Identity management and sense of belonging to gay community among young rural Thai same-sex attracted men: implications for HIV prevention and treatment

'No test, no disease': Multilevel barriers to HIV testing among young men who have sex with men and transgender women in three semi-urban areas in Thailand

Young gay and other men who have sex with men and young transgender women in Thailand continue to be at high risk for HIV infection. We explored multilevel influences on HIV testing in order to inform the design of tailored interventions. We conducted four focus group discussions with 16-20-year-old gay men and transgender persons (n = 25) and 17 key informant interviews with healthcare providers, NGO leaders, and youth advocates. Focus groups and interviews were transcribed and reviewed using thematic analysis in Thai and English language by a bilingual team. We identified intersecting, culturally situated barriers at individual (lack of HIV knowledge, low HIV risk perception, denial), social (intersectional sexual- and HIV-related stigma, lack of family communication), institutional (inadequate and non-LGBT-inclusive sexual health education in schools, lack of youth-friendly clinics) and policy levels (parental consent requirements for HIV testing by minors). Multilevel and multisystem factors coalesce to form extensive barriers to HIV testing access and utilisation and promote disengagement from HIV prevention more broadly. Multicomponent, youth-engaged interventions informed by Thai sociocultural history and practices are needed in renewed approaches to HIV prevention and testing to end the epidemic among young gay and transgender people in Thailand.

LGBT+ inclusion and human rights in Thailand: a scoping review of the literature

Background

Globally, LGBT+ people continue to struggle to achieve full realization of their human rights. Amid reported health and mental health disparities, and economic insecurity, we conducted a scoping review to explore the breadth of the literature, map and summarize the evidence, and identify knowledge gaps on LGBT+ inclusion and human rights in Thailand.

Methods

We conducted a scoping review in accordance with the methodology developed by the Joanna Briggs Institute and PRISMA-ScR guidelines. We systematically searched 16 databases for peer-reviewed literature, and government and nongovernmental organization websites for grey literature, published in English or Thai from January 1, 2000–August 21, 2020. Two reviewers independently screened studies according to pre-set criteria. We abstracted and analyzed data on publication characteristics and focal populations, and synthesized findings in six domains of LGBT+ inclusion: political and civic participation, education, family, personal security and violence, economic well-being, and health.

Results

The review captured 3327 results in total, which was scoped to 76 peer-reviewed articles and 39 grey literature sources, the majority published after 2010. Gay men and transgender women were the primary focal populations in the peer-reviewed literature, LGBT+ people as a whole in the grey literature. Health was the predominant domain across publications. Key findings include the absence of generalized antidiscrimination legislation for LGBT+ individuals and lack of recourse for transgender individuals to change their legal gender; multifaceted stigma and discrimination in the educational system; social isolation and exclusion in families; disproportionate prevalence of sexual violence and reluctance to report to police; discrimination and marginalization in employment; and LGBT+ disparities in health and mental health.

Conclusions

Future research and programmatic initiatives on LGBT+ inclusion in Thailand should aim to address: 1) understudied populations—lesbian and bisexual women, transmasculine persons; 2) underrepresented topics, including constraints to LGBT+ advocacy; 3) strategic policy initiatives around anti-discrimination laws and legal recognition of same-sex marriage and families; and 4) the need for consistent collection of disaggregated data on LGBT+ persons in education, family, economic, personal security/violence, and health domains in order to assess indicators of inclusion and progress in advancing human rights for LGBT+ people in Thailand.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11798-2.

A scoping review of HIV epidemiologic, sociocultural and programmatic studies related to transgender women and men who have sex with men in Cambodia, 1999-2019

Background

Cambodia is widely credited for its successful HIV epidemic control. However, in recent years there have been signs of increasing HIV prevalence among men who have sex with men (MSM) and transgender women (TGW). This paper reviews HIV epidemiological, social science and HIV program implementation studies conducted over the past 20 years to explore possible reasons for the rising HIV prevalence among these groups and to formulate recommendations for improved policies, HIV programmatic interventions and further research.

Methods

For this scoping review, we searched the PubMed and Google Scholar databases for scientific publications related to HIV and MSM and TGW in Cambodia published since 1999. From each of the returned citations we subsequently studied reference lists to find additional data sources. We also searched websites for reports commissioned by national and international governmental and non-governmental organizations.

Results

Twenty-seven relevant studies and papers were found and reviewed; most were epidemiological in nature. Recent epidemiological studies and reports show an increase in HIV prevalence among Cambodian MSM and TGW. The epidemiology of HIV infection in these groups has been relatively well-described and analyzed. While initially MSM and TGW were grouped together, in more recent years they have been studied in their own right, recognizing their specific HIV and other prevention needs. Few studies were found investigating Cambodian same-sex cultures and social and cultural contexts in which HIV transmission among MSM and TGW occurs. A few evaluation studies were found, but it remains unknown how effective current HIV service implementation modalities are, or how successful strategies to increase access to essential HIV prevention, testing and treatment services have been employed for MSM and TGW in Cambodia.

Conclusions

Research about Cambodian MSM and TGW in the context of HIV primarily concerns bio-behavioral knowledge generation. Cambodia is unlikely to achieve control of the HIV epidemic among MSM and TGW without doing better in-depth social science research on its multiple sexual- and gender minority cultures, and without understanding what differentiated implementation modalities, strategies and approaches are most effective to address HIV among its increasingly diverse MSM and TGW populations.

May I have the next dance? Chinese gay men exploring selves and practices through the tradition of dance in public spaces

This study explores the way in which some Chinese gay men negotiate dance performances in parks and other public spaces in an attempt to invent and experiment with 'possible selves'. In most circumstances, these same men conceal their sexual orientation for fear of stigma and discrimination, experiencing in the process something of a 'divided self'. Little attention has been given to understanding the way such individuals negotiate and construct same-sex experiences, especially through the negotiation of specific and restricted social interactions and performances. Based on participant observation with a group of dancers practising in a Chinese public park, this paper analyses how these men explore same-sex relations and lifestyles through the circumscribed performance of collective public dance.

Victimisation and life satisfaction of gay and bisexual individuals in 44 European countries: the moderating role of country-level and person-level attitudes towards homosexuality

We examined the link between victimisation and life satisfaction for 85,301 gay and bisexual individuals across 44 European countries. We expected this negative link to be stronger when the internalised homonegativity of the victim was high (e.g. because the victim is more vulnerable) and weaker when victimisation occurs in countries that express intolerance towards homosexuality (e.g. because in such contexts victims expect victimisation more and they attribute it to their external environment). Additionally, we expected internalised homonegativity to relate negatively to life satisfaction. Multilevel analyses revealed that victimisation (i.e. verbal insults, threats of violence, minor or major physical assaults) and internalised homonegativity were negatively related to life satisfaction. Furthermore, as we expected, the negative link between victimisation and life satisfaction was stronger when high internalised homonegativity was reported (and the interaction effect occurred for verbal insults and major assaults as outcome variables), while it was weaker when there was low national tolerance of homosexuality (and the interaction effect occurred for verbal insults and for minor assaults). Future research and social policy should consider how the consequences of victimisation are dependent on personal as well as national attitudes towards homosexuality.

Factors associated with disclosing men who have sex with men (MSM) sexual behaviors and HIV-positive status: A study based on a social network analysis in Nanjing, China

Objective

We explored the factors associated with disclosure of men who have with sex with men (MSM) behaviors and HIV-positive status among HIV-positive MSM in Nanjing, China.

Methods

Social network analysis and epidemiological methods were combined in this pilot study. Information about participants’ (egos’) characteristics and behaviors and their social network members (alters) were collected through interview-administered questionnaires. General estimating equation logistic regression analysis was applied in both univariate and multivariate analysis.

Results

Eighty-seven HIV-positive MSM participated. Their mean age was 35.9 ±13.81years. They were more likely to disclose their MSM behavior to their friends [adjust Odds Ratio (AOR) = 6.43, 95% confidence interval (CI):3.08–13.42] or to the social network members who were not heterosexual [AOR = 4.40, 95%CI: 2.17–8.91]. Being participants’ friends [AOR = 5.16, 95%CI: 2.03–13.10] or family members [AOR = 6.22, 95%CI: 2.52–15.33] was significantly associated with HIV-positive status disclosure.

Conclusion

HIV-positive MSM tended to disclose their MSM behaviors and HIV positive status to close friends, family members or other individuals who were HIV-positive, engaging in MSM behavior, or both. Consequently, it will be an effective way to implement HIV prevention and intervention strategies in both MSM population and their trusted social networks.

"Gay Guys are Shit-Lovers" and "Lesbians are Obsessed With Fingers": The (Mis)Representation of LGBTIQ People in Thai News Media

This article presents an analysis of news reports containing information or opinions about lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ) people taken from six Thai media outlets over a period of one year. The aim was to explore how LGBTIQ people are portrayed in news media narratives. LGBTIQ identities were found to be vastly underrepresented and, when represented, were often represented inaccurately, stereotypically, harmfully, or without a clear understanding of the diversity of sexual orientations, gender identities, and gender expressions. (Hetero-)sexist narratives, negative portrayals, harmful stereotypes, and discriminatory speech were also widely found, fueling a climate of stigmatization and discrimination of LGBTIQ people in Thai society. This article suggests that key stakeholders in Thai news media should be sensitized on the human rights of LGBTIQ people and on basic professional ethics in journalism.