Trouble in Paradise

Idyllic Phuket harbours a dark open secret. It’s a tropical paradise, a sun-soaked region of Thailand home to some of the most lavish resorts, nightclubs and pristine beach coves in all of South-East Asia.

Yet the tourist-tinged gloss of Kata, Phi Phi, Chalong and in particular Patong (the ‘party capital’ on the isle of Phuket), wears thin once the proverbial surface is scratched. It’s a chilling haven for PrEP-resistant strains among men who have sex with men (MSM), strains which could well be surging at an unprecedented rate, unbeknownst to us all.

The lions share of my experiences are laid bare in Patong, where male escorts (or ‘moneyboys’ as they’re referred to in Thailand) line the most popular esplanades and greet male foreigners with an over-enthusiastic glee as they peruse the GLBTI-friendly bars and massage parlours. I’ve forged genuine friendships with many of the moneyboys, and as a speaker of the native tongue, I’ve gleaned insight into their world and the sadness plaguing almost every single one of them.

In the seemingly never-ending dance of clamouring for the approval of the ‘farang’ (well-dressed westerners with deep pockets and even deeper desires), the Patong moneyboy hustles the streets with fervent regularity, using their physical attributes as a form of currency to negotiate terms as the farang simultaneously barters them down to the lowest price based on their perceived worth.

Prostitution, the world’s oldest profession on full display, yet in Thailand the twist is this — PrEP is available sans prescription at almost any pharmacy (yes, really) and every single moneyboy I befriended in Patong was utilising it as a frontline defence against HIV infection.

The vast majority are like Chok*, who works and lives in one of the most prestigious male-only massage parlours dotting the streets of the ‘Paradise Complex’ (the GLBTI district of Patong), offering the infamous ‘happy ending’ rubdowns for a few hundred Baht and penetrative sex for a few thousand (roughly $60 AUD).

He began his escorting career in Patong when he was just 16, travelling North and escaping the limited opportunities of his small in-land village for the bustling scene of the Paradise Complex, he began taking a Thai generic form of Truvada for two years.

Phuket has a busy gay scene, mainly concentrated in the west coast town of Patong.

He’s been escorting in Patong for five years and says he has never had an HIV test. He looks perfectly fit and healthy to me, he’s braided with muscle, with bright eyes and a cherubic face. If it weren’t for the cigarette he chugs on as he talks to me at the cobblestoned entrance to his place of work I’d say he’s the picture of perfect health.

I am very scared of taking a test, and it costs a lot of money to visit a clinic, the local hospital has long waiting times and isn’t free either.

“My shop does not require me to have a test, we are given bottles of PrEP to take by the owner and that is the only requirement we have, as long as we take the pills we will be fine,” he said.

Indeed, the owners of the parlours and bars (mostly expat retirees and a handful of local Thai ‘businessmen’) require their employees to simply take PrEP to protect themselves and their customers.

Truvada is not approved for the management of HIV infection on its own — taking the drug if you’re HIV-positive can cause the virus to ‘mutate’, thus you can then pass on the infection to others even if they’re taking PrEP correctly and consistently. We’re well-versed on this in the West.

This methodology of madness in Patong is just that, and according to local doctor Watthana Singkrittaya who splits his time between the Patong Inter Medical and Siam Medical Clinics, there are circumspect moneyboys with visible symptoms of advanced HIV working the strip and taking PrEP.

“I see them if I walk to work along Patong Beach Road sometimes, they have visible signs of wastage and papular lesions on their bodies, I cannot treat them as they never come to ask for help and it is their way of life to do what they please”.

“I think they spend their money on other things like alcohol and drugs — to come and see me, would be wasting their money if they’re hooked on illegal methamphetamines,” he says with a shrug of his shoulders.

Indeed, even to the naked eye, certain moneyboys appear to be hampered by tell-tale signs of the infection. Their sexual stocks have plummeted and thus so too have their rates for sex and the number of customers they attract per week.

As the virus ravages their body, early retirement from this competitive and cutthroat line of work beckons.

Paradise Complex Patong is a short street where you get it all from drag shows, dancing and gogo bars, to massage parlours. Patong town is Phuket’s main tourist destination.

Anuput* is one such fellow. He tells me he’s in his late twenties and has only been escorting for a few years. He is 6 feet tall yet weighs less than 60 kilograms. I ask him if he will seek urgent testing and treatment. He speaks no English so we converse in Thai with several of his co-workers nodding in agreement along the way.

“It is expensive, to see a Doctor and to get a test, to get medicine to fix me,” he lamented. “Hardly any foreigners want to buy me, and that makes me sad, but I have no money saved to help me unless I get more customers. That’s why I am still here and when I have money I will get help and become a Tuk-Tuk driver or work in a hotel. That is my dream as it is awful to do what I do”.

The cruel coalface of what I’ve witnessed is arguably a result of poor policy implementation at a national level, and somehow this region of the world has become a ‘blindspot’ for international researchers in the sexual health field.

King Maha Vajiralongkorn has ruled the three executive branches of the Thai political system since the 2014 coup. Despite Thailand being a ‘mecca’ for GLBTI acceptance and diversity, his reign has failed to unearth positive health policies for preventing the spread of HIV, particularly among at-risk population groups like gay and bisexual males.

At the time of writing, there are no peer-reviewed international studies into PrEP-resistant strains of HIV in Thailand. How many tourists flocking to Patong from countries such as Russia (1.7 million of whom visited the country last year) have become infected by these sinister strains?

PrEP data regarding usage and follow-up testing does not form any part of the 2016-2020 Harm Reduction Strategy scheme from the Soviet Government. Last year the Moscow Regional Centre for HIV Care announced they would be commencing a trial with 100 men who have sex with men in order to shape future policy around the preventive treatment.

Talk about too little, too late — and they are one of many nations with sub-par or non-existent PrEP programs whose citizens make up a sizeable chunk of the 38 million international visitors to Thailand each year. How many of them are taking PrEP unmonitored? How many of them buy the pills at a Thai pharmacy (as easily as purchasing Aspirin mind you) thinking it’ll protect them against HIV during their holiday?

One of the most popular holiday destinations on Earth is in dire need of a solution to this scourge no matter how complex. I hold hope in my heart, yet our world is so globalised, is it only a matter of time until these strains begin to erode the efficacy of the greatest HIV-prevention tool closer to home?

Rob Edward Smith is a Melbourne-based Healthcare worker and Communications specialist with extensive travel experience in the region of South-East Asia.