Migrants Affected by HIV/AIDS

 
Klong Yai, Trad Province
 
Story of Vuen: A cross-border PLHIV

Vuen is 28 years old and comes from Kampot Province in Cambodia. For the past four years, she has been working in Klong Soun, a coastal town near the Cambodian border in Trad Province; it is the only place she has worked in Thailand. Although she has a general ID (Toh Roh 38/1) she is not registered with a work permit, which means that she is not allowed to work officially and she does not have health insurance.

Vuen has a job sorting fish on the docks and makes about 2,000 Baht (1 USD = 34 Baht) a month. Her husband, who came to Thailand two years before Vuen did, works as a fisherman and makes 2,500 Baht a month. Out of the money that they make, they send 1,000 Baht a month back home to Kampot to help support their ten year old son. Vuen’s parents have passed away, so the child stays with her husband’s family. They had three other children, but they have all died. Vuen goes back to Kampot to see her son once a year if she can, depending on when she has the opportunity and the money.

Vuen and her husband are both HIV positive; she was most likely infected by him. One year ago, Vuen first found out that she had HIV when she started getting really sick. She went to the Klong Yai Hospital in Trad Province and received counseling and testing which cost 300 Baht. The hospital provided counseling in Cambodian language and Vuen felt that the service was good – something not commonly reported by migrants in Thailand. The Thai doctor recommended that Vuen go back to Cambodia to start ART.

When she got the news that she is infected with HIV, she said, “I became scared and wanted to die.” She told her husband, but he didn’t want to test in Thailand unless he started to get symptoms. They went back to Kampot and were both tested for HIV at the Kampot Hospital; the results showed that they were both HIV positive.

Concerned about their future, the husband immediately went back to Thailand to continue working while he was still healthy. For Vuen, staying in Kampot was not much of an option either. The Provincial Hospital where ARV is available for free is two hours one way from her family in-law’s home in Kampot, and the cost of transportation was relatively expensive as she would not have any income. Since Vuen had sold off her family’s land when she left for Thailand a couple of years ago, she had no place of her own. She had no family left and her in-laws considered her an added burden. There is also considerable stigma towards people with HIV in that community. After talking with her doctor, she found that she could transfer her ARV account. Thinking that she would be able to get her ARV at Koh Kong and work in Thailand, Vuen requested her treatment to be transferred.

During the screening at the Koh Kong Hospital, the doctors found out what she intended to do. Their main concern was that she would sell her medicine once on the Thai side, so, the doctors made her sign an agreement that she would receive ARVs and would attend the PLHIV meetings in Koh Kong regularly. As part of the initial agreement, they gave her two months supply. They then made it a monthly basis, and recently have changed it to every three months.
 

Koh Kong has a completely different atmosphere than Kampot. Vuen does not feel stigmatized in the community, and, in fact, is very open about her HIV status. As per her agreement, she goes to the Koh Kong Hospital when the PLHIV group meets and receives her supply of ARV on that day. Vuen is not the only one crossing the border for ART. She knew two other people from the Thai side in the group: one was also taking ARV and working on the Thai side, but that person has disappeared; another person had received counseling but had not yet started taking ARV, and that person has also since gone.

Although Vuen is committed to her treatment, she was starting to find that it is not an easy arrangement. For example, crossing the border is complicated by the fact that she does not have proper documentation (in this case a border-pass or a work permit), and trying to find the time can also be a burden, resulting in her not making it to the hospital on the appointed date. Her doctor has warned her about this but is lenient.

To get back to the Cambodia side she pays a Thai agent 300 Baht. Once she crosses, the Cambodian police check her things. Returning into Thailand is even more complicated and expensive. First, it costs another 300 Baht to cross back. When Vuen crosses the border she is searched, but has not experienced any problems carrying ARVs with her. Then she needs to meet an agent at the border, and pays another 300 Baht to get back to Klong Soun where she works - making it 900 Baht for the complete round trip. Sometimes she doesn’t make it back in one day and has to stay at the border over night, which adds to the expense.

Not having a work permit in Thailand makes life especially precarious. In November 2006, Vuen was arrested for working “illegally” and was put in jail for a week. She was able to call her cousin who brought her ARV to the jail. There was supposedly no problem regarding her taking her medicine in jail or taking her ARV with her when she was deported. She was lucky that time.

Vuen wants to receive her ARV’s on the Thai side. As it is now, she spends practically half of what she makes in one month just going back and forth to receive ARVs from Koh Kong and sometimes misses her appointment. With the other half of her income for her son back in Kampot, she and her husband are relying on his income for survival. Vuen is committed to her treatment, but it is a struggle. The question she and her husband don’t want to think about yet is, “what happens when her husband needs to start ART?” 

Postscript: Through arrangements between the Koh Kong Hospital and Raks Thai Foundation, Vuen is now one of a small group of migrants living in Klong Yai that receives a three months supply of ARV from the Koh Kong Hospital. Raks Thai Foundation provides follow-up on the Thai side.