There are two issues to highlight.

One is that central policies mean little on the ground. "Our experience is that Thai national policies are magnanimous toward migrant workers on paper but don’t translate into consistent action at local level. Government hospitals site-by-site can decide for themselves whether to implement national policy or not - nothing in law compels them."

The second is racism. It is rare to see a document that uses this word and looks at this issue.

Jamie

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Thailand, migrants and HIV - a long way to go
Scott Berry
Regional Advisor at The HIV Foundation Thailand
Following
Oct 1 2014

Thailand has been in the news a lot lately. The fluid political situation in the aftermath of the May military coup continues to grab headlines. Lost in the political spotlight is a recent study by Thammasat University and UNICEF which warns that migrant workers as well as gay men, sex workers and people who use drugs aged 15-24 are at high risk for HIV infection.

“Young gay men” and “migrant worker” groups are not mutually exclusive. It has been our experience that the two groups interact in ways that pose population-level risks for HIV. Many young migrant and Thai gay men have sex with each other in multiple settings. Thailand has an estimated 2 or 3 million mostly undocumented and young migrant workers from neighboring Cambodia, Laos and Myanmar in agriculture and fisheries, construction, manufacturing and domestic work. The ILO estimates they have made a net contribution to Thailand of at least US$53 million annually in recent years.

Thailand remains a huge attraction for unskilled youth who leave Myanmar or Laos for the Promised Land they think of as Thailand: it has a robust economy, affluent lifestyle, better opportunities and wages. Besides the economic advantages of working in Thailand, many see it as a place where they can be who they really are, unhindered in the expression of their gender or sexual orientation.

Myanmar retains British colonial-era laws against same-sex relations. Although these laws are said to be rarely enforced they continue to lead to police harassment and violence and to an environment hostile toward sexual and gender differences. In Laos same-sex relations are not criminalized but social values are conservative which keeps gay men and lesbians largely hidden.

In the anonymity of Thailand, with its silent tolerance of same-sex relations and the absence of a punitive law, concerns that gay migrants have in their home country are easily dissipated.

Yet there are other concerns as the UNICEF report points out. Migrant workers lack knowledge. They find it difficult to access condoms, services and essential HIV prevention information due to language, financial and social constraints. Moreover, anyone dealing with migrants will tell you how exploited and physically abused they can be both by brokers and employers. Although these might sound terrible, it is often better than the poverty and lack of opportunities many gay migrant workers find in their own countries.

The story about how migrants miss out on HIV testing and treatment in Thailand is complex. Our experience is that Thai national policies are magnanimous toward migrant workers on paper but don’t translate into consistent action at local level. Government hospitals site-by-site can decide for themselves whether to implement national policy or not - nothing in law compels them.

The system, the way it currently works, de-incentives local hospitals covering HIV drugs and tests for migrants. We’ve raised this with government and a range of organizations and recently met with one of the board members on the Global Forum for MSM. Even if you're Thai, we still have a hard time getting you on HIV drugs when your CD4s are below 350 but above 200 – in spite of government policy that mandates it.

Most services are testing gay men with inconsistent follow-up care for those who test positive for HIV or syphilis. Clinical testing sites for HIV are mostly separate services to tertiary hospitals that distribute treatment. Almost no one is following up newly diagnosed people after they leave the primary HIV testing site. And this is the service that we provide at The HIV Foundation Thailand -- bridging gaps between testing sites and treating hospitals – funds for which it is particularly difficult to come by. With migrants, we pay for their health insurance ourselves, then find that most of the hospitals won’t cover HIV drugs through that insurance scheme, in spite of national policy that says they will.

Another barrier, to be blunt, is racism. Accompanying non-Thais to services causes problems. Even some MSM organizations just won’t help when we bring MSM migrants to their services. Others put a cap on the number of migrant MSM we can bring to their sites to a number so small that it’s not worth it. Those in charge of providing service will tell us they lack the knowledge and language skills to deal with other cultures and this is why they resist it. But if this were true, we wouldn’t have been told that by bringing migrant MSM for testing we were denying Thai MSM access – something that is blatantly untrue.

To be fair, the Thai government has the most sophisticated migrant health policy in the region. But significant problems remain in its implementation. The problem for us now is trying to find a way to advocate for easier pathways to HIV testing, and treatment while keeping relationships with government, hospital sites and community-based organizations positive and cooperative. In the meantime we pay for treatment, testing and in some cases hospitalization when we have the money to do so.

The photo here is taken from an article on racism in Thailand: https://uglytruththailand.wordpress.com/tag/racism/

https://www.linkedin.com/pulse/article/20141001040458-37245086-thailand-migrants-and-hiv-a-long-way-to-go?trk=object-title