexual or queer, the presence of transgender GBMSM within the largely cisgender (people whose gender identity is consistent with their sex assigned at birth) gay men’s communities is often invisible. While the link between substance use and HIV sexual risk is well-documented among gay men, little is known about trans GBMSM’s relationship to this culture of substance use with sex.

Trans people are generally left out of epidemiological surveillance and the collection of other public health data, sometimes explicitly excluded from research studies. What we do know about the size of the population and their health profile is largely based on small convenience samples, with the recent exception of theTransPULSEstudy conducted in Ontario which used respondent driven sampling (RDS) to recruit 433 trans people across the province. Further to the lack of data, research with transgender people has generally focused on gender identity, leaving the experiences of trans GBMSM not well documented.

The Momentum Health Study is a new opportunity to learn more about the health of GBMSM. A five-year bio-behavioural longitudinal study, Momentum is open to HIV-positive and HIV-negative cisgender and transgender men who are sexually active with other men in the Greater Vancouver Region. Following participants in the cohort over the study period Momentum will produce quantitative clinical, behavioural and psychometric data and provide a deeper understanding of some of the complexities around sexual health, gender identity and sexual orientation, sexual risk and decision making through qualitative interviewing.

In preliminary quantitative analysis, almost half the trans GBMSM in Momentum used at least one substance (primarily alcohol and cannabis) as did their partners, during one of their most recent sexual encounters while one-quarter did not know the HIV status of their sexual partner prior to sex. Overall, transgender GBMSM in the study appear to be engaging in lower HIV sexual risk behaviours than their cisgender peers as well as employing more HIV risk reduction strategies, despite not testing for HIV as frequently.

As a longitudinal bio-behavioural study, Momentum will provide an opportunity to gain a picture of the clinical and behavioural sexual health of trans GBMSM over time, adding to the limited knowledge on these men’s health. The initial take away is that public health prevention and harm reduction interventions targeting gay, bisexual and other men who have sex with men need to acknowledge the inclusion of trans men within these communities and ensure they are inclusive of trans gay men.


Author: Ashleigh Rich, Research Coordinator, Momentum Health Study, BC Centre for Excellence in HIV/AIDS in Vancouver

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC