Prevention of HIV/AIDS Among Migrant Workers in Thailand

PHAMIT Site Profiles

Raks Thai Foundation

As of October, 2006

“Lad” boats usually have around 8 to 17 crew members – mostly all Cambodian. Some young boys have been spotted working on these boats too. The smaller boats will stay out from 1-2 years, and the larger ones will go out for 3-5 years. Crew members will go home once the boat finally docks in Samut Prakarn, and if someone gets very sick, they will be sent back to shore on a Tour boat.

Klong Dan has a migrant community of around 2,500 people, with the significant majority being men. There are around eight factories (1 animal feed; 5 mussels; 2 fish sauce) with around 30-40 people, mostly Karen men, in each factory. Most factory workers are registered. In the clam / mussel factories, where the main task is simply cutting the “hair” off mussels, the labor is composed of Mon and Karen women.

Clam cleaners get paid every 10 days at a rate of 2.5 Baht for every kilo, and make up to 200 Baht a day, or as low as 50-80 Baht (average wage is around 90 Baht a day or $2.50), with the work fluctuating seasonally. Other factories pay a minimum of 100-120 Baht a day even though the official minimum wage in the province is 180 Baht. If workers are sick or there is no work, they don’t get paid; there are also no days off and no overtime. Work shifts for factories are usually from 11 pm – 9 am or 3 am - 9 a.m.

In Tai Barn area, there are about 30 karaoke bars. Most of the women are from Essarn (Northeast of Thailand) with some young women from the North; there are also about 6-7 Cambodians, and around 10 “katoeys” or “ladyboys” (transvestites / transgenders). There is even a small number of girls aged 13 or 14 available discreetly, but most of the women are between the ages of 18 and 25, with some 35 years or older depending. None of the bars “specialize” in any one type of woman. In other words, katoeys or Cambodians, or girls from Essarn or the North can be found in any of the bars. Each shop has around 2-8 women per place, with the average being four women in a bar.

Some of the women have children, and there are a couple of women who are married. There are a lot of unplanned pregnancies among the women in these shops, accompanied by a prominent amount of abortions. Most customers in this area are Cambodian fishermen. Some of the women get pregnant from the Cambodian fishermen and in hopes that the men will stay with them. Unfortunately, this ploy rarely works, and the women end up with an unplanned pregnancy that most likely ends up in abortion.

Mon fishermen in Klong Dan are also likely to go to karaoke bars, but Karen men generally don’t go to karaoke bars since they mostly work on land and live in communities with their wife and family.

A similar approach is used in reaching fishermen. Small activities are given almost every day with fishermen from Lat Koo boats. The order of activities goes like this: HIV/AIDS on the first encounter, if they meet same boat again STIs, and the third session is TB and then penis enhancement… There is good monitoring of boats reached with activities, which is partly assisted by a list of boat docking schedules that is available from the Fisheries Association. IEC materials in Cambodian or Burmese are also given out according to the topic of activity. This site has produced a newsletter in Thai and Cambodian.

Volunteers are located strategically in the community. Their main responsibilities include recruiting people to attend activities, assisting with referral and condom distribution. The number of active RTF volunteers range from 3-10, with around 7 being active at the beginning of the year. Of these, four actively distribute condoms and take care of condom boxes. Volunteers receive money for days they assist field officers with trainings, and when they attend trainings or meetings.

Karaoke women volunteers distribute and replenish condoms, act as a linkage to RTF, provide basic health and HIV information to other women, assist in preparation of activities for fishermen including recruiting fishermen for activities, and report on the situation in the field. There were around 5 active volunteers who were trained, but this number is now down to just one. The problem is that the women are highly mobile, and many change jobs or get married. The one active, remaining volunteer is an owner of one of the bars.

This site used to get condoms from the Provincial Health Office, but now distributes PHAMIT brand condoms. Condoms are given to both men and women during small group activities (about 2-3 pieces each), even though some individuals may reject them. There are at least ten condom boxes located at advantageous points in the community, with some located at guard posts on the docks where fishermen pass on their way to land, and there are some at motorcycle taxi driver stands. Placement of the boxes has been problematic, as a couple of boxes have disappeared, and they are unable to monitor distribution.

Condoms are given to karaoke shop owners as they are not willing to have condom boxes displayed due to concerns that the police will use it as evidence of selling sex. Unfortunately, there are rumors that the owners are selling the condoms that should be available for free. Each shop goes through about one box per month (around 100 pieces). RTF is now starting to follow up more on condom use, and will limit the number of condoms given to each shop according to reports of actual demand, and will inform fishermen that condoms with the PHAMIT logo are supposed to be free.

The Karen community is reportedly starting to use condoms more, at around 20 pieces a month. The Mon community, on the other hand, is still very conservative about condoms, making it hard to place boxes publicly or talk about sex. They are more receptive to activities, but there is still a certain amount of shyness when talking about sex and condoms.

Generally, these communities prefer other forms of birth control, such as oral contraception. These are distributed at family planning activities, which are often organized by volunteers who call on women in the community. There is also high use of injectable birth control, which is feasible as the factory setting promotes a more sedentary lifestyle. There is low to no abortion reported in these migrant communities. For ANC, many migrant women generally go to the health clinic and hospital. Birthing in hospitals is also generally common; migrants will go on their own to the hospital, and employers are even known to help.

Around 5-8 fishermen each month are referred for health services. Previously only around 1-3 were being referred, but the numbers have increased due to familiarity with Raks Thai. The fishermen will contact a FOM directly, or a member of the community who then contacts a FOM by phone. They go to the district level hospital, where they can use the 30 Baht card (if they are registered) or else pay full price if they are unregistered. The hospital has no problem with treating migrants who are undocumented, and won’t call the police.

Raks Thai has active partnerships with the Provincial Health Office, two hospitals and two health centers. Both hospitals use RTF FOMs as translators, for populations from Burma, and support the idea of hiring migrants as Migrant Health Workers. The use of translators came about through an annual meeting between RTF and the hospitals, and the hospitals are using FOMs on a “trial basis” with the intention of eventually “hiring.” As follow up to this, a plan has been developed to train 30 migrant health volunteers in 3 months. The training is conducted by the health center, and since Oct 05 over nineteen volunteers have been trained.

Another result of this relationship with local health authorities has been provision of a mobile clinic through one health center at Sapan Pla. It originally started out on a once a month basis, but now is once every 2-3 months because of low need. The mobile clinic rotates areas it serves, and has a vaccine campaign for children once a year. The health center also gives training for First Aid to fishermen on a sporadic basis.

Raks Thai’s link with the hospital has also helped Thai karaoke women who come from other parts of the country to transfer their 30 Baht registration from their home communities to their place of work. In one month, they average ten cases of karaoke women needing this service.

RTF outreach teams provide rights trainings to migrants to teach about how to use the health insurance they receive when they register, including what diseases and conditions can and cannot be treated, the cost of services and where the location of the hospital is where they receive the subsidized rate. Other trainings focus on labor rights, providing information on: work hours, wages, days off, regulations for employers, how to change employers or legally leave the area.

Participation in the surrounding community has helped to improve the attitude towards migrants. In Klong Dan, for example, they had a merit making ceremony at a Mon-Thai temple two years in a row, organized by the migrant community and volunteers, with RTF support. It was found that the Thai community’s attitude improved about migrants with the merit ceremony, which was accompanied by a clean up at the school and temple. The clean up activity happens more regularly - once a month with around 20 people participating. Again, RTF supports the activity by purchasing the equipment, but it is the community that organizes the activity.