1. Social marginalization, bullying and HIV vulnerability among Thai lesbian and bisexual female (LBF) secondary school students Thasaporn Damri 1, Pimpawun Boonmongkon 1,2, Timo T. Ojanen 1, Chet Ratchadapunnathikul 3, Nattharat Samoh 1, Mudjalin Cholratana 1 & Thomas E. Guadamuz 1,2 1. Center for Health Policy studies, Mahidol University, 2 Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, 3 Center for Health Law, Mahidol University

2. Background Social belief about HIV risk among lesbian Syndemics theory among MSM Heteronormativity and prejudice against non-gender normative persons Social marginalization of LBF students Bullying in school LBF students and bullying and HIV risk

3. Objective This study explored connections between social marginalization, bullying victimization and HIV vulnerability among lesbian and bisexual female (LBF) secondary school students

4. Research Methodology -Study sites: 4 regions(Northern, Central, Northeastern and Southern) and the capital city Bangkok. -Research methodology: qualitative research -67 FGDs, 56 IDIs, observations, target group; teachers and administers, general students and LGBT students -85 LBF students ( tom and dee student) -Tom student is a masculine lesbian who dresses, acts, and possibly speaks in a masculine fashion in Thai culture -Dee student is a girl who has in relationships with Tom. - Study was reviewed and approved by the institutional review board (IRB) of Mahidol University

5. Discrimination from teachers and administers Being label by teachers Lack of power to choose the sexuality they want Choose the way they want to dress /display their hair style Findings 1 : Social marginalization exists in 3 aspects

6. There are 13 of us in the group [of toms], right? Most of us wear our hair short, dye our hair. The teachers view us as bad girls for sure, as girls that have to be given warnings very often. Something like that.” (IDI, tom student, Bangkok) Example: Being labeled by teachers

7. Physical bullying (punching and kicking) Verbal bullying (Tom rat, Tom sa, Phet phat) Social bullying (hate tom club) Sexual bullying (touching breast and bottom) Teasing and bullying by teachers and administers (cutting grade, blaming) Findings 2 : Forms of bullying among LBF students

8. “It’s harsh! If a tom steals a girlfriend from a boy, it’s going to be really rough…like punching and kicking from the boys” (FGD, gay male students, Central) Example physical bullying among tom students

9. “Like, ‘why are you a tom, not a woman, why not?’ or ‘You were born to be a woman, so why are you not a woman?’” [we get ask questions] (FGD, tom students, Northeast) Example of verbal bullying among tom and dee students

10. HIV vulnerability Depression Alcohol use Unprotected sex

11. “I fingered my girlfriend. We did not use condom because we are not at risk because we women.” (IDI, tom student, Bangkok) Example of unprotected sex

12. Linkage between social marginalization, bullying victimization and HIV vulnerability A Story from Jib: A tom student who was raped by other male students Dee students have both male and tom partners [hard to recruit]

13. Example of linkage between Social marginalization bullying victimization and HIV vulnerability “When I was in grade 7 I heard that Pee Karn was raped by her friends because they wanted to change her to be a girl and then she has changed to be a girl” IDI tom student Northern

14. discussions Heteronormative views by Thai society, including prejudice against non-gender conforming persons Myth about temporary states of tom and dee Masculine role identity of tom making them vulnerability

15. Recommendations Build acceptance of sexual/gender diversity through activities that enable LBT students to fully express their identities and abilities in secondary school Encourage participatory teaching of comprehensive sexuality education that emphasises acceptance of diversity and mutual respect regardless of sex, gender, sexual orientation, gender identity or gender expression by engaging the Thailand Ministry of Education Promote acceptance of sexual/gender diversity within society at large through public campaigns, popular and social media, or activities of civil society organisations

16. Acknowledgement