San Francisco Community Health Center
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Niko Kowell

Today I showed up for one of the only sessions about Trans men and the only workshop about TMSM (Trans men who have sex with other men). What I thought to be a discussion/info session, turned out to be me and 5 other Trans masculine folks sharing to a group of Cis folks who listened in. Led by a Trans masculine person, he opened up the discussion asking us what our community needed. It was clear throughout the entire discussion that we needed providers to be aware that we exist, and to educate themselves accordingly.

Throughout the discussion, I was able to share the incredible work we’ve been doing with tm4m ( and Trans:Thrive. This included being able to tell folks (in response to “there is no research about Trans people and PrEP”) that we are starting a demonstration project with SFDPH to evaluate PrEP in Trans communities.

To be honest, it also made me feel very vulnerable to sit in a small circle of 5 trans folks with 30 people around us, some listening intently, and others with clear confusion on their faces. I shared both as a provider and as a TMSM. I was grateful for the chance to share, but it was clear that Trans men are well below the radar. Sadly, this is not new information to me.

While there is not a lot of research on Trans men, let alone research on HIV rates in Trans masculine communities, we know that there is a lot of risk taking place. I know this, being a provider for this community for over 10 years and as a TMSM for my whole sexually active life. My hope is that we can be ahead of the HIV epidemic this once, instead of waiting until it’s already infiltrated our community at the rates of our Trans sisters and MSM brothers. We can do better, we can do more, and we can make this happen. So long as folks listen to key populations instead of being driven by uninformed and outdated information. It’s time to trust communities to tell providers what WE need, not what THEY think we need.