Sex, Drugs, Stigma put Thai TS at risk

[rxpharm]

Here's a topical story from today's Bangkok Post: http://www.bangkokpost.com/news/local/303850/sex-drugs-stigma-put-thai-transsexuals-at-hiv-risk

Sex, drugs, stigma put Thai transsexuals at HIV risk

Published: 23/07/2012 at 11:58 AM Online news: Local News

From a cafe near the go-go bars of a Bangkok red light district where she campaigns for safe sex, Gigi gives an unvarnished view of how she joined Thailand's growing ranks of transgender people with HIV.

"Some men used condoms... some didn't. Sometimes the condom broke," she says without rancour of her time turning tricks in Pattaya -- one of the centres of Thailand's flourishing sex industry and home to 3,000 transgenders in tourist season.

Soft spoken and slight with a dusting of make-up over her wan face, Gigi cuts an image far from the caricature of the bawdy "Katoey", as Thailand's estimated 180,000 transgenders -- or "ladyboys" -- are known.

But her recollection of life after her diagnosis is still shocking.

"I had sex with lots of partners," she says. "I thought I was going to die soon... so I wanted to be happy."

Antiretroviral drugs have so far spared Gigi the worst of the sickness, allowing her to leave prostitution to work as an activist, dispensing condoms and safe sex advice to young transgenders in the Thai capital.

It is, health campaigners say, an increasingly important job.

Gigi's work often takes her to red light districts such as Patpong, an area notorious for its raunchy nightlife, where dozens of transgender prostitutes flit among the sprawl of sex shows, pick-up bars and massage parlours.

Infection rates among transgenders are thought to be on the up, as high-risk lifestyles, including prostitution and drug use, and a lack of targeted healthcare take their toll on one of the kingdom's most marginalised groups.

Truvada, a breakthrough HIV prevention pill approved by US regulators this month, is likely to prove too expensive for most Thais at risk of infection when it eventually hits the market.

Around 530,000 Thais overall are estimated to be living with HIV, according to a United Nations AIDS study from 2010.

There are no nationwide HIV statistics specific to the "third sex", reflecting what activists say is their position on the fringes of society, but local surveys indicate the illness is rife.

Eleven percent of transgenders surveyed in Chonburi -- the province containing Pattaya -- had HIV, soaring to 20 percent among those aged 29 or over, local government figures released this year found.

It chimes with a stark regional view given by a United Nations Development Programme (UNDP) report published in May.

That study said HIV prevalence rates among transgenders across the Asia-Pacific could be as high as 49 percent -- albeit from scattered and often small-scale research -- a frequency that "far exceeds the general population".

Sex work, drugs and stigma collude with a lack of healthcare to push many of the region's third sex population to the "social, economic and legal" margins, the study added.

Thailand-based activists say things are getting worse as young transgenders edge into sex work and fail to undergo regular testing -- a quarter of 300 transgenders questioned in Pattaya in 2009 had never taken an HIV test.

"It's not a passing trend... if things go on unaddressed the problem is going to become a lot more severe," says Alex Duke of PSI, a global health organisation which led that survey and also runs clinics tailored to transgenders.

Chaotic lifestyles compound the challenges of HIV diagnosis and treatment, he explains, with many among the community focused on making money to support themselves or undergo expensive hormone treatment and sex-change surgery.

"HIV is also just one of a whole range of risks transgender people encounter every day," he adds, referring in particular to the threat of violence against sex workers.

Infection rates are intertwined with the wider issue of discrimination, according to transgender researcher and activist Prempreeda Pramoj Na Ayutthaya, who says health services, education and job opportunities routinely fail to reach the community.

While Thailand's famously permissive attitude affords a cultural space to the third sex, the law still refuses to recognise their new sexual identity, rooting discrimination in the kingdom's bureaucracy.

"Nobody will hit a transgender person in the street or abuse them, but it is still hard to get a decent job," Prempreeda explains.

"Many transgender people find that sex work is the only way to make a small amount of money and maintain their identity."

Travails begin early, with transgenders often rejected by their families and schools, decimating their employment prospects later on.

The result, she says, is social immobility and high numbers of transgenders working in prostitution or cabarets, which sometimes blur the lines between entertainment and sex work.

Duke says he encounters a dearth of "long-term aspiration or sense of consequence" among many transgenders, and worryingly his group has found rising HIV rates among younger people, suggesting risky behaviour is intensifying.

One solution is to direct resources specifically at transgenders in an effort to diagnose and treat those with HIV, prevent new infections and build a more detailed picture of how the illness is hitting the community.

But responsibility also falls on the community to make sexual health a priority, something it is increasingly well organised to do.

As she prizes open a tin box and heaps her daily prescription of pills into a palm, Gigi says her community is ready to address the problem as long as services recognise their unique gender identity.

"There are a lot of young people in trouble like I was," she says. "But we can help them. Just treat us like people."

Here's the caption from the accompanying photo:

Thanakorn, or Gigi, pack condoms with leaflets before giving them to transgender people at The Poz Home Center in Bangkok. From a cafe near the go-go bars of a Bangkok red light district where she campaigns for safe sex, Gigi gives an unvarnished view of how she joined Thailand's growing ranks of transgender people with HIV.

[SiamSam]

Thanks for the article RXP. Interesting.

[deepthroat]

Frightening, but important information.

Thanks Rx

[rxpharm]

Thanks for the comments guys. It really is important to know - we've heard non-substantiated guessestimates tossed around what the HIV rate is among the p4p lbs, but with figures that are more reliable we can see it's significantly high.

So what does that mean for p4p clients? Well, as discussed earlier, the use of the Oraquick HIV test might be something to consider - although I cannot recommend it due to the latency problem (someone infected doesn't show +ve until antibodies are formed against the virus but are still infectious - varies between 2 weeks to 3 months).

Use of the new antiretroviral combination drug Truvada (tenofovir and emtricitabine) - however it costs $13,000 USD a year, and if not taken daily, the protection offered is significantly reduced.

Or does it mean increasing safe sex practice and standing up for those practices to educate those who think bare backing is the ultimate sexual turn on and pleasure? I don't mean to flame those who boast about it on both lb and gg p4p forums, but at least to comment and educate so others know what the risk is, even if the OP doesn't care.

Ultimately those clients who bare back put all of us at risk - both lbs and customers.

Anyway, time to get off my soapbox - it's a personal decision for each of us to make who are involved in the p4p lb scene.

[pdogg]

Use of the new antiretroviral combination drug Truvada (tenofovir and emtricitabine) - however it costs $13,000 USD a year, and if not taken daily, the protection offered is significantly reduced.

Truvada can be considered an oral vaccine?

Is legal generic Truvada available in Southeast Asia?

Knockoff Truvada?

[rxpharm]

Truvada is NOT a vaccine - it is a combination of 2 antiretroviral drugs (tenofovir and emtricitabine) which are currently in use as part of the cocktail of antiretroviral drugs used to treat HIV patients.

It was found that for people who are HIV negative, once a day use of this drug could reduce the chance of infection by over 90%. However, for that kind of protection it must be taken daily.

As far as availability in SE Asia the separate drugs are probably available, but Truvada is probably not, except in places like Singapore or Hong Kong.

I would NOT advise the use of knock off Truvada if you happen to see it in LOS, Cambodia, Vietnam, Laos, etc.

[pdogg]

It would seem if there were no side effects and no problems down the road (which may be now unknown) the combination of condoms and Truvada would be an excellent combination.

[Jimslim]

Or does it mean increasing safe sex practice and standing up for those practices to educate those who think bare backing is the ultimate sexual turn on and pleasure? I don't mean to flame those who boast about it on both lb and gg p4p forums, but at least to comment and educate so others know what the risk is, even if the OP doesn't care.

Wise words brother Rxpharm and a very sobering article of what evidently is a serious problem we try to put to the back of our minds .

It shows the massive difference between the third world and the rest of us when it comes to healthcare , at least we have a chance of some decent quality of life .

Saddest of all is the obvious sense of fatalism many ladyboys have , they just don't believe they are gonna be around forever anyway .