peripheries

Under the tip of the iceberg: prevention amongst MSM in Asia (2006)

November 24th, 2008 | by Admin |

This piece was written in September 2006. The AIDS conference it mentionned was the one before that of 2008 where vulnerable groups where at last put under the spotlights. Names, places and minor details have been modified to protect people’s privacy.

Bedtime story

Wat, my neighbour has a new lodger, a 35-year old Thai from a village near Kantchanabury named Keaw. Keaw left his town 3 weeks ago ro come to Bangkok looking for a job. His dream job is to be a driver but he does not have the money needed for the deposit to buy a car. Wat met Keaw at his restaurant when he applied for a job as a waiter. Wat told him to come the next day for a trial. When Wat asked him where he was sleeping, Keaw answered in a temple two hours from central Bangkok, but tonight he will sleep outside Hualompong railway station. Wat offered him to stay in his room for the night. That’s where I met him and heard his story.

Keaw has done all kind of jobs. He worked as a barman, a driver, an electrician, a handyman and was even a monk for several years. He recently left his home town hoping to find a job away from a demanding family whilst still being able to send them money regularly.

Keaw happily talks about his life. He told me that he only found out recently that he prefers men to women and was able to put a name on it: gay. Keaw feels more conformable in the company of men like him than surrounded by straight people. He is not coming out; he is defining himself in a moving and evolving society. He has had mixed experiences with men. Years ago, when 18 and working as a barman in Pattaya, he was abused, not to say raped, by the foreigner who owned the place. But still, he had a “farang man” later “a nice man from Europe” but who has since died.

The following day, his assessment goes well and he is happy to be given a chance to work but he worries because he does not have much money and does not know how if he will be able to get a pair of black trouser and a pair of shoes for the job. We told him not to worry and while we are having lunch, I give 1000 Baht to Wat and tell him to lend it to Keaw. It’s not charity, it’s micro credit or “tambun” or simply giving a chance to someone if you can afford it.

I don’t worry too much about his future now that he has a job in a gay-friendly restaurant. On the day he applied to work in the restaurant a customer invited him for diner and the following day, another customer hearing that he had no money gave him 300 Baht and asked him to come later to his room to give him a massage.

When I met him again two days later he told me that his evening did not go as expected with the first customer who wanted him to play a sexual role that was not his but he nevertheless spent the night with him. His second customer, who suggested a massage, only had dollars, “mai bpen rai”, they will meet again. He still got 300 Baht that he has already sent to his family. Life goes on…

Beneath the tip of the iceberg

This might be a story with a happy ending but it is more an everyday story with a potential for an unhappy ending. Keaw is one of many men-who-have-Sex-with-men (MSM) who escape surveys and statistics. Keaw does not go to parks, he does not go to saunas, he does not use the internet and he does not frequent the trendy Silom Soi 4. In a country were the latest survey reveals a HIV prevalence of more than 28% amongst MSM, what does Keaw know about HIV and AIDS?

How many men like Keaw are out there, beneath the tip of the iceberg, a world away from information and prevention campaigns about HIV and AIDS? In the urbanized slum of Phra Pha Beng Toy a 25-years old factory worker from Buriram buys sex from straight Thai boys with whisky. In a shopping complex off Silom, Ton from Sukhotai waits all day chatting up foreigners hoping someone will take care of him for the day. Outside a business tower, Eek an office worker spends his lunch break looking for possible encounters in the public toilet of the complex. At 9 PM in the bookstore of a famous shopping mall, Wit disingenuously flicks through a magazine waiting for someone to have some “fun” with. Keaw, Toy, Ton, Eek, Wit and many others rarely see the glossy information leaflets and condom packs given by community workers. They hardly see a community worker in their everyday lives. They are the invisible ones; the one most at risk to contract HIV.

Time for a rethink

The segmentation of the MSM population is often quoted as an explanation why it is so difficult to reach MSM. Then stigma, discrimination and lack of political will contribute equally if not more to the lack of appropriate prevention message and the poor penetration of prevention campaigns.

A few courageous political figures prepared to challenge the social and cultural establishment, a politically trained grass root movement that could act as a pressure group and a proper understanding and acknowledgement of same-sex male interactions could change this.

Thailand has already a strong and outspoken political figure in Mechai Viravaidya; more are needed. But what is missing in Thailand and in Asia is vocal grass root MSM organisations, committed politically and socially to fight stigma and challenge discrimination. NGOs could extend their support to MSM organisations from public health initiatives to providing them with political training and lobbying skills. Engaging in initiatives aiming at developing a political consciousness amongst MSM should be part of community based organisations’ capacity building.

Only understanding and acknowledging that MSM are not a group of people that can easily be singled out, that MSM are everywhere and from every walk of life can overcome the segmentation issue. As a consequence, the need for multiple piecemeal actions targeting individual groups will become ancillary to interventions at the national level. The political will to make prevention campaign a national issue could ensure that all receive proper and relevant information. Neighbouring Cambodia is paving the way with huge billboards advertise condoms on the roadside.

The XVIth International AIDS conference in Toronto brought back prevention to the frontline of the fight against HIV and AIDS. In Asia, it will be crucial not to forget the MSM populations and give them the means and power to fight a growing epidemic that will have rippling repercussions on the general population unless bold actions are taken.

Related posts brought to you by Yet Another Related Posts Plugin.