‘No test, no disease’: Multilevel barriers to HIV testing among young men who have sex with men and transgender women in three semi-urban areas in Thailand

Abstract

Young gay and other men who have sex with men and young transgender women in Thailand continue to be at high risk for HIV infection. We explored multilevel influences on HIV testing in order to inform the design of tailored interventions. We conducted four focus group discussions with 16–20-year-old gay men and transgender persons (n = 25) and 17 key informant interviews with healthcare providers, NGO leaders, and youth advocates. Focus groups and interviews were transcribed and reviewed using thematic analysis in Thai and English language by a bilingual team. We identified intersecting, culturally situated barriers at individual (lack of HIV knowledge, low HIV risk perception, denial), social (intersectional sexual- and HIV-related stigma, lack of family communication), institutional (inadequate and non-LGBT-inclusive sexual health education in schools, lack of youth-friendly clinics) and policy levels (parental consent requirements for HIV testing by minors). Multilevel and multisystem factors coalesce to form extensive barriers to HIV testing access and utilisation and promote disengagement from HIV prevention more broadly. Multicomponent, youth-engaged interventions informed by Thai sociocultural history and practices are needed in renewed approaches to HIV prevention and testing to end the epidemic among young gay and transgender people in Thailand.

Keywords:

• HIV prevention
• sexual and gender minority youth
• intersectional stigma
• Thailand

Acknowledgements

We thank the young people who participated in this study, without whom this research would not be possible, and acknowledge the contributions of key informants. We dedicate this work to the memory of Leonard Unterberger, a dedicated advocate for HIV prevention for young gay men and young transgender women in Thailand, and a source of consistent support and affirmation for two decades.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Canadian Institutes of Health Research under grant PJT-152959; the Social Sciences and Humanities Research Council of Canada under grant 435-2017-0517; and the Canada Foundation for Innovation under grant 38509.