If you live in Australia and have access to Medicare, living with HIV today is different to what it was like 30 years ago. When combination anti-retroviral therapy (ART) hit the streets in 1997 it was a game changer that saw HIV move from a terminal illness to a chronic but manageable health condition. In fact, these days, the life expectancy of an HIV-positive person living in a western country with affordable access to ART isn’t much different to that of an HIV-negative person.
HIV treatment regimens today are a lot simpler, more effective and gentler on the body than they used to be. Treatment might be as little as one tablet per day and in some states and territories ART is free if you have a Medicare card, while other states charge a small co-payment for the medications. Check out how to access ART in Australia here, including if you don’t have a Medicare card.
Some people taking ARVs may experience side-effects such as diarrhoea, headaches, nausea and gastrointestinal upset, although these usually resolve within the first month or so. Other people will experience more prolonged side-effects that may need to be managed. There are many treatment options available, so it’s important to talk to your doctor about your side-effect experience so they can consider and discuss with you possible solutions, such as changes to diet and exercise or possibly changes to the medications themselves. It’s important to eliminate or reduce treatment side-effects as much as possible so that taking the medication as directed (i.e. every day) so that treatment resistance doesn’t develop.
There is limited research into the efficacy of ART on bodies where the primary hormone is exogenous testosterone (externally applied/injected) but there are also many trans guys who are on T and living well with HIV, so it can be inferred generally speaking that ART and T are compatible. The University of Liverpool’s HIV Drug Interactions published an updated Hormone Therapy for Gender Transitioning guide in April 2017 to include testosterone enanthate or cypionate, and mixed testosterone esters for the first time:
If you are HIV-positive it is important to establish an ongoing and trusting relationship with your HIV specialists so they can monitor changes to your health with you, including changes that may be related to HIV meds, hormone therapy or even recreational drugs.
You can check out how recreational drugs might interact with ART at the TouchBase website. Also, the National Prescribing Service is staffed by specialist pharmacists who will answer email queries about side-effects and drug interactions.
There is now very clear evidence that demonstrates the value of starting ART as soon as possible after diagnosis. The World Health Organization and the Australian treatment guidelines recommend ARV for all HIV-positive people, regardless of their CD4 count or duration of HIV infection. You have to be ready though: starting HIV treatment is a personal and lifelong decision that one shouldn’t be pressured into taking. Often, the best people to give real-world advice on treatments are other people living with HIV (PLHIV). The Institute of Many (TIM) is an online, peer-run community of people living with HIV that welcomes all trans HIV-positive people.
Treatment for bacterial STIs involves a short course of antibiotic tablets and/or an injection(s) in the butt.
Trans guys need to get tested regularly <Internal link testing 101>, and if you have an STI, get back to your GP or sexual health clinic for treatment ASAP. The sexual health clinic will be free for you, a GP may not be.
Current treatments are extremely effective at curing syphilis, chlamydia and gonorrhoea. These bugs can become drug resistant though (particularly gonorrhoea) so it’s critical you finish all your antibiotic pills and follow the doctor’s instructions about when you can safely start having sex again.
Viral STIs including herpes (HSV) and warts (HPV) cannot currently be cured but can be effectively treated with topical ointments or medications. Check out the Drama Downunder website for more information about these.
There is an effective vaccine for HPV and many younger trans guys will have been vaccinated against HPV at school. Some studies have shown that guys who have already been exposed to HPV could still benefit from anti-HPV vaccines, though more study is needed in this area. You might consider talking to your doctor about this, and you can find more information at The Bottom Line.
Although there is no cure for HPV, genital warts, one of the symptoms of an HPV infection, can be treated. HPV infection is the underlying cause of most cervical cancers, 90% of anal cancers, and the majority of front hole and other genital cancers, so it’s important to have a primary HPV test every 5 years if you still have a cervix, and getting an anal screen every 1-3 years—every year if you’re HIV positive—as well.
Find out more about HPV here.