Before I offer some finals thoughts about my research, a quick little story:

I held a focus group with about ten HIV-positive women the other day. It was outside in a courtyard, about 95 degrees and I was flushed as usual. After introducing myself and my work to the group, I asked them if they had any questions for me before we began. One of the women reached out to me and cupped my face with her hands and said, in Thai, "You look lovely." The other ladies started giggling, as did I, and of course, I got even redder… In any case, in light of the research I’m doing, this was such a poignant little moment, and here’s why --

This woman deals with family and friends who are afraid of her germs on a daily basis. Despite the laws in place to protect them, people living with HIV, especially women, face an endless amount of discrimination, implicit and explicit, in the workplace and at home, constantly. Yet she felt comfortable enough to reach out to me... She knew that I wasn't afraid of her. I could be completely misinterpreting cultural cues here that I don't fully understand. Still, there is something intensely powerful about simply reaching out and making contact with someone.

When I arrived here, I thought that I would research the feminization of the HIV/AIDS epidemic. Then, I began looking into religious issues regarding HIV treatment, and then ethical considerations, and then legal questions related to human rights, etc. I think that part of the reason for this wavering, aside from my own indecisiveness, is because I began to realize how closely interconnected so many facets of the HIV/AIDS epidemic really are. The feminization of HIV/AIDS, gender inequality, the commercial sex industry, human rights, legal protections – none of these topics exist in isolation. At the same time, to tackle all in seven weeks would have been an impossible task.

In the end, I decided to take the information regarding ethical and practical problems with VCT and partner notification that I learned from interviews, and to analyze it from a women's rights perspective. Something that came up again and again in interviews was the heavy burden that women bear with respect to testing, partner notification, etc. Pregnant women are almost always tested for HIV (often without their official consent), and although many of them who test positive were actually infected by their husbands within the context of the marriage, they are the ones who carry the responsibility of informing their husbands of their positive status first in many cases. Also, female sex workers have been the focus of lots of testing and condom use campaigns. On the one hand, paying a lot of attention to women by way of testing and counseling of pregnant women and female sex workers is commendable. At the same time, it seems that the male population is harder to target, and their capacity and willingness to use protection or get tested is often underestimated or even ignored. To put it bluntly, from a health care perspective, it’s much easier to tell a pregnant woman what to do than her husband. Still, to act as if all men are unreceptive to any form of HIV education, testing, or prevention is to do them a disservice.

To address this, I decided to design a mass media social marketing campaign particularly targeted toward married men and discordant couples, in which one partner is positive and the other is negative -- a very difficult and largely neglected point of transmission that no interventions have been successful in targeting as of yet.

I’ll look forward to outlining my recommendations in more detail and sharing photos and stories during my presentation back on campus in a few weeks.

Cheers!

Sarah

Over the years, as the epidemic progressed, more and more AIDS patients came to live there and they also started a big orphanage to school these people's children, as they had problems attending regular schools because of the discrimination and stigma associated with the disease. Also, over the years, the temple has garnered a lot of media attention. So now, big vans of school kids and tourists are traipsing through the collection of buildings that make up the compound. Visitors are allowed, even encouraged, to walk through the makeshift hospital where all of the terminally-ill, bed-ridden patients are lying there in 100 degree weather, wearing diapers and with talcum powder all over their bodies to cover up the skin lesions associated with the late stages of HIV/AIDS.

In one of the buildings, there is a "bone museum" of the preserved bodies of people who died of HIV/AIDS. The purpose of this display is still unclear to me, as the preserved bones of people who died of AIDS are not clearly distinguishable from the dead bodies of anyone else who died of any number of other diseases… It seems that they were there for their shock value – to scare the tourists into using condoms, or else they might end up like those bodies… Instead, the display served to increase fear and confusion surrounding HIV for visitors, which will lead to increased stigma and discrimination for people living with the disease. The bone museum was a perfect example of the wrong way to educate people about HIV. To make everything even more dehumanizing, there was also a "donations" center across the way from the hospital area, where pop music was blasting and one of the residents was using a loudspeaker to urge people to give money.

Anyway, in summary, I was not a fan of this place. Of course they need donations to stay afloat, and of course it's probably better that these patients live here than alone or on the streets, but it was set up like a freak show – a form of charity which bordered on human rights violation.

The good thing about this visit was that I went with a group of really sweet students who are all also doing research here in Bangkok, and we made visits to little towns on the way back from the AIDS temple, including one town that was famous for its monkies... When I first heard this, I pictured a monkey statue in the town square, but I was wrong. The town was crawling with monkies – on the streets, on telephone poles, in the parks, everywhere. And if you're carrying any bit of food on you, they will literally jump on you to take it. I have to admit, I was kind of rooting the monkies on sometimes... like when a little kid walked by with a candy bar and this baby monkey pummeled him – pretty entertaining… but then, in true public health fashion, I remembered all of the infectious diseases carried by wild monkies and proceeded to empty my bag of every item that might be misconstrued as food…

The trip was a mixed bag, but overall great to spend time talking with other students from all different walks of life, exchanging stories and sharing insights and opinions about our experiences here...

Until next time…

Sarah

When I first began research at UNAIDS, I originally thought that I would focus on women and HIV/AIDS here in Bangkok specifically, but over time I've narrowed my focus somewhat to ethical and human rights issues surrounding both women and men living with HIV. To that end, I have interviewed several leaders in the HIV/AIDS NGO community, and I have also held focus and discussion groups to talk about human rights issues with everyday people living with HIV. Aside from interviews, most of my time during the weekday at the UNAIDS office is spent going through a ton of literature, articles, and reports related to HIV in Thailand and around the world. In the next few weeks, I hope to bring together the background information that I've learned from these documents along with the insight that I've gained from one-on-one and group interviews with people whose professional and personal lives are deeply affected by the epidemic.

Although these formal modes of information-gathering have been eye-opening and interesting on their own, I think that I have learned just as much, if not more, from informal interactions with other people working at the UN, other students doing similar research in Bangkok unaffiliated with the UN, and just from casual, passing observations and conversations with people on the street.

Gender dynamics here are an endlessly fascinating topic and an undeniable driver of patterns of HIV transmission here. Just the other day, I stepped into a bookstore on Sukhumvit Road -- a lively, diverse neighborhood with lots of international influence -- and there was an entire pop anthropology section at the very front of the store that was devoted to the Thai-woman-with-"farang" (foreigner)-man phenomenon that is so prevalent here. Bangkok is famous for its sex tourism industry, although prostitution is technically illegal, and everywhere I go, I see white, old, tall European men holding hands with younger Thai women. People talk about this "sex tourism" industry changing slightly into a more relationship-based "industry" of white men coming to Thailand to find women to settle down with long-term. When I first arrived here, I felt very judgmental of this entire enterprise. Rich, white men were taking advantage of poor, young Thai women, I thought. But as time goes on, I have become much less judgmental of these couples... If there's one thing I have learned so far, it's that there are a vast number of different kinds of marriages and relationships, and all have their pros and cons. Why shouldn't a Thai woman look for financial security from a safe, supportive older European man? Is there anything wrong about a shy, self-conscious white man looking for companionship from a less-threatening, loyal, younger Thai woman? These are the questions I find myself asking... Except in the cases of obvious exploitation, I don't feel that I'm in the position to judge many of these couples anymore.

Anyway, those are my thoughts for the day. I hope to include in my report some more organized explorations of gender dynamics and how they relate to human rights and ethical issues surrounding HIV/AIDS.

Cheers!

Sarah