Evidently, the Beach doesn’t want to be found. This“men’s sauna” sits on a dim, unmarked residential street miles fromSilom Road, the center of Bangkok’s roiling sexual economy. For 99 baht($2.50), I’m given a locker and towel, then granted entrance to athoroughly un-Thai cement-and-stucco house. Two giggly friendsmonopolize the karaoke machine in the pleather-and-fish-tankfirst-floor lounge. Out back is an illuminated pool bordered by palmsand a comically small sauna. The place seems eerily empty—until Inotice men in towels crowding onto a spiral staircase.
On the second floor, Thai men line a dark hallway withprivate booths on each side. Most of them stare as I walk past; ofBangkok’s 21 gay saunas, the Beach is one of a handful cateringexclusively to Thai men (the others serve farang, foreigners,like me). The Beach lacks a single visible HIV-prevention poster orother paraphernalia, but peering into the only empty booth, I see anunused condom still neatly tucked into its ripped package. At the endof the hall, men cluster at a swinging booth door. They watch as thetwo naked bodies inside wrestle passionately and the sound of their sexreaches a punishing crescendo.
Thailand is Asia’s much-touted HIV success story.While neighbors India and China face skyrocketing new infections (Burmaand Cambodia have just begun to keep such statistics), Thailand hasradically reduced its transmission rates through more than a decade ofprogressive prevention measures: routine testing of female sex workersand military recruits, a police-enforced “100 percent condom use” rulein brothels, massive education campaigns that reduced the number ofThai men who pay for sex. Such measures pushed new infections intofreefall, from peaks of 140,000 in 1991 to 20,000 in 2002. Thailand hasbig treatment plans, too: Since 2001, the Government PharmaceuticalOrganization has produced generic HIV meds, providing them to one-fifthof the 100,000 Thais who have opportunistic infections or CD4 countsbelow 200. By the end of the year, the GPO hopes to reach half.
Thailand has earned well-deserved plaudits for its preventionefforts, and on July 11, the massive XV International AIDS Conferencecomes to Bangkok; conference organizers have praised the country’s“effective interventions in the prevention of HIV.” Forgotten among thegovernment initiatives, sterling statistics and international praise,however, are Thai men who have sex with men (MSMs), like those whofrequent the Beach. Forgotten, that is, until a recent groundbreakingstudy showed an alarmingly high HIV prevalence among Thai MSMs.Cofunded by the Thailand Ministry of Public Health and the U.S. Centersfor Disease Control and Prevention, the study found that 17.5 percentof 22- to 28-year-old MSMs and 20.8 percent of those 29 and older wereHIV positive, startling numbers, especially when compared to Thailand’snational adult prevalence (1.8 percent) or New York City’s MSMpopulation (12.1 percent, the highest in the U.S.).
After years of a heterosexual transmission pattern likeAfrica’s, Thailand now looks disturbingly familiar to Westernresearchers, explains Chris Beyrer, MD, an epidemiologist at JohnsHopkins University who has worked in Thailand since the early ’90s andwrote War in the Blood: Sex, Politics and AIDS in Southeast Asia.“You’ve got a country where HIV predominates among MSMs,intravenous-drug users and very high-risk heterosexuals,” says Beyrer.“Just like America.” Dutch epidemiologist Frits van Griensven, PhD, theMSM study’s lead researcher, puts it more bluntly: “Thailand’s in anemerging epidemic for MSM. It will get worse before it gets better.”
Along Silom Road, the heart of Bangkok’s Patpongdistrict, vendors hawk bootleg CDs and teak ashtrays with nude girlsaffixed to the rim. But by nightfall, most tourists are looking for adifferent kind of souvenir. Any introduction to Thailand’s sexualculture starts in the sois (alleys) off Silom, where gay and straightmassage parlors, strip clubs and go-go shows are stacked on top of oneanother. Though prostitution is technically illegal in Thailand, Silomlures customers with masturbation races, vaginal stagecraft and “fuckshows” that serve as the gateway to money-for-sex encounters.
Despite Bangkok’s international reputation for straight- andgay-sex tourism, discretion dominates Thai culture. Open references tohomosexuality, sex work and “minor wives” (mistresses) would mean“losing face,” writes Beyrer in War in the Blood, “and to forcea Thai to lose face is to make a fast and enduring enemy.” So MSMs inBangkok cruise Silom’s sois and the city’s Lumpini Park or visit one ofits gay bathhouses, although such visits carry risks. Gay bathhouses,as well as gay clubs, theaters and brothels, have been raided by policeas part of a recent “social order” campaign—a ruthless, largelyantidrug initiative that has resulted in the deaths of more than 2,000people supposedly involved in drug trafficking. (The Beach was raidedthe week before I visited.) Police often force suspects to give urinesamples and in some cases take them to the police station where theyare photographed. “A night like that could close you down for a year,”said one bathhouse owner, who requested anonymity for fear of furtherharassment. When asked whether his family knew of his work andorientation, he answered, “Are you kidding? My father would spin in hisgrave.”
Since HIV in Thailand has been seen as a heterosexualepidemic, the disease never forced gay life—or unsafe gaysex—aboveground as it did in the U.S. and Europe. Thai MSMs have fewout public figures to admire, limited political presence and a sparsegay press. “We have no ‘gay’ identity as you do in the West,” saysRapeepun “Ohm” Jommaroeng, a researcher for the Red Cross and secretaryof Rainbow Sky, Thailand’s most visible gay, lesbian, bisexual andtransgender group. “We have one word, katoey—a man who dresseslike a woman and wants to be a woman.” While katoey—akin totranssexuals—are a recognized part of Thai life, there is no word for“gay” in Thai.
The collective silence around MSMs in general has meant thatat-risk men neither get the prevention info they need to stay negativenor the HIV tests they need to survive. In the spring of 2003, VanGriensven and outreach workers intercepted 1,121 men at the Beach and16 other gay venues across Bangkok to calculate, he says, “a baseline”of HIV’s prevalence among Thai MSMs. The team interviewed subjectsabout sex behavior, administering an oral HIV test the results of whichcould be given anonymously. “Not that many followed up” to find outtheir status, says Van Griensven. “Until recently, there hasn’t beenany treatment, so there hasn’t really been any reward for knowing.Except a lot of shame.”
Van Griensven discovered sexual patterns among Thai MSMsreminiscent of black and Latino men in the U.S. who keep theirhomosexuality “on the down low” in part because of homophobia in theircommunities: 44 percent of study participants reported having hadunsafe sex with other men in the preceding six months, and 36 percentsaid they’d had sexual intercourse with a woman. Twenty-two percent ofthe latter group said they’d had sex with a woman in the past sixmonths.
Concerned, Van Griensven met with gay-bar and -bathhouse ownerslast fall to discuss his study’s findings before he was ready topublish them. An undercover reporter for a Thai newspaper leaked theresults, provoking a minor controversy. The government dismissed thestudy as U.S.-funded muckraking; the Thai newspaper The Nationquoted a health official as saying Van Griensven’s sample was too“specific” to represent all Thai gays. But fellow epidemiologistsrallied. “Van Griensven’s findings don’t surprise me,” says Beyrer. Interms of prevention and research, “virtually nothing’s being done,”says Hakan Bjorkman, the deputy resident representative of the UnitedNations Development Programme in Thailand, who calls MSMs in Thailand“the blindspot.” For his part, Van Griensven argues that “the Thaigovernment got complacent. They thought HIV was under control. Well,it’s not.”
With his boy-band insouciance and coiffed flat top, TomApasit, 35, looks about 17. That was his age back in 1987, when he cameto Bangkok from rural, northern Thailand to become a singer. The amulethe wears around his neck for luck testifies to years spent coping withHIV. “In 1989, my boyfriend told me he was positive and died fivemonths later,” Apasit says. “I got infected from him. And from then on,I hid deep within myself.”
Apasit told nobody, avoiding all medical care. There was nopoint. “The information we had was that if you got HIV, you’re dead,”he says. Apasit didn’t visit a hospital until 1997, when a rash of dryskin erupted on his arm. “I told myself that if I survived on my ownfor eight years—the point at which I should have died—then I would gethelp,” he says.
A part-time makeup artist, Apasit volunteers at the WednesdayFriend’s Club, Bangkok’s leading support group for HIVers, where mostclients are MSMs. The Club operates out of two stacked shippingcontainers behind Bangkok’s HIV-NAT Center, a research collaborationamong the Netherlands, Australia and Thailand that runs the city’spioneer anonymous-testing clinic. Inside the humble digs, the club’smen (and the occasional woman and child) do peer counseling, watchtelevision and swap stories about treatment. Many are “too healthy” toqualify for generics from the government’s new treatment initiative,which requires a CD4 count below 200 or an opportunistic infection.Apasit’s count is 400.
Instead, Apasit and other Thais scramble to enroll in“projects” (drug trials), which give free meds, albeit irregularly.Apasit has been on and off HAART therapy for three years. He’s takingAZT, 3TC and saquinavir (boosted with ritonavir), but eight months ago,he was taking three different drugs through a trial. “I’m dependent onthe projects to get the medicine,” he says. “I’ll start one, andthey’ll ask me to quit taking drugs for a while [to clear his system],so I do, and then I start up again.” With every combo change, Apasitrisks drug resistance and a dangerous narrowing of his already limitedtreatment options.
Other positive Thais run a similar risk when they buy drugsfrom hospitals and “take them just three times a week because that’sall they can afford,” says Ood, a tall and gracious 39-year-old man whowas diagnosed 12 years ago. A month’s treatment costs 15,000 baht, or$375; Bangkok minimum wage is 170 baht a day, or $4.25. Ood used to bein a treatment no-man’s-land—his CD4s were too high for governmenthelp, but too low for some drug trials. “I used to cry every daybecause there was no hope for us,” he says.
Ood eventually qualified for a trial prescribing a HAART cocktailand self-injections of the experimental immune booster IL-2, whichlifted his count to 1,364. But he suffered dry skin, “fat face” and arelentless fever. Six months ago, the trial stopped. He now gets theHAART regimen for free (one of the trial’s perks), and his CD4 counthas fallen to 250. “I’ll be on it for the rest of my life,” he says.
When Chris Beyrer began interviewing Thai soldiers abouttheir sexuality, only 3.7 percent acknowledged that they had had sexwith men—until a Thai researcher suggested his questions were wrong.“We were asking, ‘Have you ever had sex with another man?’” he writesin War in the Blood. “Why should that be confusing? Because‘man’ does not include ‘katoey.’” Thai culture has three genders in itsorigin myth—man, woman and katoey. When Beyrer added katoey, theacknowledgment rate more than doubled. Some recruits had sex only withkatoey because they will perform oral and anal sex, which Thai womenconsider off-limits.
The fluidity of Thai male sexuality poses significant challengesto HIV researchers like Beyrer and Van Griensven. When I meet cherubicChaiya “Kai” Sunanthawilat, he’s wearing a Red Cross ID card around hisneck that shows him dressed differently—as a woman with burgundy hairand ruby lipstick. He’s known he was a katoey for as long as he canremember and once considered a sex change. “But I’m afraid of it,” Kaisays. “I’m not sure how my positive status would affect the healing ofmy wounds.” Diagnosed in 1998, he has been on various drugs for thepast four years provided by Doctors Without Borders, but struggles withside effects. His CD4 count is 119, not his lowest (11), but hardly hisbest (300). “Before I knew I was positive, I dressed up like a womanall the time,” he says, grasping his ID. “Now, I don’t always feel likeit.”
The sexual identity of Thailand’s male prostitutes—many of whomare poor men enticed by the lure of good money—also defies easyclassification. A recent U.N. report found that 75 percent of male sexworkers said they were heterosexual, even if they worked predominantlywith men. (Nearly one-third were or had been married.) Consider Jupiter2002, a popular go-go club in Bangkok’s Silom area. Farm-boy typesdance in Lycra shorts with a number pinned to the hip. To meet one, youpay for his drink (200 baht, or $5). To take him elsewhere, you pay thebar 300 baht ($7.50), then negotiate with your intended.
I talk to “Pet” because he looks nervous and bewildered. He’sshy, 19 and on his third day on the job—his third day in Bangkok sinceleaving the rural Northeast. He’s never had sex with a man and isn’tsure what he’s gotten into. Pet may not be gay, but he’s definitely atrisk.
Men like Kai and Pet complicate MSM treatment and prevention, andprovincial doctors, who care for 80 percent of the population, areunderinformed and overworked. “In a hospital I know, there’s one doctorwith 20 beds who sees 200 patients a day,” says Paul Cawthorne, a nursewho works for Doctors Without Borders in Thailand. “So if somebodystarts [HIV] treatment, the doctor doesn’t know anything about HIV,plus he has about two minutes to deal with him.” There’s little chancesuch a doctor could take the time to determine where his MSM patientfits in a spectrum of sexual risk—even if he knew what to look for.“When doctors hear ‘MSM,’” says Ohm, “most service providers assumethat’s a katoey.”
The impending International AIDS conference will shinea spotlight on HIV in Thailand, and even Thai MSMs will get someattention. An “Empowering Visit” will give participants a chance tomeet Thai MSMs, and Van Griensven, who is organizing a satellitemeeting dedicated to MSMs, will present his MSM-study findings.Nonetheless, there are signs that the political climate in Thailand hascooled to AIDS. The prime minister is traditionally the head of thecountry’s AIDS committee, but the current PM, Thaksin Shinawatra, sendsa deputy instead. Shinawatra’s “social order” campaign has drivenIV-drug users underground, and prevention efforts, despite all thekudos, have been more than halved: In 1996, the Thai governmentinvested more than $85 million—$1.30 per person—in HIV programs,according to Swarap Sarkar of the Joint United Nations Programme onAIDS in Thailand. That’s fallen to 60 cents. And the “explicit appealsto sex-worker visitors in the mass media,” says Sarkar, “have goneaway.”
It’s unclear how destructive such a climate will be for ThaiMSMs. A gay-friendly HIV clinic is slated to open this summer nearSilom Road. In 2005, Van Griensven hopes to conduct a follow-up studyon Thai MSM infection rates. And a modest network of MSM organizationsseems to be taking root. Three-year-old Rainbow Sky already canvassesBangkok parks, giving condoms to MSMs who wouldn’t go near the Beach.“Since we didn’t have an office, Rainbow Sky used to meet atMcDonald’s, and it shocked people,” says Ohm. “Twenty gay men talkingabout HIV and condoms? People thought, ‘Did they just have an orgy orsomething?’” The group now has a home near the HIV-NAT clinic.
Rainbow Sky’s challenges are basic. For example, sincewater-based lubricant is expensive in Thailand, men smart enough to usecondoms choose Vaseline and Nivea hand cream, says Beyrer, whichdestroy the integrity of the condom. I asked Thawatchai “Guide” Pachun,32, who runs the group’s condom-distribution program, why he himselfhas never been tested for HIV. “I don’t know,” he answered. “There aregood reasons to get tested—you can get early treatment. But there arebad reasons, too. Knowing could affect your disposition.” If an openlygay man like Guide, who is deeply involved in HIV prevention, fearsgetting tested, educating and treating Thailand’s MSMs seems aformidable hurdle. My last night in Thailand, I joined my translator,Willi, and his boyfriend for dinner. When the subject of HIV testingcame up, his boyfriend shook his head. He has never been tested. “Idon’t see the need to,” he said. “It’s your issue, not mine.”
Thailand’s katoey pioneer was once a beautiful boxer
Thai MSMs may have few role models, but at least one katoey(a Thai man who dresses as and wants to be a woman) has struck a blowfor the LGBT cause. Nong Toom, a 23-year-old actress and model, used tobe a champion kickboxer—and a man. Like many young Thais, she startedkickboxing, at 12, to earn money for her family. “And,” says the shy,soft-spoken Toom, “to get the strength so no one would beat me up.”
Muay Thai, as Thai kickboxing is known, is a macho, oftenbloody sport, but as a teen, Toom never hid her determination to havesex-reassignment surgery, which she did in 1999. Even before hertransition, Toom’s story won the hearts of Thais nationwide and landedher in ads and on soap operas. This year, The Beautiful Boxer,a movie based on her life—“she fights like a man, so she can become awoman,” the tagline promises—was released internationally (for moreinfo, go to www.beautifulboxer.com).
“I’m worried about HIV,” says Toom, who says that despite her starstatus, “katoey are not accepted by everyone” and that “it’s common forfamilies not to accept a daughter or son who is lesbian or gay.Historically, it hasn’t been OK, and it’s not getting better.” She hasfought back by supporting gay organizations, receiving a 2003 UtopiaAward for contributions to the Asian gay community and speaking atBangkok’s Gay Festival. If they’re lucky, young Thai MSMs will findtheir way to Toom. “I teach kids kickboxing,” she says, “and then Ibecome a kid again.”