BBC NEWS / Asia-Pacific
A new drive to contain the spread of HIV/Aids in Laos is forcing officials to recognise a marginalised group - transgender men known as "katheoy". The BBC's Jill McGivering went to meet some of them in the capital, Vientiane.
Discrimination can make it hard for katheoys to find work
Khom was born male.
But she has thought of herself as female since she was about nine years old.
Now 28, she could easily be accepted as a woman. She has long, styled hair, make-up, and a gentle, feminine manner.
But when she talks about her experiences of being "katheoy" in Laos, her voice is solemn. They're not fully accepted, she says.
She uses the example of trying to find a job. If she fills in an application form, it always needs a photograph as well. The selectors look at his gender - "male" - and at the photograph. It goes in the wastepaper bin, and she never gets called for interview.
High-risk
But after being largely ignored for so long, katheoys like Khom are suddenly the focus of attention from the Lao government. Some are "long-haired" katheoys like Khom, who present themselves as women. Others are "short-haired" katheoys who present themselves as men.
Both groups have sex with men.
They have emerged as the country's highest risk group for HIV/Aids - and are now the target of a special campaign.
Sex education is vital in the fight against HIV/Aids
In Vientiane, I visited one of three new men's health and social centres which target katheoys and their male partners. The centres have free internet access, dance classes and a social programme - alongside education about safe sex and condom use, and a doctor's clinic which specialises in treating sexually transmitted infections.
Rob Gray of the charity Population Services International showed me around it, and explained the particular focus on katheoys and other men who have sex with men.
Last year, he told me, a government survey found the HIV rate amongst men who have sex with men in Vientiane was 5.6%.
For Laos, that's very high - higher than the rate amongst other high-risk groups, including female sex workers.
There are now plans for a nationwide survey which should be completed later this year and give a much broader picture.
'Unthinkable' behaviour
For Laos government officials, mostly drawn from the older generation, addressing the issue of men having sex with men has apparently not been easy. Five years ago, say health officials, it would have been unthinkable.
Dr Chansy Phimphachanh is the director of the government's Centre for HIV/Aids.
It has been a struggle, she says, to get senior leaders to understand and confront the idea of sexual behaviour which seems to them to be unorthodox.
"The first time we really held a meeting about men who have sex with men, it was hard for policymakers and some government officials to recognise this. At the beginning, it was very hard. The issue was new and it was hard to explain it. Now we can talk about it much more openly."
Wider Lao society seems far more in touch with katheoy culture - and generally tolerant of it.
I went with Khom and her friend to walk along the banks of the Mekong river.
Families were having picnics under the trees in the sweltering heat. Children were playing on the nearby swings, and vendors were selling cooked meat and cold drinks from carts.
'Third' gender
Everyone I asked knew exactly what katheoys were.
Many people described them as a "third" gender. One or two people frowned when they saw Khom and her friend pass. One man said he would rather not talk to katheoys.
But most people seemed sympathetic.
"It's their nature, they were born that way. They can't help it," shrugged one middle-aged man.
I asked one man how he would feel if his son was katheoy.
"I'd be disappointed," he said. "But I'd learn to live with it. It's not something you can change."
The issue of HIV prevention may force Laos to acknowledge its population of katheoys more fully. Khom certainly hopes for greater tolerance.
"I just want to be accepted," she told me, "and not separated from the rest of society."
Enjoy Life, Be Free!
Wider Lao society seems far more in touch with katheoy culture - and generally tolerant of it.
I went with Khom and her friend to walk along the banks of the Mekong river.
Families were having picnics under the trees in the sweltering heat. Children were playing on the nearby swings, and vendors were selling cooked meat and cold drinks from carts.
'Third' gender
Everyone I asked knew exactly what katheoys were.
Many people described them as a "third" gender. One or two people frowned when they saw Khom and her friend pass. One man said he would rather not talk to katheoys.
But most people seemed sympathetic.
"It's their nature, they were born that way. They can't help it," shrugged one middle-aged man.
I asked one man how he would feel if his son was katheoy.
"I'd be disappointed," he said. "But I'd learn to live with it. It's not something you can change."
The issue of HIV prevention may force Laos to acknowledge its population of katheoys more fully. Khom certainly hopes for greater tolerance.
"I just want to be accepted," she told me, "and not separated from the rest of society."
Enjoy Life, Be Free!
