Accessing healthcare and maintaining good health in foreign countries are challenging for many migrant workers due to various barriers such as languages, medical fees, distant or isolated workplace, and lack of knowledge and information about health and wellbeing. LGBT+ migrant workerrs’ health concerns and conditions, particularly in relation to their sexual orientation and gender identity or expression (SOGIE), remains as an understudied and little known area that affects their fundamental human rights.
This article addresses some health challenges faced by Myanmar LGBT+ migrant workers and how they deal with their health concerns in their own ways. Informed by interviews with nine Myanmar LGBT+ migrant workers in Thailand, Malaysia and Singapore, which are the most common destinations for Myanmar migrant workers in Southeast Asia, this article also aims to call for all relevant stakeholders to pay more attention to LGBT+ migrant workers, particularly to their health issues. This is the final part of the article series highlighting the situations of Myanmar LGBT+ migrant workers in Southeast Asia. The names appearing in this article are pseudonyms.
Health Challenges of Myanmay LGBT+ Migrant Workers
Myanmar LGBT+ migrant workers face challenges in accessing healthcare services that meet their needs. Among them, transgendar migrants face specific and significant challenges due to their gender identity and status as migrants. Most of the interviewees claimed that they had little or not enough knowledge about sexual and reproductive health and wellbeing, and that had encountered serious health issues including sexually transmitted diseases (STDs) at least once in their destination countries.
“I entered Thailand in 2004 and worked as a migrant smuggler in different places around the country like Mae Sot, Chiangmai and Chiangrai. Back then, it was really difficult for transgender persons like me to receive medical care. I was not well aware of risks and potential (infections with) diseases from unprotected sexual activities, and there was also neither online nor offline medical channels to seek advice or information about safe sex. As a result, in 2015, I got syphilis and I was so scared of having to go to Bangkok and receive necessary health services which were quite expensive,” says Tin Tin, a transgender woman currently working as a housemaid in Chiangmai.
Tin Tin explained that there were no health clinics or service providers, which are particularly catered for LGBT+ people, in places close to where she lived and worked back in 2005. She faced enormous challenges in accessing healthcare, finding support or feeling safe while she was suffering from syphilis. Not only her colleagues, but also some doctors and nurses at local hospitals were reluctant to have contact with her when they knew she had syphilis. She had to spend a lot of money to receive good medical care in Bangkok, and as a result she was not able to send the money to her family in Myanmar for two months while she was receiving medication.
Pan Nu is also a transgender migrant worker from Myanmar who is currently working as a construction worker in Phuket. She said, “It is quite difficult to find relevant medical centres for transgender women like me, and even if we managed to find one, the cost to get medical care from them is beyond our budget. In my ten-year experience of living in Thailand, there are always multiple obstacles for us to seek help for our health issues, for example, the distance and transportation fees to go to clinics and cost of medical services. Even sometimes, my employer did not give me paid leave to go to Bangkok for health care to deal with my medical problems. There were no other affordable and safe options for us but to go to the city”.
She added that currently in Thailand, some community clinics and medical projects have been set up and implemented by international organizations which focus on specific issues faced by LGBT+ people and provide them with complementary health care services. However, it is a recent development and it was extremely hard for LGBT+ migrant workers to obtain certain medical assistance until several years ago. It is particularly difficult and troublesome for transgender individuals even among LGBT+ people, because their health issues can be very specific including hormone treatments and gender alignment surgeries. She continued to explain that the number of community health care centres for LGBT+ people are limited, and they are located mostly in urban areas which are not easily accessible to those living and working in rural and suburban regions.
May Thu is a transgender woman from Manmar in Thailand who is currently working as a hairdresser and make-up professional in Bangkok.
“When I first arrive at Bangkok through an irregular route via Mae Sot, I had little choice but to work as a sex worker to meet my financial needs and to get a place to stay, so I worked at a club in Bangkok. It was in 2013. I had never received sexual health education and all I know was to use condoms. Besides not getting fairly paid due to my irregular status, I had to engage in several sex activities every day. One month later, I noticed I started feeling unwell and something strange in my body.”
She asked her employer if she could get any medical check-up but it was refused. She had to take unpaid leave to go to a private hospital for a specialised check-up. Eventually she found out that she was HIV positive and consequently got fired from the job at the club. She recalled that it was the most miserable and depressing time for her struggling to survive, but her friends connected her with an international HIV/AIDS organization where she could finally receive proper health care and treatment. Now she is living quite well in Bangkok and working as a freelance hairdresser and make-up professional.
(photo provided by an interviewee)
Within the LGBT+ community, transgender people often face additional and specific health care challenges. Hormone treatments and gender alignment surgeries, which are needed for their transition of or for confirming their gender identity, are very expensive and many transgender migrant workers do not have financial means for these treatment and surgeries. Some may turn to the black market to proceed unauthorised hormone treatments and silicone surgeries as a result. Using self-injection or inadequate equipment without authorised medical supervision, these acts can lead to multiple health risks.
Call for More Accessible Healthcare Services and Education
There are different challenges for LGBT+ migrant workers in seeking medical care including costs related to transportation healthcare services, and fear of disputes with employers over sick leave or paid leave as addressed by the above mentioned informants. Lack of knowledge about STDs including HIV/AIDS make them even more vulnerable. It is crucial that not only LGBT+ migrant workers but also those who come to contact with them receive sex education and be aware of STDs and the importance of protected sex.
One of the reasons why Myanmar LGBT+ migrant workers lack sex education are rooted in the education they received at school due to conservative society and education system of Myanmar. It is known that many of them face health issues while abroad, yet there is no credible data about the true situation of Myanmar LGBT+ migrant workers’ health conditions as there has been little attention paid to them in this regard.
Moreover, there is more severe lack of data and information about health situations of Myanmar LGBT+ migrant workers who work as sex workers, leaving them more vulnerable. It is unknown how many sex workers like May Thu are facing health problems in their destination countries. There should be accessible medical centres particularly cater for transgenders and LGBT+ sex workers because sex work leads to increased vulnerability against health condition as well as sexual violence which could risk lives.
Although nowadays there appear to be an increasing number of community health care centres and health care projects implemented mainly by international organizations in some Southeast Asian countries, many of them are still not accessible for many Myanmar LGBT+ migrant workers in remote and rural areas. Many of them are in desperate need of better health care services, and both countries of origin and destination should pay more attention to these groups to take necessary actions to improve their access to healthcare services, health conditions and education to protect their health.
Myoh Minn Oo
Myoh Minn Oo is an independent writer and researcher with a passion for social and political work in Myanmar and ASEAN. He is actively involved in social and political movements both locally and internationally for a democratic and just society. He conducts research and publishes articles while remaining actively engaged in local and international organisations in areas of democracy, federalism, human rights and social matters.
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