Negotiating gendered appearance and representation in the context of a PrEP study for transgender women and men who have sex with other men in Dar es Salaam

Pre-exposure prophylaxis, or PrEP, have been touted by WHO and UNAIDS as an essential tool in ‘ending AIDS’ by 2030, holding the promise of a future where HIV is no longer endemic. At a study site in Dar es Salaam, transgender women and men who have sex with men come to gain access to the novel pill, which, when taken daily, is proven to be up to 99% effective in reducing new infections of HIV. In this paper, we present the case of one PrEP user, Ibada, who performed a noticeable change in their appearance during fieldwork. Exemplified by Ibadas’ transformation and analysis of their transformation, this paper demonstrates how PrEP users may manage and negotiate gender expressions at the study site and in other areas of life, such as in sex work, dating or search for employment as a peer educator. As inclusion in the PrEP program depends on gender, sexual practices and eligibility for PrEP, discussions of the motivation for participation and appearance frequently occurred among staff at the study site. The data presented in this paper draws on a 10-month of ethnographic fieldwork between January 2021 and April 2022. Methods used were participant observation at the study site and a secondary health clinic and interviews with Ibada, research staff, health care workers and peer educators. The paper provides insight into gender discourses at a PrEP study site and how non-hetero-normative persons may navigate gender expression in creating a future for themselves.