A Social Ecology of Sexual Health and Well-being among Older Gay Men and Transgender Women in Chiang Mai, Thailand: A Qualitative Study

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.