This is the first in a series of four articles on Burmese migrants reported from the National AIDS Seminar in Bangkok recently. Watch for more postings soon.

Triple jewel, triple therapy, triple burden.

[him] moderator

++++++++++++++++++++

Triple burden: HIV-Positive migrant women in Thailand face more problems than their male counterparts
“Burma Spotlight” – Reporting from the Thai National AIDS Seminar, Bangkok, Thailand, 29-31 March 2011
By Wisa S.

Imagine…

…feeling sick one day, so sick that you know you should go see a doctor, probably take some medicine and then rest. Also imagine that you live in a foreign country, do not speak the local language and work twelve-hour days, seven days a week at a clothes factory where one day off will jeopardize your position. You have a husband and two small children, all three of whom you are expected to take care of when you come home at night. You also do all of the cooking, housework and child care, while your husband takes a break with friends, chatting over an after-work drink and smoke…so what do you do?

Sounds rather stressful, doesn’t it? Some of us may have a somewhat similar experience – working all day as businesswoman, journalist or bureaucrat, coming home exhausted and then still be expected to cater to our family’s needs while the ‘man of the house’ puts his feet up and watches TV, waiting for dinner. If we are lucky and well-off, well, then we probably have a migrant domestic worker from Burma doing all that work, and we can put our feet up alongside our husband’s…

The many thousands of migrant women currently living and working in our country do not have the luxury of hiring maids themselves and so find themselves struggling with this ‘double duty’.

Now add to this already tough scenario one more thing: you are HIV positive.

“Carrying this ‘triple burden’ severely limits the options for those female migrant workers who try to alleviate their situation,” explains Ms Namisi Jate, the MAP Foundation officer responsible for the Prevention of HIV/AIDS Among Migrant Workers in Thailand (PHAMIT) program.

“Already,” she says, “many of them have been infected through their husbands or partners, who move around much more freely. There are parallels to Thai culture, where women are often expected to keep their feelings to themselves and pressured to accept the behavior of wayward spouses; because of this, negotiating sexual relations – necessary to prevent STIs and HIV infection – is usually out of the question. This is why, among married migrant women from Burma, and also Thai women, HIV infection rates are soaring.”

HIV/AIDS groups and workers focus on key populations like men who have sex with men, drug users and sex workers, yet this is actually one of the most vulnerable groups.

Women make up about 50% of all migrant workers. In some areas – such as the garment factories of Mae Sot – women form 70-80% of the workforce, also dominating the field of urban domestic work and some parts of the service industry. Here in Thailand factories, companies, private individuals, farms etc employ migrants from a large variety of ethnic backgrounds. In and around Chiang Mai the majority come from Shan State, while mostly Karen reside in the Mae Sot area. Other ethnic groups include Akkha, Lahu, Lisu, Pa-O, Tai Yai and, increasingly, Kachin.

So: you are an HIV-positive Shan women working in your factory’s refrigeration units, with bad ventilation. You have been developing a nasty cough, getting weaker over the past few days. You know you need to seek health care, but you are scared because you are not registered and cannot access hospitals with the 30 baht card scheme. You went once before, and nobody spoke Shan, you felt the nurses treated you rudely and they charged you two days’ wages for the treatment. Also, you fear police harassment and the threat of deportation the most, because then who would take care of your children?

There are no easy answers. And in addition to these obstacles, Ms Namisi Jate explains that “there are structural issues such as prohibitive distances to health care centres, taking transport, finding correct information regarding hospitals or clinic access (even registered migrant workers often don’t know which ones they are allowed to visit), pricing of services, communication problems and, particularly for women, debilitating isolation due to being forced to stay either at work or at home all day and night, with little freedom to go out.”

Women living in or around Mae Sot can receive support from the community-based organization SAW (Social Action for Women), which focuses exclusively on the special health needs of migrant and displaced women and reaches a population base of about 20,000. Its Health Care House has supported over 175 women and children in the past six years.

In Chiang Mai, MAP’s Women Exchange Groups provide space for all migrant women to share information, advice and experiences with one another. MAP also supports a safe space for migrant PLHA to meet and share. There is also the One Stop Crisis Centre at Nakornping Hospital but it is urgently in need of resources and has not reached out to the NGO community for support…

These few groups are doing outstanding, essential work, but it is not enough; much more support is required to respond to the rights and special needs of migrant women living with HIV.

If YOU were one of these women, you would surely agree.  The thing is, you are very willing to work, and once you get quality treatment for your new illness (yes, you have tuberculosis, or TB, the most common opportunistic infection for people living with HIV) you will go back and work just as hard to produce quality work for your Thai employer…because like everyone else, all you really want for yourself and your family is a decent, happy life.

We would do well to reassess our priorities and try to more honestly and deeply understand the fundamental linkages between us and people we often like to see as representing a burden to ‘the rest of’ our society. Because it is not ‘us’ versus ‘them’ – we are all equal members of humanity, together causing part of the problem, yet together able to identify and realize solutions that are just, mutually respectful and realistic.

************************

There are friends from the MAP Foundation’s Prevention of HIV/AIDS Among Migrant Workers in Thailand (PHAMIT) program participating in the National AIDS Seminar. If you are interested in talking to them, please go to the MAP Foundation Booth number 23 or call 080-133 7718.

More on MAP Foundation at: http://www.mapfoundationcm.org/