EXECUTIVE SUMMARY: "...[T]his assessment examines mobility and HIV vulnerability among Myanmar migrants in Mae Sot District, Tak Province, Thailand. Environmental and social factors, service access, knowledge, and behavioural vulnerabilities, along with gender issues, stigma and discrimination, are addressed. Undertaken from December 2005 through April 2006, this assessment aims to assist the Royal Thai Government (RTG) and partners to develop more effective policies and programmes for preventing HIV transmission, and to improve access to HIV and AIDS treatment and care among selected Myanmar migrants. The assessment team employed a collaborative qualitative and quantitative research approach to assess HIV vulnerability among migrant sex workers and migrant factory workers. A total of six focus group discussions were conducted with both direct and indirect sex workers, while six and four focus group discussions were conducted with male and female factory workers respectively. Eight individual interviews with direct and indirect sex workers were completed. Key informants and gatekeepers were consulted and snowball sampling was used to establish the appropriate groups or individuals for interview. The quantitative component of the assessment was designed using probability proportionate to size (PPS) sampling methodology, and a pre-tested questionnaire was consequently administered to 819 migrant factory workers between the ages of 15 and 49 in 12 factories in Mae Sot District. There were 312 male and 507 female respondents, all of Myanmar origin. Through the research, the assessment team learned that migrants arrive in Thailand with little or no knowledge about HIV/AIDS and sexual health, and in some cases basic knowledge of reproductive health. Though training and outreach programmes have reached some of the factory worker and sex worker populations, knowledge remains at a very basic level and is predominantly disseminated by friends and siblings who attended various trainings. The qualitative and quantitative findings show that most of those demonstrating some knowledge of HIV/AIDS were merely reiterating what was disseminated during the outreach. Important knowledge and some behavioural gaps persist. From as far as Sagaing in central Myanmar to just across the bridge in Myawaddy, migrants working at the factories of Mae Sot District are from diverse areas within Myanmar. The largest numbers, however, are from Mawlamyaing and Bago in Kayin State, in the eastern region of Myanmar. The driving forces behind the migration of the predominantly rural Myanmar population to Mae Sot District include financial difficulties back home due to debt, death or sickness, and the hope for a better life in the future. 1 Some of those who arrive in Myawaddy are brought to the Thai side of the border through the employment of ?carriers” or brokers (commonly referred to as gae-ri in Bamar or nai nah in Thai), who offer migrants job placement opportunities that would otherwise be almost impossible to achieve without a contact. Under such schemes, female migrants are particularly vulnerable to exploitation. There is evidence to suggest that brokers provide the initial capital for the women to migrate to Thailand and then sell them to a karaoke bar or brothel. The women are then bound to work off the amount of money that was paid by the brothel to the broker. Though factory work is certainly the most sought after type of employment, it is not consistently available. Many migrants are forced to wait several months for positions or find other endeavours as day labourers, farmhands, construction workers or housemaids, or simply return home. The ultimate goal for the majority of migrants working in Thailand is to accumulate enough capital to eventually return home to family and friends and use that capital for commercial pursuits. Should such pursuits fail, the individual often considers returning to Thailand. Sex workers are vulnerable to HIV primarily due to the high risk of their profession. Indirect sex workers (those working out of a karaoke bar, restaurant or freelance) are particularly vulnerable because information and services do not reach them. Conversely, factory workers demonstrated little vulnerability to HIV due to their sparse amount of free time, restriction of movement outside the factory compound, lack of extramarital sex, conservative social values and lack of disposable income. Their lack of knowledge with respect to HIV/AIDS and sexual health, however, creates some vulnerability. These findings could be confirmed by results from studies in other provinces/countries with migrants from other countries such as Lao PDR. Efforts need to be increased to provide culturally appropriate HIV/AIDS and sexually transmitted infection (STI) information to migrants, using strategies that facilitate analysis of personal risk perception. Health-care providers require improved sensitivity to the basic needs of migrants, including respect for confidentiality in the clinical setting. The importance of the public sector in providing STI, HIV and reproductive health services to migrants cannot be overemphasized. Migrants express a clear preference for STI treatment in the public health sector because they can better remain anonymous in the clinical Thai setting. Many direct sex workers (brothel-based sex workers) are already assisted through regular check-ups at Mae Sot General Hospital. Factory workers and sex workers involved in the study trust government health-care providers over nongovernmental organizations (NGOs) and community-based organizations. Great impact can be made by strengthening collaboration between government health-care providers and both the private sector and the migrants themselves. Migrant community health workers working under the direction of the health authorities can be an effective mechanism (e.g., the IOM-Ministry of Public Health [MOPH] Migrant Health 2 Programme model). Sensitivity, confidentiality and communication skills of public sector health-care providers should be strengthened for improved impact. Moreover, existing programmes (e.g., the hospital?s STI clinic) could be strengthened to ensure that migrants receive appropriate referral to an array of government and NGO services locally available. During the study it was clear that the agencies working on HIV-related programmes are neither communicating regularly nor cooperating effectively with one another. A strengthened coordination mechanism is warranted wherein government, NGO, and private sector stakeholders can improve transparency, share materials and information, strengthen referral networks and create improved working relationships. Although the study faced several obstacles, particularly regarding issues on access to targeted populations which affected the representativeness of the study sampling, the research team had used the best of their knowledge and skills in minimizing the study bias. It is the hope of the assessment team that the information contained within this study will assist in informing policy makers and implementers in improving STIs/HIV programmes for migrants in Mae Sot District and elsewhere in Thailand.