PHAMIT Site Profiles

	Center for AIDS Rights (CAR)
	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.

As of January, 2008

Rayong

The first province at the stretch of the eastern coast, Rayong’s economy is dominated by its seafood industry with agriculture also being very significant – two industries heavily reliant on migrant labor. In the year 2004, a total of 28,618 migrants registered for work permits in Rayong Province, of which 18,714 were from Cambodia with a 3.5:1 ratio of men to women. In 2007, only 9,875 migrants registered with 4,460 being Cambodian, of which the ratio of men to women was 3:1. In all, there may be 70,000 or more migrants in Rayong Province, with those in the seafood industry focused in certain areas.  The numbers estimated on boats is about 30,000, and this number has remained constant over time.

In Pak Nam, the migrant community is intermingled with the Thai community. More of the migrants present here have been settled for a number of years, but they still consider themselves as temporary and eventually want to return home. Although there are high levels of undocumented migration to this province, it is highly organized and controlled by local agents. Migration to this location is regular with turn-over of around 200-300 people coming and going each week.

	Target Groups
	This area is dominated by medium-sized and smaller boats. There are around two hundred oun dam boats in this area, of which there is one tour boat for each set of ten oun dam. Tour boats have a crew of around twenty-five people and stay out for around thirty days. Oun dam stay out for fifteen days at a time and have a crew of around forty people. These boats have stable crews that are mostly men with families. They are also more likely to have been in Thailand longer than the crews on other types of boats.  There are around one hundred and fifty pla katak boats, which go out for only a couple of days at a time and have crews of twenty to thirty. There are also about one hundred and fifty dai muk boats that have a crew of five to seven and leave in the morning and return that evening. As for larger boats, there are around ten oun lak boats that stay out for two to three months. Due to the price of gas and other economic factors, these boats have been staying out longer. There are also around ten Pa-O boats that go into Indonesian waters and dock at Pattani, in the south of Thailand. These boats have a crew of around forty people and will only return to Rayong once a year to clear accounts.
	The long-range boats may also dock at Pattani every three months or so depending on what price they can get for the catch and if they are in closer proximity to Pattani than Rayong. Boats from Pattani also dock in Rayong to avoid the monsoon season. This movement between ports allows migrants to switch boats, and has led to a presence of Cambodian migrants in the south.
	Another observable impact of the economic situation, which is a result of the high price of gasoline, is that there are fewer fishermen on land, or else they are only on land for a short time, usually only around the full moon. With the shorter time on land, they just want to have fun. This has resulted in a suspected increase in risky behaviors, and makes fishermen harder to reach with activities.
	Around twenty percent of the fishermen have been here four or five years, forty percent have been here around three years, and the other forty percent have been here less than two years or have just arrived. Most of the Cambodian fishermen recently coming to work here are young and are generally in their middle teens. Previously, the age of new Cambodian migrants working on boats was twenty years old; now it is around fifteen.
	Another change affecting fishermen is that work contracts have been extended. Previously a contract lasted ten to thirteen months, and now they are as long as twenty months. This means that the men will forfeit their wages if they change boats or return home before the end of their term, which could lead to potentially abusive conditions.
		There is a noticeable increase in the number of women and families present. The growing presence of Cambodian families means that there is a now what could be considered a Cambodian community present. Many of these women have been here two or three years. They work, and most are wives of fishermen and have children. There are also extended family-members present, including young women in their early teens, some of whom have supposedly been sent to find a husband.
	With more women having a regular presence here, small businesses have sprung up, mainly food shops, that are run by Cambodian women. A couple of years ago these women would cook at CAR’s drop-in center. Now, they have their own resources and have started small enterprises. Out of the twenty-six karaoke shops in Pak Nam area, there are only two with Cambodian women. Each shop has around four or five women. These shops are not direct sex venues, and therefore the owners do not allow condoms to be distributed at these shops. Karaoke shop owners cooperate with the community by allowing the young women participate in outreach sessions that teach about HIV, sex education, reproductive health and condom promotion.
	CAR has good relations with employers in the area, which allows them to give activities on health and provide general information on rights. CAR’s approach is considered “human rights-based” and pragmatic. When there are disputes, CAR believes in negotiating with both sides, as each side may have either a hidden agenda or there may simply be a misunderstanding due to language or culture. Both sides appreciate this style of approach as employers feel there is no need for higher powers to get involved to resolve issues, as so much of the work is done in the informal sector anyhow, and many of the migrants do not wish to lose their jobs or suffer acrimony with employers. When there is a dispute that is hard to resolve, CAR will approach the head of the Fisheries Association (for issues with fishermen).
		Health has improved considerably among this community. Migrants understand that they either need to be registered to use their health insurance or that they have to pay if they are undocumented. They also do not fear going for health services because they know that they will not be refused services or arrested if they are undocumented. There is also no obvious bias against migrants – they are treated equally, which means they have to wait in long lines to see a doctor, just like Thais.
	Malaria and dengue are the most prominent health issues, whereas TB is not an issue. Campaigns by the hospital on these diseases are reactive though. Cambodian migrants are now bringing their elders here for medical treatment of general health issues. More migrant women are giving birth here as the quality of services is better than in Cambodia. However, they will only deliver – there is low use of the antenatal clinic. There is also an issue of not being able to pay the full cost of delivery. Mon and Burmese groups have a higher use of the ANC and will deliver in the hospital, but there is a small number of these children present in the community as most return home once they are of school age. In the last registration period, an arrangement was made between the MOL and MOPH that allowed migrants to register before passing the health exam. Although this expedited the registration process, a number of employers ended up not taking their migrant workers for a health exam, resulting in a disparity of over 1,000 migrants not receiving health insurance even though they had the fees deducted from their salaries.

	Health Problems
Health has increased as migrants are not afraid to seek services Malaria and dengue are the diseases of gravest concern, and health campaigns are reactive

			Activities and Strategies
			Condoms are widely distributed throughout the migrant community. Sixty-three boat owners each receive a box of condoms from CAR to distribute to their crew. There are another fifty-seven distribution points throughout the community. These points include volunteers, shops, barber shops, snooker halls and by owners of karaoke bars.
					Outreach activities with boats will cover three topics a session: HIV and STIs, condom use and rights. In the community, because the population is more sedentary, monthly activities will focus on one topic and cover the whole community before moving on to the next topic. Topics covered include mother and child health vaccinations, family planning, general health, HIV and rights. Activities targeting families discuss family planning and contraception. CAR also distributes oral contraception with a full explanation on how to properly take contraception and how to prevent HIV. Pregnant women also receive a specialized set of information on antenatal care and the importance of attending the antenatal clinic, issues of HIV and rights regarding delivery and children’s birth documentation.
				CAR has eight regular volunteers in the community as well a handful of others who assist when they are available. There are also around forty volunteers on the boats who can help with activities, which are given every fifteen days in sync with the cycle of the moon, and when certain types of boats are more likely to dock. Recruitment of volunteers is done informally. The basic criteria used for selection of community volunteers are people who are leaders or are respected in the community, usually someone who is older, and who shows that they want to help. On boats, they tried to get the leader of the crew, but they were too busy, so they use the same criteria as in the community, with age playing a major factor.
				After volunteers have been identified and selected through outreach activities, they will receive a 3 hour basic training on HIV prevention, and will get supplementary information once a month in volunteer meetings. Volunteers assist in distributing condoms; and they act as a referral and linkage for assisting migrants with health and rights problems. Although the CAR team wants volunteers to help organize activities, coordination has been problematic. As a result, they mostly act as the “eyes and ears”, helping to notify CAR when boats dock, and informing CAR of the situation in the field. CAR has developed an extensive list of IEC materials, which are distributed through outreach activities, volunteers and at the drop-in centers. Materials, which are produced in various languages, cover the following topics: HIV, condom use, STIs, Migrants’ Health Insurance and health rights, Labor laws, ARV and children’s rights.
				There is a mobile clinic organized by CAR with the local hospital once a month. The clinic changes location each month to cover the community and provides service to Thais as well to avoid any sense of jealousy or claims of “reverse-discrimination.” CAR promotes the mobile clinic in advance and assists with translation. Every Thursday the hospital and sub-district administrative unit provide an STI clinic in the afternoon. CAR helps with referral to the STI clinic by providing transportation from the drop-in center and assisting with translation.
				Having had drop-in centers open here since prior to PHAMIT, the function of these centers have evolved. The drop-ins are now used less for their original objective of being a place to relax, and have become more of a referral point or a health post of sorts. As a health-referral point, they have two set referral times each day. When someone needs assistance accessing health services, they can come to the drop-in center at the established times and be assured they will be assisted. There are also specific services available on certain days, such as the STI clinic mentioned and an antenatal clinic.
				Once a month, CAR, in coordination with four clinics and health centers, also helps follow up on child vaccinations. Using community volunteers, CAR’s team goes into the communities with name lists and follows up with children who need to take a series of vaccinations. These volunteers also remind pregnant mothers to visit the antenatal clinic on a monthly basis.
				As mentioned, community volunteers assist in following up with women who are taking contraception. The volunteers are given lists of women in their community, in total around one hundred and forty, who they remind and follow-up with regarding proper continuation of their contraception method. The women then need to go to the CAR drop-in center and receive their oral contraception, where upon submitting their names and signing each month they receive their pills. Volunteers and the drop-in also assist with sending migrants to the hospital to receive their injectable contraception (Depovera) every three months. There are around five to ten new women entering the family planning reminder / referral system each month. Notably, women are also starting to request condoms for themselves as well as for others.
				CAR assists a PLHA support group that is a mix of migrant workers and Thais. The Thais joined because they were afraid of being stigmatized joining the more obvious Thai group. There are six Cambodians, one Burmese and around five or six Thais. Of this group, only two are men; most are women who found out their status through the ANC. Although it is believed that there are considerably more migrants with HIV in the area, the difficulty is getting men to test for HIV. Even when their spouse has tested positive, many Cambodian men, many of who are fishermen, are incredulous or just unwilling to test or receive counseling.
					Activities with youth in the community who are mostly female, teach about the body, reproductive health, condoms and contraception, and future planning (life skills). It is important to reach these young women before they become sexually active because reportedly most of these young women come to Thailand to find a husband. Attesting to this, two or three couples get married each month.
			CAR has just recently organized a youth group. This group provides social activities for young women who are in the community but may not be working yet. Many of these young women use the center for recreation. Activities provide social outings and teach about HIV, reproductive health and general health. The group goes on trips and has had some activities with the Thai community.
			CAR has also supported cultural / religious events for the community, such as making merit by providing alms to local Buddhist monks. Community leaders, who are also CAR volunteers, help to organize these activities and CAR provides financial support.
			CAR provides a number of activities on rights which mainly consists of outreach and small group activities supported with the IEC materials produced in migrants’ languages. Although CAR wishes to assist more in resolving labor problems that migrants face, there are many complicating factors. Oftentimes, work arrangements are informal, with only verbal agreements between migrant workers and their employers, and this leads to confusion. Additionally, it is difficult for migrants to give accurate information that can lead to a formal case or complaint, or else they are unwilling to enter a formal complaint because they doubt or do not understand the legal system.
					CAR’s education program is aimed at preparing migrant children, mostly Cambodian, to enter Thai school. When the parents are unsettled and move between locations, this disrupts the children’s ability to adjust, settle in and enter school. Some families are here temporarily, whereas others have been here for at least two years. So, CAR deals with the children on a case-by-case basis. Although CAR provides non-formal education that teaches reading and writing in both Thai and Khmer, the children’s behavior is another issue. It is often hard for these children to adapt to the discipline of a school environment, and they may be considered unruly or disruptive by the teachers.
			Due to CAR’s efforts to impart an understanding of children’s rights and national policies on education, the Head of Education for the Municipal School Department understands the children’s situation and is sympathetic. As a result, there is little bother with formal requirements of documents for these children to enter school. The parents are another part of the equation. CAR also has to prepare the parents and get them to understand the importance and value of education for their children. As part of this, the parents need to be willing to pay the related expenses for the child’s education. The problem is that, in many cases, the parents see the children as economic contributors to the family and expect them to start working at the age of around ten or twelve. This is partly due to the fact that these families are impoverished, and thus mainly consider their immediate survival compared to planning for the future. The other factor that heavily weighs against their children getting an education is the fact that their home countries still provide limited opportunities, and thus there is little value placed on education.
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