Feature Story

Rena Janamnuaysook steps off the Skytrain in Bangkok’s bustling Sukhumvit shopping district. She looks up, filled with a sense of joy as her eye catches an advert just beyond the platform. The advert is promoting the PrEP in the City campaign to raise awareness and increase the uptake of PrEP among Thai transgender women and shows glimpses of the lives of four transgender women as they juggle their busy work schedules, their role as a mother and their relationship with loved ones, all the while taking control of their health with their daily dose of pre-exposure prophylaxis (PrEP). For Ms Janamnuaysook, a transgender advocate and Program Manager for Transgender Health at the Institute of HIV Research and Innovation (IHRI), this first-ever PrEP campaign for transgender women in Thailand signals promise for the country’s HIV response.

“PrEP campaigns of the past were only targeting other key populations, especially men who have sex with men and gay men. Transgender women were left out from PrEP campaigns or public messages,” says Ms Janamnuaysook. 

HIV prevalence among transgender people in Thailand was estimated to be 11% in 2018, with no sign of a decline in the past few years, and the current uptake of PrEP among transgender women is only 7%, making the group a particularly at-risk population. Less than half (42%) of transgender people reported that they are aware of their HIV status, while services catering to their specific needs are limited.

Limited awareness and knowledge about PrEP contribute to the low uptake. The campaign strategy includes reframing the conversation on PrEP use and challenging negative perceptions of PrEP within the transgender population. “For transgender women who know about PrEP already, they still don't want to get it because it has been associated with risky behaviour or negative behaviour. In Thai society, if you use PrEP then you are perceived to have multiple partners, be a sex worker or must have unprotected sex,” says Ms Janamnuaysook.

Ms Note, a client at the Tangerine Clinic, South East Asia’s first transgender-specific sexual health clinic that offers gender-affirming integrated health care and PrEP, among many other health services, speaks of the perception of PrEP, saying, “I had to be cautious so that nobody sees me taking the pills because sometimes people are worried and think that I am sick.” A goal of the campaign is to normalize the use of PrEP and promote continued use, particularly important when evidence suggests that nearly half of transgender women (46%) in Thailand did not return for their one-month visit after starting PrEP.

“The campaign makes taking PrEP seem similar to taking vitamins or supplements for good health. It removes the image that PrEP is suitable for only certain groups, when in fact it can be taken by anybody,” said Ms Note.  

Adverts for the campaign are on billboards across Bangkok, illustrative of the collaboration with the Bangkok Metropolitan Administration and the commitment to achieve the city’s Fast-Track Targets. Online, IHRI has enlisted various social media influencers, bloggers and opinion leaders in the transgender community to share information about the campaign.

“I personally feel proud to have participated in this campaign, which makes people see the other sides of us, transgender women, and our potentials,” says Jiratchaya (Mo) Sirimongkolnavin, a model and beauty blogger featured in the campaign, who is a former winner of Miss International Queen, one of the world’s largest transgender beauty pageants. She goes on to explain, “It encourages people to have general conversations about sex and how to protect themselves from HIV infection.”

Promoting positive representations of Thai transgender women is an underlying focus of the campaign. “I think the story in the video will help wider audiences to see the diversity among transgender people that actually exists in today’s society,” said Ms Note. “The fact that transgenders have many occupations and abilities.”

At a launch event for the campaign, Satit Pitutecha, Deputy Minister of Public Health, spoke about the government’s commitment to strengthening the HIV response, stating, “The Ministry of Public Health has committed to working in partnership with communities and civil society to promote access to HIV and other health services for transgender people.”

Ms Janamnuaysook is proud of the buzz that the campaign has catalysed, which has been shared widely in Thailand and in surrounding countries. She hopes that this campaign, with its tailored messaging for transgender women, won’t be the last and believes that it can serve as a model for future campaigns focusing on other key populations.

The PrEP in the City campaign was developed by IHRI and is supported by the United States President’s Emergency Plan for AIDS Relief through the United States Agency for International Development’s LINKAGES Thailand Project, managed by FHI 360 and the United States Centers for Disease Control and Prevention, the Bangkok Metropolitan Administration, the Division of AIDS and STIs of the Ministry of Public Health and the UNAIDS Asia–Pacific Office.