Episode 17: Trans and Non-Binary Sexual Health

Sex Talk- Episode 17 Trans & Non-Binary Sexual Health

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Juno: I've been trans my whole life. I'm not going to do that thing of saying I was born in the wrong body because for me it's not about that, I was born the way I was born but I was diagnosed with HIV over 25 years ago, so for 25 years I feel like I've had really difficult care being a trans woman living with HIV becasue for a lot of the time there was stuff around, they would misgender me, they would write me down as being male and there would be M all over my documents. I couldn't get anyone to give me specific advice about being a trans woman living with HIV.

Voice Over: Sex talk. Starting a conversation about sex.

Adele: Welcome back everybody to the Sex Talk podcast. We've missed you but we are ready for series 3.

Hilary : Indeed. Adele it's absolutely amazing to be back in the studio once again with you. After that scorcher of a month, or couple of months we've had.

Adele: I've been out topping up, getting in some varnish on my coat.

Hilary : It shows, you're glowing.

Adele: You too. So we're very glad you're here with us on the podcast but if you've missed any or you'd like to catch up and see what me and Hilary have been learning about and chatting about, you can go back any time to the library on your smartphone, have a little look in the app store, or even better, subscribe to us.

Hilary : Yes absolutely Adele we like that, and also you can follow us on Twitter @SexTalkRadioUK and visit our website sextalk.radio. We just heard from Juno Roche, a trans-woman who is living with HIV, who we'll be speaking to more later. Today we're focusing on Trans and Non-Binary sexual health. Trans people are considered a 'high risk group' when it comes to HIV, and in this episode we're going to be looking into why that is and what is being done to change this.

Adele: If you heard the last series of Sex Talk, you will have heard myself and Hilary at Pride in London. If you haven't heard this episode them go back through the archive and listen to episode 11. You may have heard that at Pride in London this year a transphobic group protested at the start of the parade. Sadly for trans people this is all too familiar. Although LGBT rights have come on a long way in recent years, trans people still face a lot of stigma.

Hilary : According to LGBT rights charity, Stonewall, 2 in 5 trans people have experienced a hate crime or incident in the last year, and 84% of trans people of school age have self harmed. 45% have attempted suicide.

Adele: Those stats are too high and it takes all of us to chip in and make it more comfortable for them to be accepting of who they are and help them on that journey.

Hilary : It's never easy, it's never an easy journey, especially a journey whereby society judges you a lot and if you feel that you're constantly being judged and you no longer want to be here, that's extremely concerning for me.

Adele : We want you to be here so we're going to help out. According to another survey conducted by Stonewall, 41% of trans people said that healthcare staff lacked understanding of specific trans needs. So we're asking today – does this barrier increase the risk of HIV and late diagnosis amongst trans people and what can be done to break down that barrier?

Hilary: In London there's a holistic sexual health and wellbeing service for trans and non-binary people called Clinic Q.

Adele: Joining us in the studio now is Aedan Wolton, a Director at Clinic Q. Welcome to Sex Talk Aedan

Aedan Wolton : Good afternoon guys thank you for having me.

Hilary: Welcome. I said jokingly when you first walked in the studio – director, that's a big title.

Aedan Wolton : It's a frightening one to be fair.

Hilary : You've been working there for 5 years now?

Aedan Wolton : Yeah so it's not just me there's another 6 people who take on the responsibility so it's not all coming down to me thankfully.

Hilary : Aedan, what is Clinic Q and where is it?

Aedan Wolton : So Clinic Q is a sexual health and well-being service for trans and non-binary people and their partners. It was originally based at 56 Dean St which is just around the corner from where we're recording here in Soho. We also have a counselling service which operates outside of our NHS homeland which is our service on a Wednesday evening.

Adele: So you said they're 'and their partners' I think that's vital. Also you said counselling, I'm here for that, I'm buzzing for that. What services are available through Clinic Q?

Aedan Wolton : You'd be amazed how much we've managed to fit under one roof actually. So we have anything from obviously all of the services you'd expect from a sexual health clinic, whether that is regular testing, whether it's treatment for syphilis, gonorrhea, all those sorts of things, as well as a very busy HIV clinic. As we've said we've got counselling. We've got acupuncture, we've got a yoga class which goes on in what is usually a very uninteresting basement is our boardroom, we push all the tables to one side on a Wednesday evening and have a yoga class for trans people and their partners so quite a lot going on I think.

Hilary: Aedan, Adele just picked up counselling, do you extend that counselling help to perhaps families as well?

Aedan Wolton : Absolutely, so we work in a really systemic way so anybody that is affected by any issues relating to trans people and transition if it's a partner that's struggling, if it's a young child, we can see counselling for young people who maybe have a parent that's transitioning so we're really, really flexible about who we can see.

Adele: It's lovely to hear the passion but also see the passion. We're in the studio with you right now and we can feel the passion that you have for Clinic Q. Why did you get involved in the first place?

Aedan Wolton : So I transitioned myself about 10 years ago. I definitely took the scenic route into sexual health. So when I transitioned I was working in the music industry, I was working in music publishing and at roundabout the same time that I started to feel a bit disillusioned with that I also started volunteering at a trans youth project in Norwich, which is the city I used to live in. At the same time as losing my love for music, I found something else that I felt really passionate and really strongly about and actually despite growing up in a relatively rural place I actually had quite an easy transition and I was introduced to young people who maybe didn't have such an easy time and I think I've got a bit of a responsibility to do something about that for other people.

Adele: You are being the change that you wanted to see.

Aedan Wolton : Hopefully.

Hilary: Adean, how did people around you at the time react?

Aedan Wolton : It was definitely challenging in certain respects. I think you find out who your friends are unfortunately. But actually there's a huge positive that comes from that as well so relationships that I had that maybe weren't as close to certain people who ended up being overwhelmingly supportive are now absolutely my best friends in the world.

Adele: You mentioned before that you do a lot of work with people who maybe have HIV. Why are trans people more at risk of contracting HIV?

Aedan Wolton : So a lot of the reasons that we understand about our communities and HIV it's generally research that we've got from other countries. In this country we're a little bit behind, but talking on a global scale we know in certain parts of the world that for instance, trans women in Thailand might be locked out of traditional ways of working 9-5 jobs, things like that, because they legally can't change their passports, any of their documents, so therefore you can't under Thai law get a job so we see instances of sex work and survival sex and exchanging sex for housing things like that. We see high levels of that within trans communities in certain pockets.

Adele: So rather than respecting somebody's fiber of their being, they'd be like, it's fine you go and do sex work, we'd rather you do that than just honour who you are.

Aedan Wolton : It doesn't make a lot of sense does it. Another of the reasons we think we might be slightly luckier with the HIV rates in this country compared to the rest of the population across the world is obviously we've got the NHS, we've got free healthcare which is incredible. In other places where people might have had experiences with healthcare, if you're paying for that service on top of that you're probably not going to go back, so I think that's one of the reasons that we see certain spikes in certain parts of the world.

Hilary: Aedan when you speak about HIV in relation to trans people, is it trans women who are generally spoken about, or is it an issue which is also affecting trans men?

Aedan Wolton : I think it's an issue for everyone certainly. I think for trans women they have historically been more visible so they've been included in research more frequently than trans guys have. From some research that's emerging in the states at the moment we know that in terms of trans men's sexual networks lots of them are actually having sex with cis, so non trans men, which is generally a heightened risk factor for HIV so even though we don't have the stats as far as prevalence is concerned we definitely know the ingredients are there for it to be a consideration.

Adele: You mentioned before about the NHS and how lucky we are to have that. I think we're lucky to have Clinic Q and people like you and the other six directors.

Aedan Wolton : Yeah and all of our other counsellors who volunteer their time and people helping others through the service and things like that.

Adele: We've got you so that's good, but what could be done? As you said before you're from a rural area and people might not have access to these amazing facilities, so what can be done at other clinics to help trans people feel like they can be included and not judged?

Aedan Wolton : I think training is a really important thing. So to have managerial support from people, to be allowed to go to training if it's not something that is provided locally to travel and access that because I think information and understanding is one of the most important things. For services that maybe don't have the footfall for a specialist trans clinic like we do I think it would be important even if it's for an afternoon a week, have members of the trans community come in and whether it's greeting patients or to be involved in the service I think it makes it a lot more accessible for people.

Adele: Yeah because I think as a patient you'd be like that person understands totally what I've been through.

Aedan Wolton : I think just trying to engage the communities you're trying to reach in delivering the services is absolutely key so whether that means taking on people in volunteer posts, whether that's thinking more broadly about equality and diversity in training positions and I think with trans communities we are in many ways so used to things not being for us that unless it's explicitly stated this is a training position that welcomes trans and non-binary people we might think that's not something that's appropriate for us so I think we have to be quite explicit in terms of inclusion to try and encourage people in.

Adele: Just going to back to the services that you provide, I think people are going to be listening to this who are potentially really interested in coming to see you guys at Clinic Q, because you seem so warm and lovely and I feel like a lot of people will be like, okay well maybe I'll give them a call. I just wanted to ask about other services, so maybe the more sensitive services that you might offer so things like cervical screening, breast cancer screening, and prostate examinations. Do Clinic Q also offer these services?

Aedan Wolton : So we do offer cervical screenings to anybody over the age of 25 that has a cervix so whichever identity is attached to that is as far as we're concerned is irrelevant. It is quite invasive, it can be quite frightening for people and if you're referred to a local clinic from your GP not only might someone like myself with a full beard and obviously with male presentation be forced to sit in a female waiting room which is quite challenging in and of itself, these appointments are expected to take about 15 minutes. If you become stressed it becomes physically very difficult because you tense up and it's a very hard thing to go through. So at Clinic Q none of our services are gendered, none of our waiting services or toilets or anything like that are gendered, and I think because we're aware of the difficulties, if it takes 10 minutes for one person or 45 minutes or an hour and a half for the next person it takes as long as it takes, so we try and make it as easy as possible for people.

Hilary : You've already educated us so much sir, but I do have a few more questions. Before we get into those questions and going on to learn a bit more,have you heard of the game we play here on Sex Talk, Word Porn?

Aedan Wolton : I have indeed.

Adele: Good news travels fast.

Aedan Wolton : Long time listener, first time caller!

Adele : Oh I love that! Yes!

Hilary : Classic! Do you know what it's called?

Aedan Wolton : It's word porn isn't it?

Adele: He's going to be too good at this I feel it already.

Hilary : You've read our dictionary.

Voice Over: Sex talk. Word porn.

Adele: Okay so we have the dictionary here. Aiden is it all you imagined it to be?

Aedan Wolton : And more.

Adele: The 99p sticker I've left on it there, you get these in Poundland. So we'd like you to pick a letter please, and we'll find a word and we're going to ask you to try and guess what that word means.

Aedan Wolton : Okay. Let's go with the letter H.

Adele: Okay so in the dictionary of sex let's go to the letter H.

Hilary : Any particular reason?

Aedan Wolton : Just the first thing that came to my mind.

Adele: This one made me laugh. We might do two for you because I feel like you're going to get it. How's your father. I know this one. Do you not know this one? How's your father what does that mean?

Aedan Wolton : A bit of how's your father? Is that right? Euphemism for sex.

Hilary : Oh really we don't say that in South London.

Adele: Hilary's like 'well my father…'

Hilary : He's at home watching East Enders actually. Adele's gone for a second one…

Adele: Okay… Hammock.

Aedan Wolton : A nasty pair of Speedos. I'm thinking a pair of budgie smugglers.

Hilary : If Adele's laughing like that you're probably right.

Adele: I think that should be a new meaning, that's not the one I've got here. Keep going, you're in the right area. I've got a hammock as well, didn't know. You've got a hammock, you've got a hammock, we've all got hammocks.

Hilary : Probably something to do with an organ.

Adele: Hang on a minute I've read… I don't think I have one I don't think. Okay so shall I just read it out because I've kind of ruined it a little bit but you're around the right lines in terms of budgie smugglers. A layer of connective tissue in the floor of the pelvic cavity that helps support or attach various genital organs of both sexes. I have got one! The root of the penis for example is attached to the pelvic hammock fibers. Swing your hammocks! I think we'll give you that point though. Two points.

Hilary : I learnt two new words!

Voice Over: Sex talk. Word porn. -

Adele: So Aedan, we've spoken a lot about PrEP on Sex Talk so far. Would you be able to explain for those who are new to Sex Talk what PrEP is? Also, is PrEP available to trans and non-binary people?

Aedan Wolton : Absolutely. So PrEP is actually a medication that we would use to treat HIV but we use it in a preventative way so it's pre exposure prophylaxis, that's what PrEP stands for. It is suitable and available for trans people, so there's currently an NHS trial at the moment which is called the impact study which trans people can enroll onto to take PrEP. It's not available like other medication is available, it's only on a trial basis in England unfortunately. Hopefully that's a change that's in the making at the moment. In terms of some of the things that people might have heard about PrEP before you can take it either on a daily basis or you can do something called on demand PrEP which is based on the sex that you're having. That gets slightly more complicated when you put trans people into the equation. So if you're specifically having anal sex then on demand PrEP is fine. In terms of having vaginal sex, whether it's a trans man or a trans woman or a non-binary person having vaginal sex that saturation levels so you get the safe levels of the drug takes a little while longer so we would ask people to take daily PrEP if they were having frontal or vaginal sex.

Adele: Okay thanks for that because I've not heard that before so that's a good distinction.

Hilary: Absolutely that's new information. There is not much data about trans and non-binary people and HIV infection rates available in the UK, but looking at Public Health England data published earlier this year, trans people are twice as likely to be diagnosed late with HIV than other adults. What's the effect of late diagnoses?

Aedan Wolton : It could be fatal which is completely avoidable. It also means that there's been more time for the person to pass on infections to other people if they've not been on medication. Even if cases aren't fatal in terms of the impact on people's health it can be really complicated and it can produce quite a lot of unpleasant and avoidable infections, so it's something that we would really strive to avoid to be honest.

Adele : When you see people at your clinic do you get the sense sometimes that they wish they'd come forward sooner?

Aedan Wolton : Absolutely. I've worked with some people over the years that have had some really unpleasant experiences with other health care services. Thinking about one person in particular who had very late stage HIV and lots of complications from it, had a history of being misgendered by previous HIV doctors in another service, had seen a psychiatrist who was relatively transphobic. Even at the reception at their GPs they'd been repeatedly called sir, so all of these things obviously come into their next appointment with that person and there was a real distrust of medical services so we spent a long time at Clinic Q trying to build up that trust and undo all of the work that had been done previously. We did make a lot of progress. Clinic Q is a very welcoming place for trans people and I think it really helped in a lot of ways. She was unfortunately made homeless at the same time all of this was happening and with difficulties finding somewhere to live, a trans appropriate hostel or somewhere for her to be temporarily housed it was very complex and we lost touch with her, so I'm assuming the worst and it's just completely avoidable and it's a lot of work that we shouldn't have to go back and try to undo all of those mistakes that have happened previously, they're all things that shouldn't have happened in the first place.

Adele: What would you say to trans and non-binary people listening to this who may be scared to access sexual health services in their area? Is there anything they can go into the clinic armed with?

Aedan Wolton : Yeah I think it can be really helpful, for example some of the literature that Clinic Q has produced and that's on our website we've got sexual health guides for trans women who are having sex with cis men and also for gay bi and queer trans men, they're really helpful from an individual's perspective but also if you want to take it in and tell your clinician or speak to your nurses and say this is the advice I've got this is what needs to happen I think that can be really helpful for people.

Hilary: You pretty much answered the question I was going to ask you next. How can the people in the health service, how can they help support trans and non-binary people?

Aedan Wolton : I think if we're talking about people that are working in clinics maybe look at some of the small things in the clinic that you might be able to change, for instance how easy or hard is it for people to change their name on your computer system so thinking about the little things that can make positive changes. No one's saying you have to be an expert in trans sexual health but there's little things that can help.

Adele: And they all add up.Thank you so much for joining us today on Sex Talk Aedan!

Aedan Wolton : Thank you so much guys, absolute pleasure.

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Hilary: On this episode we're talking about trans and non-binary sexual health. So far we've spoken to Aedan Wolton about the incredible work happening at trans and non-binary sexual health and wellness centre, Clinic Q.

Adele : Talking to us now on the phone, all the way from sunny Spain, is Juno Roche, who is a patron to Clinic Q. Welcome to Sex Talk Juno!

Juno Roche : Hi, lovely to be here, lovely to be here from Spain actually.

Hilary: We are incredibly jealous. So Juno, we've just been speaking to Aedan from Clinic Q. I believe you're a patron for the clinic, why did you decide to get involved with the clinic?

Juno Roche : For two reasons really. The main reason was a completely selfish reason in the sense that I've been trans my whole life. I'm not going to do that thing of saying I was born in the wrong body because for me it's not about that, I was born the way I was born. But I was diagnosed with HIV over 25 years ago, so for 25 years I feel like I've had really difficult care being a trans woman living with HIV because for a lot of the time there was stuff around – they would misgender me, they would write me down as being male and there would be M all over my documents. I couldn't get anybody to give me specific advice about being a trans woman living with HIV about my medications etc. etc. so then somebody put me in contact with Michelle who's one of the leaders at Clinic Q, so I went to meet Michelle. We just had a cup of coffee and then we walked down to Clinic Q and literally it was a visceral emotional response. I realised that actually this was the place that would have been so comforting and supportive to me for all of those years that I struggled, and it's a real struggle to go somewhere and they've got you written down as a man and you're standing there with tits and a vagina and you've got to explain to them that you're not a man, so to be able to go somewhere that fully embraces trans and non-binary and queer identities. Although I hadn't been able to have 25 years of wonderful care there what I could do is be of some use. I'm somebody in the UK who's out and open and has got a profile, so one it was a completely emotional response. The next thing I felt was this incense that we were still having to fight with such poor treatment for trans people and it was really pot luck. Most doctors are terrified about HIV still, most GPs still, and for me when I went to Clinic Q I felt I'm quite ballsy in a way – I write about this stuff all the time so I'm very confident now, but what about the 21 year old who just gets diagnosed who's trans. I don't want them to have to take chances and Clinic Q is somewhere that they can go and know that they're going to be embraced in this completely loving way.

Adele: You did say family and that really struck me from hearing you speak so passionately and Aedan as well earlier. I do feel like this is something that's really good for LGBT, it's fabulous. You also said there poor treatment. Are you still meeting young people who feel the same way you do and who have been treated in the same way you have?

Juno Roche : Certainly in relation to trans and in relation to HIV. The thing about HIV is that no one arms themselves about HIV unless they become HIV, so it remains this thing that remains outside of stuff and therefore people are set up to go we don't know, they're not set up to embrace you and say come in let's see what we can do, let's talk about drug interactions etc. etc. and I think something you said really is important and I think that notion of family because that's what gay men did really well over these last 20, 30 years of the HIV crisis, if you want to look at it like that is that they formed these families for themselves. But quite often trans women were really excluded from those places even if it was unintentionally.

Adele: What do you think needs to be done to make sexual health services more accessible to Trans and non binary people?

Juno Roche : If there are people who have never met anyone that's trans, if they don't know anything about trans stuff and they're just going off what they read in the newspapers, then quite frankly they're going to develop horrifying attitudes towards us, so I think really simple training. One of the things I was really pleased to do with Clinic Q when I first came on board was to secure some funding so we could start to work with GPs just to give them an entry level training in terms of trans stuff. If they have some understanding of the care path way with trans people, then they're not going to be terrified if a trans person walks into their office and says that they want to transition and I also think people develop policies. If the NHS collected two stage data so we knew how many trans people were going through the system then that would make a drastic difference.

Hilary: Let's talk about cisgender people for a second– for those we don't know – are people whose gender identity matches the sex they were assigned to at birth – what can cisgender people do to support trans and non-binary people?

Juno Roche : See them as being humans. Don't think what can you do for us – I don't know fall in love with us, go on dates with us, kiss us, fancy us as much as anybody else, treat us like anybody else. Don't think we're this special group where you're going to have to become this set of allies. Let's say you're a cis gay man, look inside yourself and say would I sleep with a trans gay man? Would I date a trans gay man? And if I wouldn't then I hold some kind of transphobia inside of me. It's not enough just to say I'm going to be an ally and say all the right stuff online, because quite frankly I've got a whole line of people saying to me 'I've got your back Juno'. But I don't need anyone to have my back. What I do need is for people to see us as humans, as loving breathing people that deserve all the other stuff that people do. I don't want to see trans people single and on their own. I feel like I have a really long complex life that started off many, many years ago in Peckham in South London in a insalubrious background and now I've ended up here. And many years ago I had a drug habit, I had lots of problems at that point in time and everyone wrote me off and here I am 25 years later talking to you from my beautiful little house in the mountains of Andalucia and I'm writing my next book.

Adele: We're going to talk about the book in a second if that's alright but just one more bit of advice - that advice would you give to anybody who identify as trans or non-binary who might be listening to this when it comes to their health?

Juno Roche : Don't reject the body that you're in or find a way to be kind to the body that you're in and self-care for the body that you're in but that's true for anyone. Most of the problems occur because people don't love themselves so they go and take a risk because somebody says I don't like using condoms do you mind? And they don't feel worthy enough to say no you need to use one. That's an empowered statement to say to someone no you've got to use a condom or you don't sleep with me so if you think that you've taken a chance that was risky, get yourself down to Clinic Q and get tested because being tested early makes all the difference to anything, be that chlamydia, HIV, syphilis, it makes a huge difference to any of that stuff.

Hilary : Juno, you've recently released a book haven't you? Can you tell us about it?

Juno Roche : So I released a book, it came out in April, called Queer Sex which is like my journey back to sex and thinking about sex and trans bodies. I, like most other trans people, spent many years rejecting my body. I wanted to not deal with any of the male parts of my body etc. etc. and that meant I had this real detachment from it, so I interviewed trans and non-binary people and talked to them about their sex lives and about what they're getting up to, because I wanted to write a book that was a bit sexy and naughty, and if you were trans or you thought you might be trans and you're 19 or 21 or 70 in the middle of somewhere and you don't know anyone else that's trans, you can order this book online and you can realise that trans people are having sex and non-binary people are having sex and people that just define as queer or fluid are having sex and having great orgasms and they're enjoying their bodies, and I wanted people to realise that it's not doom and gloom and there is a world out there that's vibrant. And it's done really well, surprisingly because we thought having a book that said queer and sex and trans and non-binary on the front cover would certainly be on the bottom shelf with Katie Hopkins but no. I'm on the top shelf.

Adele: Father Christmas if you're listening, get on that shelf. Juno, thank you so much for joining us on Sex Talk today.

Juno Roche : Thank you, take care

Voice Over: Sex talk. Starting a conversation around sex. -

Adele : Unfortunately that's all we've got time for on this edition of Sex Talk. If you need further advice or support on any of the issues raised in this episode of Sex Talk contact your GP. They should provide out of hours contact details for emergency calls.

Hilary : Alternatively you can go online - www.nhs.co.uk - to find your nearest STI testing and treatment service.

Adele : To find out more about Clinic Q you can visit their website, cliniq.org.uk.

Hilary : If you need somebody to talk to, you can call the LGBT switchboard on 0300 330 0630, or if you prefer, you can chat to them online by visiting switchboard.lgbt

Adele : And if you're concerned about HIV - Positively UK - can offer advice. Their national helpline is open Monday to Friday 10am-4pm on 020 7713 0444 and you can visit their website http://www.positivelyuk.org Don't forget to subscribe to our podcast to keep up to date with the latest episodes, and to follow us on Twitter, we're @sextalkradiouk

Hilary : You can join in the conversation using #SexTalkPod.Until next time stay safe

Adele: And keep talking.