LGBTQIA* Issues

Important to know:

In the Netherlands, when you are a man having sex with other men you are at the GGD categorized in the ‘risk group’, meaning that you qualify for free and anonymous sti-tests. 

These tests can be taken after 14 days after having unprotected sex. Before these two weeks, sti-symptoms have often not appeared yet. HIV, Syphilis- or hepatitis B-tests are only reliable after 3 months after having unprotected sex. Unprotected sex meaning either having sex without a condom, or when the condom has broken.

- For men under the age of 25, the GGD will test standard on chlamydia and gonorrhea, unless there is a reason to test on other STI’s.

- For men above the age of 25, the GGD will test on chlamydia, gonorrhea, HIV, and Syphilis.

- For gay men, the GGD will do an urinetest, throat test, and an anal-test (you will do this yourself in the bathroom). 

Sometimes, the GGD wants to do a blood test too. That will be tested on Syphilis, HIV, and Hepatitis B. 

PrEP is a pill that prevents you from getting HIV. PrEP is safe and is available on prescription at a pharmacy or at the GGD. RrEP stands for pre-exposure prophylaxis.  PrEP is a pill that contains two active ingredients: emtricitabine and tenofovir. These active ingredients prevent HIV from replicating in your immune cells. PrEP can be used by anyone who is HIV-negative, but it is very much recommended to men having sex with men. There are two different PrEP possibilities. There is an everyday pill, which you have to take everyday. And there is an on demand way, which consists of 4 pills which you take before and after sex. Ask your GP for emtricitabine/tenofovir disoproxil. Have them state on the prescription that you must have the generic drug and not the brand Truvada. If not, you will be paying much more than you need to for the pills. Are you only going to take it on demand? Ask your pharmacy which affordable variety of PrEP they carry that has a shelf life of longer than 30 days. Before starting PrEP, you will need to have had a medical check-up, this will be before starting and during the entire time you are using PrEP.  PrEP can cause side effects such as; headaches, nausea, and stomach issues. These side effects usually last only 2 weeks, if the symptoms do not go away or get worse, contact your GP immediately. 

PEP is medication you take after being exposed to HIV. You must take PEP within at least 2 hours and at most 72 hours after exposure through risky sex, via the GGD (local Public Health Service) or the ER at a hospital. PEP is a 28-day course of treatment with three HIV drugs. If you are not sure whether or not you have been in contact with someone who is HIV-positive, it is very important to go to the GGD or ER anyways. PEP is an emergency solution, which can have nasty side symptoms. Try to avoid having to use PEP by using condoms and PrEP. 

Costs:

PrEP is unfortunately (not yet) covered by Dutch insurance. The costs for doctors visits and lab expenses for STI and kidney function tests, will be covered by your insurance but you will still need to pay your ‘own-risk’. These costs will depend on the height of your own risk. Prices for the pills vary from around 25-60€ per 30 pills (for the daily version).  Look here if you want to see indications of prices for PrEP in different pharmacies, do note that prices may have changed https://www.prepnu.nl/prijs/ .  

For women having sex with other women, the chance of getting an STI is slim. 

• Fingering: slim chance of getting an STI or HIV, only when through the fingers lubrication from the vagina or anus, sperm or menstruation blood gets transferred from one’s to the other’s mucous membranes. 

• Oral sex: risk of hepatitis B, syphilis, and herpes. You can reduce the risk by using a female condom or a cut open regular condom. The risk of getting HIV is very slim, unless the one receiving is on her period.

• Rimming: Risk of chlamydia, gonnorrea, syfilis and HIV.  Risks of hepatitis A can be reduced by using a cut open condom.

• Using sextoys: this is only safe when using your own. If you switch through toys make sure they are very clean. You can also put a condom around them, but make sure to change it when your partner will use it.

Transitioning!

In the Netherlands, you are entitled to be registered as your gender identity, however this is limited to “Male” or “Female”. There are two cases where people have used an X instead of either identifier. To have your gender officially changed, you also need an ‘expert statement’ verifying your gender identity, even if one might think that the best expert on your gender identity is yourself. You do not need to have gone through any sort of medical transition in order to have a legal transition.

In order to begin a medical transition, you need a referral from your GP to a specialist practitioner - you can find a list of such practitioners here. After intake and screening to ensure all docs are in the right place, you will be placed on the (unfortunately rather long) waiting list for diagnosis and treatment. Once diagnosed with gender dysphoria, with sufficient mental capacity and awareness of the consequences to begin transition, you can begin hormone therapy. If you haven’t already, this is also the time you should begin your ‘social transition’. This means to begin ‘living your new life’, so to speak. This can mean anything from a haircut to a chest binder, and may also be an operation if you so wish.

The hormone treatment lasts for a year with regular medical updates, and then you carry on taking hormones for the rest of your life. On top of hormones, you may also wish to have an operation. Hospitals apply a number of conditions to qualify for a gender-confirmatory operation:

• gender dysphoria diagnosis

• 18 years or older

• social transistance of at least 1 year

• realistic expectations about the surgeries (especially for genital surgeries)

• no medical contraindications

• stopped smoking some time before the operation (period differs per operation)

• healthy weight (BMI for sex surgery 18 - 30 and for trans men for breast and uterine removal and colpectomy between 18 and 35)

Details on transition operations, as well as more details on other aspects of transgender medical help, can be found here.