Abstract

Young gay and other men who have sex with men and young transgender women in Thailand continue to be at high risk for HIV infection. We explored multilevel influences on HIV testing in order to inform the design of tailored interventions. We conducted four focus group discussions with 16–20-year-old gay men and transgender persons (n = 25) and 17 key informant interviews with healthcare providers, NGO leaders, and youth advocates. Focus groups and interviews were transcribed and reviewed using thematic analysis in Thai and English language by a bilingual team. We identified intersecting, culturally situated barriers at individual (lack of HIV knowledge, low HIV risk perception, denial), social (intersectional sexual- and HIV-related stigma, lack of family communication), institutional (inadequate and non-LGBT-inclusive sexual health education in schools, lack of youth-friendly clinics) and policy levels (parental consent requirements for HIV testing by minors). Multilevel and multisystem factors coalesce to form extensive barriers to HIV testing access and utilisation and promote disengagement from HIV prevention more broadly. Multicomponent, youth-engaged interventions informed by Thai sociocultural history and practices are needed in renewed approaches to HIV prevention and testing to end the epidemic among young gay and transgender people in Thailand.

摘要

在泰国，年轻的男同性恋者和其他男男性行为者和年轻的跨性别女性仍然处于感染 HIV 的高风险之中。我们探索了对 HIV 检测的多层次影响，以便为量身定制的干预措施的设计提供信息。我们与 16-20 岁的男同性恋和跨性别者进行了四次焦点小组讨论（n = 25) 和对医疗保健提供者、非政府组织领导人和青年倡导者的 17 次关键知情人访谈。焦点小组和访谈由双语团队使用泰语和英语的主题分析进行转录和审查。我们确定了个人（缺乏 HIV 知识、HIV 风险认知低、否认）、社会（交叉性和 HIV 相关的污名、缺乏家庭沟通）、制度性（不充分和非 LGBT 包容性性学校的健康教育、缺乏对青少年友好的诊所）和政策层面（未成年人进行 HIV 检测的父母同意要求）。多层次和多系统的因素结合在一起，对艾滋病毒检测的获取和利用形成了广泛的障碍，并促使人们更广泛地脱离艾滋病毒预防工作。多组分，