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 rancor of her time turning tricks in Pattaya — one of the centers of Thailand’s flourishing sex industry and home to 3,000 transsexuals 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 transsexuals — or “ladyboys” — are known.
Her recollection of life after her diagnosis is still shocking.
“I had sex with lots of partners,” she said. “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 transsexuals 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 parlors.
Infection rates among transsexuals 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 marginalized 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 UN AIDS study from 2010.
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 transsexuals 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 UN Development Programme (UNDP) report published in May.
That study said HIV prevalence rates among transsexuals across the Asia-Pacific region 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 transsexuals edge into sex work and fail to undergo regular testing — a quarter of 300 transsexuals 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,” said Alex Duke of PSI, a global health organization which led that survey and also runs clinics tailored to transsexuals.
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 added, referring in particular to the threat of violence against sex workers.
Infection rates are intertwined with the wider issue of discrimination, according to transsexual 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 recognize 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,” she said.
Travails begin early, with transsexuals often rejected by their families and schools, decimating their employment prospects later on.
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