Center for AIDS Rights (CAR) is the implementing organization in Thailand for the cross-border PROMDAN project in partnership with PATH and CWPD in Cambodia. CAR is at the forefront of advocacy on relevant HIV issues such as fighting against patents that limit availability of ARV, and is an outspoken representative for migrants’ rights.

Some of the migrants in this area have been here ten years, and many are still sending money home. There are also those who have married with Thais, and those who have worked for the some employer for six years or more.

The turns of the economy have affected local businesses, with the fishing industry being hardest hit by the rising price of gas. Because boats are going out less or for shorter periods and making less money, some migrants have moved into agriculture and construction. Migrants are regularly coming to this area for work, irregardless of the season. As a result, it is estimated that 60 to 70 percent of migrants present are unregistered.

This area is special in the sense that it is under the protection of the navy, which means that police are not allowed to arrest fishermen on boats or in the dock area; irregardless, the police do carry out arrests on a weekly basis in migrant communities, which are not under this special protection. Some migrants in the community have an ID, but don’t have health insurance, which is unusual, as both are supposedly co-required. Also, it is reported that migrants are able to register all year round here.

Cambodian families that are here have congregated into nine communities; there are also around twelve communities of Mon and Burmese groups that live separately. In all, these communities are spread out over seven fish drying factories and eleven piers throughout the area. Communities are generally very sanitary and clean.

Currently, three Cambodian and one Mon child are attending Thai schools in this area. Many of the children that grow up here speak Thai, making language less of a barrier. The problem is that the parents are often mobile, and since they don’t have Thai language skills or else have low education, it is difficult to assist their children with homework

In the migrant community, a person with symptomatic HIV is occasionally found. In the past there were a considerable number of migrants known or suspected to have HIV, but most of them have passed away. Those migrants that found out they had HIV while working in this area were unwilling to return home and died here. One Karen person recently died from AIDS. Currently, there are four individuals present in the community that are confirmed to have HIV, all of Mon ethnicity. One of the migrants with HIV is using his own funds to purchase ARV from a private hospital; otherwise, migrants have no public access to the life-saving medicines. Many migrant women find out their HIV status when they are pregnant and go to the ante-natal clinic. Yet, until just recently, the hospital did not have VCT available in migrants’ language.

• Health has increased with improved access to health facilities
• Migrants with HIV are unwilling to return home but have no access to ARV in Thailand
  

CAR has two outreach teams that go out into the community and the piers. The teams are usually gender specific, with men going to the boats and women going into the community. A team usually consists of a Thai Field Officer and a migrant volunteer or Migrant Field Officer (FOM) but this varies depending on the situation and the information being disseminated.

Activities often start out by discussing migrants’ situation rather than simply launching into the specific activity - a recommendation that came from community volunteers. Once they gain the trust and establish a relationship with the community, the team is able to initiate discussion and activities about HIV the next time. The teams have a basic list of issues that they try to cover with each community and use this as a check list as a form of monitoring.

CAR has three levels of volunteers. The highest level of volunteers is the Migrant Field Officers (FOM). CAR has two Thai field officers and three FOM - one Mon woman and two Cambodian men. The Mon FOM acts as a translator at the hospital, and is essential in the provision of VCCT for the ANC clinic.

The next level of volunteers must be able to speak Thai and have a higher level of job security than the average migrant worker. These volunteers provide referral to health services and assist with translation, and can help organize and assist with activities as well. There are currently eleven volunteers of this level, evenly balanced between male and female for both Mon and Cambodian groups.

There are also community volunteers who act as a linkage between communities and CAR. There are thirty volunteers in the communities and factories, most of whom are women, and they are evenly divided between Burmese and Mon groups, and Cambodians. There are also sixty volunteers on boats and the docks - all men except for a few women in the dock areas. The volunteers in the communities and factories are more stable than the fishermen. Even though volunteers on boats drop-out regularly because fishermen are highly mobile, CAR is able to maintain the number of volunteers through regular recruitment and training.

Newly recruited migrant volunteers go through a series of trainings, with a training held every three months. If a volunteer goes through the series of three trainings, they get an official bag. At each training volunteers are given condoms and IEC materials to distribute, so that they contribute in some way, regardless if they complete the course of trainings. Volunteers who do not complete three trainings can still act as volunteers. These people act as “eyes and the ears” to inform CAR of the situation on the ground; they help recruit participants for activities, and they distribute condoms and IEC.

There aren’t any sex worker volunteers, but the group has trainings once every three months. The women working as direct sex workers come and receive the condoms in person each week, and have a brief activity. Each woman receives fifty pieces, and may come back for more before the week is up. Unfortunately, the women have complained that PHAMIT condoms don’t smell good (even the scented ones).

Although karaoke bars do not provide condoms, they also do not sell sex. Even though it has been suggested to provide condoms, the owners’ fear is that having condoms would insinuate it is a direct sex venue resulting in closure by the police. The ability to access karaoke shops with activities, however, has been increased through a linkage with an informal association of owners.

Family planning activities are a major part of outreach to communities. In the communities where women are the main target group, activities teach about female anatomy using a model and aprons that show the reproductive system. CAR teams and volunteers also assist in referring pregnant women to ANC clinics and assist with translation at the hospital. Pregnant women are first brought to the drop-in center to receive a full explanation of what they should expect before they are taken to the hospital by the CAR team.

Prevalence of STI is mostly among Cambodian fishermen, sex workers and some karaoke women. They can go to the community hospital for treatment and CAR assists when necessary. If they are unregistered, treatment costs around 200 Baht.

There is no PLHA support group in this area, so migrant PLHA join the PLHA support group in Rayong, about one hour away. Currently there are two women, one Cambodian and one Mon, and one Mon man attending the group from Chonburi. The Mon man purchases ARV on his own for 1,000 Baht a month.

There are thirty kids in CAR’s day care program ranging in ages from four to twelve years. The class runs half a day until around 11 a.m. The children learn Thai and either Mon or Burmese language or both (depending on their ethnicity).

CAR has workshops with teachers and education officials to try and encourage greater enrollment of migrant children. One thing that CAR has been requesting is the lifting of the requirement for identification documents to enter school.

With minimum wage issues for example, CAR discusses options of redress, such as how to change employers using the official system. They also explain how to use the health insurance card, such as where they can go to receive the subsidized rate, what conditions are covered, how much services should cost, etc. When there are problems with migrants receiving services at the hospital, CAR will talk directly with the head of the hospital to try and resolve the issue.

Overall, the situation of migrants in this area has improved because the government has given importance to the migrant issue. This is in large part an outcome of the Provincial Migrant Committee that CAR organized as part of the PHAMIT Project.

The committee meets monthly. CAR participates as a member of the committee along with representatives from three health centers, the Provincial Health Office, the Community Hospital, the local Sub-district office, village headmen, police, immigration and the fishery association. CAR reports to the group on migrants’ situation and informs the committee of their workplan.

The importance that migrant health has received by the government and the health system as a priority issue has been facilitated by the Committee, as the various health facilities are sitting members, including the local hospital. In the Committee, agreements were made on health arrangements, including the use of Migrant Health Volunteers (MHV) and mobile clinics.

CAR also regularly coordinates with employers and owners including a meeting they organize every three months. In the meeting, they talk with employers about “hot” issues, current events and health referral. This line of communication also allows CAR to talk about rights with employers in a receptive environment.

Activities

Two gender-specific outreach teams go to boats or the community until they cover a list of issues that also acts as a form of monitoring. Reproductive health is a focus among women.

Different levels of volunteers are found throughout the communities and on boats. They provide referral, organize activities, distribute condoms and IEC, and act as the eyes and ears. The number of volunteers is balanced between migrants from Cambodia and Burma.

There are distribution boxes at snooker halls, piers, stores, fish-drying factories, in communities and at the drop-in center. Volunteers also distribute condoms and sex workers receive condoms directly each week.

There has been a good response to the IEC that CAR has produced, ranging from information on HIV to labor rights in Cambodian, Lao and Burmese languages. Distributed by volunteers and at the drop-in center.

Volunteers assist with referral to the hospital and health center. There are over 250 health volunteers that have been trained by the hospital. Volunteers can provide translation, and there is a FOM that regularly provides translation including for the ANC clinic.

Thirty kids attend CAR’s day care program, ranging from age four to twelve. Support for purchase of sanitation equipment is provided to community leaders.