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This paper is a part of a series of papers seeking insight into a holistic perspective into the lives, experiences and vulnerabilities of male-to-female transgender persons (from here on referred to as “transgender persons”/“Ladyboys”) within the sex industry in Southeast Asia. “Ladyboy” in Thai context specifically refers to the cultural subgroup, rather than the person’s gender identity and is not seen as an offensive term. Among the minimal studies that have been conducted, the majority have focused on sexual health and the likelihood of contracting or spreading HIV/AIDS, while often ignoring the possibility of other vulnerabilities. The paper aims to discuss this issue.

The study interviews 60 transgender persons working within red light areas of Bangkok. The final research instrument was a questionnaire of 11 sub-themes, containing both multiple choice and open-ended questions.

This study found that 81 percent of participants had entered the sex industry due to financial necessity. There was also a high vulnerability among transgender sex workers to physical and sexual violence. This includes nearly a quarter (24 percent) who cite being forced to have sex and 26 percent who cite physical assault within the last 12 months.

These findings can aid the development of programs and social services that address the needs of ladyboys, looking beyond gender expression and social identity to meet needs and vulnerabilities that often go overlooked.

This survey provides deeper understanding of the vulnerability of transgender sex workers, including their trajectory into sex work and potential alternatives.

The implementation of mobile health (mHealth) in developing countries seems to be stuck in a pattern of successive pilot studies that struggle for mainstream implementation. This study addresses the research question: what existing health-related structures, properties and practices are presented by rural areas of developing countries that might inhibit the implementation of mHealth initiatives?

This study was conducted using a socio-material approach, based on an exploratory case study in West Africa. Interviews and participant observation were used to gather data. A thematic analysis identified important social and material agencies, practices and imbrications which may limit the effectiveness of mHealth apps in the region.

Findings show that, while urban healthcare is highly structured, best practice-led, rural healthcare relies on peer-based knowledge sharing, and community support. This has implications for the enacted materiality of mobile technologies. While urban actors see mHealth as a tool for automation and the enforcement of responsible healthcare best practice, rural actors see mHealth as a tool for greater interconnectivity and independent, decentralised care.

This study has two significant limitations. First, the study focussed on a region where technology-enabled guideline-driven treatment is the main mHealth concern. Second, consistent with the exploratory nature of this study, the qualitative methodology and the single-case design, the study makes no claim to statistical generalisability.

To the authors' knowledge, this is the first study to adopt a socio-material view that considers existing structures and practices that may influence the widespread adoption and assimilation of a new mHealth app. This helps identify contextual challenges that are limiting the potential of mHealth to improve outcomes in rural areas of developing countries.