Migrants Affected by HIV/AIDS

 
Mae Sot
 

Mae Sot is an active border town with Burma as well as a special economic zone. Numerous migrants cross from the town of Myawaddy on the Burma side to find work in Thailand; many migrants end up working in Mae Sot area, others simply pass through it as a transit point. There are also numerous migrant communities in Mae Sot composed mainly of families.

Due to issues of documentation and language, migrants in the area and even people from the Burma side prefer to use the health services of the Mae Tao Clinic (MTC), also known as Dr. Cynthia's Clinic, rather than public health services. With the HIV epidemic that is quietly growing in Burma and among migrants in Thailand the Mae Tao Clinic has had to expand its range of services to accommodate HIV related conditions. As a base part of these services the clinic provides HIV counseling in Burmese and draws blood for HIV testing, sending the samples to be processed at the Mae Sot Hospital. The antenatal care (ANC) clinic, one of the busiest parts of the MTC, provides HIV counseling and testing as part of a standard set of services; and it is here that a considerable number of migrants living at the border find out their HIV status. According to numbers of migrant women from Burma testing positive for HIV through the ANC clinic at the MTC, current rates of HIV in the area are around 1.5%. (Mae Tao Clinic Annual Report, 2005)

 

The Mae Tao Clinic provides medical support for migrant PLHAs who find out their HIV status through the clinic. Pregnant women who are HIV positive are given ARV under the prevention of mother to child to transmission (PMTCT) program, which is jointly administered by the hospital and the clinic. Pregnant women and new mothers are also provided powdered milk, bottles and diapers, and the clinic also provides treatment and medicine for relief of opportunistic infections, as well as some home-based care. Although the clinic is able to assist with the medical aspect of health, it cannot assist with the social element of health.

To fill this gap, the clinic refers PLHAs to World Vision Foundation Thailand 's PLHA support group for migrants. Members of the group are provided supplemental financial support to help with provision of food, and the group brings migrant PLHAs together providing them the opportunity to openly discuss problems related to having HIV. The group's limit is fifty families, yet at least another twenty families who have passed through the Mae Tao Clinic are on a waiting list to become members of World Vision's support group.

A core group of members are also volunteers who help provide home-based care to the other members. The following are interviews with these volunteers.
 
Woman 1

This woman is a home-based care volunteer. She stays in Myawaddy on the Burma side, and goes back and forth taking care of migrant PLHAs on both sides of the border. She is thirty-two years old and has five children ranging in age from eleven years old to just over one-year old. Prior to her pregnancy with the last child, she had been working in Rangoon for over a year. Once she was pregnant, she came back to the border. Her husband works as a transporter at the border, assisting with loading and unloading goods being ferried across the Moei River.

She learned of her HIV status about two months prior to giving birth to her last child. She went to attend the antenatal clinic at the Mae Tao Clinic and received HIV counseling and testing there as part of the services. Upon learning that she has HIV, she was referred to World Vision's support group.

This woman comes across the border weekly for PLHA meetings at World Vision's center, and to receive milk powder from the clinic as part of the PMTCT program run through the Mae Tao Clinic.

She has been a peer counselor for over nine months now and has become one of the group leaders. Her responsibilities include providing care for those with OI (opportunistic infections), and simply checking up on those who are unable to leave their houses due to infirmity. She receives no stipend beyond the support money for food and transportationto to group meetings that is provided to all members of the support group, and World Vision pays for any additional expenses directly related to her services.

Part of her motivation to do this type of work is because she feels sympathy for her friends (the other PLHAs). She attributes her devotion to being a volunteer to her desire to be productive and help others, which, she concedes, also gets her out of the house and keeps her busy. Without this meaningful busy work she fears she would fall prey to depression. She intends to continue as a home-based care volunteer, and, if given the chance, would be willing to work in a factory or other small jobs to make more money to help support her family.

 
Woman 2

This Burmese woman from Plijon Island, near Mwalyamyne in Mon State, has been in Mae Sot for two and a half years. She worked in Bangkok for three years prior to coming to the border (she did not mention what work she did in Bangkok ). This woman is thirty-nine years old and has an eight year old boy and a nine month year-old daughter. When she crossed the border she would go through the Kawthaung-Ranong border area in the South.

Her first husband died of AIDS four years ago in Myawaddy. He had worked on construction and in a bottle factory while in Thailand. The woman has known her HIV status for three years now, and was originally tested in Rangoon. She has remarried and the new husband knows her HIV status, even though when they married she didn't have any symptoms. He tested a year ago, but the results were negative. He works as a carpenter doing construction in Mae Sot. Their daughter is drinking milk powder provided by World Vision, and will get tested for HIV at the Mae Tao Clinic after she is one-year old.

This woman is also a home-based care peer counselor and a member of World Vision's migrant PLHA support group in Mae Sot. She is happy to be able to receive the modest financial support, which goes into buying food and leaves her husband's income available to pay for the family's other needs. For this woman, being a peer counselor and a member of the support group is liberating. “I feel that I am able to expose myself here and talk freely about my health problems, especially about the infections (related to HIV/AIDS) that bother me. It feels good to have that release.” Her plans include working with World Vision as a volunteer until the baby is two, and then maybe start her own business selling handicrafts or something.
 
Man 1

The only male peer counselor in the group, (the other four are women, two of whom live on the Burma side of the border) has spent more than eight years in Thailand working in construction, as a carpenter, as a painter, and most recently in a restaurant. He has no work permit. He comes from Mwalyamyne in Mon State but is Burmese and is thirty-one years old.

He is married and has a daughter who is six years old and a son who is one year and ten months. His wife found out she has HIV when she tested positive for HIV at the Mae Tao Clinic's antenatal care clinic. Although he still finds work occasionally, he helps out with World Vision when he is asked. As part of the PLHA support group he receives financial support for food, which he says helps alleviate the stress on the family's income. Even if he can't find work, they are able to eat well, and that helps his health.

Woman 3 - Group Leader

This woman from Magwye is Burmese and is thirty-three years old. She has been in Thailand for eight years, and has been in Mae Sot for the whole time. Her husband was working in Bangkok doing construction at the time of the interview, but he was planning to return to Mae Sot when he finished that job. He doesn't have HIV, but she does.

She has known her status for two and a half years. Like almost all the other women in the support group, she found out when she was tested at the Mae Tao ANC clinic. She has a six year old son and a daughter just over two years old – the one she was pregnant with when she was tested. (There was no mention of whether the children were infected.)

Before she was pregnant she worked in a garment factory in Mae Sot. Over the past year she has been working with World Vision. Her responsibilities include disbursing money to members of the support group, accounting of the disbursements, peer counseling, home-based care, and assisting with training for other peer trainers. She helps other migrants infected with HIV/AIDS to access services at the Mae Tao Clinic or at the hospital through World Vision. Her desire to help support others is her motivation to be a volunteer. “I have HIV, but I am strong. Look at me.”

There is still a lot of stigma towards PLHA within the migrant community, so, like most members of the support group, she has not revealed her status publicly. “I don't care what others say (about having HIV),” she says defiantly. On the other hand, she also says, “they (the community) don't need to know.” Like many in the group, the only ones who know her status are in the support group and her family. Although her family knows her status, it is not a topic for conversation.