But, first, a trip to somewhere I didn’t anticipate visiting. Dundee’s largest sexual health clinic. Apparently my predecessors at Health Protection Scotland have been “hands off” leaders, which I think is a polite way of saying “lazy.” I don’t see how anyone can understand health policy in practice, and know what needs to change, without seeing it on the ground. My peers seem to think that’s radical. I think it’s just common sense, so here I am walking through the gray, dreary streets of Dundee.
I wait in the waiting room for Tanya Gilmore to pick me up and try to subtly eye up the four other people here. Two women and two men, all of whom are studiously looking at phones, magazines or their laps.
“Amanda?”
Tanya calls my name and ushers me into her office, a warm, welcoming room with fun graphic posters on the walls saying things like, “Check your boobs!” and “Be proud of your choice.”
“Thank you so much for agreeing to see me,” I say, but I don’t get any further into my speech before Tanya waves me away.
“I’m glad you want to see the work we do here. No need for a thank-you. Now, what can I do for you?”
It feels alarmingly like I’m one of her patients. I almost feel nervous despite the fact that, with the total lack of sex in my life for years, there is literally zero chance of me having an STI. “I want to know about your support groups. Your local area has lower uptakes of antidepressants and a lower suicide rate in the LGBTQ community. I want to know why, and replicate it.”
Tanya sits back in her chair and exhales. “It’s not that simple, you know.”
“Why not?”
“Well, for a start, you can’t replicate me and I’m the reason for this.”
“So help me understand.”
Tanya sighs and I sit, resolute. I need her help. The suicide rate of gay men has risen by 450 percent since November 2025. We don’t have enough data for the suicide rate of trans men and women but, anecdotally, it’s gone way, way up. There is a public health crisis in the LGBTQ community and Tanya is doing something right.
“Let’s go back to basics,” Tanya says. “Gender is a social construct. If I had a pound for every time I said that over the last fifteen years I’d have one of those Alaskan survival bunkers all the billionaires disappeared off to. But the Plague distinguished on the basis of sex and there was no fucking with it. None at all. It was the first time I had experienced a huge divide in the trans community. There wasn’t anger or discord, just stunned desolation. Trans women on this side—you’re all probably going to die. Trans men on that side—you’re all going to be fine. You have to understand, that’s not how our community normally works. Trans women were rendered helpless in the face of their XY chromosomes, and gay men became a super-minority. It was a nightmare.”
She stops and glares at me as if I’m forcing her to do something awful, dredging up terrible memories. “It was already really hard being trans in 2025, and being gay often wasn’t a picnic. But the Plague made everything so much worse. The process of supporting trans individuals, campaigning for expanded rights and making the world a better place for trans people became irrelevant to a lot of people.”
I have to interrupt and ask, as I’m dying to know. “Are you immune?”
“No. I still can’t believe that I’m alive, to be honest. It feels like for the first time in my life my body has actually helped me out. ‘I might have given you male sex at birth but I’ll do you a favor with the Plague. No death for you this time.’ I contracted it in December 2025 and survived. In the first few days after I survived I was glowing. I felt . . . lifted. Chosen. To be so close to death and have life handed back to you is an amazing thing.”
“And now you’re doing something extraordinary with your life.”