Prevention of HIV/AIDS Among Migrant Workers in Thailand

PHAMIT Site Profiles

The sex industry in Chiang Mai City is abundant, in part fostered by a high level of development and commerce, and a prominent tourist industry. The majority of women working in the sex industry in Chiang Mai include a mix of Thai women from local areas as well as from other parts of the country. Women from the different hill tribes in the North (Akha, Karen, Lahu, Lisu, Hmong) are also found in sex work, some of who may have come from across the border. A highly permeable border with Burma also contributes to a considerable presence of migrant women in Chiang Mai's sex industry. Although most of the migrant women are Shan (Tai Yai), there are other ethnic groups from Burma present as well as young women from China .

The types of venues where sex workers can be found are varied and include: bar beers, karaoke bars, massage shops, saunas, and brothels ranging in size from 10 to 60 women. These various types of venues are dotted around the city in zoned areas. Although venues that cater to foreigners are most obvious, the vast majority of sex establishments, which are less conspicuous, cater to locals and to migrant workers.

Commonly, a sex worker's work situation and clientele reflects her legal status. For example, women with citizenship or full residency status (Thais or some hill tribes) generally work in bar-beer or go-go venues that cater to westerners and Asian tourists, or they may work in karaoke bars or massage parlors for local men. As these women gain confidence, partly through increased language skills, they may start to work freelance, where they are not obligated to an employer or a bar, and are able to work independently.

Women who are migrants from other countries and are most likely undocumented migrants, notably Shan from Burma or women from China, are more commonly found in massage parlors and brothels - venues that tend to be clandestine or try to remain inconspicuous. Sex workers found in venues where the owner provides a catalogue with pictures of the women, where the woman is then brought to a mutual location or onto the premises by the owner, are in the most precarious situation. Women in these situations are oftentimes physically confined, in part, enforced by the fear of arrest for being an undocumented migrant.

Most sex establishments have poor working conditions. Many of the health problems that the women suffer arise from a lack of occupational health and safety standards, or from environmental conditions at work. At some types of venues, women work and live in the same location. In these cases, the water provided is unclean, and in many cases, bathrooms are shared with customers.

In addition to exposure to large amounts of cigarette smoke and loud music, many women complain of suffering fatigue and related symptoms. Sex workers are often forced to work more than ten hours a day with no breaks and only get one or two days off a month. When they have not had enough rest, they may get regular headaches or become sick easily.

Sexually transmitted infections, violence against women, receiving little to no training on safe sex from their employer, and having to labor under quotas where they may be forced to accept a certain number of customers over time, are the occupational hazards many sex workers face. Increased numbers of customers increases the likelihood that sex workers will encounter customers who may refuse to use condoms, use condoms improperly, or may entice the woman with money to not use a condom.

Condom use with numerous customers, without using proper lubrication, may also result in breakage, or may make the woman choose to not use condoms if there is painful chaffing. Moreover, access to condoms may be restricted if owners refuse to provide condoms at their venue for fear that it may be used as incriminating evidence that commercial sex is available, as sex work is illegal in Thailand.

Women who are undocumented migrants or are confined to their workplace are generally unable to access health services. Constraints on mobility, language barriers and fear of authorities act as palpable barriers that limit migrant sex workers' access to health services, especially STI testing and treatment.

EMPOWER works with sex workers in ten zones throughout Chiang Mai City divided in three work teams: education and community, health, and advocacy. EMPOWER's outreach is mainly done by the health team, which is composed of trained volunteers overseen by a lead staff member. A couple of times a week, the outreach teams provide health education and counseling, with an emphasis on reproductive health and safe sex, to women living in brothel-type of arrangements. The teams de-emphasize the issue of sex work and focus more on health, which promotes trust among owners and allows the teams greater access to these venues. In addition to education, the health team may also provide basic palative care, explain how to navigate the health system, or assist directly with referral to health services when necessary. Volunteers prepare their activities each week in response to on-going situation assessments done by the teams, and make changes to a basic brochure to support the focus of activities for that period.

Volunteers come from the sex worker community. They must commit to a six-month cycle and work at least two days a week, for which they are paid a daily stipend. At the end of six-months, they can re-apply and change work teams if they desire. After their initiation training, they receive training from each of the work teams, as well as training in outreach skills, leadership and counseling. Part of their training includes attending a camp that EMPOWER hosts twice a year that teaches in-depth topics such as culture exchange, health issues, taking care of PLHA and rights issues.

Condoms, samples of birth control methods and IEC materials including EMPOWER's brochure and their handbook on safe sex entitled "Starter Kit" are provided in distribution boxes provided by EMPOWER. Sex workers themselves, however, must request and negotiate for these boxes directly with their employers as a part of their “empowerment.”

EMPOWER has three drop-in centers. Participatory workshops are given at the main drop-in center twice a month with one workshop held at each of the other two auxiliary centers each month. These workshops are open to all members of the sex worker community, regardless of language, and cover various topics ranging from HIV/AIDS and safe sex to labor rights. Free Thai literacy classes are given by members of the education and community team for two hours each weekday at the three drop-in centers. Each class has around ten to thirty participants, and attendance is fluid. Topics include life skills and relates to current events that immediately affect them, such as how to register for a work permit. Mobile Thai language classes are also provided to migrant women in a couple of small brothels.

The main drop-in center also provides assistance with accessing health services and care, including referral for STIs. Once a month EMPOWER provides transportation for around ten or more sex workers from the main center to the STI clinic. The service is voluntary, and EMPOWER has established an arrangement with the clinic that does not ask for ID and where the charge is a flat rate of 30 Baht for testing and treatment regardless of whether the woman is a registered migrant with insurance or not. (This arrangement was through the Provincial Health Office. Now that the clinic has been incorporated into hospitals as part of the government's decentralization plan, it is uncertain whether this arrangement will be continued to be honored.)

The main drop-in center is open to members of the sex worker community, and the women are free to come to the center casually, or to engage in activities. The main center also acts as a safe house for women in need of temporary shelter. (In a couple of unfortunate instances, women suffering advanced AIDS have been abandoned by their employer at the center.)

EMPOWER is also a vocal advocate for sex workers' rights, and the advocacy team has recently completed a study on the need for establishing a code of “Safe Work Place Standards” for sex workers. The standards are illustrated to members of the community in a demonstration room at the main center that shows the items that employers need to provide to make sex work safe and fair. A set of advocacy posters that promote sex workers' rights as laborers have also been produced and distributed to relevant government agencies. The racey nature of the posters may, however, discourage officials from displaying them publicly, but shop owners may be more willing.