The invisible intersectionality of female gender in Thailand's response to the HIV epidemic

Intersectional stigma and coping strategies of single mothers living with HIV in Thailand

Stigma and discrimination are barriers to the prevention and treatment of HIV, and have serious biomedical, psycho-social and socio-cultural consequences, especially for marginalised groups such as sex workers, transgender people and sexual minorities. There has been little research to date on single mothers living with HIV to situate the stigma they experience within the context of gender, class, ethnicity and other intersecting social inequalities. Drawing on participant observation and in-depth interviews with 28 single mothers living with HIV in Thailand in 2020-21, this article finds that single mothers living with HIV experience intersectional stigma based on their class, ethnicity, religious status and gender, which manifests at the self, family, community and societal levels. In response to this stigmatisation, single mothers have developed four different coping strategies: self-presentation, identity talk, self-exclusion (through distancing and selective association), and empowerment. Findings from the research indicate that an intersectional approach is needed if academics, health workers, policy makers - and even the individuals concerned - are to understand and respond effectively to the HIV-related stigma experienced by specific socio-demographic groups.

Thai trans women's agency and the destigmatisation of HIV-related care

Until recently, trans women have been subsumed within the category of men who have sex with men for HIV-related care. Following a 2016 UNAIDS report finding that trans women globally are 49 times more likely to be living with HIV than the general population, health programmes have sought to expand their reach to this key population. Yet, trans women are often treated as passive subjects to be recruited into programming or clinical trials for HIV-related care. This paper uses case studies of two community-based clinics in Thailand to highlight the agency of trans women in creating and implementing unique models for the provision of care that fit their needs and those of their local communities. By tailoring goals to be trans-specific and local, trans women at these clinics help destigmatise HIV-related care. This paper argues for the importance of engaging trans women as community stakeholders in HIV-related care and prevention and identifies suggestions for stakeholder engagement in programme design both in and beyond Thailand by focussing on local conditions.