By Pattamon Wattanawanitchakorn (International Drug Policy Consortium – IDPC), with Thissadee Sawangying (Health Opportunity Network) and Claudia Stoicescu (Consultant, IDPC)
The life of a transgender sex worker in Pattaya is not easy. On the one hand, ‘Pattaya is a paradise for transgender people, a place where many transgender sex workers feel they can openly express their identities,’ says Thissadee of the Health Opportunity Network (HON). On the other hand, transgender sex workers face widespread discrimination, violence, and oppression, especially from law enforcement.
I am attending HON’s workshop on harm reduction for transgender sex workers who use drugs – the first such event organised for this group in Pattaya by HON, with support from the Ozone Foundation. HON was established in 2010 to provide peer-based health and support services for men who have sex with men (MSM), transgender people and sex workers living with HIV in Pattaya, Thailand. The Ozone Foundation is an NGO that provides community-based harm reduction services for people who use and inject drugs in Thailand. Responding to a gap in existing services, HON has begun to focus on better understanding the experiences and needs of transgender sex workers who use drugs.
The workshop is supported by VOICE as part of the year-long ‘Strengthening and empowering women who use drugs in Southeast Asia’ (SPIRIT) project (covering Indonesia, Malaysia, the Philippines and Thailand). The project seeks to empower cisgender and transgender women who use drugs to establish and strengthen community-led networks and advocate for gender equality, legal rights, and drug policy reform. Under the SPIRIT project, HON works in collaboration with the women cluster of the Thai Network of People Who Use Drugs to empower women who use drugs to advocate for their legal rights and build their capacity to integrate a harm reduction approach in their work.
The 20 transgender sex workers in the room are initially hesitant to share, but they are quick to empathise with one another as their stories take a similar turn. ‘I thought I was the only odd one,’ a participant reflected. ‘But meeting everyone else here today, I could see that we all have similar experiences and that I’m not the only one who is different.’ They share experiences of being stopped at checkpoints and forced to undergo urine tests on the spot, and of facing extortion by the police of up to 300,000 Thai Baht (USD $ 10,000) per month to avoid imprisonment and further harassment.
‘A hard job’
The women describe precarious working conditions. Getting through a regular work day often requires drinking alcohol or taking other substances to increase stamina. The daily wages earned by the sex workers are frequently the only source of income supporting their families. For a higher wage, sex workers may be asked to sell drugs, usually crystal methamphetamine (commonly known as ‘crystal meth’, or ‘ice’ in Thailand), as well as to use drugs together with clients as a part of their services. Using crystal meth before or during sex can intensify and prolong sexual experiences, but in the absence of prevention measures such as use of condoms or pre-exposure prophylaxis (PrEP), there is a high risk of exposure to sexually transmitted infections, such as HIV and hepatitis C. Some sex workers also use crystal meth for weight loss.
Although sex workers may prefer not to use crystal meth in sexual settings, it is challenging to refuse an offer of 10 times the amount of a regular fee, especially in times of economic hardship. One participant calls the nature of the work a ‘hard job’ and a ‘burden in life’, especially in relation to the constant risk of being targeted by law enforcement.
COVID-19 restrictions and economic hardship
The perilous work environment in which transgender sex workers operate has become more insecure with the onset of the COVID-19 pandemic. In response to COVID-19, the Thai government declared a nationwide state of emergency, while the Pattaya area had already been affected by an abrupt decline in tourists since early 2020. Many entertainment venues suspended their business operations or closed entirely, which in turn affected employees, many of whom were forced out of employment without compensation.
Because entertainment businesses were closed and tourism – including sex tourism – has come to a standstill, many sex workers are struggling to get by. Transgender sex workers have faced compounded challenges: In addition to now being unable to work, many were denied access to basic support from the government since they do not have identity documents. Throughout the lockdown, HON conducted house visits to provide food and hygiene supplies to over 200 transgender people in the Pattaya area, as well as conduct interviews to better understand their situation and how to best respond to it.
Drugs, stigma, and discrimination
It is difficult for transgender people to talk about their drug use freely. Pervasive stigmatising narratives on drug use mean that disclosure could expose them to judgement, discrimination and shunning. For people already targeted by multiple forms of oppression, the risk of jeopardising existing relationships with their support network can be unbearable. ‘Once they know [that I use drugs], my friends look at me differently, they treat me differently; even though I’ve always been using drugs the entire time. I haven’t changed. They have,” one participant shared.
In the two-day workshop, HON fostered a safe space that allowed transgender people who use drugs to discuss their unique challenges. Harm reduction training approaches such as Ozone’s Drug User Environment (DUE) tool were followed to improve understanding about the harms of various types of drugs and ways to manage their use in safer ways. The participants were encouraged to be more conscious of the type of drug they are using and their effects, as well as their surrounding environment. Monitoring these factors will help them to assess the associated risks and reduce potential harms, which can range from forgetting to eat and sleep, to negative mental health impacts.
One of the participants’ testimonies illustrates some of the ways how patriarchal violence impacts transgender sex workers who use drugs. ‘I was thin and beautiful when I used drugs. I won pageants and worked at an entertainment show on the border of China and Myanmar for around 10 years. Because it was so easily accessible there, everyone used it. But then one night, I hallucinated and found myself lying in the middle of the road. Not long after that, I decided to come back to Thailand. I stopped taking drugs and I gained so much weight.’ Oot shares with me two pictures of herself as if to underscore the point. I acknowledge it. Across Asia, especially in the entertainment business, significant societal pressure is placed on women to maintain a certain type of appearance. Dominant values that associate beauty with thinness also promote stigma and shame around weight gain.
For Gift, her experience has a darker, harrowing beginning. ‘I grew up around drugs. My brother, I was very close to him… and he was, let’s just say, he was one of the biggest dealers in the East area. Drugs were as normal to me as eating rice, so when I was 12 I tried it. I didn’t feel anything. It was just something the people around me did and I just wanted to fit in.’ Gift’s brother died tragically while she was still young, leaving her on her own.
The most senior person in the room, Jim, holds the honorary title ‘Mother’, a name given to her by the community as a sign of respect. She sits at a lunch table across from Boong, who appears more reserved. Asked about her experience with drugs, Jim says, ‘I went to prison for five years for using and selling drugs. She was the one who told on me’ – and she gestures to Boong – ‘but I don’t blame her. You have to do what you have to do.’She clarifies that getting caught by the police leaves one with two main choices: either surrendering to arrest, detention and sentencing (which likely lead to years of imprisonment), or acting as an informant for the police in exchange for a lighter sentence. Both of them seem to acknowledge that, faced with the potential violence of prisons, prioritising friendships rather than survival becomes nearly impossible. Sitting across the table from one another, there is no apparent trace of animosity between the two.
However, not every incident resolves itself this way. There are others who describe similar experiences which leave relationships among friends, families, and community members harmed beyond clear possibilities of repair. Hostile interactions with the police, encouraged by the ongoing criminalisation of drug use and the over-reliance on harsh policing, have bred distrust and resentment towards law enforcement within the community.
Death was also a common topic. Gift admits that awareness of harm reduction and accessible services could have saved her friend’s life. ‘We were taking drugs together. And our friend next to us who was sleeping took a gasp in her sleep. We continued to play cards until morning. We didn’t know but that was the last breath that she took. We even moved her body upstairs, not knowing that she was already dead.’ If they had access to harm reduction education and services, they likely could have helped their friend and prevented a tragedy.
Empowering transgender sex workers
For HON, empowerment means ‘strengthening power from the inside’ and ‘building value, pride, and self-respect’ through activities that help reduce internalised stigma for transgender people who use drugs. Transgender people who use drugs have limited ‘bargaining power’ and often experience rights violations, including violence from law enforcement.
HON continues to work closely with the transgender community to empower transgender sex workers through trainings on reducing stigma, building a network of transgender people who use drugs, creating a safe space to exchange experiences, developing understanding of relevant laws and mechanisms for protection, and building alliances with international organisations to advocate for more humane and less punitive policies at the national level.
Although the topics shared as part of this gathering were heavy and difficult, by the end of the second day, the atmosphere grew more relaxed. ‘I compare myself to a messy room. HON is like a key that opened my door and gave me perspective to open the windows. I can breathe,’ Gift tells the group.