Sex advice: I took the necessary steps to protect myself during sex. Um, this is going to be hard to explain.

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Dear how to do it,

I am a non-binary woman, assigned at birth, without hormone replacement therapy (HRT) or gender affirmation surgery. I sleep with men, women, non-binary people, trans or not, and I have several partners at a time. I’ve been thinking about taking pre-exposure prophylaxis (PrEP) for a while.

I just received my first prescription after two condom breaks in the same night. Since I still read a lot as a woman, even if I wear a satchel, shirt and jeans, and because I work in the health sector, I fear judgment, both from regular providers and from my colleagues if they find out, although I am quite open about my private life if people are that curious. The criterion for AFAB is to have several partners per month. I already get strange looks for asking for throat and anus swabs. For example, how do you explain that you don’t need HIV post-exposure prophylaxis (PEP) when you get a little blood on a slight scratch or a little fluid in the eye of a patient with a positive viral load and you can still provide care to the patient rather than having to be replaced while you go to occupational health?

I think more people should be taking PrEP than are currently, and I know I should encourage it in my personal life. But there’s also this stigma that comes with being AFAB with multiple partners, including bisexual men with other partners, in a largely conservative culture. I’m so excited to start, but I don’t know how to deal with any potential social stigma. I knew more than my GP about how to prescribe it when she made this prescription, and I wasn’t even told about the injectable options.

— Confused about PrEP

Dear Confused About PrEP,

Stigma is real and has always been a barrier to PrEP, but don’t let that intimidate you. The opinions of others are not more important than your health, and PrEP is an effective, low-side-effect way to stay HIV-negative. That’s really what it comes down to in your case, at least given what you’ve experienced so far. People won’t necessarily understand why you’re taking PrEP, but their ignorance doesn’t trump your awareness of what’s good for your body. Are you going to stop having sex with multiple partners because people who don’t fuck as often or outright hypocrites wouldn’t like it? Obviously not. The same thinking applies to what comes with that sex, which is the protection of PrEP for you.

I don’t know if you’ve been in a situation at work where you had to explain why you don’t need PEP or if your example was purely hypothetical, but saying “I’m on PrEP” seems enough to me. You don’t need to explain beyond that. People can draw their own conclusions, but only you can confirm if they are right. If you don’t, they may as well assume you’re being very careful. Being already protected and not needing emergency PEP medication is an asset to your job, not a liability.

I understand that the fact that you are AFAB and perceived as a woman adds another layer of stigma to the typical narrative of men having sex with men on PrEP, which can be difficult to understand in itself. I know some people may think less of you when they discover that you think highly enough of yourself to take ownership of your behavior and mitigate the health risks that come with it. These people are petty and you are smart. A little complacency is warranted here; realize that you know better than those who would tear you down just because you had a sex life.

Dear how to do it,

I recently broke up with my partner of 11 years. Our relationship had been struggling for a good year before we finally ended it. It was a very painful but necessary breakup. It’s been three weeks, so I’m definitely still grieving. But I feel a little curious to go back. When is it too soon to start dating and having sex again? I don’t want to override the important healing work by filling it with distraction, but honestly, I could use a little distraction.

—Take a look

Dear glance,

There’s nothing wrong with a little distraction. Life is sometimes such a burden that you have to find relief where possible: a stupid movie that allows you to turn off your brain, an indulgent dessert, a good time in bed. Having sex is not incompatible with healing; you just can’t focus on healing yourself 24 hours a day. Embarking on a sex-filled life to be only distracted would be another matter. There’s a big difference between that and fucking every once in a while.

Moderation is key. Listen to your body. If you’re excited, do something. If you find yourself stuck in a space where you’re constantly having or seeking sex, especially before you feel completely healed, rethink your choices. Then reintegrate your proactive attempts at healing, whatever form they take, whether therapy, journaling, mindfulness, exercise, a combination of these, or more. Try not to use sex as an escape from life, but as an enrichment of it.

But in reality, it’s never too early. Sex can be a positive way to reconnect with yourself, especially after a difficult relationship, and in particular a disappointing and/or rare sexual relationship. There’s a lot of good to come from connecting with another person, being kind, and giving to them (in whatever form you see fit), even if it’s just for a fleeting moment.

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Dear how to do it,

Most people in my life are in strong, healthy, long-term relationships. I’m gay and trans in a small town and I feel hopeless, having never experienced this. I’ll probably be moving quite far away after I graduate college, and so I don’t anticipate any relationships in the next couple of years, simply due to the difficulty of the arrangement. I’m only 21, which I know places these feelings in the realm of teenage angst rationality, but here I am among family, friends, and peers my age who are engaged, married, and/or have kids, and I can’t help but feel like I’m missing out on a side of life that I’m horribly unfamiliar with. How can I ease these feelings and learn to feel satisfied while I’m single?

—21 and sad

Dear 21 and sad,

Stay hopeful. Right now, you’re in a small town, and small towns are notoriously LGBTQ+ hostile. Generally speaking, the smaller the population, the less likely it is to contain members of sexual minorities. So the numbers may just not be on your side at the moment. Many queer people experience so-called delayed or middle adolescence once they leave the confines of their education for larger cities with more options. Know that this could very well be your future.

Your youth doesn’t make your anxiety any less real or painful, but try to let it also put things into perspective: you have your whole life ahead of you. You may be more relationship-oriented, but understand that your future may offer you the opportunity to date, find your tribe, even be slutty, if you want. Your situation is temporary and things may change once you venture out.

However, you don’t have to be completely passive. If you don’t have a sense of community in your immediate neighborhood, cultivate it. Join LGBTQ+ clubs and activities on campus. Visit the closest off-campus spaces for queer people: centers, bars, clubs. If none of this is available to you, try meeting people online. Apps can be useful, although they may be geared more toward finding sex than dating, so be clear in your profile about what you’re looking for. You can also find discussion forums specific to your identity to create a sense of community online. There’s basically a subreddit for every label you might consider applying to yourself, so find what applies. There’s no guarantee that you’ll form a romantic relationship online, and even if you do, they may be far away, but I think any kind of interaction might make the void you feel like you’re staring into less vast.

-Rich

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