Exploring factors that impede the HIV/AIDS prevention effort among men who have sex with men (MSM) and transgender (TG) sex workers. Case study: Pattaya city, Chonburi province, Thailand
Macquarie University, Media, Music and Cultural Studies, Faculty of Arts, Sydney, Australia
Background: Despite HIV/AIDS interventions for MSM and TG sex workers having been implemented from 2005 onwards in Chonburi, the HIV prevalence among male sex workers increased dramatically, from 2.6% in 2005 to 11.2%, in 2009. The objective of this paper is to identify the factors that adversely affect the efficacy of the HIV/AIDS prevention programme among MSM and TG sex workers, using the five domains (Government/policy, Gender, Socio-economic, Socio-culture and Spirituality) in UNAIDS’ communication framework for HIV/AIDS as a framework.
Methods: This study, based on an ongoing PhD project, was undertaken in December, 2009 at Chonburi province. Three methods were employed including observation of facilities; collection of documents; and In-depth interviews. Nine informants, 5 men, 4 women, including nurses, health officers and NGO workers who were engaged, at the time, in implementing STIS/HIV/AIDS programmes among MSM and TG sex workers, were interviewed.
Results: Distance from a health facility is a barrier to receiving HIV service; MSM and TG sex workers cannot afford to pay for the expensive travel expense because STI clinics are located far from workplaces in the red-light district; gender identity is another factor to reduce their access to the STI clinic; providers, who identify as male-female, report lack of understanding about MSM and TG and feel uncomfortable about interacting with these populations; unjustified arrest by police drives MSM and TG group underground. This makes it more difficult for outreach and prevention commodities to reach them.
Conclusions: Gender, socio-economic and law enforcement factors reduce access of MSM and TG sex workers to health services and increase their vulnerability to HIV. The study shows Chonburi the need to increase availability of HIV prevention services and ensure that health providers receive cultural-competency training in order to increase their knowledge, and comfort levels when interacting with population that are culturally sensitive.