Prevention of HIV/AIDS Among Migrant Workers in Thailand

PHAMIT Site Profiles

World Vision Foundation of Thailand

As of August, 2005

Tak Province (Mae Sot)

Mae Tao area starts from the physical border with Burma and extends towards Mae Sot town. In this area there are a number of factories and migrant communities. World Vision Foundation in Thailand (WVFT) has access to four factories that range in size from under one-hundred people, to a couple of hundred people to one large factory that has over 2,000 laborers. Seventy percent of the laborers in these factories are women age eighteen years of age and up, and there are no children present.

Behind a facade of Thai houses and businesses along the main road there are pockets of migrant communities with families and children. World Vision works with three of these communities. One community with over 100 families present is located just off the main road, close to the Moei River. About half of the population in this community is estimated to be children less than 15 years of age. Most people are of Karen ethnicity and Burmese, but there are also some identified as Pa-O. Those of working age, including youth, find jobs in construction, restaurants, agriculture and as general laborers. Some women work as domestic workers. Some people have been in this community for twenty or more years, while others cross the border regularly. Most people in the community have ID cards of some sort.

Although there are sex workers present at Mae Sot, they are not prominent. In fact, most sex workers seem to be freelance and are known to move around Mae Sot area and cross the border regularly. It is estimated that there are one-hundred or so sex workers, about sixty to seventy percent are Burmese with the rest representing a mix of different ethnic groups from Burma. The women are mostly between the ages of 17 and 28.

Out of the sex workers who participate in the free STI testing and treatment available through the hospital, those who test regularly generally show low rates of STI. Out of the ten to fifteen who will test in a week, for example, about two or three women will need treatment. There is concern, however, that those who do not test may have higher rates of STI. HIV rates among sex workers were at 14.8% in 2003 and 4% in 2004. (Although there is annual HIV surveillance by the Hospital, there is no pre or post test counseling and the women have no access to results.) Sex workers report that most customers use condoms but that there is low or no condom use among regular partners outside of work or with husbands / boyfriends, and that when a sex worker gets pregnant, most of the time it is from their husbands or boyfriends.

Most migrants in the Mae Sot area and even many from the Burma side go to the Mae Tao Clinic (the MTC is also known as Dr. Cynthia's Clinic) for reproductive health services, including ANC and testing for Hep B, syphilis and HIV. Since the Mae Tao Clinic started providing VCT in Burmese language (blood samples are sent to the hospital for analysis), around seventy people are testing for HIV a month. Currently, the HIV rate among ANC is estimated at around 3 women out of every 200-300 who are tested. MTC, in conjunction with the Mae Sot Hospital, have a PMTCT program for women who find out their HIV status through the ANC clinic. MTC has an arrangement with World Vision to assist those people who test positive for HIV and need social or financial assistance. Although there are no official statistics, there seems to be an increase in the number of migrants with HIV in the area. Another alarming trend recently found among migrant men in Mae Sot is the prominence of Fang Muk (bead insertion) and oil injection to enlarge their penises; the Mae Tao Clinic has had around ten referrals for related problems in one month.

World Vision develops Peer Trainers (PT) in their target communities: factories, communities and among sex-workers. Those who become a PT go through a basic training. They are then responsible for distributing IEC/BCC materials to their peers and assisting with referral for health services. In factories, condoms are distributed through boxes that PTs place and maintain in the bathroom or in the dorms. PTs also assist with distributing OC pills.

PTs are supported by Social Network Group (SNG) members, who are PTs that have attended a training of trainers. Long-standing SNGs may become Community Health Volunteers (CHV) and are able to provide home-based care to PLHA in the community. World Vision has also provided a training on counseling and VCT for twenty-five participants, including CHV, ten of who live on the Burma side.