Mercedes Allen

"MSM" Revisited: Trans Inclusion in LGBT Medical Study

Filed By Mercedes Allen | August 11, 2010 10:30 AM | comments

Filed in: Living, The Movement, Transgender & Intersex
Tags: HIV/AIDS, inclusion, men who have sex with men, MSM, trans

Recently, I'd blogged about a term that's increasing in usage in HIV research and outreach: "MSM," or "men who have sex with men." The term was originally invented because of a need to include not just sexually active gay men but also bisexuals and men who are not gay-identified but for whatever reason have casual or incidental sex with men. It can also include gay- or bi-identified trans males, although they're often overlooked in the study (or sometimes even thought not to exist). And, of course, it's often asserted that it includes or intends to include trans women. I'd commented:

I get it that effective terminology must be given to identify target high-risk groups for the sake of study. I get it that the terminology needs to be both simple and encompassing. I get it that HIV is a serious issue and relevant to the trans community, though not all trans sub-groups are high-risk. I get it that penile-anal intercourse (PAI) risk groups can include trans women.... What I don't and will not get is the gay community's insistence that transsexual women are "really men" and how it's such a bother having to state otherwise in order to be inclusive. To be fair, there are many folks in HIV study and advocacy who don't feel or act that way, but the prevalence of MSM-exclusive study sure reinforces this impression.

As diverse as the trans umbrella is, where MSM really fails is primarily when female-identified or dual-identified trans people (usually transsexual women) are forced into one of those "M" designations (i.e. also encompassing straight-identified men who date trans women). This is often justified by researchers through noting other cultures where trans women sometimes do identify themselves as "really a man," because they have not yet had the freedom to develop a language with which to self-identify, and therefore accept the language and logic that is available to and used on them. For something that was supposed to have been devised in order to respect different male identities and transcend constructions built around terms like "gay," people sometimes wonder why it's such a big deal when trans women are similarly not accommodated and their identities as not men are not respected. Especially when this is the result:

This past Spring, I'd had one such study request forwarded to me by someone who was apparently on one of the mailing lists that I forward communications to. A few days later, he wrote me, irate that I'd not forwarded it to my trans networks. I'd pointed out (feigning ignorance) that while a few trans men might qualify and be interested, much of what was being discussed in his email didn't really fit FTM configuration, or at least pre-surgical. This resulted in a missive which started off with "you know what I mean" and launched into an accusation that I'd be "guilty of the murder of" every transsexual woman who perished from HIV who might have benefited from the study. And yet, the survey was written so thoroughly to exclude those of female gender identity, I can't see any way that any self-respecting trans woman would be able to sit through the whole thing without becoming thoroughly incensed at the obvious refusal to dignify her as who she is.

Additionally, many trans women never have sex with men, being either lesbian-identified or not sexually active. And for a small few of us, HRT isn't kind, and it becomes an either-or proposition where we really do have to choose between transition and sex. So an assumption that all trans women belong in the study is as inaccurate as the assumption that all trans men don't.

But the solution does get fuzzy. I'm no longer convinced that any permutation of "MSM + ..." works effectively at all (and I see in my original article some failures to look outside transsexual identities to the nuances pertaining to some other flavours of trans). Possibly some terminology along the lines of PAI practices should be considered, but it's obvious that the status quo needs to be replaced with something more appropriate. And if that discussion needs to happen anywhere, it needs to start in the larger LGBT sphere.

This situation is also symptomatic of a fuzzy understanding of trans realities when it comes to inclusion in LGBT medical studies in general. Trans brings along with it a host of medical questions that are often entirely overlooked in such studies. Which is fine if the study is presented as a general overview that is not reflecting on trans-specific care or pretending that it encompasses all the issues of the included study groups. I also get that adding all aspects of trans to a study that is aiming to look at primarily cisgender medical issues will confuse it beyond recognition. However, too often, these studies use the fact that there is a "transgender" checkbox in the Sex question to claim that what is presented is comprehensive and targets all the LGBT medical issues that need to be addressed -- which leads researchers and medical professionals to conclude that they do not have any need to look further.

When transsexuals are factored in, there are numerous medical realities surrounding access to and cost of treatment, the fact that said treatment is part of a necessary course to righting one's life, issues around hormone access and use, or access to surgeries or tests (i.e. obtaining a mammogram for someone with a penis, or finding a surgeon willing to perform a hysterectomy on a man). Even outside the transsexual process, we find unique issues affecting genderqueer identification, or the existence of another DSM diagnosis intended for crossdressers (and which serves no useful purpose beyond stigmatization as well as the annexation of transsexuals): Transvestic Fetish.

Superficial inclusion can generate problems with survey questions like, "Have you ever been diagnosed with a mental illness?" Is this supposed to include GID? If so, isn't that a bit like rubbing one's nose in the fact that our little community still carries this stigma? And if there is no means to elaborate, how are the people conducting the study ever going to know if the respondent is referring to GID (or TF), or to something else entirely?

Such surveys can often be accompanied by assumptions: the assumption that we're sexually active; assumptions that we engage in risky sexual behaviour; sometimes assumptions that ones genitals dictate how they should be addressed; assumptions about who we're attracted to and sexually active with; assumptions that we can see just any medical professional when we need to; assumptions that prejudice in the clinic could never take the form of being treated like we're deluded or freakish by the doctor, medical staff and/or other staff; assumptions that we can access HRT, surgery and other forms of treatment without requiring letters of permission from someone who has psychoanalyzed us; assumptions that anyone with a trans history has to identify as trans(fill-in-the-blank), rather than as male or female. It can also overlook issues entirely, such as that of changing one's name on file, having it acknowledged by staff, and not having it create a crossed-wires situation were your lab tests from elsewhere don't get where they're supposed to.

And finally, there is an issue of relevance. When trans-specific care isn't in the study at all, what remains seems almost irrelevant or even foreign to trans participants. It does seem a little humorous to me to be asked, for example, "Do you trust your medical provider enough to discuss issues with him or her that might out you as being LGBT?" when an adam's apple (not to mention genitalia), medications, gender markers on identification or surgeries recorded on file all leave no doubt.

I don't mean this to be scathing -- studies do vary, and I'm elaborating on the worst I've seen in order to open discussion on making them better overall. While the MSM terminology is glaring, many other issues stem from cisgender privilege -- not in the sense that cisgender people often complain about being accused of (i.e. wilful ignorance), but from the privileged standpoint of never having experienced these things, and therefore not realizing that they need to be addressed.

There is a concern that conducting separate studies can be seen as a license to not do trans population studies at all. But because the medical situation can be significantly different for trans people, I wonder if these issues would be best handled as a trans-specific addendum? And where language fails altogether -- terms like MSM -- there is a serious need for reassessment.

Readers' thoughts on MSM and inclusion in general?

(Crossposted to DentedBlueMercedes)


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My perspective is, first and foremost, the language of "MSM" doesn't come from the gay community. It comes from public health. And many people who don't work in non-profit, or health services, or HIV prevention probably will never even encounter that acronym. If they're really lucky, they may never encounter any acronym. But that's a whole other story.

Not in defense of MSM, (because, like you, I think that HIV prevention should be looked at through actual behavior rather than identity)but MSM was supposed to be drained of identity. It was meant to encompass peoples' behavior rather than their sense of self. Of course, that's if one accepts that "M" does not signify an identity.

In addition to everything you mentioned in your article, there are more reason to disengage from "MSM". also, reasons not to.

1. the rates of HIV are artificially inflated in the category "MSM" - and funding - though woefully short - follows the epi.

2. the rates of HIV are exaggerated - MAYBE - in transwomen populations... or maybe they are underreported - we don't know because very few public health entities even have the capability to reports trans-specific data. There's no data on transmen. In LA County there is (allegedly) one HIV+ transman.

3. CDC didn't even recognize the category "transgender" for the longest time... so to obtain money to provide services to this population folks had to work within the system, thereby perpetuating the 'transwomen as really men' story.

4. If we continue to look at identity, and we want to be respectful of all peoples' identity, we might wind up in a situation where many 'transpeople' identify as 'women' or 'men' - not trans at all - and funding for this population may get lost in all of that. The flip to that is that there should be funding specific to a category of people who face specific risks.

I think that having discussions about PAI, PVI, PMI are far more useful from an epi point of view as well as from a prevention point of view. They
drive home that we are not talking about "gay sex" or "queers" or "down low brothas" or any of that. We are - specifically - talking about penile-anal, penile-vaginal and penile-oral penetration.

One thing I totally disagree with is that "And if that discussion needs to happen anywhere, it needs to start in the larger LGBT sphere.". The reason I disagree is because the "larger LGBT sphere" doesn't even have conversations about HIV anymore, let alone the nuances of epidemiology.

Here is a link to the LA County HIV Prevention Plan, where we grappled with a lot of these issues. LA County HIV Prevention Plan.

Here are some notes from the discussions when we were working on the plan:

Executive Summary

p. iv
• Paragraph 2 2nd to last line (and throughout document) “transgenders”.
o I believe we had decided that we would use “transgender individuals” as opposed to “transgenders”. Throughout the document we use both, however “transgenders” is seen by many in the community to be offensive at worst, and not culturally sensitive at least. In addition, if we are talking about transgender women, we should so specify, rather than erase an entire population of transmen.
p. v
“transgenders” should be “transgender individuals” or “transgender women”

Chapter 1: Overview of HIV Community Planning
o Again, “transgenders” is not the appropriate terminology, however I understand that was the way the BRG was worded.
p. 1-11
• paragraph 2:
o We say 7% transgender, but we could also mention that we had participation on but transwomen and transmen, further highlighting our mandate to not let any group fall through the cracks. If people read “transgender” in an HIV-related document, they will assume it was transwomen, probably.

Chapter 2: HIV Epidemiologic Profile

p. 2-2
• “age/gender composition” line 3:
o “…4,400 male-to-female transgenders…” should be “…4,400 male-to-female transgender individuals…” and there needs to be an explanation as to why the estimate went down by over 50% from the Transgender Health Study in 2000.
p. 2-8
o We discussed – at length – the conflation of MSM and transgender individuals. Though it is true that they are often housed together in custody, we could make an effort not to conflate them in our plan, especially since the rest of the paragraph indicates that there are no data for transpeople. Further, the assumption that all transwomen have sex with men is erroneous and we don’t need to further that stereotype. We could make this paragraph about MSM and have another – very short – paragraph which reports that we have no data on transpeople in custody, but we are working on it. THIS IS REALLY IMPORTANT – especially as we have transgender as its own population in this plan. We have to adjust our thinking, and our language, to show that we understand that this is its own population, completely separate from men, or from MSM.

p. 2-20
• Gender:
o “data for transgender females are included with males…” this is really important information as well, but we don’t know what percentage of the ‘male’ numbers are really transwomen, and so those numbers are artificially inflated, just as the numbers for transpeople are artificially smaller (or non-existent).

p. 2-26
• “Gender” line 2:
o “…seen for both males and females…” should be “…seen for males and females…”. Even though we don’t have data for transpeople, use of the word “both” implies a totality, and we should not forget that there is a group of people who should be, but aren’t, included in this section. Its plain cultural competency & respect.
• Paragraph 2
o Again, even though we don’t have data on transpeople, they should get at least a mention in this section, since they are one of our priority populations. Also, remember that male figures are artificially inflated because transwomen may be mis-assigned there.

p. 2-45
• Paragraph 1 line 4:
o “…1% of the MSM population is transgender” is actually characterizing transgender women as a subset of MSM. More appropriate might be something like “…1% of the population categorized as MSM is actually a miscategorization, and are transgender women (or, more empowering, transwomen)”
• Paragraph 1 line 5:
o “ …approximately 2,596 transgender” should be “ …approximately 2,596 transgender individuals” or transwomen
• Paragraph 1 last line
o “… of the overall 259,630 MSM are male-to-female transgender” again, is a mischaracterization of transwomen as a subset of MSM. Should be something like: “… of the overall 259,630 characterized as MSM are actually male-to-female transgender individuals”, or, even better, and way more empowering for the trans community: “… of the overall 259,630 characterized as MSM are, in reality, transwomen”.
• Paragraph 4 line 8:
o “i.e., men, women, and/or transgenders” again, should be “transgender individuals”, or, if we want to talk about accuracy, “transwomen”. We could attempt to acknowledge the difference in risk between sex with a transmen and a transwomen, and a pre/non-op transwomen versus a post-operative transwomen, since there are completely different risks for transmission in either direction by defining, for the purposes of the plan, “transgender” as pre- or non-op, and transsexual as post-op, but since we have no data on that stuff, and probably 100% of the pop is non- or pre-op, it wouldn’t matter much in terms of accuracy of data. It does matter in terms of cultural competency and accuracy of language, though.
• Paragraph 4 last line:
o “transgenders” should be “transwomen” or “transgender women” since the FTM population is not included in the category of highest seroprevalence rates.

p. 2-46
• Items #6-8:
o “transgenders” should be “transwomen” or “transgender women” unless we are staking a position that “transgender” means MTF and not FTM.


p. 2-50
• Syphilis, paragraph 2, line 4:
o “transgenders” should be “transgender women” (according to table 2.13 they are all MTF)

Chapter 3: Community Assessment

p. 3-2
• when talking about data collection, this would be a very opportune place to point out how few sources collect data for transpeople.


• paragraph 1 line 5:
o “transgenders” should be “transgender individuals”, or more accurately, “transgender women”.
p. 3-15
• Common challenges facing HIV prevention program participants, item 3a:
o “not wanting to be identified as Transgender” might not be an issue of stigma and shame, as we have it posited. It might not be their identity. Even if it is their identity, it might not be stigma or shame, but rather a matter of personal safety, and it is transphobic to assume that it is related to stigma/shame without having that confirmed. Also… the T in transgender shouldn’t be capitalized.

p. 3-23
• “transgenders”:
o We recommend that “all transgenders are themselves a critical target population”. This isn’t true. We said that all transgender women are a critical target population. If we are referring to both transwomen and men, that needs to be expressly pointed out, in light of the fact that there are no data indicating that transmen are at elevated risk for hiv. And, the same old complaint about “transgenders” which should be “transgender individuals”, or more accurately, “transgender women”.
o “lowered its estimate of total transgenders … based on current information” we need to explain what that current information is, how we arrived at that number, and that it is widely disputed in the community. We should also point out how a lack of agencies collecting data for this pop, the number could be artificially low.
o it’s so great, and so progressive that we included this population as a priority population that I think we own it to ourselves and to the community o be respectful of their language, and also to be honest in our work: there is limited data, this is what we have to work with etc., and this is how we hope to address this during this plan. Also, we have a unique opportunity to not use “transgenders” so cavalierly. We know that there are different risks, seroprevalence rates etc. for transmen and transwomen. We need to mention that, and we need o stop using “transgenders” to mean transgender women. That’s like using “men” to mean “men and women”. It’s offensive and inaccurate. The rest of the country will be looking to this plan, and we can put language in it that the rest of the country may pick up. We have a responsibility to the community to be accurate, and culturally competent in this area.

p. 3-48
o Line 2 “report using steroids or hormones”. It would be useful to know how many transgender men were interviewed for CRAS, and what the differences are in all of these areas – homelessness HIV status, sex work etc. If there weren’t any transgender men, and ‘steroids or hormones’ is really only ‘hormones’ that should be corrected.
p. 3-69
• Characteristics of HIV+ Clients
o When sorting between transgender and transsexual, it might make sense to define the terms, or at least what we are using as a working definition.
• Sex for Resources
o In the previous section “transgenders”, “70.4% report trading sex for something (p. 3-68), but in this section, only 2.5% of people who exchanged sex were trans. Is that because of the small number of respondents who were trans? That still doesn’t seem right, since 14% are non-trans female and 13% transwomen. Is 2.5% correct?

Chapter 4: Priority Populations
p. 4-7
• A New Planning Model paragraph 2:
o line 7
heterosexual … despite their behavior is language that makes sense with non-gay identified MSM, but it doesn’t make sense with men who have sex with transwomen, necessarily, unless we see transwomen as ‘really men’. Even if heterosexual men are interested in their transwoman’s penis, if we reflect a transphobic representation of transwomen as really men we are not culturally competent, and can be read as hostile to a transwoman’s identity,

• Prioritizing populations:
o This would be a good place to point out what percentage of the data (and which data sources) we used actually provided us with information on transpeople, and how that factored into the weighted methodology.

p. 4-12
• Step 4
o Table 4.3: if there is no data for transpeople, we should explain why we used this data, and why we didn’t substitute other data (ie: Transgender Health Study).
p. 4-18

I don’t know if it’s too much, but talking about “transgender” as a word that is very culturally specific, and doesn’t translate out of Anglo culture readily. Social service providers in non-Anglo communities have introduced the language “transgender” but it is being brought into various communities, it didn’t come from them. That might be part of why services should be open however someone identifies.
Chapter 5: Interventions
p. 5-3
• High risk level intervention:
o list
? (b) They are female, (c) they are male is good, but for continuity, and to affirm a transperson’s gender, it should read (a) they are transgender or identify their gender as “other”
? Why don’t we collapse A-C into a person who has had anal sex? Is there a reason a transperson (FTM or MTF) would be at high risk if they haven’t had anal sex or any of the other risk factors D-K?
p. 5-6
• Intervention delivered to individuals:
o bullet point 2 (internet risk reduction)
? Line 3: gay men, men who have sex with men (MSM), non-gay identified MSM and multiple genders should be gay men and non-gay identified men at sexual risk. We have to stop using BRG language. If we want to keep using BRG language, the sentence could be clarified by saying gay men, men who have sex with men (MSM), non-gay identified MSM and men who have sex with people of multiple genders (i.e., men who have sex with men and women, men who have sex with both transgender individuals as well as non-trans individuals, or men who have sex with both men and transgender individuals)



You wrote:

... the language of "MSM" doesn't come from the gay community. It comes from public health...

Good point, and while I mentioned that in the original, I failed to discuss that here. However, I do feel it's fair to say that it's an issue that should be raised here, as the studies I encounter are filtered down through LGBT organizations who often repeat the terminology and say nothing about it. Again, it's probably the privilege of never having had to think about it, but if the issue needs to be raised by the term, I think it does need to be raised by LGBT people. I am skeptical that individuals would be listened to -- communities, however....

I believe we had decided that we would use ?transgender individuals? as opposed to ?transgenders?.

"Trans individuals" is better. Transgender is an adverb -- people may have accepted "gay" and "lesbian" as nouns, but trans people largely have not embraced the same usage. "Transgender" also carries baggage. Personally, I still believe there are times where an umbrella term is needed (and this is a good example), but I'm accepting that "transgender" is not working for people. Trans also opens the door to identifying trans male and trans female populations.

Will have a further look at this when I can.

How about BAS, 'Bottoms in Anal Sex' or PRAS, 'People who Receive Anal Sex'? This would include cis-women as well, who also have anal sex with penises (though are not biologically men, like cis-men and trans-women, so perhaps this doesnt apply to them, or to trans* men who have anal sex with penises?).

The whole incusion thing seems moot to me, though. As you point out, there prolly aren't a large number of trans* women having anal sex with penises, and really, wouldn't the results of the study apply to them anyhow? And it is only recently that large mainstream trials and studies for various things have even included cis-women, and they are a somewhat larger part of the gernal population than trans* women or men are of the population of ppl who have anal sex with penises.

FWIW

I don't know that we need to detail sex practices that much. PAI is a troublesome term too, because it also has assumptions that accompany it. I'm only thinking out loud when I bring that up.

It's hard to know the percentage of the community that's high risk and not. We can't assume. Even if someone is lesbian-identified, they may do sex work, be in a non-consensual situation (i.e. prison) or resort to survival sex, for example.

MSM is not about anal sex. If it were, then it would include millions of straight men and women of all sexual orientations, but it doesn't. The purpose of looking at the category of MSM is much more about analyzing community disease vectors.

The "high risk" part of MSM sex is not just what type of sexual activity is being engaged in, but the higher proportion of the community with HIV and where HIV is being spread.

In similar studies, they track sexual activity and HIV within low income communities, different ethnicities, etc. It's not because people of different races or income levels engage in different sexual activity, but because there is some level of sexual community insulation.

With this in mind, the suggestion that trans women should automatically be included within MSM is somewhat ridiculous. From my own experience, I'm a queer woman and the vast majority of my partners have been as well. When I was in a relationship with a trans woman, my doctor called that high risk and wanted to test me for syphilis because it had been spreading throughout the local MSM population. Yet at the time neither of us had any sexual connections with that population.

Whoever is crafting their study should spend five minutes thinking about what it is they are studying. If it is community disease factors, they might want to expand to include anyone (cis or trans) who has sex with a man who has sex with men - a la the red cross. Or if it's about sexual activity, then anyone who has anal sex (regardless of the genders of the people involved). But this awkward attempt to include trans women in MSM is not only insulting, it's academically unsound.

True, and probably any study that looks at gay, bi and trans populations will carry some assumptions on who comprises the high risk group. When behaviour is stigmatized, driven underground or suppressed, that's one of a few factors that generates high-risk behaviour, but then how do you disseminate that into terminology and define a target group for study (which is still worth doing)? But at the end of the day, MSM just doesn't do it, if it means to include trans women.

I don't have much to add except that I hate reading studies that say "transsexual male" or "transsexual female" because I have no bloody clue what they're talking about. Half the time it's one way and half the time it's the other. At least use something like "mtf" or "ftm."

If they're using "transsexual female" to refer to transmen (& vv), then they're not using it right. I've seen this too, and it bears correcting.

Some object to "mtf" or "ftm" also. Maybe that's an option, but that probably should be noted.

At least terms like "mtf" and "ftm" tell me what the fuck the author is talking about. Referring to transfolk as "transmen" and "transwomen" is also something that would tell me the information I need to comprehend what is being written. In a way, I'm kind of ignoring the gender issues because I really, really want to comprehend things first. I'm also not interested in pleasing every single person. "mtf" and "ftm" are very widely accepted terms and they also clearly state the birth sex and the transition goal to the reader. That is why I like them.

At least terms like "mtf" and "ftm" tell me what the fuck the author is talking about.

Unfortunately they often tell you more than that. There's a long history of psychologists and doctors writing academic papers about "MTFs" and using male pronouns for them (there is not as much of a history of "FTM" being used the same way). And by underscoring birth assigned sex -- and even placing it before anything else -- it sends the subtle message that the person "really is male." I've seen a noticeable difference in how often people mispronoun someone introduced as a "trans woman" versus someone introduced as an "MTF." Because MTF implies someone IS A MALE who is transitioning to female, whereas trans woman implies that someone IS A WOMAN who is trans.

While you like the terms because they "clearly state the birth sex," that's the exact reason that many trans folk dislike them. Birth assigned sex is a very personal matter, in many cases it's private medical information. While identifying as trans implies that your birth assigned sex does not correspond with how you identify now, there's no reason that it needs to be specifically referenced every time trans identity is mentioned. It can even be offensive when cis folks feel entitled to that information or insist that they can't understand someone's identity without it.

Oh god no. "mtf" and "ftm" need to be killed with fire and never used again, not in science, not in academia. I don't care if individuals identify by it, but we need to eliminate language that ties transitioning trans people to the incorrect and misleading sex assigned at birth in research.

It would be much better to use standardized usage as Mercedes describes.

I don't think MSM is about anal sex either - it's a way of targeting people who are at risk for HIV for prevention, a way of grouping people that follows the way they group themselves.

Which is why including transwomen in MSM doesn't make much sense to me. The MSM designation is about getting to men who engage in various rituals and go to sites where men seek sex with men. And, in all the time I've spent doing that, I've only seen two trans women, ever, seek sex in a men-seeking-men space (and both were online). But I've seen plenty of straight-identified, bisexual, and closeted men mixed in with the out gay men (showing that "gay" is inadequate).

Anyway, including trans women in an MSM study seems about as logical as including black women because black women are a high-risk group as well, or lesbian women because they're part of "LGBT" too.

Thank you, Mercedes, for a great post on an important issue. Of the disrespectful language faced by trans and gender variant people, none is more damaging or hurtful than that which disregards our experienced gender identities, denies the affirmed gender roles of those who have transitioned full time and relegates us to our assigned birth sex. I agree that labeling transwomen as "MSM" is maligning and scientifically invalid.

Terminology in research should be both respectful and as specific as appropriate to the study. For example, the California Cancer Registrars Association limited a "transsexual" coding to "persons who have undergone sex-change surgery" until 2005, lumping together post-op transmen and transwomen while excluding the majority of transpeople on HRT. Author and cancer registrar, Just Evelyn, and I presented a case for policy reform in California that year. Our efforts led to some success but there remains much work to do in CA and other states. Sadly, there is still far too little data on incidence and treatment of cancer, heart disease, std's and other health risks for transpeople.

While I think this a great post, I just wanted to pop in and say, "Welcome back, Mercedes! We've missed your opinions on the site!" :)

One thing I would like to see in studies of all sorts is a broadening out of sexual partnering options when it comes to trans folks.

I don't know how many studies I've looked at that think to include trans folks. Then when it comes to asking about who we sleep with, of course we ONLY sleep with cisgender people! Why would we ever be dating among our own? It drives me up a tree. How's about:

1) respecting all our relationships.

and

2) Measuring the result anyway just to see what you get. Who knows what kind of data might happen?

BEAR A-M Rodgers | August 19, 2010 7:18 AM

I attempted to participate in these surveys as a pansexual FTM who "tops", as did the cisgender male I was doing the MSM with. Luckily my mind set and life time made many of the questions easy to respond to though I am sure not how they intended. His responses actually reflected mine. However I would never hand the survey to my Trans-sisters.
In one such "research" situation we had group online interviews. Even the group specifically for FTMs with Men was based on assumption that "men" meant cisgender XY males, that FTM on FTM sex was not MSM, and that all FTMs are bottoms/recievers in such encounters. For 2 hours we (6) went round and round about the researchers refusing to acknowledge Trasnmen as men. Oddest thing though is that I kept bringing up safer sex practices, HIV, and STIs, the researchers did not once mention HIV or any safer sex practices beyond "penis in condom" even though the point was HIV infection research (they even dismissed my practice of condom on silicone phallus prosthetic). Study might be MSM focused but female bodies get HIV too, and here in my part of US new infection rate in female-bodied people is 3 times higher than in male-bodied people. My buddy said heas 1 of only 2 participants in his Men with FTM group and the other guy's sex partner was actually a MTF CD (no transition, just roleplay). Over a year later we are still confused.