Thailand: Key population-led organisations deliver HIV prevention and treatment services to migrants

In December 2021, Ed (not his real name), a migrant Filipino in Thailand suspected that he had contracted HIV due to symptoms such as herpes, fever, and weight loss. After conducting a quick Google search and reaching out to HIV advocates in the Philippines, he was referred to Rainbow Sky Association of Thailand (RSAT) in Ramkamhaeng, Bangkok. RSAT is a registered community organization that collaborates with people with sexual diversity in Thailand.

Like many in the LGBT community, Ed is aware that society is quick to condemn them due to their sexual and gender orientation, particularly among migrant Filipinos.

In earlier years, HIV was commonly referred to as the “OFW (Overseas Filipino Workers) disease” due to cases among seafarers and migrant Filipinos who were infected under different circumstances while abroad.  It was also seen as a “gay disease.”
In 2022, there were approximately 14.97 thousand reported cases of HIV/AIDS in the Philippines, the highest since 2016. According to aidsdatahub.org, the Philippines has an estimated 140,000 people living with HIV (PLHIV). On average, there were 42 newly diagnosed Filipinos in 2022, which was several times higher than the average of nine in 2012.

Although Thailand has had successful campaigns against HIV, there are still an estimated 520,000 people living with HIV (PLHIV) and 6,500 new infections in 2021, but it already fell 58% compared to previous years. The numbers include migrant workers seeking treatment or undergoing testing in clinics nationwide.

Filipino Migrants and HIV

With over 17,000 Filipinos in Thailand where an undisclosed numbers do not have an insurance or health care coverage under Social Security (SSO), seeking treatment for HIV maybe expensive.

“Medication can cost up to 10 thousand baht (USD 250) per month,” said Kao Kierati Panpet, Deputy Director for Bureau of Health Service Provision of RSAT.

The first month is free for foreigners, then they are referred to hospitals to seek further treatment.

RSAT has an average of 60 clients a day, of which 15-20 are PLHIV. The organization has over a hundred foreign clients some of whom are getting free treatments while others are referred to hospitals. However, due to stigmatization and discrimination their nationalities are undisclosed.

“We do not discriminate between undocumented and documented workers. We understand and accept cultural differences and gender roles. We are a society of people of different genders, races, ethnicity, classes, religions, sexual orientation, disabilities or socio-economic status. Rainbow is a safe place for them,” she said.

Ed has no insurance, yet he is able to avail of free services from RSAT.

“All my tests were done at RSAT. I was assisted by their staff and endorsed in a public health center,” Ed explained.

The Bangkok Metropolitan Authority (BMA), a partner of RSAT shoulders the medication of migrants who cannot afford the treatment.

Stigmatization and Discrimination

Dr. Jon Fontilla, former country coordinator of Australian Federation of AIDS Organization (AFAO-Bangkok) said that Thailand and the Philippines are tolerant to the LGBT rather than accepting, but it has limitations.

Thailand is more accepting of gender diversity, acknowledging that gender is not binary or just male and female. This is probably due to the different religious backgrounds of the two countries, with Buddhism being more gender-affirming than Catholicism, according to Dr. Fontilla.

In Thailand, society does not discriminate against the clothes people wear in public. It is also more common to see LGBTQI couples holding hands in public places.

But members of the community still experience discrimination.

Darel Magramo, a teacher, recalled being mocked by a group of teen boys in a male restroom in a Bangkok mall. Magramo wore a crop top, and their friend wore a sleeveless top. The boys began to groan and act like they were having anal sex when they noticed them approaching the restroom. Even after they left the restroom, the boys followed them and continued moaning, leaving them frightened and trembling.

Gay men, men having sex with men (MSM), and transgender women (TWG) are often stereotyped as promiscuous.

Due to stigma, which particularly affects the LGBTQI community, Ed’s situation wasn’t known to his family, friends, or even employer. He fears losing his job.

In a UNDP study in 2020 found out that stigmatization among TWG in Thailand are due to cultural beliefs such as karma and most TWG, if not all, are into sex work.

“While there are different laws on prostitution in both countries, sex work in Thailand seems to be more out in the open. This plays a part in HIV in that program people know and can easily reach these sex workers offering them health programs such as testing and PreP without stigma and discrimination. This encourages sex workers to use services and take better care of themselves. Some even promote their usage of condoms and PrEP (pre-exposure prophylaxis) in sex work and routine HIV testing, according to Dr. Fontilla,” Dr Fontilla explained.

PrEP is a daily medicine taken by an HIV-negative person to prevent contracting the virus.

Government policies and commitment

In the Philippines, the Philippine HIV and AIDS Policy Act of 2018 (RA 11166) includes provisions for minors to get HIV tests without parental consent, strengthening HIV/AIDS education to reduce stigma and discrimination, counseling for PLHIV families, increased protections against discrimination, expanding access to evidence-based prevention strategies, and improving HIV and AIDS care and treatment provisions. Under SDG-related benefits, PhilHealth insurance also covers HIV treatment.

The Commission on Human Rights (CHR) and the Department of Justice (DOJ) issued Joint Administrative Circular Order No. 1 in 2021 to establish uniform rules on redress mechanisms for PLHIV. As such, the Public Attorney’s Office (PAO) provides assistance to PLHIV relating to their labor concerns and others.

Thailand does not have specific laws on PLHIV, yet it has implemented several best practices to end AIDS, including legalizing over-the-counter sales of HIV self-test kits, scaling up same-day treatment initiation for newly diagnosed people, and successfully rolling out a pre-exposure prophylaxis (PrEP) program. This has become a mechanism for sustainable HIV response financing by significantly increasing investments in key population- and community-led health services. Key population-led services are now supporting 82% of HIV pre-exposure prophylaxis (PrEP) users. Key population-led organizations are delivering health services in Bangkok, and they are essential in providing access to HIV prevention and treatment services without fear of discrimination.

The Thai government has increased the budget for HIV and AIDS services each year. In 2021, the National Health Security Office (NHO) received around 3.67 billion baht to cover HIV and AIDS services under Universal Health Coverage (UHC). The Global Fund also signed USD 61 million for 2021–2023 in the fight against HIV and tuberculosis (TB) by reaching more people in key populations who bear a disproportionate burden of these diseases. The allocation of the national budget has increased over time to support community-led organizations working with PLHIV.

End inequalities, end AIDS

After a year and half of ART (anti-retroviral therapy), Ed has reached 20 copies per milliliter of blood which is now undetectable. Undetectable means that the virus can no longer be passed on, but he remains PLHIV.

Darel, meanwhile, always undergoes a routine HIV testing to reduce the stigma and to encourage the young people to have themselves tested not only for HIV but for other sexually transmitted diseases.

The UNAIDS launched the Global AIDS Strategy 2021-2026, called “End Inequalities. End AIDS.” This strategy aims to use an inequalities lens to close the gaps that are preventing progress towards ending AIDS. The Global AIDS Strategy prioritizes reducing inequalities that drive the AIDS epidemic and aims to get every country and community on-track to end AIDS as a public health threat by 2030.