A comparative study of transgender women accessing HIV testing via face-to-face and telemedicine services in Chiang Mai, Thailand during the COVID-19 pandemic and their risk of being HIV-positive.

BACKGROUND: Due to the restricted availability of health services in Thailand, there are still some transgender women (TGW) who do not have access to HIV counseling and testing. Telehealth, which is accessible to individuals who are reluctant to undergo face-to-face interviewing, played an especially important role during the COVID-19 epidemic. The objectives of this study are to compare the characteristics, pattern of accessing HIV testing, and the HIV-positive rates of TGW between the face-to-face and telemedicine services. METHODS: We conducted a cross-sectional study to compare the access to HIV testing and the HIV-positive rates among TGW via face-to-face service and telemedicine services and examined the influence of potential associated factors on the risk of being HIV-positive. RESULTS: Of the 637 TGW participants, 26 (4.1%) were HIV-positive. Accessing the telemedicine service increased in the third and fourth COVID-19 waves (28.1% in the first and second vs. 71.9% in the third and fourth). There was no difference in the risk of being HIV-positive between the types of service. Having sex work experience (adjusted odds ratio (aOR) = 5.92; 95% confidence interval (CI): 1.57-22.30) and either never having been or tested more than 1 year ago were independently significantly associated with a higher risk of being HIV-positive (aOR = 4.05; 95% CI: 1.11-14.77). CONCLUSION: The telemedicine service became more popular among TGW during the COVID-19 pandemic and was not related to a higher risk of being HIV-positive. Moreover, it proved to be an effective alternative channel to access HIV testing, especially for intravenous drug users. Sex work experience and irregular HIV testing are key risk factors for HIV infection in TGW seeking either the telemedicine or face-to-face service.

Effects of Gender Affirming Surgery on the Quality of Life of Transgender Women in Chiang Mai Province, Thailand.

Gender affirming surgery (GAS) helps individuals to achieve a physical presence consistent with their gender identity. In this study, we explored the decision, expectation, experience, satisfaction, and quality of life (QOL) of transgender women (TGWs) who have undergone GAS and compared their QOL with transfeminine individuals (TFs) who have not and are seeking to do so in Thailand. The median overall QOL score of the TGWs who have undergone GAS was slightly higher than that of the TFs who have not (95 (92-103) vs. 92 (86-98); p = 0.003), which was also reflected in the specific domains of psychological health, social relationships, and environmental health, the exception being physical health. Not being financially prepared was the most relevant reason for delaying undergoing GAS among the TFs who have not undergone it and want to do so. In addition, more than half of the TGWs who have undergone GAS regretted not being socially accepted after surgery. Although the difference between the QOLs of the two groups is statistically significant, the clinical significance should be further investigated to provide more insight. In addition, the higher QOL of TGWs might not solely be due to having undergone GAS.

Discrimination against and Associated Stigma Experienced by Transgender Women with Intersectional Identities in Thailand.

Although Thailand is overtly open to diversity and promotes equality, discrimination of minorities based on gender, ethnicity, and/or certain occupations is unfortunately still prevalent. Society either obstructs their inclusion or accepts them but only under certain conditions. The objective of this study is to examine the discrimination of TGWs with intersectional identities within Thai society. A total of 19 TGW participants were recruited and underwent in-depth thematic interviews about their experiences of discrimination. Rechecking of the extracted information from the interview transcripts and the subsequent encoding process were conducted using the NVivo program. The results show that the median age was 30 years old, and the majority of the individuals with intersectional identities were ethnic minority TGWs (47%). The in-depth interviews were divided into four main themes, including discrimination at an educational institution, discrimination in the workplace, discrimination in daily life, and discrimination at a healthcare facility. Our findings reflect problems associated with multiple sources of discrimination aimed at transgender women with an intersectional identity in Thailand in every aspect, including harsh speech or physical abuse; occupational, social, and legal inequality; and healthcare provision disparity. Raising awareness about gender diversity and intersectionality, as well as enforcing anti-bullying legislation and anti-discrimination laws, should be continually pursued in order to protect the rights and improve the quality of life of transgender individuals with an intersectional identity.

Reproductive desires in transgender and gender diverse adults: A cross-sectional study in Thailand.

Objective: To explore the desires and barriers to fertility preservation among transgender women and gender diverse people assigned male at birth in Thailand. Material and methods: This study is a cross-sectional study in clinic-based setting. The data was obtained from a questionnaire. Three hundred and three participants visiting the Gender Care Clinic at Chiang Mai University Hospital and Mplus clinics between April 2019 and December 2019 were included. Of these, 199 were transgender women and 104 were gender diverse people assigned male at birth. Results: The overall parental desire was 30.4% which was similar across the 2 groups (p = 0.897). A genetically related child was preferred in 40.9% of transgender women and 50.5% of gender diverse group (p = 0.115). Factors impacting a parental desire were a good relationship with family (OR 2.905, 95%CI 1.315-6.420, p = 0.008), being in a stable relationship (OR 4.183, 95%CI 1.738-10.069, p < 0.001) and belief in a positive attitude of society toward LGBTQ parenting (OR 2.572, 95%CI 1.207-5.479, p = 0.014). Access to fertility preservation services was low. The majority of transgender women (75.3%) and gender diverse people (95.2%) never received a consultation regarding fertility. The utilization rate of fertility treatments was 5.3% in our study. Conclusion: Transgender women and gender diverse people assigned male at birth have parental desires for a genetically related child. However, access to reproductive information, consultation and services were very limited. Social support along with competent health services might increase access to reproductive services in transgender and gender diverse populations.

Awareness, perception and perpetration of cyberbullying by high school students and undergraduates in Thailand.

The modern online society requires everyone, especially children and young people, to learn how to use the Internet. Cyberbullying is one misuse that can be detrimental to the cyberbullied individuals' mental health and lifestyle, and it often ends up with the victim becoming depressed, fearful of society, and in the worst cases, suicidal ideation. The aim of this study is to investigate the awareness, perception, and perpetration of cyberbullying by high school students and undergraduates to find ways to prevent cyberbullying in the future. For this cross-sectional study, data were collected in 2020 from 14 schools throughout Thailand and 4 universities in Chiang Mai, Thailand, using two-stage sampling. Chi-squared tests were used to compare differences between the groups. Of the 2,683 high school students, girls perceived cyberbullying more than boys (81.6% vs. 75.4%; p <0.001), with those from the later academic years being more aware of cyberbullying (p = 0.033) and more likely to conduct cyberbullying behavior (p = 0.027). Of the 721 undergraduates, women were more aware of cyberbullying than men (92.1% vs. 82.7%; p <0.001). The most common cause of cyberbullying was aiming to tease the target (67.6% of high school students vs. 82.5% of undergraduates). The most commonly cyberbullying victimization was sending mocking or rebuking messages (29.6% of high school students and 39.6% of undergraduates). The most popular solutions for cyberbullying were to avoid leaving a trace on social media and be with friends who accept who you are. Our findings show that most of the cyberbullying perpetrators did not consider that their actions would have serious consequences and only carried out cyberbullying because of wanting to tease their victims. This is useful information for the cyberbullying solution center, teachers, and parents to recognize how to make the students realize the effects of cyberbullying on the victims.