Navigating Gender Sexuality and Health Lab, University of Michigan Kevin Jefferson

1. Navigating Gender Sexuality and Health Lab, University of Michigan Kevin Jefferson Abstract Learning Objectives Research Question and Background • Research Question: How do TMSM define gender affirmation and how, if at all, does this relate to sexual health? • Studies highlight multiple partners, unprotected receptive sex, drug use, and sex work as risks to TMSMs’ sexual health.[2] Nonetheless we don’t know much about why TMSM experience these risks, or how prevalent they are among transgender men. Needs assessments do indicate that some transgender men feel sex with non-transgender gay/bi/queer men validates their gender, and that this may affect condom negotiation; that is, desire to be seen in an accurate gender may influence some TMSM to forgo condoms.[2] While I wanted to learn more about how such desire could influence sex practices, I also sought to broadly understand how TMSM fulfilled this desire, and how it may relate to sexual health. I began thinking of gender affirmation simply as recognition and acceptance of one’s gender (by oneself or others). I did not feel it was unique to transgender people, or that it inherently drove unsafe sex practices. I wanted a richer understanding of what gender affirmation meant to TMSM, how they recognized it, and what its importance was. I hoped to identify strategies that could inform sexual health programs for transgender men, while better understanding TMSM sexual health issues. To better understand this I asked how do TMSM define gender affirmation and how, if at all, does this relate to sexual health? • Background: “SexLab conducts research on psychosocial factors associated with HIV prevention, comprehensive sexual health, and sexuality-related health disparities. Our studies seek to identify innovative strategies to inform sexual health promotion interventions, including the prevention of HIV infection and transmission, and decrease sexuality-related health disparities.”[4] Literature suggests transgender men who have sex with men (TMSM) may be at risk for HIV, yet little is known about their risk.[1-3,5-7] NGender is a SexLab project that examines how TMSM define affirmation of their gender, and how this relates to sexual health. • Methods: Semi-structured in-depth interviews were conducted with 15 TMSM in the San Francisco Bay Area, a location sexual minorities are known to live. Interviews ranged from under 90 minutes to over 120 minutes, with 90 minutes as a target. The interview guide covered topics of identity, community, gender affirmation, how one’s gender is read, and sexual health. Participants were reimbursed $30 to thank them for their time, and were offered the opportunity to provide input into interpretation of their interview and overall study themes. • Results: 13 out of 15 interviewees expressed an interest in participating in the study’s analysis. Secure online technology shall be used to give interviewees this option. Thematic analysis and member checking with the 13 interviewees shall be used to interpret study findings this fall and winter. • Conclusion: This study hopes to add to our understanding of TMSM health, and of the role gender has in sexual health. It may model an effective participatory model with interviewees. Responsibilities • Create in-depth interview guide covering study domains • Identify recruitment venues and perform outreach for NGender • Conduct 16 interviews with TMSM in the San Francisco Bay Area • Provide opportunity for participants to give input into study analysis Critical Analysis • Although I am from the San Francisco community I conducted NGender in, I started the project identifying as an insider-outsider researcher. I felt being at U of M separated me from my community; I wanted to acknowledge this along with my race, educational/class, and gender privilege. My community however was diverse enough to hold me in it as a researcher and someone with these privileges. For its part the community didn’t assume what I was doing was amazing, or awful. I was held to the same standards of scrutiny that a non-community researcher would be; belonging was no guarantee of my politics. I believe my insider status did mean that once TMSM decided to participate, they were very motivated to help me out with my project. At the same time, my insider status may have caused some participants to downplay their sexual risks to look “better” to another community member. Challenges and Solutions • Wanted to include a fuller diversity of TMSM stories. Targeted recruitment to harder to reach TMSM and met interviewees flexibly • The community gets many research requests but findings are rarely brought back. Prioritized community feedback and input • Participant incentive ($30) was not clear in IRB approved outreach items. More time recruiting and emphasized community benefits References and Acknowledgments 1 Reisner, SL., Perkovich, B., Mimiaga, MJ. (2010). A mixed methods study of the sexual health needs of New England transmen who have sex with nontransgender men.AIDS Patient Care STDS. 24(8):501-13. 2 Rowniak, S. (2011). Transmen: The HIV Risk of Gay Identity. Manuscript pending publication in AIDS Education and Prevention. 23(6). 3 Sevelius, Jae. (2009). "There's no pamphlet for the kind of sex I have": HIV-related risk factors and protective behaviors among transgender men who have sex with nontransgender men. J Assoc Nurses AIDS Care. 20(5):398-410. 4 Sexuality and Health Lab. (2012). About Us [web page]. Retrieved September 10, 2012, from: https://www.sph.umich.edu/sexlab/sexlab_about.html 5 Thompson, H., Wall, S., Roebuck, C. (2008). A Rapid Needs Assessment Transgender Male Risks for HIV in San Francisco 2008. Posted on San Francisco Department of Public Health Community Programs HIV Prevention Section website: http://www.sfhiv.org/documents/0312TransmaleRAP.pdf 6 Thompson, H., Wall, S., Roebuck, C. (2008). FTM Rapid HIV Risks Needs Assessment 2008. Posted on San Francisco Department of Public Health Community Programs HIV Prevention Section website: http://www.sfhiv.org/documents/AbbreviatedReport.pdf 7 Thompson, H., Wall, S., Roebuck, C. (2008). 2008 SF FTM Rapid HIV Risks Assessment Preliminary Findings. Posted on San Francisco Department of Public Health Community Programs HIV Prevention Section website: http://www.sfhiv.org/documents/ExecutiveSummary.pdf I wish to thank my faculty adviser Jose Bauermeister, MPH, PhD as well as my SexLab colleagues and NGender participants Achievements Contact • Collected stories that highlighted diversity of experiences among TMSM, community assets along with challenges • Integrated opportunity for participant input and dialogue, results sharing and interpretation with community • Conducted over 31 hours of interviews! Kevin Jefferson MPH Candidate, 2013 Health Behavior Health Education University of Michigan School of Public Health Email: kevinaje@umich.edu Sexuality and Health Lab, University of Michigan José Bauermeister, MPH, PhD 3822 SPH I, 1415 Washington Heights Ann Arbor, Michigan 48109-2029 Office: (734) 764-6653 Fax: (734) 763-7379