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THAILAND: Women with HIV Break Silence, Confront Stigma

Marwaan Macan-Markar*

TRAT, Thailand, Feb 19 2010 (IPS) - Veena Panudej makes a living in the night like so many other women and men in this quiet eastern corner of Thailand. They work under the light of the stars in rubber estates spread beyond this city close to the Cambodian border.

By sunrise, Veena takes stock of what she has finished in her nocturnal job, tapping rubber trees for the white sap that is collected in coconut shells attached to the slender trunks of each tree.

The 34-year-old was hardly disappointed on a recent Tuesday by a ritual that began shortly after midnight. The tools she used as she made her way in her family-owned plot of rubber trees were a torch and a special knife.

But sleep was farthest from her mind after six hours of such labour. For by eight in the morning, Veena was ready to plunge into another role she has carved for herself, which entails shouldering community concerns – a role she took on after being diagnosed with HIV.

“I go to the local hospital and stay there till three in the afternoon to help in the counselling service offered to HIV-positive women,” says the rubber tapper. “On some days, I pay home visits to meet families in nearby communities.”

It has been a life-changing two-year journey, she admits. For living with HIV has shown a side of her that she barely knew she possessed. She has gone from being the quiet person of her youth to a confident leader determined to confront the stigma hounding women after they have been diagnosed with the deadly virus.

“I have to be brave to speak out and to express my concerns and those of the other women,” reveals Veena, who is also the president of the HIV-positive women’s network in her town, Laem Ngob, 10 kilometres east of Trat. “Our role is to help positive women who face discrimination at home, in their communities or even in the hospital.”

Veena is one of the beneficiaries of a joint initiative by the Raks Thai Foundation, a non-governmental organisation helping women affected by HIV/AIDS, and the United Nations Development Fund for Women (UNIFEM).

The programme seeks to raise the dignity and secure the rights of women living with HIV. One of its objectives is to develop peer-based community outreach efforts that will support HIV-afflicted women in the Trat and Chiang Mai provinces and conduct awareness-raising campaigns with local authorities and health service providers.

Veena is not alone in her efforts. There are a growing number of women like Naowares Khlangkamnerd faced with similar health predicaments in this urban centre and nearby towns and villages, who are demonstrating similar daring as the former to reduce the burdens women living with HIV have to bear.

Naowares says that when she first started going to communities, people did not speak about HIV-positive women, thinking they did not exist. “But over time, as people got to know who I am and what I do, women have begun consulting me,” she says.

But it is a daunting task for such women to step out of the shadows in order to break the silence that other women with HIV who live here have to endure.

Negative perceptions are among the most challenging, says Dararat Boonpak, a psychologist at the 312-bed state hospital in this city. “In most communities, HIV-positive women are often seen as being promiscuous. They are often verbally abused and sexually harassed if their status is known.”

Consequently, such an environment has driven such women into silence, adds Wantong Rattanasongkram, field officer of Raks Thai. “They find it difficult to reveal their status.”

“Women are often blamed for getting infected,” adds Wantong, who has been working on Raks Thai-UNIFEM programme. “Our task is to build confidence and to deal with quality-of-life issues.”

Over the past two years, some 250 women have been drawn into this programme here in Trat, and initial results suggest that there are hints of emerging change. Antenatal clinics (ANC) in the local hospitals that once shut their doors to women like Veena are more welcoming now.

For instance, nurses in ANCs have begun referring pregnant women who have tested positive for HIV to the women living with HIV that Raks Thai-UNIFEM have been training.

A similar sea change is emerging at local councils, where leaders of HIV women’s networks are not shying away from officials as they used to before. “When positive women go to the sub-district office, they are now presenting themselves as positive women and that they belong to a group of similar women,” says Wantong.

This campaign to help women discriminated against for their HIV status reveals a darker side of the battle against the deadly virus in Thailand, which has gained universal praise over the past decade for its successful efforts to contain the spread of HIV and for its public health initiatives to ensure people living with HIV have access to the life-prolonging anti-retroviral (ARV) drugs.

Thailand has recorded over 1.1 million cases of HIV since the start of the HIV/AIDS epidemic in this South-east Asian kingdom in 1984. Over a third of the infected people – close to 400,000 – are women.

The country has also recorded some 300,000 deaths due to AIDS – a number that could have been far higher had not cheap, generic ARV therapy been given through state hospitals. Currently, over 150,000 people are on such first-line medication.

But while Thailand’s successful public campaigns for sex workers to use condoms have borne results, transmission rates among married women have been cause for concern, according to U.N. reports. They are among the three vulnerable populations for the spread of the virus, the others being men who have sex with men and injecting drug users.

According to recent reports by the Joint U.N. Programme on HIV/AIDS, while the epidemic in Thailand has been spreading through men having sex with men and injecting drug users, “now the main mode of transmission is among married couples.” Women are getting infected by their HIV-positive partners who demand having sex without using condoms. Naowares is one of these women.

Some men living with HIV are sympathetic to the HIV-positive women due to the trials they face. Rungroj Nuamprem, a fruit farmer, admits that the undue pressure placed on women in local communities has forced them to cower in silence.

“Because of the pressure and the lack of confidence, there could be many HIV-positive women who have not revealed their status to their communities,” he says. “For women it is also difficult because of expectations about their roles to be good mothers and housewives.”

“I know what it felt like for me when I tested positive. I felt valueless,” he admits. “But I discovered my inner power after that and made my status public. But even then I still face some discrimination like being denied joining a savings fund that helps pay for funerals.”

(*This feature was produced by IPS Asia-Pacific under a series on gender and development, with the support of UNIFEM East and South-east Asia Regional Office.)