Thailand’s first National Seminar for men who have sex with men (MSM) and transgender (TG) people on 29-31 May 2012 in Bangkok provides an opportunity for civil society organizations, networks and stakeholders working on HIV and AIDS to share experience and lessons learned and to strengthen their collaborated efforts in eradicating stigma and discrimination and reducing new infection rates. At the conference, UNESCO’s Asia-Pacific Regional Bureau for Education is launching a new report, "Promoting Health-Seeking Behaviours and Quality of Care among Men who have Sex with Men and Transgender Women: Evidence from 5 provinces in Thailand".
The study was commissioned by the HIV Prevention and Health Promotion Unit of UNESCO Bangkok and aims to:
• increase understanding about the health-seeking behavior of MSM/TG women in Thailand, including perceptions of illness, sources of information on sexual health, types of health services accessed, and constraints and obstacles in accessing healthcare; and
• evaluate whether existing sexual health services meet the needs of MSM and TG women in the current Thai context, and develop recommendations for community groups/organizations, policy-makers (in light of Thailand’s revised National AIDS strategy), health service providers and developing partners to improve the health-seeking behaviours of MSM and TG women.
The report drew on the experiences of 100 MSM/TG women from Bangkok, Ratchaburi, Chiang Mai, Phuket and Khon Kaen provinces, through interviews and focus group discussions. It finds that – despite concerted efforts by civil society, the government and international not-for-profit organizations to contain the epidemic among MSM and TG women – many continue to face challenges in accessing health services due to a number of factors. As reflected by this study participant, stigma and discrimination continue to prevail. The worst reaction was observed by a 24-year old gay Bangkokian, who said the service provider “didn’t give me information, was unfriendly, and told me that being gay, I should go receive services elsewhere.”
Trustworthiness and credibility were the most common criteria participants reported they used in choosing a sexual health venue. These were commonly linked to confidentiality and privacy in using the services, as well as to having a personal connection (such as personally knowing a staff member) and being familiar with a venue. Others reported the availability of MSM-specific services as an important criteria, as this participant put it, “I’d go to … clinic because I know it’s a specific men’s health service. That is, the staff will have received training about taking care of men’s health, and so they’d be more likely to have the skills and the knowledge. If we go to an ordinary hospital, some staff members won’t be friendly, and sometimes when I sit waiting, they’ll call out loud “For the AIDS test!” and then call my name.”
More than half of the participants found the physical venue of their sexual health services problematic. By far the most common complaints were that the venue was too cramped and offered little privacy. The location of services was also identified as an obstacle for those living outside both the national capital and provincial capitals, where there were no group-specific clinics. Cost of traveling from a rural district to receive services in the provincial capital could exceed the daily salary of a person on a low income. STI diagnosis and treatment was generally sought only when symptomatic, whereas HIV testing was more commonly initiated due to perceived risk, anxiety and only sometimes due to health symptoms that could be construed as possible signs of HIV. Only thirty-five participants reported ever having been tested for HIV. The side effects of hormonal preparations used by many TG women in Thailand were discussed as often being diverse and rather debilitating.
Participants from Khon Kaen mentioned the options of taking “detox breaks” off the hormonal treatment, or taking diuretics, believing that they would expedite the detoxification of the body. Six TG participants expressed a wish to have more access to information and counseling on surgical operations and on the safe use of hormones, or on cosmetic issues. “I’d like to have a service centre directly for sao praphet song, on taking hormones and providing counselling on surgical operations” (21 years, Phuket). A 20-year old in Ratchaburi had similar wishes: “I’d like them to have a separate sao praphet song room, on taking oral contraceptives, on beautiful skin, rather than… sexual matters – that would be both fun and informative.” Thailand has seen rapid rises of HIV infections among men who have sex with men and transgender women in recent years.
Data collected in Bangkok among community sample of MSM in 2003 showed an HIV prevalence of over 17.3 percent. The figure rose to 28.3 and 30.7 percent in 2005 and 2007 respectively. Though 2009 has seen a decline to 24.7 percent for the first time, the rate remains high when compared to the general population. Similarly, among TG women in Bangkok, Chiang Mai and Phuket in 2005, an average HIV prevalence of 13.5 percent was found – roughly 10 times the national average among the general population. Projections made in 2005 using the Asian Epidemic Model suggested that the number of new HIV infections due to male-to-male sex would remain high and become the most common type of all new infections, replacing the previously most common type, sexual transmission from husband to wife. This suggests that controlling the HIV epidemic among MSM and TG women is a key element of controlling the epidemic in Thailand. Reversing the epidemic, however, requires an improved response that includes better and friendlier sexual health services for these populations.
“This report signals the importance of quality of care to health-seeking behaviours for all kinds of illnesses, but particularly for those to which stigma and discrimination is attached. UNESCO hopes that this study will pave way for civil society, government and international partners to improve their interventions, thereby ensuring and maximizing the well-being of everyone infected and affected by HIV regardless of their gender and sexual orientation, and fostering healthcare provision where every individual’s right is respected,” says Etienne Clement, Deputy Director of UNESCO, Bangkok.
Download the report: English or Thai
For further information on this report or on UNESCO Asia-Pacific Regional Bureau for Education (UNESCO Bangkok), please contact: Justine Sass, Regional AIDS Advisor at (j.sass@unesco.org) or Kritsiam Arayawongchai, HIV National Programme Officer, Thailand at k.arayawongchai@unesco.org