Sex, Drugs, Stigma Put Thai Transsexuals At Hiv Risk: Feature

[webfact]

Sex, drugs, stigma put Thai transsexuals at HIV risk

by Aidan Jones

BANGKOK, July 23, 2012 (AFP) - 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.

Sex work and injecting drugs left the 40-year-old vulnerable to the disease, which she was diagnosed with six years ago.

"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.

-- Pushed to the margins --

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.

-- 'Sex work is the only way to make money" --

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."

-- (c) Copyright AFP 2012-07-23

[Arkady]

Went to a ceremony that featured music and dancing at a village high school in Isaan last year and was surprised when the headmaster proudly showed off two 14 year old katoeys who were his best dancers!

[OzMick]

Katoeys have stigmata?

[kiniyow]

I read where Type E HIV is prevelant here....80% of the spread of HIV from what I have read is Spread by Women in LOS not just Ladyboys , Gays or Drug users.....All this info can be found by using Google....

[Arkady]

I read where Type E HIV is prevelant here....80% of the spread of HIV from what I have read is Spread by Women in LOS not just Ladyboys , Gays or Drug users.....All this info can be found by using Google....

By "spread by women" do you mean spread by women only through gay sex without contact with men?

Edited July 23, 2012 by Arkady

[WinnieTheKhwai]

I read where Type E HIV is prevelant here....80% of the spread of HIV from what I have read is Spread by Women in LOS not just Ladyboys , Gays or Drug users.....All this info can be found by using Google....

And yet, there is no link. And of course, all content found by Google is 100% factual. The above makes no sense whatsoever. Does it mean that 80% of males who contract HIV contract it from a woman? Hint: "Google" is not a source.

[OzMick]

I read where Type E HIV is prevelant here....80% of the spread of HIV from what I have read is Spread by Women in LOS not just Ladyboys , Gays or Drug users.....All this info can be found by using Google....

HIV virus is transmitted by a body fluid (other than saliva) transfer from an infected person to a non-infected. It is readily transmitted TO women in seminal fluid.

Your claim that it is spread BY women is inaccurate, unless you are engaging in sexual or other practices that involve a fluid transfer. Up to you.

My Aus doctor informs me that the vast majority of HIV infected persons in oz are intravenous drug users, those engaging in unprotected anal sex, and the female partners of the prior two groups.

Anecdotally, I know 3 men who have HIV infected Thai wives. None of them have contracted the disease despite prolonged exposure and sexual contact.

[KLL]

detailed AIDS UN reports

http://www.unaids.org/globalreport/global_report.htm

http://www.unaids.org/en/dataanalysis/monitoringcountryprogress/progressreports/2010countries/thailand_2010_country_progress_report_en.pdf

[meom]

Anecdotally, I know 3 men who have HIV infected Thai wives. None of them have contracted the disease despite prolonged exposure and sexual contact.

Yes there's always people that beat the odds.

Similar to smokers that live in their 90's on a pack a day.

Maybe science should spent some money on studying these type of cases.

[WinnieTheKhwai]

Anecdotally, I know 3 men who have HIV infected Thai wives. None of them have contracted the disease despite prolonged exposure and sexual contact.

Yes there's always people that beat the odds.

Similar to smokers that live in their 90's on a pack a day.

Maybe science should spent some money on studying these type of cases.

It's more than that; it's pretty hard for a male to get infected from a female through vaginal sex. Not impossible, especially when other STDs come into play, but it's just not as easy to contract compared to high risk behavior. (Not a reason not to practice safe sex of course; it just means playing Russian roulette with fewer bullets)

[Trouble]

Would think it would be quite clear to all by now that men can surely get HIV through vaginal sex. Would think that is the reason the HIV rate in Africa is so high. May not be as high a risk as other ways but as someone said it is like playing russian roulette with fewer bullets. Not a risk worth taking, if you ask me. Kind of stupid to be talking about which risk is greater.

[JohnBozi]

Kind of feel sorry for Katoeys.

Female sex workers seem to have a chance to finally escape working the beat and settle with a farang into old age. Where as Kateoys, tell me if I am wrong I haven't seen any yet that have settled down with a partner.

I wonder if there nature would suit settling down, if all the yaba life style would allow it. Not to say that female pros don't do yaba.

Ah I don't know.

As a school teacher of primary school teachers in Pattaya, I know that people don't become Kateoys because of drugs. It is just an accepted part of their culture that if a boy starts to hang out with all the girls instead of the other boys he starts becoming more feminine.

Even at 10 years old I am suprised that other kids bully these more feminine boys. I try my hardest to step in and stop it. The bullying that is, but it is quite obvious that boy in question and everyone around them is aware that they will most probably change gender as soon as they can.

I hope that more will take the safe sex message ALWAYS to heart because these boys are still human, and I see the "boy" / child in everyone of the Katoeys walking working around town.

I hate bigots.

The thing I like about Pattaya is the opened mindedness, the thing I hate about farangs is their close mindedness.

[tombkk]

Two troll posts and replies have been deleted.

[Nigel1500]

I read where Type E HIV is prevelant here....80% of the spread of HIV from what I have read is Spread by Women in LOS not just Ladyboys , Gays or Drug users.....All this info can be found by using Google....

Oh really? You'd better post a link then. I've been reading http://www.avert.org/thailand-aids-hiv.htm#contentTable1 and http://www.unaids.org/en/dataanalysis/monitoringcountryprogress/progressreports/2010countries/ ... according to the UN report, male sex workers and men who have sex with men are about 7 times more likely to be HIV positive. Both documents WILDLY contradict your claims.

[Nigel1500]

I read where Type E HIV is prevelant here....80% of the spread of HIV from what I have read is Spread by Women in LOS not just Ladyboys , Gays or Drug users.....All this info can be found by using Google....

HIV virus is transmitted by a body fluid (other than saliva) transfer from an infected person to a non-infected. It is readily transmitted TO women in seminal fluid.

Your claim that it is spread BY women is inaccurate, unless you are engaging in sexual or other practices that involve a fluid transfer. Up to you.

My Aus doctor informs me that the vast majority of HIV infected persons in oz are intravenous drug users, those engaging in unprotected anal sex, and the female partners of the prior two groups.

Anecdotally, I know 3 men who have HIV infected Thai wives. None of them have contracted the disease despite prolonged exposure and sexual contact.

That's a 10Bt bet that I'm not willing to take ... a condom is 10Bt !!!

[jigagee]

Would think it would be quite clear to all by now that men can surely get HIV through vaginal sex.

Take it from me , you can , as I know to my cost and wasn't even a player .... also transmittable by oral sex .... both ways M to F and F to M.

If in doubt get a check up , because it can be years before you know you have a problem .... and you can do so much harm in that time ...

Edited July 24, 2012 by tombkk
: Font

[Ashoka]

I read where Type E HIV is prevelant here....80% of the spread of HIV from what I have read is Spread by Women in LOS not just Ladyboys , Gays or Drug users.....All this info can be found by using Google....

HIV virus is transmitted by a body fluid (other than saliva) transfer from an infected person to a non-infected. It is readily transmitted TO women in seminal fluid.

Your claim that it is spread BY women is inaccurate, unless you are engaging in sexual or other practices that involve a fluid transfer. Up to you.

My Aus doctor informs me that the vast majority of HIV infected persons in oz are intravenous drug users, those engaging in unprotected anal sex, and the female partners of the prior two groups.

Anecdotally, I know 3 men who have HIV infected Thai wives. None of them have contracted the disease despite prolonged exposure and sexual contact.

And if you believe that you are foolish, they have just not manifested symptoms yet.

http://www.health.ny.gov/diseases/aids/facts/questions/transmission.htm

[Jingthing]

I read where Type E HIV is prevelant here....80% of the spread of HIV from what I have read is Spread by Women in LOS not just Ladyboys , Gays or Drug users.....All this info can be found by using Google....

Oh really? You'd better post a link then. I've been reading http://www.avert.org...m#contentTable1 and http://www.unaids.or.../2010countries/ ... according to the UN report, male sex workers and men who have sex with men are about 7 times more likely to be HIV positive. Both documents WILDLY contradict your claims.

Think this through dude. Gay men and MSM are indeed a high risk group and generally in most countries have a higher infection rate than the general population. But they are a small minority. So even if 100 percent of MSM were infected, heterosexual infections would likely be greater overall in total numbers (as opposed to percentage of them) based on the much larger population even assuming a much lower infection rate per capita. Edited July 23, 2012 by Jingthing

[mowgus]

Where I'm from they have a finger prick test... just one drop of blood and near instantaneous results. I wish they would take that system to the streets of Pattaya to allow fast, anonymous HIV testing right in the red light district. I think many more sex trade workers would go and get tested if they didn't have to go into a hospital where they may be ridiculed.

I was told by a sex clinic worker that yes, it is slightly more difficult for a male to contract HIV through vaginal sex than vice versa. HOWEVER, you'd be stupid to think that makes it ok! It only takes one time. There are plenty of very quick (same day) cheap (500 baht) places to get HIV tests in Thailand so get yourselves tested. Not only will you get peace of mind but you wouldn't want to spread HIV and, if caught before symptoms show, you can go on meds to prevent AIDS.

[OzMick]

I read where Type E HIV is prevelant here....80% of the spread of HIV from what I have read is Spread by Women in LOS not just Ladyboys , Gays or Drug users.....All this info can be found by using Google....

HIV virus is transmitted by a body fluid (other than saliva) transfer from an infected person to a non-infected. It is readily transmitted TO women in seminal fluid.

Your claim that it is spread BY women is inaccurate, unless you are engaging in sexual or other practices that involve a fluid transfer. Up to you.

My Aus doctor informs me that the vast majority of HIV infected persons in oz are intravenous drug users, those engaging in unprotected anal sex, and the female partners of the prior two groups.

Anecdotally, I know 3 men who have HIV infected Thai wives. None of them have contracted the disease despite prolonged exposure and sexual contact.

And if you believe that you are foolish, they have just not manifested symptoms yet.

http://www.health.ny...ransmission.htm

5555 - you claim that 3 persons about whom you have almost no information are definitely HIV+, and I'm foolish. FYI:

Case 1/ Couple together/married 8 years. HIV found on migration visa blood test. Since separated 6+ years ago - initial and annual tests show 0 viral count.

Case 2/ couple together/married 7 years. Wife dies of AIDS ~7 years ago. Male has had severe medical problems since but no sign of HIV.

Case 3/ together ~6 years before wife develops AIDS symptoms ~2 years ago. Husband is medical worker has regular tests with no sign of HIV, and wife treated to "undetectable" level.

These cases are not at all unusual, and certainly not worthy of intense study. Understand clearly that condom use is to protect the woman from YOU not the other way round. Men are reluctant to use condoms, and sex clinic workers are quite happy to spread a little dis-information to help overcome that reluctance.

Even though I am now in a monogamous relationship, I have a HIV blood test in oz, annually, and have done since my first trip over 15 years ago. My doctor for over 20 years informs me of test results by SMS or e-mail rather than waste a visit because the odds are so low.

[OzMick]

I read where Type E HIV is prevelant here....80% of the spread of HIV from what I have read is Spread by Women in LOS not just Ladyboys , Gays or Drug users.....All this info can be found by using Google....

Oh really? You'd better post a link then. I've been reading http://www.avert.org...m#contentTable1 and http://www.unaids.or.../2010countries/ ... according to the UN report, male sex workers and men who have sex with men are about 7 times more likely to be HIV positive. Both documents WILDLY contradict your claims.

Think this through dude. Gay men and MSM are indeed a high risk group and generally in most countries have a higher infection rate than the general population. But they are a small minority. So even if 100 percent of MSM were infected, heterosexual infections would likely be greater overall in total numbers (as opposed to percentage of them) based on the much larger population even assuming a much lower infection rate per capita.

You forget to include bi-sexual men, most of whom reject vehemently that they are homosexual. They are the cross-over link between the 2 distinct groups.

[wallcracks]

Would think it would be quite clear to all by now that men can surely get HIV through vaginal sex.

Take it from me , you can , as I know to my cost and wasn't even a player .... also transmittable by oral sex .... both ways M to F and F to M.

If in doubt get a check up , because it can be years before you know you have a problem .... and you can do so much harm in that time ...

As of my knowledge if performed unprotected ORAL Sex the chance to catch HIV is almost not existent.

That goes both ways round if M-F or F-M

[tombkk]

A troll post has been removed.

[Jingthing]

Would think it would be quite clear to all by now that men can surely get HIV through vaginal sex.

Take it from me , you can , as I know to my cost and wasn't even a player .... also transmittable by oral sex .... both ways M to F and F to M.

If in doubt get a check up , because it can be years before you know you have a problem .... and you can do so much harm in that time ...

As of my knowledge if performed unprotected ORAL Sex the chance to catch HIV is almost not existent.

That goes both ways round if M-F or F-M

It's low risk but certainly possible in cases with cuts (even tiny ones) in the mouth and/or genitals. Also people with OTHER STDs in the mouth of genitals would have higher risk. Also it is recommended not to brush your teeth or floss for FOUR HOURS before doing oral sex because there may be fresh gum tears. Almost not existent? Nope.

Responsible health advisers will suggest using condoms or dental dams for oral sex if the STD/HIV status of your partner is unknown. Of course realistically we all know how rarely that advice is followed.

Edited July 24, 2012 by Jingthing

[wallcracks]

Would think it would be quite clear to all by now that men can surely get HIV through vaginal sex.

Take it from me , you can , as I know to my cost and wasn't even a player .... also transmittable by oral sex .... both ways M to F and F to M.

If in doubt get a check up , because it can be years before you know you have a problem .... and you can do so much harm in that time ...

As of my knowledge if performed unprotected ORAL Sex the chance to catch HIV is almost not existent.

That goes both ways round if M-F or F-M

It's low risk but certainly possible in cases with cuts (even tiny ones) in the mouth and/or genitals. Also people with OTHER STDs in the mouth of genitals would have higher risk. Also it is recommended not to brush your teeth or floss for FOUR HOURS before doing oral sex because there may be fresh gum tears. Almost not existent? Nope.

Responsible health advisers will suggest using condoms or dental dams for oral sex if the STD/HIV status of your partner is unknown. Of course realistically we all know how rarely that advice is followed.

The chance to catch HIV as Performing Partner unprotected Oral= 0,005%

the Chance to catch HIV as Receiving Partner unprotected Oral= 0,01 %

the chance to catch it as receiving Parther is slightly higher as for the Performing Partner

as I said it s almost not existent

[Jingthing]

The chance to catch HIV as Performing Partner unprotected Oral= 0,005%

the Chance to catch HIV as Receiving Partner unprotected Oral= 0,01 %

the chance to catch it as receiving Parther is slightly higher as for the Performing Partner

as I said it s almost not existent

Link please. That statistic is way too SPECIFIC not to provide a link.

[jigagee]

The chance to catch HIV as Performing Partner unprotected Oral= 0,005%the Chance to catch HIV as Receiving Partner unprotected Oral= 0,01 %the chance to catch it as receiving Parther is slightly higher as for the Performing Partneras I said it s almost not existent

Link please. That statistic is way too SPECIFIC not to provide a link.

Yup , everyone's a google expert ... we all think we know enough ... until it's too late ....my only information is from my " HIV Specialist " in the UK ... Yea this thing is treatable ... but it screws your life in so many other ways .... I only posted to warn others ,but hey do any of us ever listen ... ?Fact I caught it 100% (-: Edited July 26, 2012 by tombkk
: Font

[Jingthing]

Here is a source that I find very credible on HIV. The CDC. They seem to think logically that placing a statistical risk on oral sex is simply not scientifically practical. But they make it clear that oral sex though safer than genital or anal is NOT risk free:

Oral Sex and the Risk of HIV Transmission

The risk of HIV transmission from an infected partner through oral sex is much less than the risk of HIV transmission from anal or vaginal sex. Measuring the exact risk of HIV transmission as a result of oral sex is very difficult. Additionally, because most sexually active individuals practice oral sex in addition to other forms of sex, such as vaginal and/or anal sex, when transmission occurs, it is difficult to determine whether or not it occurred as a result of oral sex or other more risky sexual activities. Finally, several co-factors may increase the risk of HIV transmission through oral sex, including: oral ulcers, bleeding gums, genital sores, and the presence of other STDs. What is known is that HIV has been transmitted through fellatio, cunnilingus, and anilingus.

http://www.cdc.gov/hiv/resources/factsheets/oralsex.htm

[Jingthing]

The chance to catch HIV as Performing Partner unprotected Oral= 0,005%

the Chance to catch HIV as Receiving Partner unprotected Oral= 0,01 %

the chance to catch it as receiving Parther is slightly higher as for the Performing Partner

as I said it s almost not existent

Link please. That statistic is way too SPECIFIC not to provide a link.

OK, I found the link.

http://www.spid-vich...dachi-vich.html

That source vs. the CDC which refuses to publish a specific number to the risk.

Up to you.

Edited July 25, 2012 by Jingthing

[WinnieTheKhwai]

Kind of feel sorry for Katoeys.

Female sex workers seem to have a chance to finally escape working the beat and settle with a farang into old age. Where as Kateoys, tell me if I am wrong I haven't seen any yet that have settled down with a partner.

I see it more and more, especially as more and more places allow 'gay' marriage. (gender-agnostic marriage).

Suddenly all of that is within reach for 'true' transgendered people. (those who aren't partly in it for the money) Thats actually a huge thing in terms if living a sane lifestyle, with equal freedoms.