Migration and HIV/AIDS in Thailand: A Desk Review of Migrant Labour Sectors IOM is committed to the principle that humane and orderly migration benefits migrants and society. As the leading intergovernmental organization for migration, IOM acts with its partners in the international community to assist in meeting the growing operational challenges of migration management; advance understanding of migration issues; encourage social and economic development through migration; and uphold the human dignity and well-being of migrants. Review Team: Jason D. Theede Dares Chusri Editors: Chiaki Ito Katrien Rennemeier Publisher: International Organization for Migration, Thailand Office 18th Floor, Rajanakarn Building 183 South Sathorn Road Sathorn, Bangkok 10120, Thailand Tel: +66-2-343-9300 Fax: +66-2-343-9399 ISBN 978-92-9068-462-6 Copyright © International Organization for Migration, Bangkok, Thailand 2008 All rights reserved. No part of this publication may be reproduced, stored in retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording; or otherwise without the prior written permission of the publisher. The opinions expressed in the report are those of the authors and do not necessarily reflect the views of the International Organization for Migration. ACKNOWLEDGEMENT Authors of this report would like to express sincere gratitude to International Organization for Migration (IOM) and the funding support from the Joint United Nations Programme on HIV/AIDS (UNAIDS) Thailand Country Office and the Canada South East Asia Regional HIV/AIDS Programme (CSEARHAP). A special thank goes to Mr. David Patterson of CSEARHAP, Ms. Montira Inkochasan and Dr. Nigoon Jitthai of IOM Thailand for their extensive technical review and valuable inputs. Numerous individuals, key informants, and organizations, who provided valuable information through the interviews and published and gray literature, are also gratefully acknowledged. Without their generous supports, this study could not have been possible. MIGRATION & HIV/AIDS IN THAILAND: A Desk Review of Migrant Labour Sectors ACRONYMS AIDS Acquired Immunodeficiency Syndrome AMC Asian Migrant Centre AMI Aide Medicale Internationale ARC American Refugee Committee ARCM Asian Research Center for Migration ART Antiretroviral Therapy BATS Bureau of AIDS, Tuberculosis and STDs, Ministry of Public Health BCC Behaviour Change Communication CBO Community-based Organization CSEARHAP Canada South East Asia Regional HIV/AIDS Programme DLPW Department of Labour Protection and Welfare GO Governmental Organization HIV Human Immunodeficiency Virus IEC Information, Education and Communication IOM International Organization for Migration IRC International Rescue Committee KABP Knowledge, Attitudes, Beliefs, and Practices KEWG Karen HIV/AIDS Education Working Group MOL Ministry of Labour MOPH Ministry of Public Health MOU Memorandums of Understanding MSF Médecins sans Frontières NGO Non-governmental Organization PHAMIT Prevention of HIV/AIDS among Migrant Workers in Thailand PHO Provincial Health Office PLHA People Living with HIV and AIDS PMTCT Prevention of Mother to Child Transmission PROMDAN Prey Veng - Rayong Operation on Migration Dynamics and AIDS Interventions PSI Population Services International RTF Raks Thai Foundation SHARE Services for the Health in Asian and African Regions STIs Sexually Transmitted Infections VCT Voluntary Counselling and Testing WVFT World Vision Foundation of Thailand UNAIDS Joint United Nations Programme on HIV/AIDS UNHCR Office of the United Nations High Commissioner for Refugees ACRONYMS iv TABLE OF CONTENTS Executive Summary.........................................................................................................................vi 1. Introduction ................................................................................................................................. 1 2. Migrant Labour Sector and their Associate Risk and Vulnerability to HIV Infection ................ 6 Seafarers and Seafood Factory Workers ....................................................................... 6 Other Factory Workers ................................................................................................... 9 Sex Workers ................................................................................................................. 12 Labourers ..................................................................................................................... 13 Refugees ..................................................................................................................... 15 3. Policy and Regulations towards Migrants in Thailand ............................................................ 17 Labour Law and Migrants............................................................................................. 17 Current STIs/HIV/AIDS Policy ....................................................................................... 17 Code of Practice on Prevention of HIV in the Work Establishment .............................. 18 4. Barriers for Migrants’ Access to STIs/HIV/AIDS Services ....................................................... 20 5. Programmes for Migrant STIs/HIV/AIDS Prevention, Care, Treatment and Support ............. 21 6. Recommendations .................................................................................................................... 24 References ..................................................................................................................................... 28 Interviews ....................................................................................................................................... 31 Appendix 1: Key Literature on Migrants in Thailand.................................................................... 32 Appendix 2: Key Literature on Thai Migrants Abroad ................................................................. 52 Appendix 3: Key Literature on Refugees in Thailand .................................................................. 53 Appendix 4: Key Literature on Other Migration Issues ................................................................ 57 TABLE OF CONTENTS TABLE MIGRATION & HIV/AIDS IN THAILAND: A Desk Review of Migrant Labour Sectors v MIGRATION & HIV/AIDS IN THAILAND: A Desk Review of Migrant Labour Sectors EXECUTIVE SUMMARY Reliable data are required in order for the Ministry of Public Health (MOPH) to properly develop Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) policies and programmes for various types of migrants in Thailand. It is estimated that more than two million documented and undocumented migrants live and work in Thailand and have remained predominantly underserved on HIV/AIDS healthcare services. With the creation of the Master Plan on Mobility and HIV and the National AIDS Strategy for 2007-2011, migrants are now recognized as an important target population in the national strategic response. The MOPH has placed a high priority on improving the information base for developing and implementing effective policies and programmes. To facilitate and build upon this information base, this report reviews the available documents from 2000-2006 and describes the HIV vulnerability associated with the predominant migrant sectors from the three source countries which together comprise the largest majority of migrants in Thailand: Myanmar, Lao People’s Democratic Republic (PDR) and Cambodia. Complementary discussions covering policy and regulations towards migrants, factors that limit migrants’ access to sexually transmitted infections (STIs)/HIV/AIDS services and programmes for migrant STIs/HIV/AIDS care and support are reviewed. There is great diversity of migrant sectors in Thailand, each unique with regards to HIV vulnerability. Research and programmes implemented by government, international and national non-governmental organization (NGO) and community-based organization (CBO) have certainly achieved some level of success with several of the key populations considered to be at higher risk such as migrant sex workers, factory workers and fishermen. However, there are many sectors that remain relatively unknown due to unavailable literature and unreached through programming such as domestic workers, agriculturalists, displaced persons outside of the temporary shelters and even Thai migrants abroad to name but a few. For instance, migrant workers who are classified as “labourers” under the current data system in recording HIV cases are not sub-grouped; therefore, occupation variable needs to be defined in a more specific way relating to the contexts and characteristics of all the various labour sectors. Research also must be continued to gain better understanding on the needs, risks, vulnerabilities and hardships faced by all migrant sectors, and thus, respond appropriately. Labour sectors contained within the review include: seafarers and seafood factory workers, factory workers outside of the fishing business, sex workers, and displaced persons from Myanmar so called “refugees” who reside in the temporary shelters (or the “camps”) along Thailand-Myanmar border. Sex workers and seafarers may be considered the two sub-populations at highest risk for STIs/HIV infections due to their vulnerability and unsafe sex with multiple partners. Other sectors do not exhibit such high behaviours and vulnerability though demonstrating a serious lack of knowledge in the areas