Transgender women take health into their own hands

The sun is starting to dip low over the horizon as Prayune Sawangnam (Prayune) steps into the brightly decorated offices of the Sisters Foundation. The non-profit organization provides health, education and support services to the transgender community in Pattaya, a beach town located a two-hour drive from Bangkok. Ms Prayune with her neat bun and long flowing dress presents a commanding figure and is treated respectfully by the dozen other transgender women gathered at Sisters.

“Ms Prayune is a “Mama” and in the transgender community a “Mama” is an important leader, who many other members view literally as a mother. She is someone other TGs go to for advice,” said Thitiyanun Nakpor-Doi (Doi), the Director of the Sisters Foundation.

Today, Ms Prayune has come to give a lesson on healthy cooking, deftly slicing up limes, crushing chili peppers and mixing everything together in a big bowl. Soon, everyone is munching contentedly on the spicy chicken noodle salad.

“I come to Sisters because it’s a friendly place and I like to meet friends and share experiences,” said Ms Prayune.

The cooking lesson is part of the Sisters Foundation regular Friday night activities and it is followed by an interactive talk on sexual health by Ms Doi.

Cooking class at Sisters Foundation.

Cooking class at Sisters Foundation.

“We link up with transgender leaders and host these activities, mixing fun, friendship and health awareness regularly. These non-threatening sessions  initially attract community members, who are reluctant to go to clinics,” said Ms Doi.

After dropping by for the social gatherings, participants make friends and start to use the many health services offered by the foundation, which include hormone replacement therapy counseling, HIV counseling and testing and HIV prevention.

The programme was developed with support from the United States Agency for International Development (USAID) under the U.S. President’s Emergency Fund for AIDS Relief (PEPFAR) and other donors. Founded in 2004, Sisters distinguishes itself from other organizations in the Asia and Pacific region. Most HIV services for transgender people are merged into programming for gay men and other men who have sex with men (MSM) and fail to resonate with transgender people. In contrast, Sisters’ programme is based on research that determined the specific needs of the transgender community in Pattaya.

“The Sisters programme is run by transgender people for transgender people. Most of the staff and volunteers are from the community,” said Ms Nakpor-Doi, a rotund and energetic transgender woman, who likes to dress in pink power suits. “In the past we distributed condoms and talked about HIV, but that didn’t work. Even if transgender people knew how to use condoms, they weren’t using them.”

The organization particularly focused on trying to increase HIV testing among transgender women. Pattaya is a centre for transgender activity in Thailand, with many people attracted to its relaxed and open environment, as well as booming nightlife. Transgender women often work in the entertainment industry as waitresses, hostesses, performers and sex workers. According to Thailand’s Bureau of Epidemiology, epidemiological surveys of transgender women at five sites report high HIV prevalence ranging from around 9 % to 17 % in 2014. Despite the risk of HIV infection, many transgender people balk at getting tested for the virus and studies find only about a third know their status.

“Most transgender people fear having an HIV test because they don’t like needles, they are afraid of the result and also because they just don’t think they are at risk, “ said Pannui Thatpaiboon (Nui), as she waited to consult with Sisters’ transgender nurse.

From its cheerful reception area to its solicitous staff, Sisters makes HIV testing as comfortable and normal as possible. The HIV testing drop-in hours are from 1pm to 7pm Monday through Friday, which are convenient for clients, who often work at night.  Pitak Katekongkoy (Bong), a licensed transgender nurse provides pre-counselling and then a rapid HIV test, with results available in under an hour.

“Rapid HIV testing makes my sisters feel comfortable. They have no need to worry about the results or wait a long time. We make them know that whatever the outcome, they will be taken care of,” said Nurse Bong.

“I come to Sisters to have a blood test. It’s easy and convenient. There is no need to wait at a hospital,” said Ms Nui.

After an HIV test, Sisters provides a small gift, which is often a cosmetic like a body lotion or lipstick.

“For many transgender women being beautiful is very important. We don’t believe in handing out money for HIV tests, but we know a beauty item is going to make the experience end well,” said Ms Doi.

If a person is reactive on a first rapid test, they will undergo further confirmatory tests. Once an HIV positive result is confirmed, a member of the Sisters Foundation team will accompany the person to a local health facility for HIV treatment. In this way, the foundation is helping to link transgender people with established health systems, which they often shun because of fear of discrimination.

The Sisters Foundation has expanded from around 250 clients in 2006 to more than 500 in 2014. In 2014, it conducted over  500 rapid HIV tests with nearly 50 people testing positive. That’s almost four times the number of people tested in 2009. Volunteers and staff also regularly conduct outreach education and HIV testing in bars, cabarets and other venues where transgender people gather and work in Pattaya.

“I strongly believe that Sisters is a good example and we need more of this kind of service and programme in the region,” said Natt Kraipet, Network Coordinator of the Asia-Pacific Transgender Network (APTN). “I think this is a crucial time to separate the transgender population from the men who have sex with men umbrella. You have to realize that we have a different gender identity. We have different behaviours. Transgender people are not men who have sex with men. We need more health services specifically for transgender people.”

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