Thai trans women’s agency and the destigmatisation of HIV-related care

Abstract

Until recently, trans women have been subsumed within the category of men who have sex with men for HIV-related care. Following a 2016 UNAIDS report finding that trans women globally are 49 times more likely to be living with HIV than the general population, health programmes have sought to expand their reach to this key population. Yet, trans women are often treated as passive subjects to be recruited into programming or clinical trials for HIV-related care. This paper uses case studies of two community-based clinics in Thailand to highlight the agency of trans women in creating and implementing unique models for the provision of care that fit their needs and those of their local communities. By tailoring goals to be trans-specific and local, trans women at these clinics help destigmatise HIV-related care. This paper argues for the importance of engaging trans women as community stakeholders in HIV-related care and prevention and identifies suggestions for stakeholder engagement in programme design both in and beyond Thailand by focussing on local conditions.

Keywords:

• Thailand
• transgender women
• HIV prevention and care
• HIV destigmatisation
• community-based organisations

Acknowledgements

We thank participants for sharing their lived experiences with us. We also thank the journal editor and three anonymous reviewers for their feedback while developing this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 We refer collectively to HIV prevention and treatment as ‘HIV-related care’ because they are both vital parts of the healthcare programming needed to address the health and social disparities affecting trans women.

2 Transgender identity is not defined by medical procedures. Some Thai trans women pursue surgical procedures like breast augmentation and facial feminisation, but genital gender-affirming surgery is typically not central to their identity.

3 Both authors are USA-based cisgender scholars of Thai culture, medical practices and gender and sexuality. AL is a sociologist who has volunteered as an English teacher and conducted several qualitative studies in Thailand since 2013. JE has spent over three years living, studying and teaching in the Bangkok area since 1992. Each author currently works on medical interventions and trans issues in contemporary Thailand. 

4 This study also contained two interviews with trans men at Clinic A not included in our analysis.

5 Public health programming in Thailand typically classifies sex without a condom and receptive anal sex as high-risk behaviours. Peer counsellors conduct risk assessments at Clinic A.

6 ID or passport numbers must be used to register a new mobile phone in Thailand. With members’ permission, Clinic B keeps these numbers on file so they can re-establish contact when a member registers a new phone and phone number.

Additional information

Funding

This article could not have been written without the generous support of the Sexualities Project at Northwestern (SPAN). Both authors thank SPAN for funding their individual research programmes. Additionally, AL is grateful to the Buffett Institute for Global Studies for funding her research.