Diverse contexts and social factors among young cisgender men and transgender women who sell or trade sex in Bangkok and Pattaya, Thailand: formative research for a PrEP program implementation study

ABSTRACT

HIV incidence is high and persistent among cisgender men who have sex with men (MSM) and transgender women (TGW) who have sex with men, particularly among those who sell or trade sex. In preparation for an open-label combination HIV pre-exposure prophylaxis (PrEP) program for these groups, we conducted formative research to explore the context of sex work/trade and factors that affect implementation of PrEP interventions. This study analyzed interviews with 20 young (aged 18–26 years) MSM and TGW who sell/trade sex and three sex work venue managers in Bangkok and Pattaya, Thailand. Participants described diverse contexts of sex work/trade, including in multiple informal and formal sex venues. Several participants reported mobility across provinces and out of the country, which led to intermittent sex work/trade. TGW sex workers reported challenges with access and cost of femininizing hormones and limited employment opportunities. Factors that could facilitate or challenge PrEP program implementation included HIV stigma, the role of venue management in sexual health practice, lack of PrEP knowledge, lower perceived HIV risk, and interest in personal health and wellbeing. Program implementers must consider myriad factors to successfully implement PrEP among young MSM and TGW engaged in sex work or trade in Thailand.

KEYWORDS:

• HIV
• pre-exposure prophylaxis (PrEP)
• men who have sex with men
• transgender women
• sex work
• Thailand

Acknowledgements

We are grateful to the men and women who participated in this study. Without their experiences, this research would not be possible. This study is a collaborative effort between Johns Hopkins Bloomberg School of Public Health, the CDC Division of HIV Prevention, the Thailand Ministry of Public Health, Mahidol University, APCOM, and the community-based organizations Rainbow Sky Association of Thailand (RSAT) and Service Workers in Group Foundation (SWING). This work would not have been possible without the hard work and contributions of the Combination Prevention Effectiveness (COPE) Study Team.

Disclosure statement

The study drug, Truvada®, was donated to the project by Gilead Sciences. Gilead Sciences had no role in the design of the study nor in the interpretation of study results. AW and CB also receive separate research funding support from Gilead Sciences and ViiV Healthcare. All other authors declare no conflicts of interest.

Additional information

Funding

Research reported in this publication is supported by the National Institute of Allergy and Infectious Diseases (NIAID) of the NIH under Award Number R01AI118505 (PI: CB) and the U.S. CDC Division of HIV Prevention. This research has been facilitated by the infrastructure and resources provided by the Johns Hopkins University Center for AIDS Research, an NIH funded program (P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, National Institute of Aging (NIA), Fogarty International Center (FIC), NIGMS, NIDDK, and OAR.