Thai Kathoei and Their Experiences of Accessing Sexual Health Care

1. Thai Kathoei and Their Experiences of Accessing Sexual Health Care Prempreeda Pramoj Na Ayutthaya Project Secretary of Thai Queer Resources Centre www.tqrc.org

2. . Who’s Kathoei? According to my research about: Contesting Identity of Kathoei in Cabaret Show I found that at least Kathoei can be divine to 5 types.

3. The diversities of kathoei • If I assume“female”to be the starting point, and concern about the self-consciousness of one [kathoei]who aware on femininity. • “Kathoei-plang-phet” (Post-operated transgender) is the person who used to defined as‘male’bygenital organ. When sheperformed as woman, base on her self-conscious, so she try to change her gender and her genital organ to be female. Anyway, this not mean that, she would like to be a woman. Sex changed might be a “strategy” to get closer to the beauty as woman. So, she can used it for another target.

4. “Kathoei-sao-young-mai-plang-phet” (Pre-operating transgender) is the one who try to dress up as woman. She does not apply for SRS because of her own reason or some limitation.

5. “Kathoei-sao-mai-plang-phet” (Transgender who deny to apply for SRS, possible to called as transvestite) is the one who would like to be beautyful as woman but she don’t want to be a woman. So, she denySRS. She keep dressing as woman, some might enjoyliving with her own male genital organ. • “Sao Seab” (penetrating-girl)might define her self as male or neither male nor female, she just dress up as woman forflirtingwith a guy.She remain prefer on her own male genital organ.

6. “Kathoei chay” who dress up as a guy but they define themselves to be male or neither male nor female so she just express some manner or character seem like a woman. Some special occasion she might do cross dress.

7. . What happen when Kathoei go for sexual medical check up?

8. Thai scene: sexual health clinic • In general, Kathoei has to go to the same sexual health clinic as male do. Even post-operated transgender, they still remain using pronoun as Mr., so they has to go to male clinic, but that clinic have no instrument to put into sexual organ which same shape as female. • Every Kathoei feel uncomfortable, or shy to take off her dress in front of male medical staff. • Even friendly female staff, may not understand about gender diversities and sexual fluidity. • I done interview with senior nurse who was head of MSM clinic located near by Silom area of Bangkok, expressed her opinion about the other gender which make me quite scared that: “According to nature, homosexuality does not exist” I also asked her that, if Kathoeiwho passed the hard sex and her anus was torn… “If these cases come here, that one was seriously bleeding, could you help that one?” • She answered, “Cannot, we cannot heal that case because we do not have any instrument for sewing a wound, And I think, if that case happened the client might go to other hospital.” • “If client already come to this clinic?, I kept asking” • “Here we are not allowed to stitch the anus and might not even refer them to another hospital, because this clinic is responsible for sexually transmitted diseases. Any other symptom which not fit the term of STDs, we have to deny help.”

9. . • What about sexual health of one who fit in the term queer?

10. The story of Amm • Amm mentioned that he is “CD” or cross dressed person. Amm did not call him self as kathoei, he consider him self as a man, and also he has girlfriend (straight woman). Amm prefer kathoei more than female, but never approach any kathoei if he not dress up as woman. Whenever Amm dress up as woman for go out with his friends at nightclub. He regularly approaches kathoei and sometime go out for sex. • Penetrating girl is a good choice for Amm. Amm mention about his experience when he has sex with penetrating girl that, he very enjoy to be passive. Amm said, “I feel like both of us as lesbian.” • Amm portray about image of penetrating girl who have long term relation with him that, “She is quite beautiful, long hair, 36’ of breast, she prefer to let me touch it.” • Amm feel good with this penetrating girl not because of that one can do the anal penetration for him, but because of the understanding. • Amm said, “She knows that I got (permanent) partner as female, she also know that I prefer to be a woman when we are stay together, our relation similar as lesbian partner. I always dress up as woman when I stay with her, even in the day time, and I know that she like the way I pretend to be woman in front of her”

11. Amm (cont.) • Amm is the one who prefer both active and passive sexual role, Amm do the active role when he has sex with his girlfriend and he also do the passive role if he dress up as woman and has sex with penetrating girl. Amm said, both active and passive sexual role are separate from each other, its can not compare to each other. • Even Amm’s sexual identities related much to the term femininity, but Amm a bit concern about erectile dysfunction. He think that it might be the impact of estrogen which he takes everyday. • About safe sex, Amm try to make friend and get to know the one who he want to has sex with. And also, Amm regularly use condom with penetrating girl while having sex. • About sexual health care, Amm mention that, • “If I go for medical check up, may doctor know or not that I take estrogen? If doctor use spectroscope then put at my breast, he might doubt about it, it’s bigger and bigger.” • Amm’s voices showing that, the more patient feel uncomfortable to talk about their sexual identities the more they try to avoid sexual health services. And also some might concern about their sexual health, but more concern about the discrimination within the process of sexual medical checked up. This point show that, patient satisfaction and quality of care for homosexual and queer peoples still not exist, have to improve.

12. The story of Auu • Auu infected “Human Papilloma Virus” (HPVs) (ไวรัสที่ก่อให้เกิดหูด) at her anus. First, she thinks of this symptom as hemorrhoids. Later, she feels that it bigger and bigger.So, she makes decision to consult to her mom, Auu said to mom that, “Something wrong at my anus” • Auu have to show her anus to her mom and then she makes decision to go to hospital near by her house. Auu admit to section of general medical check up, she ask for the service by female nurse, but unsuccessful. Auu have to check up her symptom by male doctor and male nurse, she said that a bit shame but really want to release that symptom. • Auu said that, “Doctor asks me…what were you done?...I said…had sex with my boyfriend” “Did you check you blood? You are in the risk group”- -Doctor reply to Auu. Auu said she quite fears to hear that sentence. • Later, Auu have to go to hospital for healing condyloma (หูดหงอนไก่) again. Even Auu dress up quite polite, but she also faces some of nurse and doctor at OPD make gossip upon her in front of her. Some nurse laughing at Auu’s image as woman, but according to her profile, the data show that she is a man with a pronoun “Mr.” • Some nurse observes Auu from head to toe and talk to friend that, “You see a man beauty than you.” • Auu said that, at that time, she does not guilty because of any gossip but she thinks much about the way to heal that symptom.

13. Auu (cont.) • After, Auu got some “anesthetics” (ยาชา) and doctor done the operation for her. When Auu wake up, she knows that some of staff push her bed to male patient building, and she heard some one said that “full”. Staff change target, so push her bed to private room. This point, Auu said that, she still lucky. And if she can choose to stay in male or female section, Auu prefer to stay with female because she think, she might has a good take care better than stay in the male section. • Auu also be the one who have penetrating experiences, some guy, sexual partner of Auu let her do the anal penetration. After finished, Auu ask him for the reason, why he prefer like that. He said, “I just want to know that how hurt is it, when kathoei got penetrated by some guy.” • About safe sex Auu said that she always lets her sexual partner take off his trouser first. And she will observe his genital organ, how clean it is. Auu used to face one guy with some “condyloma” at his genital organ. That guy still young and never know that he got some disease. Auu take a chance to talk to him that he has to go for medical check up. • According to Auu, she accept that her sexual orientation is fit to the term penetrating girl, and she said the way she do the anal penetration is depend on situation. If ask about her sexual identity, Auu define her self as kathoei. Even Auu quite prefer to use her genital organ for sexual relation. She also plans for sexual reassignment surgery. But she needs time to get more information. • Auu’s stories resist the orthodox meaning of kathoei, which considered as the passive gender role. Auu’s experiences also let us know the difficulties when kathoei utilizing sexual health services.

14. Conclusion • I would like to mention that, Kathoei and queer people need more friendly clinic for sexual medical check up. • The friendly medical staff may not understand genders diversities and sexual fluidity. • Information about genders and sexualities need to spread out, more and more, in order to bring to the policy of STDs, HIV/ AIDS prevention and treatment. • Review legal aspects of gender change to make kathoei’s rights equal to others. • Develop kathoei-specific HIV interventions.

15. Thank you- for the future kathoei of Thailand .

16. Reference Prempreeda Pramoj Na Ayutthaya (2007). Fluidity of Thai Queer Sexualities and their experiences of accessing sexual health care. MA. Thesis, Health Social Sciences International Program, Mahidol University, Thailand http://www.sh.mahidol.ac.th/hssip/theses/2005/thesis2005/Prempreeda2.pdf

17. Premodern Meanings of Kathoei 18th century • Infertile • Seedless (fruit) 19th century • neither male nor female • Bandorh (Buddhist Manuscript) • Napungsaka (Lanna Manuscript) (Northern Thai) Contemporary Meanings of Kathoei Male-to-female Transgender or Transsexual