Sexual identities and lifestyles among non-heterosexual urban Chiang Mai youth: implications for health

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Sexual identities and lifestyles among non-heterosexual urban Chiang Maiyouth: implications for healthArunrat Tangmunkongvorakula; Cathy Banwellb; Gordon Carmichaelb; Iwu Dwisetyani Utomoc;Adrian Sleighb

a Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand b NationalCentre for Epidemiology and Population Health, Australian National University, Canberra, Australia c

Australian Demographic and Social Research, Australian National University, Canberra, Australia

First published on: 27 July 2010

To cite this Article Tangmunkongvorakul, Arunrat , Banwell, Cathy , Carmichael, Gordon , Utomo, Iwu Dwisetyani andSleigh, Adrian(2010) 'Sexual identities and lifestyles among non-heterosexual urban Chiang Mai youth: implications forhealth', Culture, Health & Sexuality, 12: 7, 827 — 841, First published on: 27 July 2010 (iFirst)To link to this Article: DOI: 10.1080/13691058.2010.499150URL: http://dx.doi.org/10.1080/13691058.2010.499150

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Sexual identities and lifestyles among non-heterosexual urban ChiangMai youth: implications for health

Arunrat Tangmunkongvorakula*, Cathy Banwellb, Gordon Carmichaelb,

Iwu Dwisetyani Utomoc and Adrian Sleighb

aResearch Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand;bNational Centre for Epidemiology and Population Health, Australian National University,Canberra, Australia; cAustralian Demographic and Social Research, Australian NationalUniversity, Canberra, Australia

(Received 16 September 2009; final version received 3 June 2010)

Using quantitative and qualitative data we explore perspectives on and experiences ofsexual lifestyles and relationships among more than 1750 young people aged 17–20years who reside in urban Chiang Mai, Thailand. We focus on respondents’representations and understandings of their sexual/gender identities derived mainlyfrom in-depth interviews and focus group discussions, supplemented with observationsand field notes. Our results show that while many young Thais described themselves asheterosexual women or men, others described themselves as gay, kathoey, tom, dii,bisexual or something else. The terms gay, kathoey, tom and dii are commonly used bythese Thais to denote a range of sexual/gender identities relating to persons who aresexually or romantically attracted to the same sex. We use case studies to illustrate thedistinctive characterisations, sexual lifestyles and relationships of each of theseidentities, together with possible health implications.

Keywords: sexual identity; gender identity; non-heterosexual; young people; Thailand

Introduction

Studies on young people’s sexuality in Thailand have only been undertaken in the last few

decades. Triggered by the HIV epidemic within the context of modernisation, sexuality,

which was traditionally considered to be a private issue, has been exposed to the public

gaze. Studies of sexual attitudes and behaviours have revealed that changes are underway

in sexual values, norms and practices among Thai youth (Thianthai 2004;

Tangmunkongvorakul, Kane, and Wellings 2005; Rasamimari, Dancy, and Smith 2008).

This paper describes Northern Thai young people’s sexual experiences and identities

that may affect their lifestyles and relationships. It aims to provide academics, healthcare

providers and health policy makers with a comprehensive understanding of contemporary

young people’s lives and with information that may be used to provide more sensitive

sexual health programmes and services for young people in Thailand.

Before discussing sexual and gender identities, it is important to delineate agreed upon

definitions of terms such as sex, gender and sexuality. However, achieving consensus

about the meanings of terms has proved difficult. As changes in thinking and attitudes

toward sexual/gender diversity both within Thai society and within the sexual health

ISSN 1369-1058 print/ISSN 1464-5351 online

q 2010 Taylor & Francis

DOI: 10.1080/13691058.2010.499150

http://www.informaworld.com

*Corresponding author. Email: [email protected]

Culture, Health & Sexuality

Vol. 12, No. 7, October 2010, 827–841

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research arena have occurred, the meanings of these terms have evolved. The World

Health Organization (WHO) (2006) defines the term ‘sex’ as referring to the biological

characteristics that define humans as female or male. This term also encompasses general

behaviour and sexual expression that refers to reproductive status and needs, while

‘gender’ is used to differentiate the roles of men and women that are determined by social

and cultural attributes and opportunities. WHO (2006) defines ‘sexuality’ as:

A central aspect of being human throughout life [which] encompasses sex, gender identitiesand roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality isexperienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values,behaviours, practices, roles and relationships. While sexuality can include all of thesedimensions, not all of them are always experienced or expressed. (5)

Sexual identity refers to whether a person is attracted to members of the other sex, their

own sex or both. Sexual identity is sometimes described as heterosexual, homosexual or

bisexual in English-speaking societies (Diamond 2002), although some Western academic

theorists use many other terms. The International Commission of Jurists (2007) defines

‘gender identity’as:

Each person’s deeply felt internal and individual experience of gender, which may or may notcorrespond with the sex assigned at birth, including the personal sense of the body (which mayinvolve, if freely chosen, modification of bodily appearance or function by medical, surgicalor other means) and other expressions of gender, including dress, speech and mannerisms. (6)

In the arena of gender/sexuality studies, concepts and categories related to non-normative

Thai sexuality and gender have attracted increasing academic attention. Many earlier Thai

gender studies concentrated on Thailand’s categorisation of male ( phuuchai; ),

female ( phuuying; ) and transsexual, transvestite or hermaphrodite (kathoey;

) (Morris 1994), although more recent studies have discussed the proliferation of

Thai sexual and gender identities (Jackson and Sullivan 1999, 5; Jackson 2000, 2003;

Jenkins and Bryan 2004; Chonwilai 2008).

Sexual and gender identity is still less understood in transitional Asian countries such

as Thailand rendering research in such locations fruitful and timely. Accordingly, this

study is set among young people and is focused on the less studied Northern region, which

is culturally, linguistically and geographically different from other Thai regions and has

particular sexual health issues. In the 1990s, for example, it had the highest reported levels

of HIV infection in Thailand (Nelson and Suriyanon 1994).

Work was conducted in Chiang Mai, which is the second largest Thai city and the

cultural, economic, communication and tourism centre of Northern Thailand. It has

become a major site of in-migration for rural residents, in particular young people who

move there for education and work (Timpan 2005). For young rural migrants, the city is a

new social space removed from the social and community surveillance or support of

families and relatives. They live in rented rooms among strangers who pay little attention

to them. As they gain new friends and social networks they define their own culture with

freedom to adopt new social behaviours and values and eventually sexual partners

(Timpan 2005; Tangmunkongvorakul 2009).

In Northern Thailand, little research has been conducted on the diversity of young

people’s sexual and/or gender identities which may affect their lifestyles, sexual

relationships and health consequences. Instead, most studies have focused more narrowly

on sexual behaviours and associated health risk outcomes (van Griensven et al 2004) or on

narrowly defined groups such as kathoey (Totman 2003) or male bar workers (De Lind van

Wijngaarden 1999).

828 A. Tangmunkongvorakul et al.

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Methods

This study focused on literate young men and women aged 17–20 years who lived or

worked in Chiang Mai City and had not yet married. The study population was

systematically recruited from three broad educational groups: (1) an out-of-school group,

(2) a vocational school students group and (3) a general school and university students

group. The out-of-school group consisted of participants recruited from the six biggest non-

formal education centres in Chiang Mai, where they usually spent three hours each

weekend attending a tutorial, and through four major non-governmental organisations that

worked with young people. Big private and public vocational and general schools and

universities in Chiang Mai were asked to participate. From each of them, classes

representing the full range of disciplines and courses available that contained appropriately

aged students were asked to participate. All students in the selected groups voluntarily

agreed once invited. A detailed description of the stratified sampling process and sample

size calculations are described elsewhere (Tangmunkongvorakul 2009).

The field research team consisted of the principal investigator (first author) and five

young research assistants (three females and two males), aged 20–23 years, trained in

sociology and anthropology and with additional training specific to the project. The

research assistants helped create an ambience in which young people would feel

comfortable discussing sensitive issues and providing their own perspectives.

Fieldwork involved a self-administered 22-page questionnaire, in-depth interviews

and focus group discussions. The questionnaire, covering socio-economic background,

recreational activities, alcohol, tobacco and other drug use, relationships, sexual/gender

identity and experience, sexually transmitted diseases, birth control, pregnancy and

abortion, mental health and need for sexual health services, was completed by 909 young

men and 840 young women. In-depth interviews and focus group discussions were the

main sources of qualitative data, supplemented by extensive field observations and field

notes. Sixteen men and fourteen women participated in the in-depth interviews. They were

recruited from amongst survey participants once enough rapport had been established to

be able to discuss their sexual activities. Along with ensuring that they came from the three

educational groups they were selected to represent a range of sexual/gender diversity.

Focus group topics were designed to further explore results from the survey. The group

interaction process was used to probe the normative aspects of young people’s daily lives

and intimate relationships. More than three-quarters of young people who participated in

the focus groups were also survey respondents. Eight male and eight female groups

consisting of four to eight participants who were homogeneous in terms of sexual/gender

identity and educational background, were conducted.

Questionnaire data were collected over a 12-month period in 2006 and analysed in

2007–2008 using SPSS version 14. Information from in-depth interviews and focus

group discussions was collected on digital recorders and fully transcribed in Thai into

Microsoft Word then analysed thematically using Atlas Ti version 5.2. This process

involved looking for unexpected themes as well as responses to directed questions.

Passages most relevant to the study were then translated into English.

This study received ethical research approval from Chiang Mai University and the

Australian National University. All efforts were made to protect participants’ anonymity

and confidentiality. To facilitate their comfort and security, participants chose the place

and time for interviews and group discussions. After interviews if they wished they were

provided with information, advice and brochures regarding the matters under discussion

and available services.

Culture, Health & Sexuality 829

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Findings

Sexual/gender identity

From field observations and informal discussions with Thai young people, it was

determined that, consistent with previous studies (Jackson and Sullivan 1999;

Archavanitkul and Tangchonlatip 2008), Thais do not distinguish clearly between

heterosexuality, homosexuality and bisexuality, nor do they consistently employ the global

terms gay, lesbian, bisexual, transsexual, transgender (Jackson 2000). The terms ‘gender’

and ‘sex’ are generally translated by the same Thai word ‘phet’ ( ), making it difficult to

distinguish between ‘gender identity’ and ‘sexual identity’ in a general Thai sense (see

Jackson 2000). Our construction of ‘sexual/gender identity’ (‘atalak thang phet ru tua ton

thang phet’; ) derives from one survey question

(and elucidated in interviews) that asked respondents to identify themselves as members of

a variety of categories. They were offered a choice between heterosexual (rak tang phet;

), gay (gay; ), kathoey ( ), tom ( ), dii ( ), bisexual (rak song phet;

), ‘questioning’ (yang song sai/mai nae jai; ) and other

(aun aun; ).

As stated by Jackson (2003) and Taywaditep et al. (2004), the term kathoey in Thai

usage formerly implied a man who saw himself more as a woman and often dressed to

varying degrees as a woman. Today it mostly refers to a man who has feminine social

behaviours, without much specific reference to sexual behaviour. Some Thais believe that

kathoey exists as a third gender identity in Thai society. The term kathoey has been used

for at least the last several decades to describe a feminine male person who is sexually

attracted to men.

Likewise the terms tom, which is short for ‘tomboy’, and dii, which comes from the

Thai word for ‘lady’, are categories of female homosexual, differentiated mostly on the

basis of social manners and appearance (Sinnott 2004; Taywaditep et al. 2004). Tom and

dii roughly correspond to the Western terms ‘butch’ and ‘femme’. Masculine tom women

are seen by Thais as women who want to be accepted as and live like men. On the other

hand, dii women are feminine-looking and passive in their gender role, being similar to

typical Thai women in their social manners. Among Northern Thai young people, the term

‘lesbian’ (lesbian; ) has not become very widely accepted and because of its

unpopularity most Thais now refer to female homosexuality by describing women as being

‘tom-dii’.

In the questionnaire survey (Table 1), almost 90% of male respondents described

themselves as heterosexual; others described themselves as gay (5.0%), kathoey (2.1%),

bisexual (1.2%), still questioning their sexual identity (3.5%) or as members of other

categories (such as tri-sexual, multi-sexual, and ‘I am what I am’). [Table 1 here]Young

men from out-of-school and vocational schools were more likely than those from general

schools/universities to define themselves as heterosexual ( p , .05).

However, nearly half the young men recruited from one particular commercial school

defined themselves as non-heterosexual (data not shown) and some revealed in interviews

and group discussions that they were attracted to particular vocational courses there, such

as accounting, marketing, hotel service and management. One-fifth of male university

students also described themselves as non-heterosexual.

A group of male university students and male commercial school students who

identified themselves as either ‘gay’ or kathoey were recruited to participate in focus group

discussions. They claimed that some male students who displayed feminine tendencies, or

sometimes had romantic feelings towards other men but had not ‘come out’, might feel

830 A. Tangmunkongvorakul et al.

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Tab

le1

.N

um

ber

san

dp

erce

nta

ges

of

surv

eyed

mal

esre

po

rtin

gd

iffe

ren

tse

xu

al/g

end

erid

enti

ties

by

edu

cati

on

alg

rou

p.

Sex

ual

/gen

der

iden

tity

Ed

uca

tio

nal

gro

up

Het

ero

sex

ual

mal

eG

ayK

ath

oey

Bis

exu

alQ

ues

tio

nin

gO

ther

To

tal

Ou

t-o

f-sc

ho

ol

ado

lesc

ent

gro

up

22

25

21

80

23

89

3.3

2.1

0.8

0.4

3.4

0.0

10

0.0

Vo

cati

on

alsc

ho

ol

stu

den

tg

rou

p3

69

10

11

21

25

40

99

0.2

2.4

2.7

0.5

2.9

1.2

10

0.0

Gen

eral

sch

oo

lan

du

niv

ersi

tyst

ud

ent

gro

up

20

63

06

81

20

26

27

8.6

11

.52

.33

.14

.60

.01

00

.0T

ota

l7

97

45

19

11

32

59

09

87

.75

.02

.11

.23

.50

.61

00

.0

Culture, Health & Sexuality 831

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uncomfortable defining themselves as gay or kathoey, so they identified themselves as

heterosexual or did not acknowledge any sexual identity. Also, those with obvious

‘feminine manners’ might not call themselves kathoey, but, rather, self-identify as gay or

not identify with any group because of sensitivity of the term kathoey. Consistent with

prior research (Jackson 2003), findings suggested that although Thai gay and kathoey

persons were more publicly visible than homosexual and transgendered persons in the

West, their place in society was quite marginal and sometimes subject to contempt:

I am not happy to call myself kathoey, and don’t like it either when someone else calls me thisname. I don’t know. Kathoey is not a polite word. . . . Or even if people call kathoey as a ‘saopra phet song’ ( ) [woman of the second kind], I still don’t like it. But if youask me, I would call myself gay. I don’t wear a girl’s clothes. (Jo, Male FGD, 17–20 years,private commercial school)

In the questionnaire (Table 2), around 85% of female respondents described themselves as

heterosexual, while far fewer described themselves as tom, dii, bisexual or still questioning

their identities. [Table 2 here]When compared by educational background, respondents

from general schools/university group were more likely than those in out-of-school and

vocational school student groups to define themselves as heterosexual ( p , .05). Higher

percentages of respondents in the vocational school group called themselves tom or dii,

while a higher proportion of those in the out-of-school group claimed to be bisexual or still

questioning their identities. Female respondents from public and private technical schools

were more likely to define themselves as tom, suggesting that the masculinised vocational

study courses (mechanics, electronics and construction) on offer were attractive to them.

Qualitative information revealed that the term tom used to describe female

sexual/gender identity might not be perceived to be as sensitive among females as

kathoey is among males, both from a self-identification perspective and from the

perspective of being labelled by others. This might reflect a hegemonic masculine

ideology (Taywaditep 2001) or the degree to which one subscribes to the value system in

which masculinity is an asset is considered superior femininity. Moreover, when

discussing this issue with female informants across many recruitment sites it was apparent

that self-identification and the perceptions of others in tom-dii terms could be changeable

over time, regardless of sexual experience:

Now in Chiang Mai it’s like a fashion that women who have a boy’s characteristics callthemselves tom. Some don’t even have the experience of having a girlfriend. I have knownmyself since I was very young that I am tom, and I have a girlfriend. But the kids may callthemselves this word [tom], and change their mind when they fall in love with a boy. (Karn,Female FGD, 17–20 years, public technical school)

Listening to boys and girls

The following are selected case studies of boys and girls (identified by pseudonyms) who

participated in in-depth interviews. The stories presented in this paper highlight the

lifestyles and sexual relationships of those who defined themselves as kathoey, tom or dii

or were still questioning their own identities. They present different approaches to

negotiating the conventions of bipolarity of gender.

A kathoey taking pleasure in her female appearance

Aom (18 years old) studied at a private vocational school which had more than 3000

students. In the following narrative, female pronouns such as ‘she’ or ‘her’ will be used

832 A. Tangmunkongvorakul et al.

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Tab

le2

.N

um

ber

and

per

cen

tag

eo

ffe

mal

esre

po

rtin

gd

iffe

ren

tse

xu

al/g

end

erid

enti

ties

by

edu

cati

on

alg

rou

p.

Sex

ual

/gen

der

iden

tity

Ed

uca

tio

nal

gro

up

Het

ero

sex

ual

fem

ale

To

mD

iiB

isex

ual

Qu

esti

on

ing

Oth

erT

ota

l

Ou

t-o

f-sc

ho

ol

ado

lesc

ent

gro

up

13

86

38

14

01

69

81

.73

.61

.84

.78

.30

.01

00

.0V

oca

tio

nal

sch

oo

lst

ud

ent

gro

up

16

32

35

61

22

21

17

7.3

10

.92

.42

.85

.70

.91

00

.0G

ener

alsc

ho

ol

and

un

iver

sity

stu

den

tg

rou

p4

10

10

41

32

20

45

98

9.3

2.2

0.9

2.8

4.8

0.0

10

0.0

To

tal

71

13

91

22

74

82

83

98

4.7

4.6

1.4

3.2

5.7

0.2

10

0.0

Culture, Health & Sexuality 833

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when referring to Aom, since she openly referred to herself as a ying song ( )

(woman two) or used the Thai wording ‘kathoey’ or ‘sao pra phet song’ (woman of the

second kind) or ‘the third gender’ in the general Thai sense.

Aom, who had moved from a small district to study in the city more than two years

ago, always wore makeup and dressed in female clothes. The school which Aom attended

allowed a group of kathoeys to dress in a female student uniform on the condition being

that they had to dress up and behave like ‘decent’ Thai women – being sweet, gentle,

graceful and pleasant, yet modest when interacting with older persons.

Aom said her kathoey gender was accepted at home by her parents. She had been

wearing female outfits occasionally since she was in grade 9 (aged 14 years). However,

when she first moved to Chiang Mai City to study her parents had felt uncomfortable about

letting her use a female student uniform, as they were afraid people would laugh at her

and her family, yet they allowed her after she begged and promised to behave like a polite

Thai girl.

Aom met a lot of boys when going out to pubs on Friday nights. In the pub she had

developed her own way of flirting with a boy; by not talking first, but only giving him a

smile and lifting her glass of beer. She would dress in a sexy female outfit and maintain an

attractive but somewhat shy manner. Although she employed her feminine manner to

make her feel valued by men, Aom had more confidence than is usual among Thai women,

who are expected to be modest in their appearance and manners and conservative in their

sexuality.

Aom valued boyfriends who offered her emotional benefits. She did not think that she

wanted to have sex with every boy she met: ‘Sex is not always necessary for me’, she said.

She went on:

I think having sexual intercourse is not the most important moment . . . I want to havesomeone to talk to, and care about me. . . . But anyway, if a guy wants to have sex he will askme if I will allow him. A guy is usually the one who makes a move. If he makes a good move, Iwill allow him to have sex with me. . . . Well, sometimes I also have one night standrelationships, maybe because I was drunk.

The contested and problematic nature of condom use was described by Aom who said:

I would prefer to use condoms every time [when having sex], but sometimes there wassomething I could not control. . . . Some boys took off the condoms before ejaculating, tellingme after that they could not get to orgasm with the condoms on. I did not know until I felt thefluid was in my body or wet outside. It was awful, but it still happened from time to time. . . .I am really scared to get AIDS because of those acts.

Aom said she had never reached climax by ejaculating, but felt good during foreplay and

was satisfied when boys ejaculated. The first few times she had had sex it had been very

painful and she had experienced anal bleeding. Her kathoey friends told her how to take

care of the pain and how to look after or her personal hygiene. It was a huge trade-off for

her to put up with the pain that resulted from having sex with men. But she kept doing it to

fulfil her sexual needs, explaining to herself that it was for pleasure.

Aom and a group of kathoey in the school were members of a local Men-who-have-

sex-with-men Health Centre (soon doo lae sukapap chai rak chai;

). Membership was not compulsory, but most of the kathoey

students joined this centre. It gave them a chance to get to know other kathoeys from

different schools, to participate in activities, to receive sexual health information and to get

access to sexual health services offered by the Health Centre. Aom visited the centre

sometimes when staff organised activities to promote sexual health for young people.

834 A. Tangmunkongvorakul et al.

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Despite her integration into a sexual education centre, Aom still had difficulty managing

sex and condom use:

The difficult part is how we can protect ourselves every time we have sex. . . . It is hardbecause sometimes we forget the necessity of protection, even when a condom is just thereclose to us. . . . I am also one who doesn’t make use of it properly.

A tom with a masculine personality

Ink (18 years old) in the third year of a public technical school (equivalent to year 12 in a

general school), was of masculine appearance, with a man’s mannerisms and style of

walking and talking. She had a short fashionable hairstyle which was popular for toms at

that this school. Since most students were boys and the minority who were girls usually had

short hair, all students in the school looked alike. Also, the school uniform for both male

and female students was a workshop outfit and trousers, which was preferred by groups of

toms in the school. They therefore did not look much different from boys in general.

Ink said she had behaved like a boy since she was very young. She had a brother who

she played with and she usually received old outfits like T-shirts and jeans from him:

We talk to each other like boys talk. My brother taught me how to play football, go fishing andfight to defend myself. In the family I was very close to my brother and happy to behave like him.

When Ink was 13, her parents became worried about her behaviour. They sent her to live

with her older sister in the city during a summer break, hoping that she would learn to

behave like a girl from her sister. ‘It turned out to be fun for me, as my sister had a lot of

female friends and I started to learn how to flirt with girls’, Ink said. Later her parents had

to admit that she could not be the girl they wanted her to be. Ink had a lot of tom friends at

school and started a gang when she was in grade 8 (aged 13–14 years). They wore similar

style clothes, accessories and hair.

Ink had her first girlfriend when she was in grade 8. This girlfriend was two years older

than her and went to the same school. She took care of her girlfriend, helped carrying her

school bag or books and they had soft drinks or ice cream together. Said Ink, ‘I held her

hand sometimes, and kissed her cheek when we were alone. When she left school I started

new relationships with others.’

However, as a child living with her parents in a small district, Ink did not have much

chance to be alone with girls. She explained that at that time her tom friends and she had

just watched X-rated videos and looked at cartoon books showing girls having sex with

girls. Ink started to have more serious sexual relationships with girls in Chiang Mai city.

She had had a girlfriend who studied at a commercial school and had sex with her by using

her fingers in the girlfriend’s vagina:

I liked her and wanted to know what it’s like when we had sex. . . . We did it in my apartmentwhen we sneaked out from school. . . . It was not so much fun for me the first time, as it was tomeet my girlfriend’s needs. She used to have sex with a boy, and wanted to try it with me.

By talking with Ink and some other toms, we found that sexual performance between

women and women could also lead to blood loss and fluid transfer that might enhance the

risk of adverse sexual health consequences, particularly HIV infection. On one occasion,

Ink told how, when having sex her partner had suffered bleeding from her vagina:

She didn’t have a period. But when I did it to her, using my fingers, fresh blood came out. . . .I was a bit shocked, but she kept asking me to continue. She said she didn’t feel any pain. . . .What was that? I didn’t understand why the blood flowed out and she didn’t feel pain. Did shehave cancer or something like that?

Culture, Health & Sexuality 835

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Ink addressed this question to the interviewer anxiously and curiously. All the interviewer

could do was suggest Ink tell the girl to see a doctor. Although Ink had had sex with many

young women she indicated that she would like to have a more intimate relationship with a

girl she really loved.

A dii’s first love story

Linda (18 years old) was a student in grade 12 in a public general school. She had been

born in Bangkok and lived there until she was seven years old before moving to Chiang

Mai to be taken care of by her aunts and a grandmother. Linda’s parents were divorced

when she was young. Once Linda was living in Chiang Mai she barely had contact with her

parents. She was supported financially by her relatives in Chiang Mai.

‘I like a woman with a masculine look’, Linda stated when asked about love and

relationship issues. Then, sadly, she went on:

I used to be in love with a friend who is two years younger than me. . . . It was two years ago,when I studied in grade 10 and she was in grade 8. . . . I saw her for almost two years and thenwe split up. But I do remember every moment of our being together. . . . I still feel heartachewhen I talk about her.

Linda’s relationship with Nat, her intimate girlfriend, was a ‘tom-dii’ relationship. Nat was

a tomboy and had been introduced to Linda in school by a friend. They had started the

relationship as if an older feminine sister was taking care of a younger masculine sister.

But as it turned out, Nat was the one who took care of Linda. When Linda was sad and

needed someone to cheer her up, Nat was always with her. Nat had some experience of

girl-girl relationships. For Linda, this was the first time.

Linda’s family acknowledged that Nat was her good younger friend and both of them

were very close. Nat’s parents allowed Linda to spend time at Nat’s home. The

relationship between Linda and Nat was like ‘being sisters’ in both of their families’

perceptions. Linda’s aunts were very protective and serious with her about boys. Often she

was criticised when male friends called her at home and told that it was inappropriate. ‘But

if a friend who calls me is a girl, they never criticise me’, Linda said:

As time went by Nat and I were so close, and she started to ask to be allowed to touch me. . . .We did it at Nat’s house, in her room upstairs, with her parents in the living room downstairs.I was confused and excited, and I admitted that it was good. We touched bodies, hugged andkissed. . . . A few months later we tried to do something more. . . . Nat had a series ofcartoons, magazines and DVDs of girl-girl relationships. Some were music videos, and otherswere movies. I read and watched them with her and felt so shy. Not very long after that, Nattried to have an intimate experience with me in her room.

Linda continued the narrative on her love life by telling the interviewer about the first time

she and Nat had sex, which was around half a year after they met. Nat used her fingers to

touch her and inserted them into her vagina. After that they tried it a lot more. Sometimes

Nat had sex with her a few times in one afternoon:

The more she did it the more I liked it, and it was much more exciting when she did it harder.Like using three fingers at the same time, having oral sex, or sometimes she inserted a bottle of‘roll on’ (deodorant) into my thing [vagina].

Nat never asked Linda to do it to her. ‘She said she felt good already when she saw me

reach it [an orgasm]’, Linda said. Apart from sexual issues, Linda and Nat shared some

other aspects that bonded their relationship. They were best friends and talked about

other things, such as school issues, families, friends, movie stars, personal problems and

so on. After a year of intimacy, Linda found out that Nat had another girlfriend who

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was in the same class as her. Linda was angry and disappointed and their relationship

broke up:

After I broke up with Nat I really had a difficult time. I had spells when I would cry, eat less,and could not sleep well. Sometimes I had a bad dream and could not sleep again untilmorning. . . . I know I talked less with my family, and my aunts were curious about this. Howcould I tell them that I broke up with Nat? Our families knew only that we were like sisters.. . . The persons I could share my feelings with were friends at school. But, you know, at thatmoment I could not concentrate on my school work.

The end of Linda’s intimate sexual experience led to her feeling quite depressed. She

anticipated that she might fail the university entrance exam because it would be held at the

end of the year and she still could not concentrate on school subjects. Linda said she had a

teacher who might listen to her and she might talk to her. She had good friends to talk to

who understood the ‘tom-dii’ situation. Nevertheless she continued to say, ‘I don’t

understand why I can’t forget about these things [Nat and their intimate relationship]. How

can I move on from this? . . . I want to forget it’.

A questioning boy: I am what I am

Ping (19 years old) was born in Chiang Rai, a neighbouring province of Chiang Mai. He

had studied in his home town until he finished grade 12, then came to Chiang Mai to study

business management. He was accepted into university because he was a talented cheer

leader. He was a university representative when it competed with other famous universities

in the ‘University Cheer Leader Cup’, nationally and internationally. Ping was a good

looking young man, conforming to a popular Thai slogan, ‘white, tall and handsome’.

Ping’s family had migrated from China. His father still travelled between China and

Thailand, so he felt closer to his mother. At home he never wanted to dress like a girl, but

he wanted to learn about cosmetic makeup and his sisters were always the subjects for his

makeup class. He also loved playing sports, like basketball, volleyball and swimming.

Ping had met his current boyfriend when he was in grade 10. They were friends in the

same sports club after they started to practice gymnastics, preparing to be cheer leaders.

After being so close they fell in love and had sex. Ping introduced his boyfriend to his

family, who were accepting. ‘In my love life with Ken [his boyfriend], I sometimes had

sex with someone else, as from time to time I met cute guys during sports activities’, said

Ping. They were only casual sexual encounters and he used condoms on those occasions,

but not with Ken as they trusted each other. In Chiang Mai, Ken was still with Ping. They

studied in the same programme and lived in the same rented room. They practiced in the

cheer leader class every evening until nightfall and over weekends and in their free time:

In our cheer leader group there are twelve women and eight men, but only two men are realmen. But, you know, we are always told by our coach that in front of an audience all malecheer leaders have to behave like men . . . to be strong, be well-mannered and look smart.

In terms of defining his identity, he simply answered, ‘Who knows?’:

I am not kathoey, but I don’t call myself gay. Sometimes I feel like I am a ‘Sailor Moon’ in aJapanese cartoon who can transform oneself into several body images with a magic power.Once here in this uni there was a kathoey beauty contest, and I just jumped in to dress like atraditional Thai girl to compete in the beauty pageant. . . . It was so enjoyable. . . . And when Iact like a man in a cheer leader activity I still feel so good. I cannot find a definition that fits me.

Ping explained that his relationship with Ken at the moment was all right. They were so

close that they loved each other more than just as lovers. ‘We are truly friends’, said Ping.

However, he continued:

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But, you know, life always has its own way. My mum wants me to pursue my study inShanghai, China. I don’t think Ken can go with me there because he is not from a rich family.Living expenses there are quite high. Maybe, I think, he deserves to live like a man’s life,having a family and kids if he wants to. I would be happy for him. For me, I have my own lifeto dream of . . . I may behave like a boy on seeing a girl in Shanghai, who knows.

Being a student in Chiang Mai and joining the famous group of cheer leaders had been

great fun for Ping. But he repeated that life always had its own way. ‘I will go for it’ – Ping

ended his narrative with these striking and thoughtful words.

Discussion

A focus of this paper is on the blurred borders between normative and non-normative sex

and gender roles among young people in Thailand. Here we report on a comprehensive

analysis of diverse sexual/gender identities and cross-gender practices drawing upon data

from a large questionnaire survey and interviews with young people in diverse settings in

Chiang Mai City. Stories from four non-heterosexual young people were selected to reflect

their distinctive lifestyles and their problems as they saw them. Only one (Aom) had

contact with a service regarding sexual health concerns. Ink and Linda mentioned that they

received information on sexual and reproductive health from the Internet and magazines.

Consistent with previous research in Northern Thailand (see, for example, van

Griensven et al. 2004), our survey results show that although most young Northern Thai

people define themselves as heterosexual, a certain proportion of them are attracted to the

same sex or to both sexes. Our study joins a growing body of research that shows that Thai

discourses relating to sexual and gender identity are multiple (Jackson 2000, Sinnott

2004), fluid (Thaweesit 2004, Pramoj na Ayutthaya 2007) and relevant to the Northern

Thai context. Moreover, our study suggests that non-heterosexual identities are more

widespread among some categories of in-school youth and that young people are

identifying with a sexual/gender identity which then influences their educational and

career choices. However, the identities described by young people may be expressed

without their having corresponding sexual experience.

Our case studies highlight the lifestyles and sexual relationships of those who define

their identities in different ways from heterosexuals. Aom’s narrative illustrates the

lifestyle of a young kathoey in Northern Thailand, showing how she relates to conventions

of gender and sexual identity. Sexual gratification was not a prominent drive in Aom’s

account, which supports Brummelhuis’ (1999) observation that a strong motivation for a

kathoey is that her ‘body [is] being admired and completely accepted as female’ (129).

However, to achieve this Aom sometimes submitted to penetrative sex without a condom.

Her story demonstrates the difficulties of a young kathoey in managing desire and

maintaining control over condom usage, even though she has an awareness of safe sex and

the condom’s benefits. This reflects the importance of having regular sexual health check-

ups, counselling and lessons on safer-sex negotiation.

Ink’s story enhances understanding of how a young tom chooses to have intimate

relationships with the same sex. She had displayed a masculine or boy-like personality

since she was young, regardless of her parents’ upbringing and support and she anticipated

maintaining her tom status in the future. Her concern over blood when having sex with her

girlfriend implies that the information on safer sex for girl-girl relationships has not been

provided; a point also noted by some Thai activists (see, for example, Chonwilai 2008).

Information on the risks of exposure to HIV infection is required for young toms and diis,

along with gender-sensitive sexual health education and care and mental healthcare.

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Representing herself as dii, Linda exemplifies the difficulties and benefits of her

relationship which was unquestioned but also unsupported by her guardians. The case

shows how challenging it is to get help with sexual issues since a Thai girl is expected to be

inexperienced in sexual relationships of any sort. Linda’s depression could lead to long-

term negative consequences, both for her mental health and her future education. Both

Linda and Ink like other young people learned about sexual practices via commercial

sources such as pornography and X-rated cartoons and magazines, the most popular of

which were Japanese.

Finally, Ping’s story demonstrates how a boy who had had sexual experiences with

many people of the same sex was not settled on a gender/sexual identity that he was

comfortable with, but was nevertheless happy. It suggests that non-heterosexual identities

may be for some a temporary phase and that a person’s gender identity can be relatively

fluid, depending on the surrounding environment and situation.

This study focuses on young people who are likely to use new technologies to provide

access to globalising and modernising influences concerning sexuality and gender. They

are also likely to be amenable to novel or non-normative forms of sexuality at a time in

their lives which is associated with risk-taking (Steinberg 2006) and when they sometimes

lack practical knowledge gained through experience. Young people are also more likely to

be exposed to judgemental social attitudes or authoritarian and institutionalised discourses

based on pervasive social values, norms and ideologies (Thaweesit 2004) than adults.

Young women are still expected to refrain from pre-marital sex, while young men

previously often had their sexual debut with sex workers. Exposure to a persistent HIV-

prevention campaign based on fears about commercial sex has led some young men to

seek other forms of sexual outlets (Kilmarx et al. 2000) while tom-dii relationships allow

young women a sexual expression that attracts little attention (Sinnott 2004).

In this context it is unsurprising that young people’s sexual lifestyles could contribute

to negative physical or mental health consequences. Although some exhibited an

awareness of safer sex, their stories suggest that they are still at risk of sexual and mental

health problems. Rattachumpoth (1999) identified a dearth of services for non-

heterosexual people in Thailand and noted that ‘Thailand’s sexual minorities are very

poorly served in terms of counselling, health support and other areas’ (xix). The same can

be said of services for young people based on their own reports (Tangmunkongvorakul

2009) and those of providers (Tangmunkongvorakul et al. 2006). We believe that Thai

health practitioners, youth counsellors and policy makers need a sound understanding of,

and sensitivity to, the lives of contemporary young people if they are to provide services

and counselling appropriate to their sexual/gender identity backgrounds.

Acknowledgements

This study was part of the Thai Health-Risk Transition Research Program supported by theInternational Collaborative Research Grants Scheme with joint grants from the Wellcome Trust UK(GR0587MA) and the Australian NHMRC (268055). We thank the research staff in Thailand andAustralia for their support, without which this work would not have been possible. We also thank theyoung people of Chiang Mai who contributed to this research.

References

Archavanitkul, K., and K Tangchonlatip. 2008. Highlighting sex/sexuality in population and socialstudies. In Population and social 2008: Highlighting sex/sexuality in population and socialstudies, ed. K. Archavanitkul and K. Tangchonlatip, 1–5. Nakorn Pathom: Institute forPopulation and Social Research, Mahidol University.

Culture, Health & Sexuality 839

Downloaded By: [Tangmunkongvorakul, Arunrat] At: 02:18 17 August 2010

Brummelhuis, H. 1999. Transformations of transgender: The case of the Thai kathoey. Journal ofGay & Lesbian Social Services 9, no. 2: 121–39.

Chonwilai, S. 2008. [Missing identity insexual health service]. In [Fluid-[Fluidity of sexuality: Gender identity, sexuality and health]. Nakorn Pathom: The SoutheastAsian Consortium on Gender, Sexuality, and Health. Center for Health Policy Studies, MahidolUniversity.

De Lind van Wijngaarden, J. 1999. Between money, morality and masculinity: Bar-based male sexwork in Chiang Mai. Journal of Gay & Lesbian Social Services 9, no. 2: 193–218.

Diamond, M. 2004. Sex and gender are different: Sexual identity and gender identity are different.Clinical Child Psychology & Psychiatry, Special Issue for July 2002 (Web version). Universityof Hawaii–Manoa. http://www.hawaii.edu/PCSS/biblio/articles/2000to2004/2002-sex-and-gender.html

International Commission of Jurists. 2007. Yogyakarta principles: Principles on the application ofinternational human rights law in relation to sexual orientation and gender identity. UNHCR.http://www.unhcr.org/refworld/docid/48244e602.html

Jackson, P.A. 2000. An explosion of Thai identities: Global queering and re-imagining queer theory.Culture, Health & Sexuality 2, no. 4: 405–24.

Jackson, P.A. 2003. Performative genders, perverse desires: A bio-history of Thailand same-sex andtransgender cultures. Intersection: Gender, history, and culture in the Asian context 9, August2003. Australian National University. http://intersections.anu.edu.au/issue9/jackson.html

Jackson, P.A., and G. Sullivan. 1999. A panoply of roles: Sexual and gender diversity incontemporary Thailand. Journal of Gay & Lesbian Social Services 9, no. 2: 1–27.

Jenkins, R.A., and K. Bryan. 2004. Cultural norms and risk: Lessons learned from HIV in Thailand.Journal of Primary Prevention 25, no. 1: 17–40.

Kilmarx, P.H., S. Supawitkul, M. Wankrairoj, W. Uthaivoravit, K. Limpakarnjanarat, S. Saisorn,M. Supachai, and D. Timothy. 1988. Explosive spread and effective control of humanimmunodeficiency virus in northernmost Thailand: The first decade of the epidemic in ChiangRai province 1988–1999. AIDS 14: 2731–40.

Morris, R.C. 1994. Three sexes and four sexualities: Redressing the discourses on gender andsexuality in contemporary Thailand. Positions 2, no. 1: 15–43.

Nelson, K.E., and V. Suriyanon. 1994. The incidence of HIV-1 infections in a village population ofNorthern Thailand. AIDS 8: 951–5.

Pramoj na Ayutthaya, P. 2007. Fluidity of Thai queer sexualities and their experiences of accessingsexual health care. MA thesis, Mahidol University.

Rasamimari, A., B. Dancy, and J. Smith. 2008. HIV risk behaviours and situations as perceived byThai adolescent daughters and their mothers in Bangkok, Thailand. AIDS Care 20, no. 2: 181–7.

Rattachumpoth, R. 1999. Forward. Journal of Gay & Lesbian Social Services 9, no. 2: xiii–xx.Sinnott, M. 2004. Toms and dees: Transgender identity and female same-sex relationships in

Thailand. Honolulu: University of Hawaii Press.Steinberg, L. 2006. Risk taking in adolescence: What changes, and why? Annals of the New York

Academy of Sciences 1021: 51–8.Tangmunkongvorakul, A. 2009. Sexual health in transition: Adolescent lifestyles and relationships

in contemporary Chiang Mai, Thailand. Ph.D. Thesis, Australian National University.Tangmunkongvorakul, A., R. Kane, and K. Wellings. 2005. Gender double standards in young

people attending sexual health services in Northern Thailand. Culture, Health & Sexuality 7,no. 4: 361–73.

Tangmunkongvorakul, A., C. Ruangyuttikarn, S. Sombatmai, and S. Biphodi. 2006. Providers’perspectives in addressing adolescents, sexual and reproductive health needs in NorthernThailand. Chiang Mai University Journal 5, no. 1: 103–19.

Taywaditep, K.J. 2001. Marginalization among the marginalized: Gay men’s anti-effeminacyattitudes. Journal of Homosexuality 42, no. 1: 1–28.

Taywaditep, K.J., E. Coleman, P. Dumronggittigule, R. Bishop, and L.S. Robinson. 2004. Thailand.In The Continuum complete international encyclopaedia of sexuality, ed. R.T. Francoeur andR.J. Noonan, 1021–53. New York and London: Continuum.

Thaweesit, S. 2004. The fluidity of Thai women’s gendered and sexual subjectivities. Culture,Health & Sexuality 6, no. 3: 205–19.

840 A. Tangmunkongvorakul et al.

Downloaded By: [Tangmunkongvorakul, Arunrat] At: 02:18 17 August 2010

Thianthai, C. 2004. Gender and class differences in young people’s sexuality and HIV/AIDS risk-taking behaviours in Thailand. Culture, Health & Sexuality 6, no. 3: 189–203.

Timpan, U. 2005. Sexuality of male adolescents: A case study of urban male adolescents at risk tosexual behaviour in Chiang Mai Province. MA Thesis, Mahidol University.

Totman, R. 2003. The third sex. London: Souvenir Press.van Griensven, F., P. Kilmarx, S. Jeeyapant, C. Manopaiboon, S. Korattana, R.A. Jenkins,

W. Uthaivoravit, K. Limpakarnjanarat, and T.D. Mastro. 2004. The prevalence of bisexual andhomosexual orientation and related health risks among adolescents in Northern Thailand.Archives of Sexual Behaviour 33, no. 2: 137–47.

World Health Organization. 2006. Defining sexual health: Report of a technical consultation onsexual health, 28–31 January 2002. Geneva: World Health Organization. WHO. http://www.who.int/reproductivehealth/topics/gender_rights/defining_sexual_health.pdf.

Resume

En utilisant des donnees quantitatives et qualitatives, nous explorons les points de vue sur les stylesde vie sexuels et les relations sexuelles, ainsi que les experiences dans ce domaine, parmi plus de1 750 jeunes ages de 17 a 20 ans qui vivent dans la ville de Chiang Mai, en Thaılande. Nous nousconcentrons sur les representations et les comprehensions des repondants en ce qui concerne leursidentites sexuelles/de genre, principalement documentees au cours d’entretiens en profondeur et dediscussions de groupes thematiques, completes par des observations et des notes de terrain. Nosresultats montrent qu’alors que beaucoup de jeunes thaılandais se decrivent comme des femmes oudes hommes heterosexuel(le)s, d’autres se presentent comme gays, kathoey, tom, dii, bisexuel(le)sou autre chose. Les termes gay, kathoey, tom, et dii, sont couramment employes par ces jeunesthaılandais pour annoncer une serie d’identites sexuelles/de genre correspondant a des personnesattirees par le meme sexe, d’un point de vue romantique ou sexuel. Nous utilisons des etudes de caspour illustrer les caracterisations distinctives, les styles de vie et les relations sexuels propres achacune de ces identites, ainsi que les potentielles implications en matiere de sante.

Resumen

Con ayuda de datos cuantitativos y cualitativos, analizamos las perspectivas y las experiencias deestilos de vidas y relaciones sexuales de mas de 1750 jovenes con edades comprendidas entre los 17 y20 anos que residen en la zona urbana de Chiang Mai, Tailandia. Prestamos atencion al modo en quelos entrevistados representan y comprenden sus identidades sexuales y de genero a partir sobre todode entrevistas exhaustivas y charlas en grupo que se complementan con observaciones y notas decampo. Nuestros resultados indican que si bien muchos jovenes se describen como mujeres uhombres heterosexuales otros se consideran homosexuales, kathoey, tom, dii, bisexuales u otrosterminos. Los terminos homosexual, kathoey, tom y dii suelen ser muy usuales entre los tailandesespara designar toda una serie de identidades sexuales o de genero con respecto a personas que sesienten sexual o romanticamente atraıdos por personas de su mismo sexo. Con ayuda de estudios decaso, ilustramos las caracterizaciones distintivas, los estilos de vida sexual y las relaciones de cadauna de estas identidades, junto con las posibles repercusiones para la salud.

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