During a medical check-up, Pin consulted a doctor about receiving gender-affirming care. In an ideal setting, a sign language interpreter would communicate with her by painstakingly finger-spelling the concept "hormone". But when such assistance was not available, she and the doctor resorted to writing on paper.
"The conversation ended up in vain. It was too short to understand how hormone treatment works," she said.
Pin is a deaf LGBTI person who recently attended a sign language glossary workshop as part of the 2nd Thailand Transgender Wellbeing Conference. While the total population of this group remains unknown, at least 3,000 individuals have registered with the Deaf Thai Rainbow Club, founded in 2013 to empower deaf LGBTI individuals.
Participants join a sign language glossary workshop for deaf LGBTI people as part of the 2nd Thailand Transgender Wellbeing Conference. (Photo: Kontaros Teangtrong)
While terms such as LGBTI and trans rights have slipped into everyday use in Thai, converting them into sign language has been daunting. However, a community-led project is ensuring they are included in public conversation.
The Deaf Thai Rainbow Club has collaborated with the Rainbow Sky Association of Thailand to create 100 signs for deaf LGBTI people. Starting last year, the project has received funding from the Department of Empowerment of Persons with Disabilities. In March, representatives of from four regions brainstormed and reached a consensus on 86 signs. Approved by the National Association of the Deaf in Thailand, they are being publicised on social media weekly.
"They have been left in the dark. Despite Thailand's leading position as a transgender hub, those who are deaf are denied access to health knowledge," said Caesar Rittiwong, deputy director of the Office of Human Rights and Sustainability at the Rainbow Sky Association of Thailand, who is serving as an adviser to the Deaf Thai Rainbow Club.
Caesar Rittiwong. (Photo: Kontaros Teangtrong)
Caesar said the lack of signs limits their health literacy. Interpreters have had to make different gestures to body parts or finger-spell each letter of health concepts, for example, gonorrhea. Despite receiving treatment, communication barriers makes them less apt to follow through on medication. Moreover, they fall prey to health misinformation on social networks. Because they communicate in visual language, some easily follow influencers' advice on gender-affirming hormones, some of which are expensive and harmful. Others join chat groups that practise chemsex (party sex under the influence of drugs), which can heighten the risk of sexually transmitted infections (STIs).
"Thailand is renowned for its healthcare, but our friends have been left behind. I want to bring them along and increase their access to healthcare services," she said.
For example, the government has recently allotted 145.6 million baht for hormone therapy for 200,000 transgender individuals following the enactment of the Marriage Equality Bill.
Caesar recalled her experience from two decades ago. After graduating from university, she applied for jobs and passed written tests, but failed interviews due to her transgender identity. She then worked in a cabaret show, which made her familiar with transgender people with intersectional identities. A deaf transgender friend taught her sign language, which has since opened her to their world.
The Deaf Thai Rainbow Club is collaborating with the Rainbow Sky Association of Thailand on a new sign language glossary for deaf LGBTI people. (Photo: Kontaros Teangtrong)
"I feel compelled to support them. During my time at the Service Workers in Group Foundation [Swing], I put my experience to use at the Deaf Support Unit," she said.
In Oct 2019, Swing expanded HIV services for high-risk key populations, including transgenders with hearing impairment. It trained staff on working with them and partnered with the Thai Communications Relay Service Centre to relay translation via mobile phones. It also employed staff with hearing impairment to facilitate clinic services and assist in production of health communications materials for clients with hearing challenges.
Between October 2019 and December 2020, Swing provided HIV testing to 40 people with hearing impairment, including 19 men who have sex with men (MSM), 13 transgender women, three male sex workers (MSW) and five female sex workers (FSW), none of whom had ever been tested. Of these, seven MSMs (37%), two transgender women (15%), and three MSWs (100%) tested positive. All of them successfully received antiretroviral treatment. While the total number of hearing-impaired clients tested was low, the case-finding rate was much higher compared to other key populations without disabilities tested during the same period (30% versus 7%).
Caesar explained that the sign language glossary project involves community members, sign language interpreters and experts. During the four-day workshop in March, representatives from four regions proposed, debated and counted votes for new signs in a democratic way. It takes a simpler conceptual approach, creating meaningful visual representation rather than finger-spelling.
"However, some words are really difficult to represent. The concept of 'sex' is signified by placing both hands downward and pointing to sex organs. The concept of 'coming out' is conveyed by opening the closet. The concept of 'hormone' is shown by snapping indexes of both hands up and down to imitate the natural change of chemicals," she said.
Earlier this month, the workshop introduced examples that covers a wide range of topics from health to identity and human rights. Caesar noted that while hearing people have already reached the stage of gender unicorn, deaf people are starting at the genderbread person model. For example, the concept of "gender identity" involves pointing at the head to show that it is based on self-determination, while the concept of "sexual orientation" involves pointing at the heart to show that it is romantic attraction.
Meanwhile, the concept of "LGBTI" starts with raising the thumb of the right first (person), followed by expanding the left hand and moving it at the back to create an arc's shape of a rainbow (gender diversity). The concept of "transgender woman" begins with touching the tip of the ear, moving the right hand down to the chest and holding fingertips together as if a flower folds inward.
"While older generations can accept signs for katoey and sao praphet song, younger generations have ditched these two derogatory terms to use phu ying kham phet [transgender woman] which shows that sign language is evolving," she said.
The workshop also features new signs for syphilis, gonorrhea and HIV/Aids. Gestures for prevention include condom, PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis).
Beer, a participant in the workshop, said most of them use sign language and do not understand Thai very well, so sign language should be expanded to facilitate everyday conversation, for example, in healthcare services. Like many others, she struggles to identify pills that have similar colours.
"I hope that sign language becomes more prevalent. It should cover all existing terms in Thai. Interpreters should also learn new signs to facilitate communication between deaf and hearing people," she said.
