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Sexuality Research & Social Policy

http://nsrc.sfsu.edu
June 2009 Vol. 6, No. 2
Sexuality Research & Social Policy: Journal of NSRC, Vol. 6, Issue 2, pp. 434, electronic ISSN 1553-6610. 2009 by the
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Sexual/Gender Minorities in Thailand:
Identities, Challenges, and Voluntary-Sector Counseling
Timo T. Ojanen
Abstract: This article has 3 objectives: (a) to chart current Thai sexual/gender-minority terminology
and identities, (b) to identify challenges in the lives of sexual/gender minorities in Thailand, and (c) to
evaluate how both identities and challenges are reected in voluntary-sector counseling. The author
summarizes terminology and issues from existing Thai and foreign studies and reports the results of
a qualitative inquiry into the state of counseling in 3 Thai nongovernmental organizations. The Thai
sexual/gender-minority identities charted include saaw-prphet-soong/kthoey, gay (king, queen,
quing), tom (one way, two way, gay), dee, les (king, queen), and bi. These individuals face a number of
challenges, such as legal nonacknowledgment, prevention of HIV, insufcient health and psychologi-
cal services, discrimination, and troubled relationships. In the voluntary sector, HIV/AIDS counseling
is the service most often emphasized, but all of the challenges that these minorities face need to be
addressed through both services and continued activism to effect societal changes.
Key words: psychology; psychiatry; discrimination; multicultural; gay; lesbian; transgender
Address correspondence concerning this article to Timo T. Ojanen, Graduate School of Psychology, Assumption University,
Coronation Hall Building, 9th Floor, Huamak, Bangkok 10240, Thailand. E-mail: timoojanen@hotmail.com
In the Western world (particularly in the United
States), the marginalization and discrimination that eth-
nic and sexual- or gender-minority groups face has led
to the creation of group-specic models of professional
practice seeking to assist them, such as approaches de-
veloped in the eld of psychology (American Psycho-
logical Association [APA], 2000; Sue & Sue, 1999). Such
perspectives emphasize the need to understand specic
identities and problems found among these minority
groups in order to devise maximally appropriate and ef-
fective ways of helping individuals who are members of
such groups (APA; Sue & Sue).
Inasmuch as the starting point for these approaches
is a professional practice (such as psychology or psychia-
try) created in Western countries, groups such as Thai
sexual/gender minorities
1
(e.g., homosexuals, bisexuals,
1 These groups in Thai society are not clearly either sexual
minorities or gender minorities, but rather a combination
of the two. Hence, this article uses the term sexual/gender
minorities to describe them.
transgender people) can be considered double minori-
ties: not adequately described by understandings con-
cerning Thai heterosexuals, Western sexual or gender
minorities, or a combination of the two. Thus, practi-
tioners and policymakers interested in designing and
implementing interventions appropriate to these partic-
ular subcultural contexts should base their programs on
direct study of the identities and concerns found among
these minority groups.
The situation of Thai sexual/gender minorities has
been a subject of controversy for some time. Some ob-
servers (e.g., Winter, 2006c) have emphasized what they
perceive as relatively high acceptance of these groups
in Thai society. Others have underlined the nonaccep-
tance such individuals experience (e.g., Sulaiporn &
Pimpawun, 2009), and a large body of research (both in
Thai and in English) has listed examples of the problems
these minorities face. One conceptualization of this ap-
parent contradiction is Jacksons (1997, 1999) descrip-
tion of Thai society as tolerant but unaccepting of such
June 2009 Vol. 6, No. 2 5
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
minorities, based on his review of pertinent research
conducted in the 1980s and 1990s.
In general, research on Thai sexual/gender minori-
ties seems to suggest that although Thai society does not
actively persecute sexual/gender-minority individuals, it
often limits the social space available to them. A person
perceived to be a member of these minorities may, for
example, be rejected entry, services, or decent treatment
in many contexts, especially in the more ofcial ones
(e.g., Winter, 2002). Specic needs of sexual/gender
minorities, created both by discrimination and by their
particular lifestyles, often are ignored or misunderstood
by Thai society at large.
Existing research (e.g., Sutham, 2005) also has sug-
gested that Thai psychology and psychiatry may mirror
the broader societys lack of understanding regarding
local sexual/gender minorities, showing little acknowl-
edgment of the specic challenges these groups face.
Moreover, perspectives pathologizing such minorities
still may be commonplace among practitioners. The
Thai Department of Mental Health (under the Ministry
of Public Health) issued the rst ofcial document stat-
ing that homosexuality is not pathological as recently as
2002. This one-page document, reiterating the World
Health Organizations stance on homosexuality in the
International Classication of Diseases (10th Revision),
was issued only because the Thai yng-rk-yng
2
organi-
zation Anjaree requested it (Piyarat, 2003). Hence, most
Thai psychologists and psychiatrists are likely to have re-
ceived their training under a paradigm that pathologized
sexual/gender minorities. The author of this article has
not found any recent, nonpathologizing Thai models of
providing psychological or psychiatric services for ho-
mosexual, bisexual, or transgender clients.
Although Thai psychology and psychiatry seem
slow in recognizing the need for such models, this gap is
now being addressed by those planning services for HIV
prevention, testing, and treatment for men who have sex
with men (MSM). This action is understandable given
the sharp increase in HIV prevalence among MSM in
Thailand (Thanarak, Kiratikan, van Griensven, & Vipas,
2008), as well as the more prevalent role of counseling
in the context of HIV testing than in psychology or psy-
chiatry proper in Thailand. A chapter on national policy
(Worasinan & Kiratikan, 2008) in a new Thai-language
compilation explicitly states that HIV services should
offer counseling that increases clients self-image, is
friendly, and understands the identities and the life-
styles involved.
2 Literally, woman-loving woman.
If models that understand and respect the identi-
ties and specic concerns of such groups are introduced
as a part of HIV-prevention work, these groups will gain
better services and better health. However, provision of
HIV-related services should not lead to negligence in pro-
viding non-HIV-related services. The psychosocial needs
of yng-rk-yng (females with same-sex preferences) in
particular seem likely to be ignored, because yng-rk-
yng do not constitute a risk group for HIV. Counseling
with sexual/gender-minority groups involves more than
HIV issues; for these populations, many identities and
many issues need to be understood.
Both non-Thai and Thai authors have produced nu-
merous works on such topics. The aforementioned book
about MSM and HIV (Anchalee, Thareerat, & Wipas,
2008) has a bibliography with 155 entries of Thai- and
English-language research on Thai MSM alone, chart-
ing types of methodology used, topics studied, and his-
torical developments in the eld. Including research on
yng-rk-yng, the number of reference entries related to
Thai sexual/gender minorities is even higher. For prac-
titioners and policymakers seeking to create models of
service provision, the amount of research literature avail-
able may be daunting, making it difcult to gain a broad
picture of the identities and the problems involved.
To clarify these issues, Part I of this article sum-
marizes recent Thai- and English-language literature on
Thai sexual/gender minorities into a single, up-to-date
account. The author hopes that this summary will make
it easier, especially for practitioners and policymak-
ers, to grasp what recent research has said about Thai
sexual/gender-minority identities and the problems that
people with those identities face in Thai society. In turn,
making this information more accessible may help fos-
ter culturally appropriate models of providing psycho-
social or health services for Thai sexual/gender-minority
individuals.
Part II of this article evaluates how these identities
and issues are reected in existing counseling services
in Thai nongovernmental organizations (NGOs) speci-
cally targeting sexual/gender minorities. Based on pri-
mary interview and focus group data, Part II details these
services from three NGOs: Rainbow Sky Association of
Thailand (RSAT), Sisters, and MPlus. Presenting experi-
ences from these organizations offers a way to evaluate
the validity of existing research on Thai sexual/gender-
minority identities and concerns, as well as identify what
counselors who themselves are members of these popu-
lations consider elements of good counseling with such
groups. These counselors hold a unique vantage point
because they have both their own and their clients lives,
June 2009 Vol. 6, No. 2 6
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
as well as experiences from counseling interactions, as
points of comparison.
This article uses a quasi-phonetic system of tran-
scription from Thai to English, a method similar to that
employed in courses teaching Thai to foreigners, except
without the use of special phonetic symbols. Each let-
ter symbol represents a sound; long vowels are indicated
by a doubled vowel symbol (e.g., e in saaw-prphet-
soong is a long e sound). Exceptions to this rule are
Thai vowels that do not have a single-letter symbol in
the Latin alphabet, such as -oey in kthoey. The two
Thai o sounds ( and ), both of which roughly ap-
proximate the English oh, are differentiated by under-
lining the former in transcription (e.g., underlined oo in
saaw-prphet-soong refers to the sound; the o in
naew-nom-nam-thaang-phet refers to the sound).
Tones are indicated by tonal marks placed on the vowel
in each syllable, as follows: [], high tone; [`], low tone;
[], rising tone; [], falling tone; no tonal mark, middle
tone (e.g., the rst syllable in kthoey has a low tone and
the second syllable has a middle tone). Aspirated conso-
nants are indicated by h after the consonant (e.g., ph in
prphet). Consonants without the h are nonaspirated
(e.g., k in kthoey). Exempted from these principles al-
together are words borrowed from English, such as gay,
tom, dee, and bi, which have been left in their original
or typical form. Direct quotations also have been left in
their original form. This article uses names of people or
places in their given transcription, when available.
Part I: Recent Research on Thai
Sexual/Gender Minorities
This section summarizes the contemporary Thai
sexual/gender order and the types of identities it in-
corporates, then reviews the issues that sexual/gender-
minority groups face in Thai society. Research for this
review was specically sought at Assumption, Chiang
Mai, Chulalongkorn, Mahidol, Ramkhamhaeng, Sri-
nakharinwirot, and Thammasat university libraries, as
well as Princess Sirinthorn Anthropology Center, RSAT,
and from Internet sources. Materials were also obtained
directly from authors and from the National Human
Rights Commission of Thailand (NHRC).
Sexual/Gender Categories and
Associated Identities
The Thai indigenous (nonacademic) way of rep-
resenting or constructing sex, gender, sexuality, sexual
orientation, and gender identity does not differenti-
ate between these concepts, all of which are covered by
the word phet (Cook & Jackson, 1999), a term that can
be translated as sexual/gender category. According to
Jackson (2003), While having distinctive erotic inter-
ests and objects of sexual fascination, each of the mod-
ern Thai identities is a gender more than it is a sexuality
( 86). Indeed, in Thai, phet are represented much as
genders are in English. Types of phet are differentiated
on the basis of various aspects of sex, gender, and sexual
orientation (Jackson). However, these Western analyti-
cal concepts have not become a part of lay terminology
in Thailand as they have in Western countries. Western
sexuality labels have been borrowed to name some phet
that have emerged in the modern era in Thailand, but it
seems that Thai society has not incorporated the Western
sexual/gender system underlying these labels (Jackson
& Sullivan, 1999).
Three traditional categories: man, woman,
kthoey. Jackson and Sullivan (1999) have stated that
the three traditional Thai phet are man (chaay), woman
(yng), and kthoey. Men are by denition anatomically
male individuals with masculine behavior and primary
sexual interest in women; women are anatomically fe-
male individuals with feminine behavior and primary
sexual interest in men (Totsaworn, 2002). Note that het-
erosexuality and sex-congruent gender are implied with
the use of the terms man and woman; individuals who
fail to fulll these criteria are assigned (or assign them-
selves) into one of the other phet. Table 1 collates all the
phet labels used in this article.
How long the term kthoey has been used in Thai-
land is under debate (Jackson, 2003). Previously ap-
plied to both non-gender-normative females and males,
as well as to intersexual individuals, today the term
tends to denote only people born with a male body who
have more or less feminine behavior and dress, as well
as sexual interest in men (Sulaiporn, 2009a). Not all
who are assigned the label kthoey ever complete (or
want to complete) full sexual reassignment procedures;
some have only somewhat feminine behavior (Luh-
mann & Laohasiriwong, 2006). The term kthoey thus
is broader than Western labels such as male-to-female
(MTF) transsexual or MTF transvestite. In its everyday
Thai use, kthoey denotes an alternative phet rather
than a category of medical abnormality. However, some
authors (e.g., Sulaiporn & Pimpawun, 2009) maintain
that only man and woman are truly acknowledged as
phet by Thai society.
Furthermore, the term kthoey often has a negative
connotation (e.g., Cameron, 2006) and can be used as a
derogatory word for those who self-identify as gay, appar-
ently because it compromises their privileged masculin-
ity (Herder, 2006; Purin, 2004). Even more derogatory
June 2009 Vol. 6, No. 2 7
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
Table 1. Thai Phet and Composite Terms, Transcriptions, and Equivalents in English
Phet/term in Thai Transcription Equivalents in English Remarks
chaay man implies heterosexuality
yng woman implies heterosexuality
/
/

kthoey/
s aaw-prphet-s oong/
phu-yng-prphet-s oong
male-to-female (MTF)
transsexual/transgender/
transvestite
all three terms used interchangeably
without distinguishing among their
English equivalents
/ khon kham phet/TG transgender term used in academia and by
nongovernmental organizations
(NGOs)
// pu mia/poo nae/phu me tranny northern, southern, and northeastern
Thai old colloquialisms
chaay-plaeng-phet MTF transsexual academic term
gay gay male nonspecic
/ gay king/fay rk masculine, sexually insertive
gay male
/ gay queen/fay rp feminine, sexually receptive
gay male
/ gay quing/both sexually versatile gay male
chaay-rk-chaay gay male or MSM (men who
have sex with men)
term used in academia and
by NGOs

tt faggot abusive word used against gay

and s aaw-prphet-s oong
/ tom/pu butch (lesbian) often considered transgender; tom
one way denotes a tom who takes
the active or insertive role in sex;
tom two way species a sexually
versatile tom; tom gay is a tom
who prefers tom (rather than dee);
pu is a northern Thai term
dee femme (lesbian) not always adopted as a self-referent
les lesbian (versatile) king and queen speciers indicate
taking an active or a passive role in
sex, but do not indicate gender role
yng-rk-yng lesbian term used in academia and by NGOs
/ bi/s uea bi bisexual male not always adopted as a self-referent
khon rk phet diau kan homosexual male or female current neutral term used in
academia and by NGOs
khon rk ram phet homosexual male or female outdated, pathologizing, can be
mistranslated
khon rk tang phet heterosexual male or female academic term; rarely used
khon rk s oong phet bisexual male or female academic term; rarely used


khon thi mii khwaam lak
l aay thaang phet
a person with sexual diversity:
LGBTIQ (lesbian, gay, bisexual,
transgender, intersex, queer or
questioning)
a composite, polite term used by
NGOs


bkhon th mii khwaam
beng been thaang phet
sexual deviant previously common, now outdated
academic composite term for
sexual/gender minorities
lkkphet transvestite literally, stolen phet; now outdated
phet thi s aam third sex may refer to any nonmainstream
phet
June 2009 Vol. 6, No. 2 8
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
is tt, used to ridicule both kthoey and gay (Purin;
U-sa, 1998). The terms saaw-prphet-soong (second-
category girl; Cameron) or phu-yng-prphet-soong
(second-category woman; Winter, 2006a) are often
considered more polite alternatives to kthoey, as is the
more technical khon-kham-phet (person-crossing-
phet), a Thai equivalent of the word transgender
(Janjira, 2007), which is sometimes abbreviated to TG
(Chonwilai, 2007). U-sa used the term chaay-plaeng-
phet (male-change-sex) for postoperative MTF trans-
sexuals. In Luhmann and Laohasiriwongs (2006) study
with 67 MTF transgender people in Khon Kaen province,
55.2% self-identied as saaw-prphet-soong, 35.8% as
kthoey, and 9.0% as women. To respect this majority
self-denition, this article uses saaw-prphet-soong
as a primary term (cf. Winters [2006a] study, in which
the majority of Thai transgender participants identied
simply as women).
Traditional regional terms used in place of the word
kthoey include pu mia in northern Thailand (Sulai-
porn, 2002), poo-nae in southernmost Thailand (Som-
rudee, 2003), and phu me in northeastern Thailand
(Pongthorn Chanleun, personal communication, April
10, 2009). Female-to-male transgender individuals were
traditionally called pu in Northern Thai (Sulaiporn).
Like kthoey, these terms are negatively loaded and
seldom used as self-referents. Terms denoting saaw-
prphet-s oong identity are numerous; see Winter (2002)
for more terminology.
Costa and Matzner (2007) explored the diversity of
Thai MTF transgender identities by presenting and ana-
lyzing autobiographical narratives of transgender people
in northern Thailand. They compared the identity labels
kthoey, saaw-prphet-soong, and gay both with each
other and with foreign transgender categories, taking
into account factors such as conscious identity construc-
tion and uidity or nonuidity between categories. Their
work, together with Totmans (2003) book, which in-
terspersed a literary narrative (based on actual life his-
tories) with chapters on related topics, seem to be the
single most comprehensive English-language works on
Thai MTF transgender individuals. The narratives these
researchers presented provide a personal, contextual-
ized picture of many identities and concerns discussed
in this article.
Winter (2006a, 2006b, 2006c), on the other hand,
has produced more systematic, mostly quantitative work
on various aspects of transgender women in Thailand.
A study by Winter and Udomsak (2002) reported on
the actual and ideal self-concept, as well as the gender-
trait stereotypes believed about women, of 204 young
transgender womenin other words, what study par-
ticipants thought their identities implied. Although the
respondents commonly held a stereotypically feminine
view of themselves, they often aspired toward a broad
range of less stereotyped traits and commonly disowned
stereotypically female traits. Their actual and ideal self-
concepts varied considerably, a nding that Winter and
Udomsak interpreted as a continuous striving toward
personal development. Indeed, transgender identities
are constructed through important transitional events
and pathways (processes of becoming), processes that
have been documented in interviews with transgender
individuals by Somrudee (2003), Totman (2003), U-sa
(1998), Warunee (2003), and Watcharin (2003); eluci-
dated through autobiographical narratives by Costa and
Matzner (2007); and studied quantitatively by Winter
(2006a).
Male homosexualities. Thai use of the term gay
dates to circa 1965, when it was used as the self-assigned
label of masculine, male homosexuals (Jackson, 1999).
Gay are not dened as a binary opposite to straight, and
the term heterosexual is largely unintelligible to many
Thais outside of the academic domain, because its mean-
ing is already contained in the heteronormative conno-
tations of the words man and woman. Hence, concepts
such as gay man do not make sense in Thai. If one is gay,
one cannot be a man.
The terms gay king and gay queen explicate the
gender-based construction of phet. The term gay king
denotes a degree of masculinity and an insertive role in
anal and oral sex; gay queen species a more feminine
gender expression, together with a receptive role in anal
and oral sex (Wipha & Wichai, 2004). Gay kings are also
referred to as fay rk (penetrating side) and gay queens
as fay rp (receiving side; Piyarat, 2003). Although
many gay identify with these gendered subtypes, those
who are versatile in their roles do not. These individu-
als might describe themselves with the unspecied term
gay (Piyarat), or call themselves gay quing (Jackson
& Sullivan, 1999) or both (one who can do both in anal
sex; Piyarat). In practice, the sexual roles of gay are not
always stable and seem to vary depending on the expe-
riences and preferences of both sexual partners (Totsa-
worn, 2002).
Currently, in academic Thai, homosexual males are
often referred to as chaay-rk-chaay (Piyarat, 2003), a
term sometimes used interchangeably with MSM (which
is used primarily in health promotion concerns). Ac-
cording to Cameron (2006), the majority of Thai MSM
do not identify as gay, so MSM is a more useful grouping
for reaching them. MSM is an analytic category rather
June 2009 Vol. 6, No. 2 9
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
than an identityalthough the author has personally en-
countered Thais who referred to themselves as MSM or
em (an abbreviation of MSM). According to Cameron,
NGOs sometimes use the term MSM to refer to male sex
workers (MSWs) rather than to all men who have sex
with men; the term sometimes does and sometimes does
not cover saaw-prphet-soong (Cameron). Because
saaw-prphet-soong do not identify as men, MSM is a
problematic label for them (Cameron).
A recent large-scale study (Wipha & Wichai, 2004)
that combined qualitative and quantitative methods and
had health-promotion aims used the phrase men who
like men (MLM) instead of MSM because MLM was what
most participants called themselves. This study plotted
the nonnormative phet of biologically male people on
a continuum from kthoey to bi, from the more femi-
nine to the more masculine. However, because sexual
uidity is common, with such manifestations as sexually
insertive saaw-prphet-soong (called saaw sep) and
individuals who shift between categories (Prempreeda,
2007), it should be clear that these categories are not set
in stone and that individuals sexual practices cannot be
inferred from their external gender presentation alone.
Jackson (e.g., 1999) has written extensively on gay
identities in Thailand. Recent interview-based Thai
works on gay identities include those of Piyarat (2003),
Purin (2004), Sutham (2005), and Totsaworn (2002),
all of which are qualitative investigations with small
sample sizes that feature extensive personal narratives.
Although not all of the aforementioned studies are au-
thored by gay, they all nevertheless attempt to enter the
experiential world of gay in Thailand.
Female homosexualities. From the 1980s onward,
specic terminology has also been used for those born
female but not conforming to the norms of feminine
sexuality in Thai society (Sinnott, 1999). According to
Sinnott, a large segment of female homosexuality is
now divided into the gendered types of masculine tom
(from English tomboy) and feminine dee (from English
lady).
Sinnott (1999) considered tom to be transgender
and stated that tom identity is a uid concept struc-
tured by class, ethnic, and educational background,
but the idiom of masculinity, or maleness is a consis-
tent feature of being a tom (p. 105). This masculinity
shows in toms attire, hairstyle, and behavior, as well as
in being sexually interested in feminine women, or dee.
Tom are stereotyped in Thai society as engaging in the
traditionally masculine pursuits of excessive drinking,
smoking, gambling, and promiscuity (Sinnott, p. 106).
They are expected to take care of their partners as a man
would (Sinnott). At the same time, some idealized femi-
nine qualities, such as understanding their partners bet-
ter than men could, are also supposed characteristics of
tom (Sinnott).
Like gay, tom are sometimes divided into subtypes.
Tom one way refers to a tom who does not allow her dee
partner to take an active role in sex, whereas a tom two
way would allow this (Sulaiporn, 2009b). According to
Sulaiporn, these terms have emerged within Internet
communities in the last 45 years and are known only
in limited circles. In addition, as of 2009, this author has
come across the term tom gay on tom-dee online mes-
sage boards. This apparently yet undocumented phet
label refers to tom who prefer other tom (rather than
dee) as their sexual partners.
Dee, who are more gender normative than tom in
their appearance and behavior, are characterized pre-
dominantly by their sexual interest in tom (Sinnott,
1999). They attract less societal attention and criticism
than tom because they are less differentiated from het-
erosexual women (Sinnott, 1999). The dee identity la-
bel is not universally accepted or even recognized by all
partners of tom, which makes characterizations difcult
(Manitta, 2003). Sinnott (2004) emphasized that seeing
tom and dee as facing the same concerns due to their
homosexuality would imply ignoring the importance
gender has in shaping Thai sexual identities. She also
pointed out that considerable differences can be found
within both tom and dee categories.
The term lesbian is often seen as negatively loaded
in Thailand, because it connotes female-on-female por-
nography produced for straight men (Mathana, 1996).
However, the shortened version, les, is a common term
for female individuals who prefer same-sex partners but
who, unlike tom and dee, do not engage in strict division
between masculine and feminine types (Piyarat, 2003).
Like dee, les typically have a feminine appearance, but
unlike dee, they are not predominantly sexually inter-
ested in tom. Some les state their sexual role preference
with speciers borrowed from the Thai gay culture (les
queen: passive; les king: active; Sulaiporn, 2009b). The
term yng-rk-yng was deliberately created to intro-
duce a label for female homosexuals that would move
beyond the gender-role-bound identities tom and dee; it
is also used as a collective term for all female individuals
who prefer same-sex partners (Sinnott, 2004). Manitta
(2003), Mathana, Piyarat, and Sulaiporn all have pre-
sented interview-based, small-sample qualitative studies
in Thai on the experiences of yng-rk-yng in Thailand;
Sinnott has provided a more comprehensive account in
book form.
June 2009 Vol. 6, No. 2 10
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
Bisexuality. Bi (or suea bai) in Thai refers exclu-
sively to males who are sexually interested in various
genders (Prempreeda, 2008). This denition may result
from local discourses linking bisexuality to promiscu-
ity, which in Thai society is more acceptable for males
than it is for females (Prempreeda). Behavioral bisexu-
ality seems common in Thailand: Beyrer et al. (as cited
in Cameron, 2006) reported that half of their sample
of central Thai MSM also had casual female sex part-
ners. Although behaviorally bisexual individuals exist
in Thai society, many of them do not adopt a bisexual
identity, and society generally does not recognize them
(Prempreeda). Furthermore, many bi dene themselves
as men (Prempreeda). Prempreeda (2007, 2008), who
seems to be the rst writer to have paid serious attention
to Thai bi identities, offered examples of the diversity of
behaviorally bisexual individuals, some self-dening as
bi, some not. Many dee are behaviorally bisexual and are
especially perceived as such by tom, but the label bi is
not used for them (Sinnott, 2004). Indeed, some part-
ners of tom self-identify as women (Manitta, 2003), just
as many behaviorally bisexual males identify as men.
Composite terms and related vocabulary. The
newer term referring to both male and female homo-
sexuals, khon-rk-phet-diaw-kan (person who loves
the same phet; e.g., Thanaphong, n.d.) seems to have
almost fully replaced the earlier rk-ram-phet (ho-
mosexual), a term that could be mistranslated as loving
intercourse (Sinnott, 2004) and that has been used in a
pathologizing way (Sinnott). The even more negatively
loaded bukhon-beng-been-thaang-phet (person de-
viant in terms of phet) and lkkphet (stolen phet,
or transvestite; Sinnott) seem rare in current academic
writing. Chaloemphol (2006), however, still uses the
former when referring to saaw-prphet-soong. News-
papers and academic articles often refer to both gay and
saaw-prphet-soong as phet-thi-saam (third sex); the
term also is sometimes used by sexual/gender-minority
individuals themselves (Costa & Matzner, 2007; Sinnott,
2004).
Transgenderism
3
and homosexuality are sometimes
confused even in academic writing; for example, U-sa
(1998) has used the term rk-ram-phet as equivalent
to postoperative transsexual. Thai NGOs are now lob-
bying for the term khon-thi-mii-khwaam-lak-laay-
thaang-phet (people who have sexual diversity) as a
politically correct composite term for sexual/gender mi-
norities (National Human Rights Commission [NHRC]
3 The author of this article uses the term in a nonpatholo-
gizing sense.
& Rainbow Sky Association of Thailand [RSAT], 2007),
but the term has not been universally accepted (NHRC
& RSAT). In this authors opinion, the main weakness of
the term is its implication that gender-normative hetero-
sexuals have no sexual diversity.
Although Thai researchers and NGO activists often
use English loanwords to describe sexual and gender is-
sues, several Thai translations have also been suggested
for such terms as sex, gender, sexuality, sexual orienta-
tion, and gender identity. The lack of consensus on the
terminology used for these concepts may cause confu-
sion in the eld. The term sex has been translated as
phet-sriir (physiological phet; Chonwilai, 2007) or
simply phet. The word gender has been referred to in a
number of ways: as phet-phaaw (Chonwilai), phet-
sphap (Sutham, 2005), and sthaanphap-thaang-
phet (Warunee, 2003), all meaning state of phet; as
phet-s amnek (phet-consciousness; Wipha & Wichai,
2004); and as bt-bat-chaay-yng (male-female roles;
Mathana, 1996). The general terms used for sexuality
include phet-wthi (way of phet; Chonwilai), reang
phet (phet issues; Totsaworn, 2002), khwaam-pen-
phet (phet-ness; Totsaworn), and rbp-khwaam-
maay-thaang-phet (phet meaning system; Sutham).
The phrase sexual orientation has been called naew-
nom-nam-thaang-phet (Martin, 2003) and khwaam-
nom-ieng-thaang-phet (Sulaiporn & Pimpawun, 2009),
both literal translations of the English term; other terms
are phet-nyom (phet-preference; Wipha & Wichai) and
khwaam-pheng-phoo-jai-thaang-phet (phet pleasure;
Martin). Gender identity has been translated as ekk-
lk-thaang-phet (U-sa, 1998) or ttlk-thaang-phet
(Warunee), both meaning phet-identity, or as tua-ton-
thaang-phet-phaaw (self in terms of state of phet;
Chonwilai); sexual identity specically has been termed
tua-ton-thaang-phet (Sutham uses this term and
translates it as sexual self and sexual identity) or tua-
ton-thaang-phet-wthi (self in terms of way of phet;
Chonwilai). This list is unlikely to be exhaustive.
Areas in Which Sexual/Gender Minorities
Face Specic Difculties
This subsection evaluates a number of areas in which
sexual/gender-minority individuals face problems in
Thai society. The phet labels used here are those used
by the original authors.
Law. Unlike many Southeast Asian countries, the
Thai state does not conduct active legal repression of
sexual/gender minorities. Although an antisodomy law
was created in the 1900s, no one was ever judged guilty
of sodomy, and the law was eliminated in the 1950s as
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SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
redundant (Jackson, 2003). Instead, the Thai state as-
serts its sexual and gender norms through nonacknowl-
edgment of specic identities, as Yutthana (2000) has
analyzed in his thesis on the legal situation of homosexu-
als in Thailand. The only mention of phet other than
man or woman in current Thai law is found in the state-
ment of intentions document of the 2007 constitution,
which explicitly states that reference to phet in the anti-
discrimination article (article 30 of the constitution) also
covers homosexuals, bisexuals, hermaphrodites, trans-
gender people, and postoperative transsexuals (Chanta-
lak, 2007; English terms given in the Thai original).
To date, Thai constitutions and resulting laws have
not protected the rights of homosexuals (Yutthana,
2000) or of transsexuals (Warunee, 2003). Legal nonac-
knowledgment has several consequences. A report draft
distributed at an NHRC (2008) meeting summarized
many of them quite systematically: Couples of chaay-
rk-chaay and yng-rk-yng, as well as saaw-prphet-
s oong and their partners, are denied the right to marriage
or registered partnership, barred from receiving welfare
provisions that are given to heterosexual couples who
live together, not treated as couples by taxation authori-
ties (which would lead to tax reductions), denied the
right to adoption, and not given rights to the inheritance
of wealth created together as a couple (NHRC, 2008;
Yutthana).
Saaw-prphet-soong are particularly affected by
legal issues because the Thai state does not legitimize
any gender or sex transitions by altering personal docu-
mentation (NHRC, 2008; Warunee, 2003). For example,
a bill that would have allowed postoperative transsexu-
als to change their personal title from Mr. to Miss (or
vice versa) was proposed in the Thai National Legislative
Assembly,
4
but it was passed only after sections pertain-
ing to transsexuals had been omitted (Sanders, 2008).
In addition to the difculties chaay-rk-chaay and yng-
rk-yng experience, saaw-prphet-soong also face
hardship when traveling abroad, because Thai passport
ofcials often force them to appear masculine on their
passport and national identication card photographs,
causing foreign immigration ofcers to suspect falsied
documents (NHRC). Many everyday actions, such as
contacting banks, insurance companies, or state bodies,
are hindered by similar suspicions (NHRC).
Saaw-prphet-soong also are affected by a lack of
legal protection from discrimination, which causes more
4 The National Legislative Assembly was the Thai legis-
lature under the military-enacted interim constitution of
2006.
difculties for them in employment and education than
it does for the more gender-normative sexual/gender
minorities (NHRC, 2008). In some geographic areas
(e.g., Pattaya district), saaw-prphet-soong experience
police harassment and violence (NHRC) and are denied
entry to some entertainment venues and hotels (NHRC).
If they are jailed, saaw-prphet-soong are housed
together with men (NHRC), exposing saaw-prphet-
soong to sexual violence (Cameron, 2006).
The Sexual Diversity Network, a coalition of organi-
zations for sexual/gender minorities, is pushing for legal
changes, assisted by the NHRC. Network lobbying led to
the statement of intentions document of the 2007 con-
stitution, specifying sexual/gender minorities as deserv-
ing protection (Sanders, 2008). In addition, law on rape
was modernized to include nonvaginal forms of rape and
all phet as possible victims (Male Rape, 2007). Sand-
ers documented much of this lobbying work, its partici-
pants, and its context in English. A book copublished
by NHRC and RSAT (2007) contains Thai-language ac-
counts by some of the participants in this process.
Military. Military service in Thailand is compulsory
for men at the age of 21 (Chaloemphol, 2006). Only a
section of each cohort is drafted; lots determine who is
taken into service (Chaloemphol). Women are permit-
ted to apply for employment within the military, but it
remains a very male-dominated organization (Sinnott,
2004). Existing research does not address any concerns
of chaay-rk-chaay or yng-rk-yng with the military.
However, the gendered draft system affects those saaw-
prphet-soong who have already undergone physical
transformations (Cameron, 2006). The military has tra-
ditionally freed them from service, seeing them as unt
to serve due to what it has termed permanent mental
illness (Cameron) or, more specically, psychosis (ME
Document Declares Permanent Psychosis, 2006). Ap-
plicants with a male birth certicate are required to show
their military documentation in job interviews for many
sectors of employment; in the case of saaw-prphet-
soong, this requirement often results in rejection of the
application due to the so-called mental illness shown in
their military documents (Cameron).
Working with the Sexual Diversity Network and
the NHRC, the Thai military has agreed to use other,
less stigmatizing criteria of rejection for saaw-prphet-
soong, such as the description malformed chest or other
body-related criteria (NHRC, 2008). However, the mili-
tary is legally unable to change documents that have al-
ready been issued (NHRC). One saaw-prphet-soong
challenged this legislation by appealing to the Special Ad-
ministrative Court in November 2006 (ME Document
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SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
Declares Permanent Psychosis, 2006). Curiously,
confusion within the military about transsexuality and
homosexuality seems to have beneted saaw-prphet-
soong, because the military has referred to the Thai
Department of Mental Healths afrmation of the non-
pathology of homosexuality as a reason for the military
to stop labeling saaw-prphet-soong as psychotic (ap-
parently either considering saaw-prphet-soong as ho-
mosexual rather than transsexual, or not differentiating
between the two categories). Chaloemphol (2006), for
example, used this kind of argumentation in his study
that combined legal documents and interview data from
saaw-prphet-soong draftees (whom he called sexual
deviants).
Employment and education. Existing literature
(e.g., Mathana, 1996; Totsaworn, 2002; Watcharin,
2003) has suggested that all sexual/gender-minority
groups in Thailand experience employment difculties.
Saaw-prphet-soong are most clearly affected, due to
the military documentation that brands them perma-
nently mentally ill (Chaloemphol, 2006). However, their
employment issues also include general difculty get-
ting jobs or promotions in both public and private sec-
tors, lower salaries, ridicule and lack of acceptance by
coworkers (despite the higher-than-usual workload that
many of them take on because they typically are lowest
in the pecking order), being singled out for psychologi-
cal testing, and work contexts that severely limit their
working livesfor example, not allowing them to wear
feminine clothing, barring them from womens toilets,
or forcing them to remove existing breast implants as
a condition of continued employment (NHRC, 2008;
Warunee, 2003; Watcharin, 2003).
According to Watcharin (2003), these difculties
prevent some saaw-prphet-soong from working to
the best of their ability and willingness, discourage oth-
ers from employment altogether, and reduce the work-
related welfare provision that saaw-prphet-soong
can access. Afuent saaw-prphet-soong can become
private entrepreneurs and avoid many of the aforemen-
tioned problems (Watcharin). Therefore, socioeconomic
class is an important moderator in this issue (Watcharin).
Based on qualitative data from a few informants, both
Watcharin and Warunee (2003) have concluded that the
private sector is more tolerant of saaw-prphet-soong
than the public sector. Cameron (2006) has pointed out
that discrimination leads most saaw-prphet-soong to
be employed in service professions, including but not
limited to sex work (p. 31). She has linked these difcul-
ties to a more general pattern of discrimination, whereby
criteria of rejection within employment include age,
gender, appearance, and ethnicityunconstitutional in
theory, but matter of course in practice. Because many
jobs are specied as either male or female positions,
saaw-prphet-soong may be excluded from both, either
due to their legal sex or to their de facto gender (NHRC,
2008).
Regarding education, saaw-prphet-soong may
either be refused entry into educational programs in in-
take interviews or, if accepted, be forced to dress in male
student uniforms (NHRC, 2008).
Mathana (1996) has reported a pattern of employ-
ment difculties for tom similar to those experienced by
saaw-prphet-soong. The nonnormative appearance of
tom can make nding employment difcult, particularly
in sectors that prefer employees with feminine appear-
ance. Wealthier tom can become self-employed and are
therefore less affected by this issue (Mathana). However,
a tom dependent on wage earnings may be required to
take on a false feminine identity in the world of work
(Piyarat, 2003). This point can be problematic for tom
because they often take on the role of economic provider
in the relationship, and the importance of earnings is
high; furthermore, some tom are ridiculed by their dee
partners when compromising their masculinity to satisfy
workplace demands of normative femininity (Sinnott,
2004).
Both Piyarat (2003) and Totsaworn (2002) have re-
ported that chaay-rk-chaay/gay have to be more skilled
in some respects than heterosexuals to be employed or
accepted at the workplace because their nonnormative
image puts them under societys gaze. In the absence of
superior ability, an employer may reject an openly gay
candidate on the basis of his phet alone. Certain occu-
pations, such as cabaret or makeup artist, hairdresser, or
some service jobs, facilitate coming out as gay, whereas
other occupations, such as teacher, for example, make
it more difcult (Chaiyo, 2003). Because they have a
more gender-normative image, gay kings are less likely
to face this problem than gay queens (Piyarat). Sutham
(2005) and Totsaworn both have observed that lack of
acceptance in many workplaces drives chaay-rk-chaay
to work in chaay-rk-chaaydominated environments.
Economic hardship and limited employment options
also push some MSM (Cameron, 2006; Herder, 2006)
and yng-rk-yng (Sinnott, 2004) into sex work, which
has its own specic risks and concerns (see Cameron;
Herder).
Families. Families are an important site for main-
taining gender norms (Sutham, 2005). According to
Totsaworn (2002), families are constructed through so-
cietal mechanismsespecially through a sexual/gender
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SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
system that denes maleness and femaleness from the
supposed implications of idealized images of anatomy,
mind, and sexual expressionso gay clash with the con-
ventional values of conservative parents. When Thai
parents notice or worry that their child might grow up
gay, they try to repress this side of their sons person-
ality and teach him about aspects of normative mascu-
linity (Totsaworn). Such repressive upbringing not only
may lead to tension and worsening of familial relations
but also makes it more difcult for the individual to de-
velop a strong personal identity (Totsaworn). In many
(especially Sino-Thai) families, the crucial issue is fam-
ily pressure for a gay son to marry a woman (Sinnott,
2004). Tensions and verbal or physical abuse between
heterosexual and gay siblings also may be found, due to
the shame that some heterosexual siblings feel simply
because they belong to the same family (Totsaworn).
Purin (2004) considered the family as often the
most difcult space for chaay-rk-chaay to express their
true sexuality. Instead of confronting their family by
coming out, many chaay-rk-chaay distance themselves,
for example, by moving elsewhere (Sutham, 2005). This
physical distancing may lead to emotionally distant, un-
supportive relationships with families (Piyarat, 2003).
Verbally coming out to the family is still considered an
untypical reaction in Thai families (Sinnott, 2004), yet
some view it as an important developmental task for
chaay-rk-chaay (e.g., Purin; Totsaworn, 2002). Chaiyo
(2003) found that of the 35 chaay-rk-chaay participants
in his study, most had indirectly communicated their
sexuality to their parents since childhood and some had
communicated it directly when older. Less than half of
the families completely accepted their sons communi-
cation; reactions in the majority of families ranged from
grudging acceptance to physical violence or expelling
their son from home (Chaiyo). Pichai (1996) investigated
the psychological signicance of coming out among Thai
male homosexuals using a Thai version of the Symptom
Checklist-90; those who were overt about their sexuality
had lower distress levels than did their covert counter-
parts (the difference was statistically signicant in the
Depression and Hostility subscales). Nantaya (2001) re-
ported a similar trend for Thai lesbian (as Nantaya called
them) participants in her study, but with no statistical
signicance.
Although families of origin often condemn male-
male sexual relationships, attitudes toward tom-dee
relationships seem more relaxed. Sinnott (2004) has
argued that these relationships do not attract the per-
ception of being dirty that male-male relationships do.
Furthermore, because the Thai concept of having sex is
pervasively linked to penetration, female-female sex is
perceived as playing rather than as real sex (Sinnott). This
distinction is particularly important in areas where con-
cern over daughters virginity, reputation, and eligibility
for marriage is high (Sinnott). Furthermore, Sinnott has
stated, many families can accept tom-dee relationships
more easily than premarital heterosexual relationships.
However, the pressure to marry a husband who can
support both the daughter and her parents can be in-
tense, so tom-dee relationships may be tolerated only if
they are seen as temporary and nonthreatening to mar-
riage prospects (Sinnott, 2004). Sinnott suggested that
dee may face more pressure to marry than tom, because
it is more difcult for the family to view the dee as any-
thing but a woman (implying heterosexuality and eligi-
bility for marriage). As with chaay-rk-chaay, hiding a
same-sex relationship from ones parents and living far
away from them also occurs with tom and dee (Sinnott).
However, Manitta (2003) reported that 12 of 13 partici-
pants in her study (all of whom had tom as partners) had
directly or indirectly come out to either close friends or
family, because they could trust them.
Winter (2006b) has reported that for 195 trans-
gender females, 62.9% of mothers and 40.6% of fathers
either encouraged or accepted their childs transgender
status from its rst expression. Only 5.8% of mothers
and 21.0% of fathers were outright rejecting. Further-
more, parental attitudes improved as the parents had
time to adapt to the realization of their childs phet. In
comparing the acceptance of transgender within Thai
society at large with the situation in other countries,
Winter (2006a, 2006c) found that Thai society seemed
relatively accepting of transgender. However, Win-
ter cautioned that these gures should be understood
as limited because they were based on self-report data
among an opportunistic sample.
Friendships and sexual relationships. Existing re-
search has suggested that Thai sexual/gender-minority
individuals have difculty nding friends and lovers.
Both Totsaworn (2002) and Sutham (2005) have noted
that heterosexuals (particularly straight men) are afraid
of being stigmatized by socializing with known gay
people; hence, gay may nd that their friends are lim-
ited to those who also are gay. Sutham, who has called
friends the gender police, believes that a male persons
development may be shaped by his pursuit of friends
approvalan approval that depends on the masculinity
of his gender expressions. Gay feel less repressed when
they spend time with self-identifying gay friends (Tot-
saworn), and people who have difculty nding similar
friends may feel isolated.
June 2009 Vol. 6, No. 2 14
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
Totsaworn (2002) and Sutham (2005) also have
written about the problems chaay-rk-chaay experience
when looking for satisfying sexual relationships. These
include the scorn that those expressing homosexual af-
fection may face, the lack of societal acceptance of these
relationships, and, perhaps, a dearth of role models
and sources of learning regarding what such a relation-
ship might constitute (Totsaworn). Sutham added that
chaay-rk-chaay may hesitate to show affection in rela-
tionships that begin as friendships, which they may con-
sider too valuable to risk losing, because the other party
may reject a communication of affection and terminate
the relationship; a show of affection in these cases is also
a form of coming out. Obviously, these limitations affect
closeted gay more than those who are open about their
phet. Purin (2004) viewed these difculties as being
at the root of the sexual lifestyle of many chaay-rk-
chaay, a lifestyle that involves seeking sex without emo-
tional involvement in gay saunas, public parks, or public
toilets.
The large-scale study by Wipha and Wichai (2004)
classied all contacts of MLM as either sexual or so-
cial; they typied sexual contacts as having sex within 1
week of rst encounter and dened all other contacts as
social. Wipha and Wichai also noted that one quarter of
MLMs networks were initiated as sexual contacts, which
frequently terminated after the rst sexual experience
and rarely developed into long-term relationships. The
authors have stated that they are concerned about the
trend because they believe it endangers both the physi-
cal and the mental health of the involved individuals. Al-
though the physical risks of unprotected casual sex are
clear, the authors do not state why such contacts would
endanger the mental health of the people involved.
Sinnotts (2004) research has suggested that yng-
rk-yng are in a better position to form friendships
than chaay-rk-chaay, because Thai society perceives
yng-rk-yng less negatively than chaay-rk-chaay.
Sinnott added that because society views sex between
women as not being real sex, even quite obvious yng-
rk-yng couples can pass as just friends. However, Sin-
nott has identied several factors that regulate whether
friendships between yng-rk-yng can occur. Tom often
build groups of tom friends, but dee may be excluded
from these and isolated from other dee. Rural and ur-
ban yng-rk-yng may not nd common ground. Even
more important, yng-rk-yng of different social classes
may have very little potential or willingness to interact
(Sinnott).
In yng-rk-yng sexual relationships, many sources
of tension exist (Sinnott, 2004). Strict rules concerning
the roles of tom and dee are supported by some, whereas
others nd them limiting (Sinnott). For example, some
tom would like to be touched during sex but have dee
partners who refuse the request because they think it
would compromise the toms active role (Sinnott). Many
tom think of themselves as incomplete men rather than
as liberated women, fear that the dee will abandon them
for a man, and construe their own lives as suffering (Sin-
nott). These insecurities lead some tom to emulate male
sexual practices (e.g., rough penetration with a dildo),
which dee do not necessarily enjoy. On the other hand,
dee tend to perceive tom as womanizers (Sinnott), and in
some cases this perception is accurate. Because tom are
considered masculine, this behavior is not condemned
as similar heterosexual behavior would be for a woman
in Thai society (Sinnott).
U-sa (1998) has viewed the ability of saaw-prphet-
soong to nd friends rather positively, nding that they
can gain attention and even special privileges while in
school. Later, she wrote, they tend to stay in their own
group or become friends with women. However, the de-
sire of saaw-prphet-soong to nd lasting partnerships,
as well as the difculties they have in achieving this wish,
has often been mentioned in research. For example,
the personal narratives in Costa and Matzners (2006)
study have presented many accounts of one-sided love.
A number of narrators made a point of emphasizing the
difference between their love ideal and that of gay peo-
ple, which they viewed as short term and sex centered.
Some mentioned sexual harassment. The identities and
experiences of their partners remain unclear in these ac-
counts and seem not to have been studied in the Thai
context.
Religions. Thailand is predominantly a Theravada
Buddhist country, with notable Muslim, Christian,
and other minority religions (Cameron, 2006). Al-
though members of these groups are present through-
out Thailand, the southernmost provinces are Muslim
dominated.
Buddhism does not condemn sexual/gender mi-
norities and does not sanction heterosexual marriage as
Christianity does (Sinnott, 2004), but it views men as
spiritually superior to other phet (Cameron). This be-
lief has at least two consequences: Saaw-prphet-soong
(like women) usually are unable to ordain as monks, a
constraint that may cause tension in families seeking to
gain merit from their sons ordination (Cameron); and
both sexual/gender-minority individuals and others may
view the lives of sexual/gender minorities as suffering
caused by bad karma accrued through harmful actions
in their previous lives (Cameron; Sinnott).
June 2009 Vol. 6, No. 2 15
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
Islam specically forbids both sodomy and cross-
dressing (Somrudee, 2003). As far as this author knows,
no research has documented the experiences of Islamic
chaay-rk-chaay or yng-rk-yng. However, Somrudee
studied the lives of eight kthoey in southern Thai Mus-
lim areas and found that they had to hide their sexual
relationships with men and attempt to reduce their femi-
ninity. These kthoey felt that home and work environ-
ments necessitated some reserve in showing their real
identity (such as not wearing feminine clothing) and that
religious contexts required them to reduce their femi-
ninity even more (Somrudee). Reduction of femininity is
the nal stage in Somrudees model of kthoey identity
development. This model contrasts with the increased
acceptance and condence resulting from obtaining sex-
reassignment surgery (SRS), which is the nal stage in a
similar model of identity development that U-sa (1998)
has postulated for Buddhist MTF transsexuals in cen-
tral Thailand. Based on a small sample, Somrudee has
concluded that kthoey in southern Thai Muslim areas
generally can cope with the sanctions they face. How-
ever, Winter (2006a) has shown that those transgender
people who anticipated reducing their femininity also
anticipated less happiness for the future; hence, such a
forced squelching of femininity may be psychologically
costly to these individuals.
Like Islam, Christianity also has principles forbid-
ding sodomy. Winter (2006c) has found that whereas
both Thailand and the Philippines have well-established
transgender subcultures, transgender people are more
accepted in Thailand than in the predominantly Catholic
Philippines, where Christian discourse is used to con-
demn them. However, this author could nd no research
addressing whether Thai Christian sexual/gender mi-
norities also experience such condemnation.
Health and health care. Each sexual/gender mi-
nority faces quite distinct health risks. For example, HIV
prevalence among groups of MSM and saaw-prphet-
soong in large cities has risen very sharply in the past
few years (Thanarak et al., 2008). Antiretroviral treat-
ment is now available free in Thai government hospitals,
but only for patients with a CD4 count
5
lower than 200
(or lower than 250, with serious symptoms); the number
of drugs available on the government health care plan is
also limited (Cameron, 2006).
Among saaw-prphet-soong, the most recent
(2007) estimate of HIV prevalence is 16.8% in Chiang
5 CD4 count is used to assess the strength of the immune
system after a diagnosis of HIV infection by counting the
number of CD4 T-lymphocytes in the blood.
Mai; 2005 investigations estimated a prevalence of
11.5% in Bangkok and 11.9% in Phuket (Thanarak et al.,
2008). Unprotected sex and promiscuity are likely to
be major reasons for this increase; Luhmann and Lao-
hasiriwong (2006) found that 59.1% of a sample of 67
saaw-prphet-soong in Khon Kaen province (mean age
26.3 years) had a lifetime history of 20 sexual partners
or more, and more than 80% were usually receptive
partners in penetrative sex. More than half had sold sex
and three quarters of the particular respondents had
unprotected sexual intercourse with their regular part-
ners and more than half of them with their commercial
(57.1%) and casual (55%) partners in the last 6 months
(Luhmann & Laohasiriwong, pp. 2122).
Despite a clear need for group-specic sexual health
services, according to Cameron (2006), no such services
were available for saaw-prphet-soong and specic
HIV-prevention campaigns were very rare. However,
Sisters, the Pattaya NGO for saaw-prphet-soong, does
offer such services, which are described in Part II of
this article. In general clinics, knowledge about treating
saaw-prphet-soong for sexually transmitted infections
(STIs) is insufcient; clinic staff attitudes toward saaw-
prphet-soong echo the general stigmatizing attitude
of Thai society (Cameron; Prempreeda, 2007). Among
Luhman and Laohasiriwongs (2006) sample, 59.3%
of those who had ever taken an HIV test thought that
testing facilities needed improvement, particularly in
that the staff should be more knowledgeable (43.7%),
the provision of knowledge regarding HIV prevention
should be improved (37.5%) and that stigmatization
should be decreased (31.2%) (p. 24). These needs seem
to be recognized in the new national policy document
(Worasinan & Kiratikan, 2008), which one hopes will
lead to improvements in the services.
Estimated HIV prevalences among MSM are even
higher than among saaw-prphet-soong: in Bangkok,
30.7%; in Chiang Mai, 16.9%; and in Phuket, 20.0%.
Rates of HIV infection among MSWs are slightly lower
in each area (Thanarak et al., 2008).
Currently, a few specic sexual health services are
available for chaay-rk-chaay in Chiang Mai (Herder,
2006) and Bangkok (e.g., the experimental Silom Com-
munity Clinic; http://www.silomclinic.in.th/). Prem-
preeda (2007) evaluated two of the Bangkok-based
services and concluded that services still needed im-
provements. NGOs including RSAT, Sisters, MPlus,
and Swing (focusing on MSWs in Bangkok and Pattaya)
are addressing HIV among chaay-rk-chaay and saaw-
prphet-soong in some areas. Although the Thai state
has arguably responded too slowly to the epidemic, the
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SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
new national policy document recommends a broad-
base, minority-friendly, large-scale plan for extending
the services (Worasinan & Kiratikan, 2008).
Yng-rk-yng are likely to face a lower risk of HIV
infection than MSM or saaw-prphet-soong (or even
the general population). Of course, they still need sexual
health services, but no sexual health services are tar-
geted specically for yng-rk-yng (Sulaiporn, 2007).
Yng-rk-yng who use conventional womens health
services have found them to be ignorant of particular
risk patterns and the psychosocial aspects of yng-rk-
yng sexual health (Sulaiporn). Many yng-rk-yng are
not able to discuss their sexual practices or preferences
honestly with these practitioners (Sulaiporn). Together,
these factors may negatively affect the sexual health of
yng-rk-yng.
Besides HIV infection and sexual health problems,
saaw-prphet-soong also face risks from the use of
hormonal treatments and surgeries, including but not
limited to SRS, despite the fact that sex reassignment
surgery is world class in Thailand (Cameron, 2006,
p. 30). Most saaw-prphet-soong begin hormonal
treatments on their own (Cameron). Of those who
used hormones among the 67 saaw-prphet-soong
studied in Khon Kaen province, 50% had consulted
a medical doctor at least once before regarding their
hormone use and only 27.5% had established their cur-
rent hormone dose with a medical doctor (Luhmann
& Laohasiriwong, 2006, p. 2). Many saaw-prphet-
soong start taking hormones early in life. Among Win-
ters (2006a) sample of 195 participants, the mean age
of beginning hormone use was 16.3, with some tak-
ing hormones as early as age 10. A Chiang Mai study
(Somchai, Sasiraporn, & Supawinee, 2005) that com-
pared two groups of 100 kthoey, one taking and the
other not taking hormonal supplements, found that
quality of life was signicantly higher in the non-hor-
mone-taking group in six out of eight domains in the
SF-36 health survey questionnaire. More than half of
those taking hormones experienced adverse effects,
although a majority reported that these effects had little
or no impact on their quality of life (Somchai et al.).
Low rates of completed SRS among transgender
women (27.7% among Winters [2006a] sample) pri-
marily may be due to lack of money (Cameron, 2006).
Only a minority do not desire SRS (Winter). However,
the majority do use hormones (93.8%; Winter). SRS
may cost up to 150,000 baht, whereas hormones cost
approximately 3,000 baht monthly (Cameron). Nei-
ther type of treatment is subsidized by the state (Cam-
eron). Although SRS is personally signicant for many
saaw-prphet-soong, a qualitative study on eight post-
operative cases (Warunee, 2003) found that SRS led
to no improvement of their status within society, be-
cause no legal framework was in place to facilitate the
transition.
Psychology and psychiatry. Both psychology and
psychiatry have a less signicant role in Thai society
than they do in Western societies (Tapanya, 2001). Of
the two, psychiatry has a more powerful status than psy-
chology (Tapanya).
Jacksons (1997) analysis based on 206 articles,
books, theses, and other materials published before 1994
has suggested that historically, Thai psychosciences
were predominantly antihomosexual from the early
1960s, following gradual acceptance of Freudian-based
theories of homosexuality (with exceptions to this pat-
tern throughout the period). In the early 1980s, there
was a shift in research from attempts to cure (raksa)
individual homosexuals through psychotherapy (which,
as elsewhere, proved a dismal failure) to attempts to
prevent (porng-kan) the creation of more homosexu-
als through intervention in the family (Jackson, p. 73).
Jackson has contended that such accounts increasingly
mirror a belief that (adult) homosexuals cannot change
their behavior and so should be understood (khao-jai)
and accepted (yorm-rap) (p. 73). Jackson has pointed
out that the eld has been much more interested in
male than in female homosexuality; he also concluded
that perspectives toward transsexuality were more un-
derstanding than toward homosexuality because trans-
sexuality was usually conceptualized as a physical rather
than a mental disorder. Thai psychosciences thus tended
to call for supporting such individuals and helping them
undergo necessary physical transformations.
Terdsaks (2002) analysis of psychiatric textbooks
in use at the time of his research on the history of gay in
Thailand noted a grudging acceptance in the eld that
homosexuality need not be treated if the patient does not
request it, but the materials he reviewed still portrayed
a variety of methods for treating homosexuality (e.g.,
psychoanalysis and aversion therapy). Terdsak found
that Thai psychiatrists generally were divided into two
groups: one supporting a pathologizing view and the
other supporting a nonpathologizing perspective on ho-
mosexuality; he concluded that those who pathologized
homosexuality seemed more inuential.
Besides Terdsak (2002), Sutham (2005) and Tot-
saworn (2002) also believed that most Thai practitio-
ners still pathologized homosexuality. Their views seem
to be based on a few individual cases based on inter-
views reporting an interaction between a mental health
June 2009 Vol. 6, No. 2 17
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
professional and a gay person. Totsaworn found that gay
respond with confusion and lack of condence to the
anxiety created by societys messages that they are ab-
normal. In his view, mental health professionals would
take these symptoms as further evidence of the assumed
pathology of being gay. Totsaworn also mentioned that
parents sometimes bring their male child to see a profes-
sional psychologist or psychiatrist with the hope that the
childs homosexuality can be reversed.
Information available on the websites of the Thai
Department of Mental Health (http://www.dmh.go.th;
http://www.thaimental.com) in 2008 reected the di-
visions among psychiatrists, as identied by Terdsak
(2002). Of the information on these websites geared for
the general public, some portrayed homosexuality as prob-
lematic (e.g., Department of Mental Health, 2003) and
some did not (e.g., Thanaphong, n.d.). Nonpathologizing
accounts of homosexuality failed to delineate any inter-
vention strategies for the specic issues that homosexual
clients may face. Bisexuality, which tends to be invisible
in Thai society (Prempreeda, 2008), also seems to be ig-
nored by the psychosciences. On the Thai Department of
Mental Health websites, all information on transsexual-
ity pathologized it, following the international psychiatric
mainstream. Winter (2003) believed that psychosciences
are irrelevant for Thai transgender people:
Thai society broadly operates in accordance with
the view expressed by our respondents; that is, that
transgender is a difference rather than a disorder. It
stands by as kathoey transition in large numbers in
ways that bypass psychiatry entirely. True, psychi-
atric services would be expensive anyway, but the
point is that no one seems to think them necessary,
or even helpful. (p. 9)
However, in 2007, Winter argued further that when
psychosciences regard transgenderism as pathological,
similar beliefs and discriminatory practices occur in
other areas of society. If this assertion holds true for all
minority phet, then whenever these sciences patholo-
gize minority phet, other elds follow this belief and
discriminate against the pathologized groups. In this
way, these sciences are important as discourse makers,
even if they see only a few clients. However, research evi-
dence on the services these sciences provide is very frag-
mentary. To address this gap in knowledge, the author of
this article is currently studying the experiences of prac-
titioners and their sexual/gender-minority clients.
Discussion on Part I
The purpose of the previous literature review was to
summarize recent research ndings about the identities
and concerns of Thai sexual/gender-minority people.
The following discussion outlines some generalities
in this area of research, as well as the phenomena on
which the eld reports. This section also suggests ways
to improve the current situation through advocacy and
counseling.
Characteristics of recent research. The recent lit-
erature this author has reviewed seems almost univer-
sally accepting of the sexual/gender identities of study
participants; unlike earlier research, current studies
no longer call for curing or preventing such identities.
Todays researchers, both Thai and foreign, seem to hold
that society should adapt to the needs of these minori-
ties, rather than vice versa. In contrast, Jacksons (1997)
analysis of 206 Thai studies published before 1994 found
that the majority of these earlier studies were nonaccept-
ing of homosexuality. Now, less accepting or cautious
attitudes mostly are associated with works that never-
theless seem to have genuine concern for their popula-
tions well-being, such as in Chaloemphols (2006) use
of the term sexual deviants for saaw-prphet-soong or
in Wipha & Wichais (2004) belief that promiscuity en-
dangers the mental health of MLM.
The eld now seems to comprise three main types
of studies: (a) one-off, qualitative research with small
sample size, based mostly on interviews and observa-
tions, conducted by postgraduate students for Thai-
language theses, dissertations, and special-problem re-
ports (e.g., Manitta, 2003; Somrudee, 2003; Sutham,
2005); (b) broad, foreign researcherled, ongoing lines
of study (e.g., the work of Jackson, Sinnott, or Winter);
and (c) both Thai and foreign larger epidemiologi-
cal studies (e.g., Thanarak et al., 2008). Other types of
works, such as action-oriented reports to various organi-
zations (e.g., Cameron, 2006; NHRC, 2008) supplement
the three main types.
The ongoing type of research offers perhaps the
most comprehensive general picture of a particular mi-
nority, due to researchers deep, long engagement with
the topic. Yet, as new Thai theses emerge, despite their
limitations, they help update knowledge on specic as-
pects of these minority groups lives, as well as portray
vivid idiographic images of individual participants and
settings. Because most of these recent Thai studies com-
prise small-scale qualitative investigations, they are not
very generalizable on their own; sometimes their authors
fail to acknowledge this limitation when drawing conclu-
sions. Medical studies play a limited yet important role
in health promotion for these populations.
The research literature has a number of obvious
gaps. First, most of the studies reviewed in this article
June 2009 Vol. 6, No. 2 18
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
concentrate on teenagers or young adults. Accounts
from sexual/gender-minority individuals older than
40 years of age are very raresome examples can be
found in the work of Sinnott (2004). Second, the ex-
periences of those identifying as bi are only beginning
to be explored (e.g., Prempreeda, 2008). Third, hardly
any information is available on the partners of saaw-
prphet-soong. Fourth, the experiences of Christian
sexual/gender-minority people have not been studied,
even though these individuals might face quite specic
challenges due to religious pressure; the same is true for
Islamic yng-rk-yng or chaay-rk-chaay. Finally, most
studies still tend to concentrate on describing the lives of
sexual-gender minorities as they are, with little research
examining how to improve specic service provision in
various elds, such as psychology. Exceptions include
Piyarat (2003), who has suggested improving quality of
life for these populations through education, and Prem-
preeda (2007) and Sulaiporn (2007), who have focused
on sexual health services.
Mechanisms of discrimination. Looking at the
general picture across all the sexual/gender-minority
groups studied, saaw-prphet-soong seem to face the
most discrimination. Gay generally have a higher sta-
tus than kthoey, making rejection of the kthoey label
an important part of gay identity development (Purin,
2004). Piyarat (2003) has written that gay kings seem
to have fewer problems than gay queens, and that tom
seem to experience more problems than dee.
These ndings suggest that sexual/gender minori-
ties whose gender expression conforms with normative
male or female presentation face fewer problems than
those whose gender expression is nonconforming. Al-
though heterosexism prevails in Thai society (Sutham,
2005), sexual practices or preferences expressed in pri-
vate enjoy relative noninterference. Thai society lends
more importance to outward propriety or conventional-
ity (khwaam-rep-roy), such as marrying for appear-
ances; a nonconforming gender expression may conict
with these mores. This valuing of appearances may ex-
plain why saaw-prphet-soong and tom seem to experi-
ence more discrimination than masculine-appearing gay
or bi and feminine-appearing dee or les. Thus, trans-
phobia or transprejudice (i.e., feelings of fear, disgust
and/or hatred towards transpeoplefeelings that are
often expressed as discriminatory behaviour towards
transpeople; Winter, 2007, p. 1) seem to be more se-
vere problems than heterosexism in Thai society, even
though they may be less severe in Thailand than they are
in some other Asian countries, such as the Philippines
(Winter, 2006c).
However, although the relative invisibility of the
more gender-conforming groups often saves them from
rejections in such contexts as education or employment,
they still face the same nonacknowledgment of their
needs and rights as do other sexual/gender-minority
groups, whether in terms of legislation (Yutthana, 2000)
or service provision (such as the availability of group-
specic sexual health services; Chonwilai, 2007). Invisi-
bility is a double-edged sword in Thailand, as elsewhere;
a number of Thai authors (e.g., Chaiyo, 2003; Manitta,
2003; Nantaya, 2001; Pichai, 1996) have shown that
coming out is a psychologically and socially signicant
issue for many Thai sexual/gender-minority individuals.
Furthermore, fear of visibility may be one of the factors
behind the risky sexual practices of some chaay-rk-
chaay, who seek anonymous sex in public parks or toilets
(Purin, 2004).
Some authors (e.g., Piyarat, 2003; Totsaworn,
2002) have identied patriarchy as a further factor de-
termining the relative status of the various groups of
sexual/gender-minority individuals in Thailand. In the
Thai context, this issue is not so much about anatomy
as it is about gender expression (Sinnott, 2004). For
those who claim their share of masculinity, including
tom and gay, a patriarchal system might allow more
special privileges (Purin, 2004; Sinnott)such as more
freedom from criticism when engaging in Thai so-
called manly vices (i.e., drinking, gambling, promiscu-
ity, etc.)than it would extend to the feminine dee, les,
and saaw-prphet-soong.
Furthermore, some authors (e.g., Mathana, 1996;
Sinnott, 2004; Watcharin, 2003) have identied social
class as an important factor moderating the impact of
sexuality- and gender-based discrimination; however,
the role of social class has not yet been evaluated sys-
tematically in this context.
Counseling and societal change. As the research
summary in this article makes clear, sexual/gender-
minority people in Thailand still face group-specic
problems not only with their immediate contacts, such
as families, friends, and lovers, but also in more formal
contexts, such as when dealing with state ofcials or
seeking employment, education, or health services. Be-
sides these issues, health problems (related to HIV, STIs,
hormone use, and SRS in particular) are key concerns
for these populations, as might be self-denition, self-
acceptance, and personal development.
When dealing with issues closely related to societal
nonacceptance or nonacknowledgment of sexual/gender
minorities, arranging counseling services for these indi-
viduals is not enough; a big-picture response involves
June 2009 Vol. 6, No. 2 19
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
campaigning or lobbying for societal change to help
eliminate discrimination at the source. Changes in so-
cietal discourse and attitudes are needed because these
mediate the thinking and actions of signicant others in
the lives of sexual/gender-minority individuals, whether
in formal or familial contexts. Fortunately, many of
these changes already seem to be underway in Thailand,
as evidenced by the newly accepting or at least tolerant
tone of the research literature, as well as the Thai De-
partment of Mental Healths ofcial reafrmation of the
nonpathology of homosexuality in 2002.
Legal changes seem to follow changes in societal
discourse. As evidenced in this article in the section on
identities, a continual search is underway for new phet
labels that portray sexual/gender-minority groups in a
better light and for appropriate analytical concepts that
describe nonnormative gender and sexuality in Thai
without pathologizing them. NHRC commissioner Nai-
yana Suphapueng recounted in an NHRC seminar held
on March 19, 2008, that one of the NHRCs early semi-
nars on transgender rights began by taking down a sign
(which had been prepared beforehand) that described
the seminar as being for the rights of the sexually de-
viant. Since this early NHRC seminar, sexual/gender-
minority groups have been specied in the statement
of intentions document for the 2007 Thai constitution
(Chantalak, 2007; Sanders, 2008), the rape law has
been modernized (Male Rape, 2007; Sanders), and
a temporary compromise has been reached between
saaw-prphet-soong and the military (NHRC, 2008;
Sanders). Steps that remain to be taken in Thailand
include enacting enforceable antidiscrimination laws,
legalizing change of sex in personal documents for trans-
gender people, and providing partnership rights for
sexual/gender-minority couples.
However, although roughly 40 years of activism
have led to signicant societal improvements in the status
of sexual and gender minorities in the Western world,
they have not erased the need for specic counseling per-
spectives for sexual- and gender-minority individuals.
In fact, context-specic, nonpathologizing counseling
perspectives seem to have developed as part and parcel
of the larger societal changes. Western psychology and
psychiatry gradually have responded to societal pressure
by (largely) transforming their stigmatizing practices to
more progressive ones.
Presently, Thai psychiatry and psychology do not
seem to be at the forefront of societal change in Thai-
land. Even the 2002 ofcial letter of recognition of the
nonpathology of homosexuality from the Department of
Mental Health was gained only through NGO activism,
as was the rst decision to the same extent by the Ameri-
can Psychiatric Association 3 decades earlier. Hence,
NGOs may need to lobby these elds to encourage them
to truly embrace the societal changes and newly created
understandings surrounding the sexual/gender-minor-
ity identities and the associated concerns involved, to
create professional practices that are truly helpful for
sexual/gender-minority clients, and to make these sci-
ences also play a part in creating nonpathologizing dis-
courses in the Thai context.
In this section, the author has attempted to provide
an adequate summary of Thai sexual/gender-minority
identities and concerns, as well as analyze the impor-
tance of societal activism and counseling as ways to
address those concerns. The next section of this article
will focus more explicitly on counseling by presenting
experiences from Thai NGOs that already provide con-
text-specic counseling to sexual/gender-minority cli-
ents. Part II specically addresses the following research
questions:
1. What characterizes the counseling that Thai NGOs
provide to sexual/gender minorities?
2. How are Thai sexual/gender-minority identities
and their concerns, as represented by recent re-
search, reected in this counseling context?
3. What individual and organizational practices are
viewed as contributing to appropriate counseling for
sexual/gender minorities in this counseling context?
4. What do NGO counselors think of Thai mental
health professionals services to sexual/gender
minorities?
Part II: Experiences From Counseling in Three
Thai NGOs Serving Sexual/Gender Minorities
This section reports the ndings of a qualitative in-
quiry on the experiences and opinions of people in three
Thai NGOs that provide counseling to sexual/gender-
minority individuals.
Method
Procedure
The author, who was a postgraduate student in the
eld of counseling psychology at the time of conduct-
ing the research, arranged one focus group and two in-
dividual interviews. The focus group, comprising four
volunteer counselors and one paid staff member (who
headed the counseling service) of the RSAT central ofce
in Bangkok, convened on January 30, 2008. In addition,
the author interviewed the drop-in center supervisor
of Sisters at KU Home (a hotel operated by Kasertsart
June 2009 Vol. 6, No. 2 20
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
University) upon her visit to Bangkok on March 14,
2008, as well as the drop-in manager of MPlus at the
Montien Hotel, Bangkok, on August 17, 2008.
The focus group occurred in the context of a monthly
volunteer counselor meeting at RSAT. The usual facilita-
tor of the meeting, Kamolset Kanggarnrua, founder and
present secretary general of the organization, had asked
the author to conduct this session, which combined the
purposes of research and service provision development.
The author told those at the meeting that he was prepar-
ing a research article and that participants could express
their views anonymously. Everyone attending agreed to
participate. During the meeting, which was conducted
entirely in Thai, the author asked questions (see the
Materials section of this article for the list of questions)
and elicited clarications. With participants permission,
the author audio-recorded the session, then extracted
relevant statements to a text le. RSAT focus group
participants were given a printed document containing
these statements and asked to correct any mistakes and
omissions in the data. All forms were returned. Correc-
tions involved typing errors and choices of wording (e.g.,
the exact form of the Thai word for counseling; changing
the Thai word crazy to psychotic).
Because focus group participants had indicated
that RSAT served few yng-rk-yng and saaw-prphet-
s oong clients, the author sought alternative services
focusing directly on the needs of these populations.
No such services existed specically for yng-rk-yng
(although RSAT had some group activities for them).
However, both Sisters, located in Pattaya, and MPlus,
based in Chiang Mai, were identied as serving saaw-
prphet-soong clients. Hence, the author contacted
each organization and asked permission to interview a
staff member. The author based these interviews on the
same list of questions used for the RSAT focus group and
employed the same procedure for validating data except
that the information was given to interviewees via e-mail
rather than as hard copies. Perhaps reecting their sta-
tus as paid staff rather than volunteers, both intervie-
wees made relatively more additions and corrections to
data than RSAT focus group participants.
The author translated all validation forms from
Thai into English, reworded the statements into a nar-
rative, past-tense form, and edited them for clarity. The
translated and edited statements constitute the data pre-
sented in the Results section.
Participants and Their Organizations
All participants were Thai nationals from different
parts of Thailand. The RSAT focus group participants all
lived in Bangkok; the participant from Sisters resided in
Pattaya and the interviewee from MPlus lived in Chiang
Mai. The RSAT focus group participants were ages 26
to 59, comprising four gay and one yng-rk-yng. Some
were self-employed, some worked in the private sector,
some did not have paid work, and one was a paid staff
member at RSAT. Their educational level ranged from
senior high school to bachelors degree. At the time of the
study, the participant from Sisters (Natchanon Aonket),
a northern Thai saaw-prphet-soong with a bachelors
degree in social work, was 28 years old; the participant
from MPlus (Pad Thepsai), a northern Thai gay with
a bachelors degree in social development, was 37.
Because they were members of staff rather than vol-
unteers, the interviewees from Sisters and from MPlus
agreed to be identied by name. All participants already
were acquainted with the author, who was a volunteer
and a member of RSAT.
RSAT (http://www.rsat.info) began its activities
circa 1999 as a group of friends who met around
a table in Lumpini Park in Bangkok and distributed
condoms to address unsafe sexual practices among
MSM in the park. The organization has since grown
into a registered association and has ofces in Bang-
kok, Chiang Mai, and Phuket. By 2008, RSAT mainly
was focused on improving the mental and physical well-
being of Thai sexual/gender minorities (specically
chaay-rk-chaay, yng-rk-yng, and saaw-prphet-
soong), as well as advocating for their human rights.
Among this NGOs activities was a telephone- and
Internet-based counseling service for sexual/gender
minorities. Although it was advertised in the organi-
zations newsletter and in other publicity materials of
interest to all sexual/gender-minority groups, most cli-
ents learned about the counseling service through ad-
vertisements placed on primarily gay web boards and
MSN (Microsoft Network) lists. The advertisements
emphasized services relating to HIV/AIDS, STIs, and
the sexual health of chaay-rk-chaay.
Sisters (http://www.psi.org/where_we_work/thailand
.html), a counseling and health service center for s aaw-
prphet-s oong in Pattaya, was established in 2005. Run
by Population Services International, Sisters was as
of 2008 the only organization in Thailand exclusively
targeting s aaw-prphet-s oong. Working on health issues,
particularly HIV/AIDS and STIs, the organization offered
both receptive and proactive services, such as programs
at the center, outreach, home visits, and individual and
group activities. Sisters did not have a formal hotline at
the time of investigation, but could provide counsel-
ing by telephone when necessary. Many of the clients
June 2009 Vol. 6, No. 2 21
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
were sex workers, and some were students or corporate
employees.
MPlus (http://www.mplusthailand.com/mplus.html)
is a Chiang Maibased organization serving the needs
of chaay-rk-chaay, saaw-prphet-soong, and MSWs,
all of whom it groups under the umbrella term MSM.
The organization was created in response to research
conducted in 2003 in Chiang Mai that identied these
groups as engaging in high-risk behaviors, lacking
knowledge on sexual health, and requiring group-
specic sexual health services. By 2008, MPlus was
operating a drop-in center, as well as outreach activi-
ties and campaigns, still emphasizing HIV prevention
as its main goal.
Materials
Materials included a list of questions that guided
the focus group and the interviews, as well as a laptop
computer for audio recording. Questions addressed the
following topics:
1. What means of communication does the organiza-
tion provide for individuals who wish to contact the
service? How many people contact the organization
monthly?
2. Which phet do clients belong to, divided into per-
centages? Do counselors ask clients which category
they identify with?
3. What issues do clients consult about and which
concerns are most important to them?
4. What needs do clients have and what kinds of help
do they expect?
5. What are the characteristics of good counseling for
sexual/gender minorities, working in the context of
a voluntary-sector organization?
6. Does helping sexual/gender-minority individuals
differ from assisting gender-normative heterosexu-
als? What issues would a counselor especially need
to consider with sexual/gender minorities?
7. How do the counselors help clients in crisisfor ex-
ample, suicidal cases?
8. Does the service have chronic clients? If yes, how
many, and how does the service help them?
9. If the counselors feel they need to refer a client to
other services, especially in cases of mental health
problems, where can they refer a client, and how
often do they do so?
10. What do the counselors think of the quality of pro-
fessional Thai psychologists and psychiatrists ser-
vices to sexual/gender-minority individuals?
After each of the three occasions of data collection, the
author created individual validation forms based on the
audio recordings. The validation forms, reviewed and
corrected by participants, summarized relevant content
from the respective recordings as brief statements.
Results
This section reports the ndings of the qualitative
inquiry conducted in one focus group and two interviews
with volunteers and staff of three Thai NGOs serving
sexual/ gender minorities: RSAT, Sisters, and MPlus. The
extracted data are presented subsequently in the form of
statements validated by study participants. The author
translated, condensed, and edited these statements for
clarity, grouping the statements into categories reect-
ing the questions presented in the Materials section.
Some categories were merged with others to conserve
space, and repetition across categories was eliminated.
Because participants indicated that organizational fac-
tors in counseling were important, a new category was
added for that topic. In each section, RSAT data are pre-
sented rst, followed by Sisters and MPlus data. All data
in this section represent the views, knowledge, and ex-
periences of the participants at each organization at the
time (2008) that they validated them, not those of the
author. Furthermore, it is important to note that since
then, participants views, knowledge, and experiences
may have changed.
Communication Medium Used,
Number of Monthly Contacts
The focus group participants stated that approxi-
mately 100 individuals per month contacted RSAT
counseling via telephone. Of these, 20 to 30 were new
cases. In addition, approximately 300 to 400 clients
per month contacted the counseling service through
MSN. The counselors advertised the service on various
web boards (primarily gay sites); those who wished to
contact the organization via MSN would first add the
MSN address of the service to their contact list and
then communicate directly with the service. RSAT
counselors felt that the number of clients they re-
ceived was manageable, although they mentioned that
sometimes they must ask a client on MSN to wait while
they answer a telephone call from another client. Both
those who contacted the service via MSN and clients
who telephoned clearly needed assistance with their
concerns. Many clients had learned about the RSAT
service from leaflets distributed in entertainment
venues.
June 2009 Vol. 6, No. 2 22
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
Natchanon Aonket from Sisters estimated that
roughly 300 to 400 people contacted the organization
monthly (counting all activities). Clients comprised
both saaw-prphet-soong in general, as well as saaw-
prphet-soong who were direct or indirect (cabaret
artist) sex workers.
Pad Thepsai explained that MPlus offered both
face-to-face counseling and a telephone hotline, with ap-
proximately 20 to 25 clients using each mode per month.
The organization was considering also offering counsel-
ing over the Internet, with plans to possibly design the
service in collaboration with a foreign gay organization.
Pad said that he provided the bulk of the counseling to
clients by himself, with junior members of MPlus occa-
sionally assisting.
Phet and Other Characteristics of Clients
The RSAT focus group participants estimated that
about 90% of the people who contacted the organization
were MSM. The rest were yng-rk-yng, saaw-prphet-
soong, or parents who contacted RSAT about their child
whom they suspected was gay (a thought they were un-
able to accept). Yng-rk-yng clients tended to contact
the service several times (as opposed to just once) and
speak for a long time.
Sisters targeted saaw-prphet-soong in Pat-
taya district. However, Natchanon Aonket stated that
sometimes other groups, such as MSM, also used the
services.
MPlus, based in Chiang Mai, provided services to
MSM, a group that the organization considered to in-
clude gay, saaw-prphet-soong, and MSWs. Pad Thep-
sai estimated that about 50% of MPlus clients were gay,
approximately 30% were saaw-prphet-soong, and the
remaining 20% were MSWs.
Presenting Issues and Needs of Clients
The focus group participants stated that a major-
ity of RSAT clients asked questions about HIV/AIDS,
sexually transmitted diseases, and other health topics,
or about the services RSAT provided. A minority sim-
ply wanted to vent their problems. Many callers were
worried about whether the sex they had recently had
was risky. Furthermore, many RSAT clients were HIV
positive.
A minority of clients contacted RSAT about prob-
lems with partners or with society at large, or about self-
acceptance. Gay clients living in the provinces (outside
of Bangkok) usually were closeted when at home but
out when staying in another province; they also tended
to have difculty nding gay friends. Sexual uidity led
some clients to experience problems: For example, a
saaw-prphet-soong told an RSAT counselor that she
wanted to be the insertive party in sex, but that when
she discussed it with her boyfriend, he said no and told
her that she was mentally illwhich made her wonder
if indeed she was. Yng-rk-yng callers usually wanted
to talk about families, society, or love rather than health
issues.
Natchanon Aonket from Sisters stated that the
organization primarily worked for behavior change
among saaw-prphet-soong by offering them infor-
mation and understanding, hoping to reduce the num-
ber of new cases of HIV/AIDS among them. HIV/AIDS
and STIs were a concern for many saaw-prphet-
soong, regardless of whether they engaged in sex work.
In fact, those who did not sell sex were less likely to
realize their risk of infection and many of them con-
sequently failed protect themselves against HIV and
other STIs.
Natchanon Aonket reported that as far as she
knew, Sisters had never come across a client who had
an internal conict about being saaw-prphet-soong;
these individuals had no problem acknowledging their
phet. Natchanon stated that she considered Pattaya
to be a territory of freedom because it is one of the big
saaw-prphet-soong communities in Thailand; she
believed that this community increased the happi-
ness and condence of the saaw-prphet-soong living
there.
Depression among the saaw-prphet-soong clients
who contacted Sisters usually resulted from disappoint-
ments, such as troubled love affairs (e.g., clients who had
had a lover who rst gave hope of a long relationship but
did not follow through); from the use of illegal drugs
(in this group, sleeping pills, amphetamine, metham-
phetamine [yaa ba], etc.), which some saaw-prphet-
soong take to bolster their courage to engage in sex work
and solicit clients; from facing criticism
6
; or from sur-
gery gone wrong (e.g., misshapen or hard breasts, an
obstructed vagina, appearance of outer sexual organs
unlike those of women).
6 The author contacted Natchanon Aonket by telephone
(personal communication, February 24, 2009) for further
clarication on what she meant here by the word criticism.
She explained that saaw-prphet-soong typically would
be criticized for less than perfect looks, including any
remaining masculinity in their outward appearance or the
results of unsuccessful beauty-enhancement procedures,
such as silicone injections. Depression resulting from such
criticism underlines the pressure that saaw-prphet-
soong face in trying to reach ideals of beauty prescribed by
society.
June 2009 Vol. 6, No. 2 23
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
Clients usually contacted Sisters when they experi-
enced stress, anxiety, or fear resulting from various issues;
had symptoms of STIs; worried about recent behavior that
had involved risk of HIV transmission; needed a friend;
wanted to use the center as a meeting place; or had prob-
lems with a lover. Sometimes they asked for counseling
on other topics, such as surgery or hormone use. Gener-
ally, they sought both friends and information.
Pad Thepsai from MPlus said that client needs var-
ied from group to group. However, all the groups MPlus
serves (i.e., gay, kthoey, saaw-prphet-soong, MSWs)
included many HIV-positive clients who had misunder-
stood the old Thai government slogan, Get AIDS and
diea belief that led them to feelings of hopelessness
and, for those who lacked access to information, confu-
sion about whom to consult.
Some MPlus clients (gay or kthoey) had psycho-
logical issues stemming from not being able to under-
stand themselves as a manifestation of societys sexual
diversity, or from having experienced pressure to behave
like a heterosexual man rather than be themselves. Re-
jection by parents, friends, and teachers spurred some
clients to act out (e.g., dressing as a woman while going
to dentistry school, speaking loudly to gain attention,
habitually stealing to save money for SRS or to buy fash-
ion items) and suffer the consequences.
The promiscuity of some groups of gay clients re-
sulted in problems with STIs and unfullling relations
with partners. For these individuals, there was no clear
separation between liking, lust, love, and infatuation.
Their relationships tended to lack communication and
agreements on the conditions of living together, lead-
ing to one-sided decisions and problems exacerbated by
the rather big egos (marked by individualism, obstinacy,
self-centeredness) of some gay. Both parties in such re-
lationships commonly held the belief that if they split
they would have no difculty nding a new partner, and
so moved on without trying to salvage the relationship.
Some troubled relationships lacked reconciliation and
forgiveness between the partners.
Pad Thepsai stated that in addition to advice on
relationships, gay who contacted MPlus needed correct
and comprehensive information on how to take care of
their sexual health. Clients typically wished to speak with
someone who knew how to listen and with whom they
could vent their problems, someone who had a friendly
personality style, did not judge them, maintained con-
dentiality, and understood their identities based on
knowledge about sexuality.
Pad explained that saaw-prphet-soong clients
tended to have issues related to the use of hormones,
SRS, or castration (a popular alternative to full SRS due
to its low price). Besides asking for information on these
topics, they sought advice on skin and body care with the
goal of gaining an appearance more like a heterosexual
woman. MPlus clients often had information on these
topics that they had gleaned mostly from their friends
and from the mediainformation that was not always
correct. Excessive hormone use, for example, can lead to
psychological or physical health problems, such as un-
stable emotions, lack of concentration, strain on the liver,
or even death from shock. Saaw-prphet-soong clients
also had issues with partners, such as being abandoned
by their partners and experiencing broken-heartedness,
or having partners take extradyadic lovers. Thus, many
contact MPlus to vent and consult on issues related
to love.
MSW clients of MPlus typically had issues with STI
and HIV/AIDS transmission, often due to their selective
use of condoms with clients but not with partners. Of-
ten, Pad explained, MSWs decided to forgo condom use
even with a client, either because the client agreed to pay
more or because the MSW himself was too drunk or high
on drugs to think clearly. Some MSW clients were mi-
grant workers (e.g., ethnic Shan
7
). For those who could
not speak Thai, communication problems were an issue.
Those who did not have legal permits to stay in Thailand
were particularly vulnerable to exploitation by state of-
cials or establishment owners. MSWs needed condoms
and information on sexual health, STIs, and HIV/AIDS,
as well as on the services that MPlus offers.
Characteristics of Good Counselors and
Special Characteristics of the Setting
RSAT focus group participants stated that good
counselors working in their context should (a) always
have the latest health information (which must be in line
with that available in other organizations, they empha-
sized, because clients contacting several organizations
lose their trust in the services if they receive incongru-
ent information); (b) be able to cite a reliable source for
their health information (e.g., the Thai Red Cross); (c)
have some psychological training; (d) have a very good
understanding of both HIV and sexuality (because the
sexualities of chaay-rk-chaay and yng-rk-yng dif-
fer from the sexuality of most people in society); and
7 Most Shan speakers live in the Shan States in Myanmar
(Gordon, 2005), but many have ed harsh living conditions
and human rights violations by migrating to Thailand,
where a large proportion of this group live as undocu-
mented migrants and work in low-paid jobs or as sex
workers (Herder, 2006).
June 2009 Vol. 6, No. 2 24
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
(e) be proactive about seeking further training rather
than waiting for the organization to arrange it.
Although clients at RSAT often would ask for the
counselors opinion, focus group participants said they
believe in helping clients analyze their problems rather
than making decisions for them. They added that coun-
selors often had to explain that they were trained vol-
unteers, not medical doctors (as clients often believed
them to be), and that they therefore could not diagnose
a clients condition. However, for clients who had clear
physical symptoms of disease, counselors could give an
opinion and refer clients to a sexual health clinic for test-
ing and treatment.
Natchanon Aonket from Sisters said that identify-
ing clients issues is helpful for deciding whom to refer
them to for assistance. For example, those who can best
counsel saaw-prphet-soong on life experiences or
problems are people close to them whom they trust (e.g.,
friends, siblings, or mothers). In some cases, a counselor
who has credibility and understands the clients lifestyle
can build trust with clients by offering an empathetic
ear. Once clients feel comfortable with a counselor, they
will seek advice from that person willingly. The most im-
portant issue in counseling, Natchanon emphasized, is
having a positive attitude toward the phet of the per-
son with whom one is working. Counselors can build up
condence, she added, by staying up to date on issues
important to saaw-prphet-soong.
Natchanon emphasized that psychologists who
work with saaw-prphet-soong need to understand
them in all respects and be aware of all salient issues.
Some psychologists can immediately work with saaw-
prphet-soong due to their good attitudes, she said, but
others need to learn about saaw-prphet-soong before
they can work with these individuals effectively. Those
who are to counsel saaw-prphet-soong should truly
get into contact with saaw-prphet-soong lifestyles,
respect differences and recognize clients value and dig-
nity, have good attitudes (particularly toward the phet
of the people with whom they work), and be patient. Psy-
chologists behavioral cues during counseling sessions
are also important: The counselors facial expressions,
glances, eye contact, speech, and gestures must com-
municate sincerity and willingness to work with saaw-
prphet-soong clients. The phet of the service provider
is not important; Natchanon said she believes that saaw-
prphet-soong can accept service providers of all phet,
provided they fulll the aforementioned criteria.
Pad Thepsai from MPlus stated that good coun-
selors are skilled (i.e., they listen to clients problems,
invite clients to take turns talking and to seek various
appropriate solutions, return questions to clients, always
maintain condentiality, and do not judge clients); they
give correct information (e.g., getting AIDS is not neces-
sarily a death sentence for people who get antiretroviral
treatment and take good care of their health); and have
friendly attitudes on issues related to phet, sexuality,
and sexual diversity. He also stressed that counseling
skills can be improved directly via training (commonly
offered both by MPlus and by other organizations), and
that training on sexual issues helps improve the credibil-
ity of the information given (e.g., if the counselor can re-
fer to the American Psychological Association (APA) and
the World Health Organization decisions that being gay
does not constitute having a mental problem, the client
will be more likely to believe the assertion and feel re-
lieved). Pad said that he believes he can give good coun-
seling not only because he does it from the heart but also
because he has received various kinds of training.
Pad also thought that helping individuals belonging
to the target groups of MPlus differs from helping people
in general because for such groups, the counselor must
understand issues related to phet, sexuality, and sexual
diversity. Understanding that these issues do not consti-
tute perversions or wrong-sexedness [pht-phet] leads
to appropriate attitudes, he said. If a counselor fails to
understand these issues, the services will be character-
ized by stigmatization and discrimination, adding insult
to injury and doing more harm than good.
In addition, Pad emphasized that with s aaw-prphet-
s oong, a counselor should have knowledge about the use
of hormones and should recommend moderate use, giv-
ing clients real-life examples of the dangers of overuse. As
long as the counselor understands the issues of the clients
sexual/gender minority, the counselor need not belong to
the same group as the client. Pad added that at MPlus, cli-
ents have the option of speaking with the same counselor
they have already spoken with, if doing so makes them
feel more comfortable. Finally, because HIV/AIDS is a
major problem among MPlus clients, a counselor work-
ing with these individuals should have knowledge about
HIV/AIDS.
Characteristics of Organizations
Benecial for Operating a
Sexual/Gender-Minority Counseling Service
Counselors at RSAT thought that good organizations
are not too hierarchical, because such a management
structure can slow down decision making and nega-
tively affect the quality of the counseling service (e.g., by
preventing the organization from arranging necessary
training). Furthermore, they said, effective organizations
June 2009 Vol. 6, No. 2 25
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
should publicize their services in a way that reaches the
target group (e.g., with an easy-to-use website that has
complete information) and should arrange training for
counselors at least once a month (preferably outside the
ofce and for longer than half a day at a time), inviting
experts to give training when necessary. They added that
the person assigned to update information, such as data
on health topics and referral sources, should have suf-
cient time to fulll the task.
Natchanon Aonket said she thinks Sisters has been
quite successful because the organization has been able
to reach its target group in great numbers. She said that
many, many clients have received knowledge, informa-
tion, and news from Sisters, and consequently have
changed their behavior for the better. Sometimes, she
explained, when members of the target group come to
use the service center, they are seeking companion-
ship rather than informationjust seeing or listening
to friends talk about amusing topics, hearing peoples
laughter, and being with individuals who speak the same
language
8
helps them feel better.
Natchanon added that she envisions an organiza-
tion that would serve saaw-prphet-soong with all
concerns and in all parts of Thailand, beginning with
provinces that have large communities or concentrations
of saaw-prphet-soong (e.g., Bangkok, Chiang Mai,
Pattaya, Phuket, Udon Thani), and would use the same
methods in every location. She added that a hotline ser-
vice should be available specically for saaw-prphet-
soong, a service that would be publicized effectively and
thus become well-known among this population, would
offer counseling on all issues that are important in their
lives, would provide anonymous services so clients could
feel safe talking about their problems, and would have
high standards and a good system of service provision.
She also said she hopes for an organization that would
provide psychological services specically to saaw-
prphet-soong.
Pad Thepsai from MPlus said he felt that informa-
tion about the various hotline services should be better
distributed than at present, perhaps through the mass
media. The counseling room, he stated, should be inti-
mate, colorful, friendly, and decorated according to the
tastes of the client groups: a space creating physical and
mental comfort. Finally, he emphasized that state, pri-
vate, and NGO sectors, as well as local, regional, state,
8 The phrase speak the same language can, in this case,
be understood either metaphorically (i.e., being with
people who understand one) or literally (i.e., speaking the
same in-group slang or the dialect of the same geographic
area of origin).
and international levels, should cooperate and create
networks to reduce new cases of HIV/AIDS and suicide
among sexual/gender-minority populations.
Dealing With Chronic
Clients and Clients in Crisis
The counselors at RSAT explained that they might
refer some clients in crisis to RSATs secretary general,
whose primary career has been as a social worker in a
public hospital. They also said that they found counsel-
ing clients in crisis to be mentally taxing and wondered
whether their own mental health was sufciently strong
to help such individuals. Furthermore, the RSAT coun-
selors reported that they felt they needed psychological
information to better help clients with mental health
problems. Some clients contacted the service repeat-
edly, without any apparent progress, explaining their
problem anew each time, and the counselors nonethe-
less felt that they had to talk with such clients each
time they contacted RSAT. Other clients contacted the
service over and over again because they worried about
HIV infection, even after having received a negative HIV
test result; these clients also tended to contact several
organizations. Some chronic clients changed the details
of their story each time in order to lead counselors to
believe that they were calling for the rst time, and some
contacted the service repeatedly to check whether they
would get the same information every time. Still other
chronic clients tried to use the hotline as they would a
sex-phone service in order to get sexually aroused; coun-
selors at RSAT said they were not sure how to deal with
such cases.
According to Natchanon Aonket from Sisters, likely
crises among saaw-prphet-soong included disap-
pointments in their love life (which could even lead to
suicide), nancial difculties, problems with society,
and issues stemming from illegal drug use. In the past,
she said, numerous saaw-prphet-soong have died as
a result of stress, worry, and lack of support, commit-
ting suicide because they did not know where to turn
for help. Clients who continually contacted Sisters were
likely to be people who needed a friend, particularly
those with STIs that needed to be treated several times
(e.g., condyloma, herpes, gonorrhea, AIDS); once the
symptoms were gone, or when such clients became able
to help themselves, they were likely to start distancing
themselves from the organization.
At MPlus, several suicidal clients had been helped
so that they went on with their lives, an achievement
Pad Thepsai felt the organization could take pride in.
Examples of such cases included a client with severe
June 2009 Vol. 6, No. 2 26
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
symptoms of AIDS who had been red from a job, and
another client whose partner brought home a casual lover,
an action the client could not accept. Methods of dealing
with suicidal clients at MPlus included providing psycho-
logical and emotional support, listening, giving correct
information, inviting the client to join various MPlus ac-
tivities, and referring the client to mental health services.
MPlus clients did not tend to contact the organization
more than two or three times; if they did, they tended to
turn from clients into friends and members of MPlus.
Avenues of Referral and
Quality of Professional Helpers
RSAT counselors reported that they did not feel
they could refer clients to the services of the Department
of Mental Health, even if clients showed signs of mental
health problems, not only because such a recommenda-
tion could cause clients to feel that the counselor was
not interested in the clients problems but also because
mentioning psychiatric services could make clients won-
der whether the counselor thought they were mentally
ill. Yet, RSAT counselors did feel the need to refer some
clients to more professional helpers and at the same
time worried about what might happen if they were to
refer a client to a psychiatrist who was not accepting
of homosexuality. Although RSAT counselors said they
assumed that in general psychiatrists already might ac-
cept sexual/gender diversity, they were not condent in
referring clients because they were unsure whether any
given psychiatrist truly could accept the clients sexu-
ality. They also suspected that if they referred a client
without rst contacting the psychiatrist, both the client
and the psychiatrist might feel dissatised. RSAT focus
group participants thought that problems in the quality
of psychiatric services might be reduced if psychiatrists
became part of a network with RSAT and other NGOs
serving sexual/gender minorities.
In contrast, referring a client who had symptoms of
sexually transmitted disease or who was worried about
HIV to a specialized clinic or hospital (such as Bangrak
Hospital) was everyday practice at RSAT and did not in-
volve the problems engendered by referral to psychiatric
services.
At Sisters, the onsite sexual health service was pro-
vided by a public health ofcial, saaw-prphet-s oong
herself, who visited the organization twice a week to
check clients for symptoms of STIs and to recommend
HIV testing. For HIV testing or STI treatment, clients
might be referred to Pattayarak Center at Banglamung
Hospital or to various clinics with which Sisters had
contact.
Natchanon Aonket added that Sisters was limited in
its operations because the organization had an agreement
with the funders that limited its role to providing sexual
health services. Consequently, for clients who had con-
cerns related to hormones, surgery, drug rehabilitation,
or legal rights, Sisters had to refer them to other sources
of help. However, according to her, policy in many areas
(including Pattaya) did not give importance to the is-
sues of saaw-prphet-soong, who consequently lacked
group-specic services in many of these areas. For as-
sistance with legal rights, clients could be referred to the
NHRC. Clients who had experienced problems following
SRS might be referred either to experts or to people with
personal experiences of such problems, as well as guided
to study information on the Internet (such as on http://
www.thailadyboyz.net) or to contact the founder of the
Thailadyboyz website, who has been a trusted source of
help for many saaw-prphet-soong.
According to Natchanon, psychological testing
prior to sex-reassignment surgery (SRS) was very rare
in Thailand. To her knowledge, such testing took place
only in Chulalongkorn hospital (Bangkok), which had a
strict, systematic regime that might take years to pass,
had professional psychologists with years of experience
counseling saaw-prphet-soong, and gave services on
the basis that the client is a mental health patient.
Natchanon emphasized that saaw-prphet-soong
(whether clients of Sisters or not) generally did not want
to receive services from psychologists, even before SRS,
because they preferred to consult their friends or other
trusted people for relieving stress or getting informa-
tion. She said that one reason why saaw-prphet-soong
might not want psychological services prior to SRS was
that they simply might not realize that it is necessary.
She also pointed out that Thai people in general (includ-
ing saaw-prphet-soong) are likely to believe that only
so-called crazy people need a psychologist. However, her
experience was that when saaw-prphet-soong were re-
quired to see a psychologist (in the process of obtaining
SRS), they were likely to talk about several issues and
feel better as a result. No psychological services in Thai-
land catered specically to saaw-prphet-soong, but if
such a service became available, Natchanon thought that
saaw-prphet-soong might feel more condent using it
than the current services.
At MPlus, HIV-positive clients would get a coun-
selor who listened to them and gave basic advice, then
referred them to Violet Home (http://www.violethome.
org/), an organization that provides care and treat-
ment to HIV-positive MSM. MPlus counselors would
send MSM clients who wished to have STI or HIV/AIDS
June 2009 Vol. 6, No. 2 27
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
checks to Chiang Mai STI Center or Phiman Center. Pad
Thepsai felt that, in general, he could capably counsel
clients with mental health problems; if not, he said, he
could refer clients to Suan Prung Hospital in Chiang Mai
for therapy and treatment.
Pad also reported feeling that mental health profes-
sionals stuck too much to a framework, resulting in an
excessively academic tone that made such services lack
friendliness and created discomfort in clients. In addi-
tion, he said, some professionals still held negative at-
titudes and lacked correct information on sexual issues,
sexuality, and sexual diversity, as well as had incorrect
or insufcient knowledge. However, Pad was unsure
about the level of Thai mental health professionals pres-
ent knowledge or how to assess their ability, because
individuals and organizations each had their own stan-
dards. Generally, he felt that because communication
techniques and attitudes on sexual matters, sexuality,
and sexual diversity varied among professionals, the ap-
propriateness of services also varied.
He suggested that if NGOs could arrange forums in
order to exchange knowledge, to connect professionally,
and to ascertain gaps in service provision, the quality of
services both for MSM and for clients in general could be
improved and the circle of counselors for sexual/gender
minorities could be widened.
Discussion on Part II
Overview of the services provided. Data this study
gained from three Thai NGOs serving sexual/gender mi-
norities (RSAT, Sisters, and MPlus) present a picture of
three helping contexts that have both similarities and
differences. At RSAT, counseling took place mainly via
telephone and over the Internet; at Sisters and MPlus,
face-to-face services had relatively more importance.
Of the NGOs studied, RSAT provided perhaps the most
formal type of service, with volunteers concentrating ex-
clusively on counseling during their work shifts, whereas
at Sisters and MPlus, counseling was interspersed with
other activities and the relationship between clients and
counselors also seemed less formal. At the time of the in-
vestigation, none of the organizations used psychologists
or psychiatrists as counselors.
Issues and appropriate responses to them. In all of
these organizations, the primary rationale for the services
they provided was responding to the HIV epidemics among
MSM and saaw-prphet-soong. This rationale reects
the fact that HIV-prevention circles place greater im-
portance on group-specic counseling for sexual/gender
minorities (Worasinan & Kiratikan, 2008) than do Thai
psychology and psychiatry. Hence, an important cluster
of presenting issues among clients of these counseling
services related to HIV and STIs, whether dealing with
anxiety about the risks involved with recent sexual be-
havior or about the health and social implications of
being HIV positive.
Although providing health information may not be
a component of counseling as dened in a traditional
sense, all three of the organizations studied considered
the ability to give accurate, referenced information on
HIV-related issues to be a crucial component of good
counseling. Some aspects of this information are con-
text specic, related to the particular risks of the groups
involved (e.g., the realization at Sisters and MPlus that
sex workers often use condoms only with customers,
not with partners) or to the local historical context (e.g.,
the emphasis Pad Thepsai from MPlus gave to undoing
psychological damage caused by earlier fear-based HIV-
prevention messages).
Besides voicing their concerns about HIV and STIs,
clients of all minority phet consulted these organiza-
tions about relationship problems with their partners
(RSAT, Sisters, MPlus); difculties with society at large,
such as having to remain closeted or facing rejectiona
concern especially relevant among those who lived out-
side of Bangkok (RSAT, MPlus); and problems with
self-acceptance (RSAT, MPlus). These issues were seri-
ous enough to render some clients suicidal; documented
cases have shown that the support these organizations
offer has been essential for some clients regaining their
desire to live. The aforementioned concerns not only echo
Pichais (1996) and Nantayas (2001) ndings about the
importance of coming out for sexual/gender-minority
individuals mental health but also parallel the difcul-
ties in sexual/gender-minority individuals relationships
that have been identied by Costa and Matzner (2006),
Sinnott (2004), Sutham (2005), Totsaworn (2002), and
others.
Besides the aforementioned issues, saaw-prphet-
soong consulted these organizations about group-
specic concerns regarding hormone use, various kinds
of surgeries, and skin care (Sisters, MPlus)an under-
standable choice given that saaw-prphet-soong may
perceive medical doctors as not being relevant sources
for these types of information (cf. Luhman & Laohasiri-
wong, 2006). The saaw-prphet-soong community in
Pattaya seems specic in building self-condence among
the saaw-prphet-soong living there, but also in pre-
senting specic health risks, such as widespread abuse
of psychoactive drugs (Sisters). A unique characteris-
tic among yng-rk-yng clients was that they usually
sought counseling for issues relating to family, society,
June 2009 Vol. 6, No. 2 28
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
or love rather than health topics (RSAT). Counselors at
RSAT also have encountered parents who are worried
and disappointed about their offsprings sexuality.
These concerns (together with those related to HIV
and other STIs) seem to reect quite closely the patterns
of problems identied in Part I of this article, lending fur-
ther support to various studies that have identied these
issues as pertinent among the sexual/gender-minority
groups studied. However, some issues may remain in-
visible to these services, perhaps because the potential
clients do not expect the organizations to be able to help.
For example, legal nonacknowledgment may be a struc-
tural problem in many sexual/gender-minority peoples
lives (Warunee, 2003; Yutthana, 2000), but because the
NGOs mentioned in this article can do little in the short
term to change the legal context, many clients may not
consider consulting them on such issues.
NGOs' ability to provide services for sexual/gender
minorities on all topics and in all parts of Thailand (as
envisioned for saaw-prphet-soong by the supervisor
of Sisters) obviously depends on funding. At the time
of investigation, RSAT, Sisters, and MPlus all operated
on HIV-based funding, which is recognized as a double-
edged sword throughout the region (Bondyopadhyay,
2008). The rising HIV prevalence among MSM and
saaw-prphet-soong is a real crisis that is rightly ad-
dressed. Yet, restrictive funding agreements may pre-
vent organizations from doing other important work,
even when rights work would facilitate HIV work (Bon-
dyopadhyay). This type of funding restriction especially
seems to be a problem for Sisters, which perceives that
the support needs among its constituency are broader
than those the organization can presently meet. For-
tunately, new national policy (Worasinan & Kiratikan,
2008) seems to recognize the need for a broader range
of services within HIV-related counseling.
Bondyopadhyay (2008) has noted that HIV-based
funding may selectively help gay more than other mi-
nority groups. Such selective assistance seems to be a
reality in the Thai context, in which yng-rk-yng are
left without any counseling services specically designed
for them. Of the organizations studied, only RSAT had
some yng-rk-yng clients, and even there, yng-rk-
yng formed a small minority of all clients and the ser-
vice might not fully respond to their needs. RSAT has
recognized this gap and as of November 2008, the or-
ganization was considering the possibility of arranging
phet-specic services if funding could be found. The
specic psychosocial issues related to bi identities also
remain invisible to these NGOs, which may limit their
ability to help such individuals. These two service gaps
suggest that donor organizations should permit those in
receipt of their HIV-based funding to provide other kinds
of counseling in addition to that focusing on HIV-related
issues, as well as allow them to engage in advocacy; al-
ternatively, other funding sources should be created for
counseling related to concerns other than HIV.
Besides funding issues, study participants in all
three NGOs identied characteristics that strengthen
an organizations ability to provide good counseling. At
RSAT, counselors emphasized the importance of provid-
ing volunteers with sufcient training and up-to-date
knowledge. Natchanon Aonket from Sisters emphasized
reaching the target group by offering a friendly space;
she also looked to the future, when she would like to see
a nationwide, well-publicized, broad-scope, high-quality
anonymous service specically for saaw-prphet-soong.
Pad Thepsai from MPlus also emphasized the impor-
tance of a friendly space, describing characteristics of an
appropriate counseling room, and discussed the need for
good publicity, as well as cooperation between various
sectors and levels.
Study participants from both RSAT and MPlus em-
phasized the importance of letting clients make their own
decisions, whether dealing with HIV or other concerns.
This clarication is important: Giving health informa-
tion does not imply making choices for clients, even
though some clients (at least at RSAT) seem to expect
it. Perhaps the fact that study participants felt the need
to emphasize this point suggests that Thai counselors do
not always nd this distinction obvious or practice ac-
cording to this ideal. Yet, letting clients make their own
decisions, respecting clients dignity, being sincere and
patient, and having nonverbal behaviors communicating
acceptance to clients (characteristics of counseling that
Natchanon Aonket from Sisters identied as benecial)
are universal facets of good counseling, at least in the
humanistic tradition. At RSAT and MPlus, these char-
acteristics were conceptualized in terms of possessing
strong counseling skills and having received some psy-
chological training.
However, participants in all of the studied organiza-
tions also saw the need to combine these universal char-
acteristics of good counseling with a comprehensive,
up-to-date understanding of sexual/gender-minority
identities and lifestyles, an idea rather similar to the
current APA (2000) guidelines for psychotherapy with
gay, lesbian, and bisexual clients. Lacking this knowl-
edge could lead to stigmatizing services that would be
more harmful than helpful, as Pad Thepsai from MPlus
pointed out. Having such knowledge contributes to the
growth of trust between counselors and clients, Sisters
June 2009 Vol. 6, No. 2 29
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
supervisor Natchanon Aonket emphasized. Condence
among clients that staff and volunteers in these NGOs
understand and accept their lifestyles and identities is
probably one of the most important factors in their deci-
sion to turn to such organizations rather than to mental
health professionals or general practitioners when they
need help.
Comparisons with psychological and psychiatric
services. Current Thai psychological and psychiatric
practices with sexual/gender-minority clients seem to be
guided by no particular set of specic standards. Study
participants from both RSAT and MPlus were unsure
about the appropriateness of such services in general, to
the point that they almost never referred clientseven
those with clearly identiable mental health problems
to these services. Pad Thepsai from MPlus stated that
the professional counseling services stick too much to a
rigid framework, are excessively academic, and, in some
cases, are outright prejudiced against sexual/gender mi-
norities. As outlined in Part I of this article, some Thai
authors (e.g., Sutham, 2005; Terdsak, 2002; Totsaworn,
2002) agree with this assessment and view these services
quite similarly. However, the evidence on which these
authors base their opinions is quite limited. Perhaps the
appropriateness of psychological and psychiatric ser-
vices provided to sexual/gender-minority client groups
depends entirely on each practitioners individual inter-
est and attitudes, as Pad Thepsai suggested.
Given this situation, it is unsurprising that accounts
from all three of the NGOs studied suggested that Thai
sexual/gender-minority individuals generally are not
willing to seek psychological or psychiatric help, regard-
less of the issue they are dealing with. Furthermore,
clients of volunteer counselors may be insulted by the
implication of a psychological or psychiatric referral. Be-
sides lacking trust in the appropriateness of these ser-
vices, study participants from RSAT and Sisters believed
that Thai people tend to perceive psychologists and
psychiatrists as medical experts whose services are only
for those with mental illnessand the stigma of being
perceived as mentally ill remains strong. As Natchanon
Aonket from Sisters suggested, clients seeking counsel-
ing may trust psychologists or psychiatrists only if they
are recommended by friends who already have used
their services.
In general, psychologists and psychiatrists seem
only marginally relevant in Thailand. For example, the
author of this article recently led a group discussion on
counseling and sexuality at a Thai sexuality studies con-
ference, expecting to see both psychologists and inter-
ested members of sexual/gender minorities attending.
Of the 25 individuals who joined the session, most were
gender-normative heterosexuals who were working in a
variety of occupations and also giving semiprofessional
counseling; they frequently brought up the need for
counseling on sexuality topics. Their experience sug-
gests that although counseling is practiced quite widely
in Thailand, professional psychologists and psychiatrists
are not the ones primarily giving it. Such an option cur-
rently might not even be feasible in a country of approxi-
mately 65 million people (Cameron, 2006) served by
an estimated 300 psychiatrists and 400 psychologists
(Tapanya, 2001).
Ways forward. Given the low number of psychia-
trists and psychologists in Thailand, as well as peoples
lack of trust in the services they provide, especially
among sexual/gender-minority individuals, it is per-
haps unrealistic to view them as becoming direct ser-
vice providers of supportive services to more than a
fraction of sexual/gender-minority people in the near
future. However, referral avenues could be created for
clients with mental health problems more serious than
volunteer or semiprofessional counselors can handle,
by identifying professional practitioners whose track
record shows that they already have provided helpful
services to some sexual/gender-minority individuals
and by inviting such practitioners to become part of the
NGOs referral network (as RSAT focus group partici-
pants suggested).
Furthermore, the expertise of Thai psychologists
and psychiatrists could be tapped by inviting them to
provide training to both volunteer and semiprofessional
counselors on issues such as mental health or counsel-
ing techniques. Such training would be both relevant
and useful, because volunteer counselors (e.g., at RSAT)
are sometimes at a loss when they encounter clients with
such mental health problems as clinically signicant ob-
sessions and compulsions about HIV (manifested in re-
peated calls to the service), or callers who try to use NGO
hotlines as a phone-sex service.
In addition, NGO volunteers and staff alike could
provide training to psychologists and psychiatrists (as
well as students in these elds) on topics relating to
sexuality and gender. A similar role seems appropri-
ate for researchers who study sexual/gender-minority
issues in such elds as sociology or anthropology, which
have contributed much more to the present understand-
ing of sexual/gender minorities in Thailand than have
psychology or psychiatry. Moreover, as Pad Thepsai
from MPlus suggested, NGOs serving sexual/gender mi-
norities could arrange forums in which individuals and
organizations could learn from each other.
June 2009 Vol. 6, No. 2 30
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
A more ambitious task would be the creation of even
a single psychological-psychiatric service unit that would
specialize in the concerns of Thai sexual/gender minori-
ties, as Natchanon Aonket from Sisters envisioned. Such
a unit might play a very helpful role as a resource center
for designing exemplary clinical practices and providing
training on sexuality, mental health, and counseling for
professional, semiprofessional, and volunteer counselors.
One further area that should be investigated is the
possible role of indigenous helpers (e.g., fortune tellers,
astrologers, and spirit mediums) for lling gaps in service
provision to sexual/gender minorities. While discuss-
ing psychological and psychiatric services in Thailand,
several people have pointed out to the author that indig-
enous helpers may be more relevant and trusted in the
Thai context than psychologists or psychiatrists. Unlike
using psychological services, seeking help from these
indigenous helpers is not stigmatized. Providing such
helpers with further education on sexuality and mental
health could be an innovative, supplementary way to ad-
dress the challenges identied in this article. Another
avenue that bears investigation is whether indigenous
helpers would be willing to share some aspects of their
methods with more societally marginalized helpers, such
as psychologists, in order to render the services of the
latter more accessible and acceptable to the public.
Finally, the role that researchers play also merits re-
ection. Pad Thepsai from MPlus summarized this idea
very well from the NGO point of view:
Both Thai and foreign researchers have asked
MPlus to act as a coordinator between the re-
searchers, their sample groups, and nighttime
entertainment entrepreneurs. Researchers have
generally only stayed for a short time and then
left; some have presented one-sidedly negative
information, which has reproduced old societal at-
titudes. It has often seemed as if the entrepreneurs
and the target groups have become passive objects
of [the researchers] actions. However, research-
ing and disseminating the ndings to the public
is a positive step because it can help support HIV
prevention work, create correct and comprehen-
sive understanding on diverse sexualities and
gender identities, andreduce stigmatization and
discrimination against such groups.
In Part II of this article, the author has attempted
to highlight the experiences and views of people provid-
ing important services to Thai sexual/gender-minority
individuals in the voluntary sector, as well as sum-
marize what kinds of actions may help improve those
services.
Conclusion
This article reects the continuing evolution of the
terminology referring to Thai sexual/gender categories
(phet) and shows how labels and analytic terms are being
consciously developed and adapted to improve the status
of each minority group. It also makes clear that although
Thai discourses on sexual/gender minorities are becom-
ing less pathologizing, many challenges remain in the
everyday lives of Thai sexual/gender-minority individu-
als, in both ofcial and unofcial contexts. Furthermore,
these minorities are not eager to address their concerns
with psychologists or psychiatrists, who may not under-
stand or accept sexual/gender diversity and whose ser-
vices are viewed as existing only for the mentally ill.
Thai NGOs that offer counseling for sexual/gender
minorities are more accessible and acceptable service
providers for their constituencies than psychologists or
psychiatrists. These organizations dene ideal counselors
as those who have basic psychological training; are sincere,
accepting, and understandingand able to communicate
these qualities to their clients; possess up-to-date, reli-
able health information; and understand sexual/gender
diversity. In other words, NGO counselors must master
not only the universal characteristics of good counseling
but also the group-specic knowledge and attitudes re-
quired in these contexts. However, these counselors often
lack expertise on mental health issues, as well as the fund-
ing they would need to deal with all issues pertinent to all
sexual/gender-minority groups in all relevant locations.
Existing services for sexual/gender minorities could
be improved by arranging forums in which participants
could share their varying areas of expertise, and by cre-
ating referral networks between NGOs and those Thai
psychologists or psychiatrists who already are providing
appropriate, effective services to sexual/gender minorities.
Ultimately, professional mental health services specializ-
ing in the concerns of sexual/gender minorities could be
created. Campaigning, lobbying, and furthering educa-
tion for sexual/gender rights and a better public image of
sexual/gender minorities, as well as for reducing stigma re-
lated to mental disturbance, remain important adjuncts to
service provision for these populations in the Thai context.
Acknowledgments
The author wishes to acknowledge the helpful sug-
gestions, source materials, and encouragement provided
by Holly Dugan, Peter Jackson, and Sam Winter; the
author also would like to thank Anjana Suvarnananda
for informing him of the call for papers for this special
issue.
June 2009 Vol. 6, No. 2 31
SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC
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Appendix: Explanation of Reference Entry Style
Author Names
In both English- and Thai-language academic liter-
ature published in Thailand, Thai authors are usually re-
ferred to by their rst names. Therefore, this article also
refers to Thai authors by their rst names. The reference
section gives the rst name followed by the surname of
all Thai authors, whenever both are available. Entries
for Thai authors cited from Thai-language sources also
include the authors name in Thai script delineated by
square brackets. Transcriptions of names vary; this ar-
ticle uses the cited authors transcriptions. For names
available only in Thai script, the author of this article has
transcribed the name.
Publication Year
This article cites publication years according to the
Western calendar (CE: Common Era). Thai-language
publications indicate publication year according to the
Buddhist Era, which began 543 years before Common
Era. Hence, the publication year of Thai-language en-
tries in the reference section is given in both Western
and Buddhist years (e.g., 2003/2546).
Titles
Many Thai-language materials have both Thai and
English titles. The English titles sometimes do not cor-
respond to the Thai title, and errors in grammar and
vocabulary are common. English titles given by Thai
authors have been cited as they are in the original docu-
ments; the author of this article has translated those
titles that were available in Thai only.
Reproducedwith permission of thecopyright owner. Further reproductionprohibited without permission.