'No test, no disease': Multilevel barriers to HIV testing among young men who have sex with men and transgender women in three semi-urban areas in Thailand.

Young gay and other men who have sex with men and young transgender women in Thailand continue to be at high risk for HIV infection. We explored multilevel influences on HIV testing in order to inform the design of tailored interventions. We conducted four focus group discussions with 16-20-year-old gay men and transgender persons (n = 25) and 17 key informant interviews with healthcare providers, NGO leaders, and youth advocates. Focus groups and interviews were transcribed and reviewed using thematic analysis in Thai and English language by a bilingual team. We identified intersecting, culturally situated barriers at individual (lack of HIV knowledge, low HIV risk perception, denial), social (intersectional sexual- and HIV-related stigma, lack of family communication), institutional (inadequate and non-LGBT-inclusive sexual health education in schools, lack of youth-friendly clinics) and policy levels (parental consent requirements for HIV testing by minors). Multilevel and multisystem factors coalesce to form extensive barriers to HIV testing access and utilisation and promote disengagement from HIV prevention more broadly. Multicomponent, youth-engaged interventions informed by Thai sociocultural history and practices are needed in renewed approaches to HIV prevention and testing to end the epidemic among young gay and transgender people in Thailand.

My space, my body, my sexual subjectivity: social media, sexual practice and parental control among teenage girls in urban Chiang Mai.

This ethnographic study conducted among young women aged 18-21 years in Chiang Mai, northern Thailand, explored the parental control mechanisms imposed by Thai middle-class families on the sexuality of their daughters. It addressed the ways in which young women tactically use the social media in order to negotiate the sexual controls they encountered in everyday life. Taking the teenage girls' point of view, this paper argues that, as active agents, young women achieve a certain level of sexual autonomy and construct their own sexual selves in modern northern Thai society, despite their parents' attempts to prevent this. The paper highlights the ways in which social media are used by Thai girls in order to achieve such a goal. Research findings should inform the development of future programmes on sexual health promotion, parental skills and sexual communication between Thai parents and their children.

Multilevel Factors Impacting PrEP Engagement Among Young Gay Men and Young Transgender Women in Thailand: A Qualitative Analysis.

Half of new HIV infections in Thailand are among young people, the majority of whom are young gay and other men who have sex with men (YMSM) and young transgender women (YTGW). Amid low pre-exposure prophylaxis (PrEP) coverage, we explored practice-based factors that impact PrEP engagement among YMSM and YTGW. In 2018, we conducted 4 focus group discussions with 20 YMSM and 5 YTGW, and 22 in-depth interviews (5 in 2022) with healthcare providers (HCPs), community-based organization (CBO)/nongovernmental organization (NGO) staff, and peer educators. The inclusion of PrEP in universal healthcare coverage, including YMSM and YTGW, is a substantial facilitator of PrEP use; however, systemic barriers at microsocial (lack of communication about PrEP from HCPs, teachers, parents), mesosocial (healthcare-service fragmentation, lack of PrEP-competent HCPs), and macrosocial levels (annual quotas on free HIV-testing, HIV- and sexual-stigma) constrain and disincentivize adolescents' engagement with PrEP. National scale-up of youth-friendly and LGBT-affirmative CBO/NGO clinics, HCP training, and tailored programs to support adolescents' adherence may promote PrEP engagement among YMSM and YTGW in Thailand.

"Being Born like This, I Have No Right to Make Anybody Listen to Me": Understanding Different Forms of Stigma among Thai Transgender Women Living with HIV in Thailand.

This study explores the ways Thai transgender women are affected by internalized, perceived, vicarious and enacted stigma. Participants were eleven Thai transgender women living with HIV, who were asked about experiences of stigma in their daily lives. Various forms of verbal, psychological and physical harassment were reported. Internalized stigma and stigma within the transgender community itself were significant. Participants tended not to blame their family members or others in their social structure for their experiences of stigma. They tended to see the solution to tackle the problem of stigma mainly in changes in the behavior of transgender women themselves. This paper suggests that transgender people themselves should better understand how the structure, culture and institutions of mainstream society instill, reinforce and perpetuate stigma against, within and among them. There is a need for advocacy directed toward manifesting societal emancipation of Thai transgender people-starting with legal reform.

Uptake of oral fluid-based HIV self-testing among men who have sex with men and transgender women in Thailand.

BACKGROUND: Suboptimal uptake of HIV testing remains a primary bottleneck to HIV prevention and treatment for men who have sex with men (MSM) and transgender women (TGW) in Thailand. The World Health Organization has recommended HIV self-testing (HIVST) as an additional strategic HIV service. However, HIVST has not been fully endorsed and implemented in many countries in Southeast Asia. The aim of this study was to assess the uptake of oral fluid-based HIVST in MSM and TGW populations in Thailand. METHODS: During 2017 and 2018, we conducted a cross-sectional study using convenience sampling to enroll 2,524 participants from three major urban areas. Participants were recruited during outreach and online activities and were offered unassisted or assisted HIVST, or referral to HIV testing services. A descriptive analysis was performed for summarizing data. RESULTS: A total of 2,502 participants (1,422 MSM and 1,082 TGW) were included in the analysis with about one-third (36.1%) of them being first-time testers. Among all participants enrolled in the study, a total of 2,486 participants (99.3%) selected HIVST versus referral to HIV testing services. Of those who selected HIVST, 2,095 (84.3%) opted for assisted HIVST while the rest opted for unassisted HIVST: 1,148 of 1,411 MSM (81.4%) and 947 of 1,075 TGW (88.1%) selected assisted HIVST. While no serious adverse events were reported during the study, we found that among 179 participants who needed a confirmatory test and were referred to HIV testing services, 108 (60.3.4%) accessed these later services. CONCLUSIONS: This study demonstrated a high uptake of oral fluid-based HIVST among MSM and TGW populations in Thailand and that HIVST could be scaled up through the national epidemic control program. However, a better understanding of HIV testing-seeking behavior and innovative follow-up solutions are needed to improve and monitor linkages to services for people who undertake HIVST.

"Gay Guys are Shit-Lovers" and "Lesbians are Obsessed With Fingers": The (Mis)Representation of LGBTIQ People in Thai News Media.

This article presents an analysis of news reports containing information or opinions about lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ) people taken from six Thai media outlets over a period of one year. The aim was to explore how LGBTIQ people are portrayed in news media narratives. LGBTIQ identities were found to be vastly underrepresented and, when represented, were often represented inaccurately, stereotypically, harmfully, or without a clear understanding of the diversity of sexual orientations, gender identities, and gender expressions. (Hetero-)sexist narratives, negative portrayals, harmful stereotypes, and discriminatory speech were also widely found, fueling a climate of stigmatization and discrimination of LGBTIQ people in Thai society. This article suggests that key stakeholders in Thai news media should be sensitized on the human rights of LGBTIQ people and on basic professional ethics in journalism.

Early adolescent peer leader development in HIV prevention using youth-adult partnership with schools approach.

This article describes the development and evaluation of an HIV prevention program developed for early adolescents through participatory action research. The HIV prevention program included a curriculum that was delivered by trained younger youth leaders through a youth and adult partnership with 10 schools in Chiang Mai Province, Thailand. The curriculum used participatory learning experiences, "edutainment" approaches, and skills-building strategies for enhancing youth leaders' capacities. Results of the evaluation showed that the senior-junior peer education program was effective in leadership role preparation, in improving youth leaders' ability to share sexual and reproductive health knowledge, and in promoting positive attitudes toward themselves. Success also rested on the fact that adults took a critical role in providing the opportunities, assistance, and guidance so that young people could develop their leadership capacity in an atmosphere of trust and respect.

HIV/sexual and reproductive health program for HIV prevention: the youth-adult partnership with schools approach.

The aim of the present study was to describe the development and evaluation of a program designed to prevent HIV/AIDS. A participatory action research (PAR) approach was used in collaboration with ten schools in Chiang Mai Province, Thailand, to develop a youth- adult partnership with schools (YAPS) model. The YAPS model included curricula using participatory learning experiences, edutainment approaches, and skills building strategies for enhancing youth leaders'capacities. Results showed that the YAPS model was effective in leadership role preparation and in empowering youth leaders to undertake activities on their own, initiate creativity and share knowledge on sexuality education and HIV prevention messages with students in schools. The use of partnerships and the participatory process mobilized parents, teachers, and school administrators to play a proactive role in sexuality education and HIV prevention for early adolescents in schools, resulting in the integration of the program into the school system.