From “transsexualism” to HIV care: The categorization of transmasculine sexualities in relation to lived experience

Within clinical approaches to transsexualism, transmasculine people have been categorized as heterosexuals. This perspective was subsequently adopted in the fight against HIV, shaping how transmasculine people have been viewed in terms of prevention. Building on this observation, this paper investigates how these categorizations have impacted transmasculine people’s sexual trajectories and their reception within HIV prevention services, as well as how community health initiatives have worked to close the gaps in prevention and care created by these categorizations. Drawing on a thematic analysis of 13 interviews and community health literature, we show that – contrary to the dominant medical conception – a plurality of trajectories exist. First, for individuals who have experienced pre-transition heterosexuality, their sexual orientation complicates the process of self-recognition as trans and requires a reworking of medical representations of sexuality. Second, we highlight the persistence of a cisnormative conception, and even a erasure of transmasculine people within HIV care, resulting in discrimination, a sense of illegitimacy in accessing prevention, and a withdrawal of transmasculine people from such services. Finally, we show that trans communities have developed alternative prevention tools that take into account the diversity of anatomies and practices involved. However, for some transmasculine individuals, the form of “maximization of protection” presented therein is not seen as applicable to their actual sexual practices.