Abstract:
With increasing ageing populations in Thailand, including sexually diverse communities, there has been little attention to older gay men and transgender women regarding their sexual health and well-being. Several international studies indicated that these communities have been underserved, especially in countries that lack human rights to protect against social and cultural stigma. The well-being of this population, that had experienced discrimination, victimization, and identity concealment in their early years, could have been better understood through open-ended exploration. This study explores the social-ecological factors contributing to the sexual health of older gay men and transgender women in Chiang Mai. This qualitative study was guided by a grounded theory approach. Eighteen in-depth interviews were conducted in Thai with 9 older gay men and 9 older transgender women aged 60 years and older and were locals. The semi-structured interview guide was informed by the social-ecological model. The interviews were digitally recorded and transcribed. The researcher conducted thematic analysis using line-by-line and thematic coding from the transcripts. Several themes emerged from the interviews across the social-ecological model–individual level: embarrassment of ageing, feeling of loneliness; interpersonal level: isolation, friends and family support; sociocultural level: culture and beliefs, stigma and discrimination; structural level: social exclusion, discrimination and stigmatization from service providers, and lack of law supporting ageing sexual minority populations. The intersectional impact of multi-level factors on sexual health and well-being of older gay men and transgender women demonstrated that individual- and interpersonal-level experiences could contribute to their well-being, both physically and mentally. Interventions on acknowledging awareness and the health needs of such marginalized communities may support understanding and improvement of their health quality. Sociocultural- and structural-level factors suggest that further social policy and intervention research should promote inclusion and equality for older gay men and transgender women in Thailand.
