amfAR, The Foundation for AIDS Research

Young Activists Reflect on Identity, Community, and Diversity Among Asia’s MSM



February 2007—One of the greatest challenges to slowing the spread of HIV/AIDS among men who have sex with men (MSM) in Asia lies in the rich complexity of MSM communities across the region—and the necessity of tailoring prevention and education messages for each community. Recently, four young MSM from Southeast Asia—AIDS prevention and education advocates—spoke with the TREAT Asia Report about the issues of identity, community, politics, and stigma that they all encounter in the course of their work. 

TREAT Asia Report: There has been much discussion recently about the diversity within MSM communities. Could each of you tell us a bit about the groups you work with?

Sovannara (Thaiy) Kha (Cambodia): There are many kinds of MSM in Cambodia. In the Khmer language we call them kteuy, like katoey in Thai, but in English we call them MSM Long Hair and MSM Short Hair, which is what Cambodian MSM call themselves. MSM Long Hair can be transgender or transsexual, or neither.

When we say MSM, it doesn’t matter whether in your heart you prefer men or not. If you sleep with men, we say that you are MSM. But MSM Short Hair do not want to sleep with MSM Long Hair, although if Long Hair pay money, maybe they will go with them. If someone is really gay—not just MSM but preferring men from the heart—most of them will not sleep with MSM Long Hair. I’ve asked and they say, “If I sleep with MSM Long Hair, why wouldn’t I sleep with girls?” In Cambodia, most MSM Short Hair are married and they do not disclose their status. 

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From left to right: Addy Chen of Myanmar, Jack Arayawongchai of Thailand, Thaiy Kha of Cambodia, and Nguyen Van Trung of Viet Nam. (Photos: Dredge Kang)

Jack Arayawongchai (Thailand): That’s similar to our situation in Thailand. I have a friend who is identified as Long Hair MSM and she has complained to me many times, “Oh, I don’t have a boyfriend.” And I asked, “Why don’t you go find one? There are all those gay men out there.” But she said, “No, I am not attracted to gay men, I’m only attracted to straight men.”

Addy Chen (Myanmar): It is complicated. Jack, how do you identify yourself? You would be considered a Long Hair MSM, right?

Jack: Well, I would identify myself as one of the Short Hair. In Thailand, there are MSM who look totally straight and MSM who look “out” a little bit but they still consider themselves Short Hair.

Addy: That’s why in Myanmar we end up having six categories of MSM, and with all these groups we need different outreach and education approaches.

One group we call Apone, which is someone who has sex with men and is not very effeminate—someone like me, okay? Similar to gay men in the West. And we have Achouk, who are totally MSM, and it’s obvious when you see them. Achouk are very effeminate in behavior, dress up like women, wear make up—they behave totally like women. Then we also have Apwint, which is slightly between Apone and Achouk. Apwint means that a man dresses like a man but is a little bit effeminate—for example, when they’re talking they have certain kinds of gestures and maybe sometimes they like to cross-dress when there is a special party or something. But mostly at work and in the family, Apwint are not open about their status—they may be open only with their peers.

We also have Offer, which is a male sex worker. Whether they prefer it or not, they have sex with men because they’re working for money. And we have Tha-nge, the husband of Apwint, Apone, or Achouk. They don’t identify as straight men but they don’t accept themselves as MSM or gay because they are mostly taking the penetrator role.

We also have Inglan. Inga is a sexual reproductive organ and lan means reverse. So what it means is that when Tha-nge meets Apone, Apwint, or Achouk, they are supposed to penetrate, but sometimes they want to be penetrated. That kind of Tha-nge we call Inglan. It means that when they’re supposed to use their organ in one way, they use it the reverse way.

Nguyen Van Trung (Viet Nam): Viet Nam is very open and the gay community is fairly close knit. Short Hairs and Long Hairs go to the same places. Many of my friends use the Internet and gay web sites to connect with each other. If you’re a Long Hair and you want to become a Lady Boy—a Long Hair who has had an operation to get big breasts—you have to go to Thailand, but you can get a lot of help from the gay community in Saigon. If you need money, you can get maybe half from other MSM.

For example, on Sunday mornings we have a coffee shop and about 400 people go there. We transfer news very easily. So if I say, I have a friend who wants to go to Thailand to become a Lady Boy, my friends will put in a donation, and so will the friends of my friends. Last Friday a close friend died and his family was very poor so gay people in Saigon gave his family about US$1,500 for his funeral. That’s a very good part of life in Viet Nam.

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MSM activists pictured at a police station in Cambodia's Batambang province in 1998 after being arrested for educating MSM about AIDS. (Photo courtesy T. Kha)

Addy: I don’t know about in other countries, but in Myanmar the gender imbalance within the gay community is still very high. For example, in most MSM couples, the breadwinner is the Long Hair. Long Hairs have to treat their husbands like princes or kings, they have to buy everything, and they may even put up with being hit by their husbands.

Thaiy: It’s hard in Cambodia, too. The Long Hairs try to earn money and then they give it to the Short Hairs they love. And then the Short Hairs sometimes spend that money to buy a girl or to buy another Short Hair.

TA Report: What do you find to be some of the greatest challenges as educators in your countries and among the MSM with whom you work?

Addy: In Myanmar, in the general population as well as among MSM, people don’t know much about STIs [sexually transmitted infections], much less HIV. People working on AIDS who are not MSM don’t know about the diversity of MSM communities or much about their sexuality—they don’t understand how vulnerable MSM are to AIDS and how high their risk is. Among MSM themselves, awareness about health issues is still very low. MSM who are more educated and informed often don’t want to disclose their status because they will face stigma and discrimination, so there are very few educated people who can lead the community. Also because of the situation here in Myanmar, we cannot form MSM-specific self-help groups.

Doing peer outreach, it’s best to work through informal MSM groups or networks that already exist. A lot of the beauticians in Myanmar are MSM, and some are transgender. They have a group of young MSM followers and they have a big influence on them. If there’s a famous beautician in a township, his or her followers will gather at their salon. So that is one channel we go through for outreach and education. Peer outreach workers go to the beauty salons and provide boxes of condoms that they can sell or give away. Whenever they visit the salons, they provide an education session about condom use because there are always five to ten or twenty MSM gathered there.

Another way we can reach MSM is through certain transgenders called Nat-Gadaw who act as interpreters of the spirit. Lots of people in Myanmar have a spiritual belief in those sorts of things, especially in rural areas. These men are quite influential, not only among MSM but even in the larger community or in villages, and they can take a leading role in spreading information. So when we do outreach work we go to the beauticians first and also to the Nat-Gadaw.

There are also drop-in centers for MSM, which provide voluntary counseling, treatment for STIs, and testing. At the moment in Yangon, we have two MSM drop-in centers. There they have monthly gatherings of around 400 people. Recently, because there were too many people and the place was small, they split the gatherings up and now every Wednesday they have a so-called tea party where MSM can also get information and entertainment. MSM come together for these kinds of entertainment activities and during these activities they have a session on education. It is quite famous within the MSM community, so most of the MSM from Yangon know where to go to seek services.

What has also happened is that a lot of male sex workers who don’t identify as either MSM or gay have come to these gatherings. At first they might have been looking for clients or whatever, but they got services also and they enjoyed it. And so now they come and bring some of their friends who don’t identify themselves as MSM but who have sex with men. So it has been snowballing.

Thaiy: In the Cambodian organization I volunteer for we have two projects—one is with MSM Short Hair and one is with MSM Long Hair. It’s the same project but we have to have two offices because if MSM Short Hairs see Long Hairs, they will not come.

Most MSM Short Hairs don’t want to be involved with peer outreach because they don’t want the public to know or to recognize that they are MSM. But overall, MSM now seem to be more accepted in Cambodia. Even the father of the Cambodian king has started to give our programs money.

TA Report: How do you reach MSM Short Hairs, then?

Thaiy: We do it through a hidden network—the hidden reaching out to the hidden. I work with MSM Long Hairs, which is easy because they’re so open. But sometimes we have had problems when we’re doing trainings, because the authorities disapprove or because of stigma in the communities. In September 1998 we were training MSM in Batambang province [in western Cambodia] and we were arrested and held by the police for two nights. They warned us that we were introducing improper things into Cambodian culture by mobilizing for gay and lesbian solidarity and training people about HIV/AIDS. But this was an illegal detention and they let us go.

Now, before we arrange meetings, we set up a support network first and we go through the police leader in the district or the provincial government. We invite the authorities to join the meeting so they can see what we are doing, and after that they give us the phone number of the police so if the police beat MSM Long Hairs we can call them. And the authorities are also donating money to the support networks. It’s much better than before.

Trung: In the future, I think that Cambodia will be similar to Viet Nam. I’ve been working in HIV prevention for MSM for about seven years and at the beginning Viet Nam was the same as Cambodia. Sometimes we couldn’t work together with different groups of MSM, we had to keep them separate. But now it’s much easier.

In Viet Nam, a lot of men move to the big cities like Saigon because they’re very open for gays—we have a sauna, we have a swimming pool, we have gay massage, we have a disco, we have a cruising area. But we have only one MSM workshop, which is controlled by the government.

It is a very good workshop, with a clinic, a library, videos, and counseling for men who want advice. The workshop has meetings two days a week and they have a big show, maybe a fashion show including a cabaret. They’re very good shows, and they can offer lessons about safe sex, prevention, and medical treatment. And when people come to hear karaoke every Friday night they can also receive information about safe sex and STDs.

The government workshop has many volunteers. They go out at night to meet with gay men in Saigon in bars or discos, but they don’t go everywhere. So about 15 or 20 of my friends founded our organization and we go to places where government volunteers don’t want to go, like brothels or the countryside, and we provide information, education, and condoms. Then we refer them to the government workshop to learn more because in Viet Nam, the law says that we cannot have discussion groups like this one. You can only have less than five people.

Addy: It’s the same way in Myanmar. Let me ask you, when you say your groups go to brothels, are those male-specific brothels?

Trung: Yes. When we go we talk to the mama-san who controls the boys. We train them about safe sex, how to use condoms, and we refer them to the workshop.

TA Report: What are each of you seeing in regard to stigma and discrimination in your countries?

Trung: In the big cities in Viet Nam things are much better than they once were. Still, we have 64 cities and provinces, and only five of the biggest have MSM workshops. In Saigon, seven years ago, a man might go to the doctor and say “I am gay, I just had sex with a man last night,” and the doctor would just send him away. I’ve worked with government places like hospitals and prisons and explained to them what it means for men to be gay or MSM, and now they understand, so it’s much easier for gay people in Saigon to go to the doctor and talk honestly. But in the provinces, things are like they used to be in Saigon.

Thaiy: In Cambodia things are better, too—stigma and discrimination from doctors or health providers, people in the clinic, for example, are less of a problem. The difficulty we face now is that MSM Short Hair are very secretive, so when they go to the clinic they conceal the fact that they have sex with men. They might have a problem but the doctor won’t check the right place. If the patient tells him that the problem is behind, the doctor will ask why? How come there? So now we’re trying to develop a sensitivity to MSM among health-care providers so that when men come in for checkups they don’t have to explain what they need and they can get treated.

Addy: Do you still find any type of stereotyping? People calling you names or being violent towards you?

Trung: There is not much violence against MSM in Viet Nam, but sometimes in the countryside when people see Lady Boys or gay people they call them pédé or other bad words. Pédé is French and what it means is not very polite. Gay people in Saigon really do not like it. If you say they are gay, or say they are bong, they are very happy, but they never like pédé.

Addy: Well, I have some friends who have experienced sexual violence. Those kinds of things happened a lot in the past and they still do in some provinces where stigma is very high.

Jack: In Thailand, stigma and discrimination still exist but at different levels. It used to be quite bad years ago, but as the MSM population has grown and more people have come out, we have became more normal and accepted in the eyes of others. There is still violence against MSM, but less so. Even upcountry in northeastern Thailand, I have friends from a small town where the public presence of MSM is limited, and some of them have told their families that they are gay and have been accepted. Many places upcountry are open to it now. That’s a sign that things are getting a lot better.

Addy Chen of Myanmar works with the International HIV/AIDS Alliance. Jack Arayawongchai of Thailand is the coordinator of the Greater Mekong MSM support network Purple Sky. Sovannara (Thaiy) Kha is a local independent MSM consultant and HIV/AIDS activist in Cambodia who works for Kanhnha CBO as a volunteer. Viet Nam’s Nguyen Van Trung works with the Nguyen Friendship Society. Thaiy, Addy, and Trung are all members of TREAT Asia’s Asian Community for AIDS Treatment and Advocacy, and Jack works for TREAT Asia in Bangkok.