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From silicone and hormone injecting to sex reassignment surgery: the precarious road to becoming female of transgender funeral performers in Ho Chi Minh City, Vietnam

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This paper examines aspects of feminisation among a group of transwomen funeral performers in Ho Chi Minh City, Vietnam. It highlights the health hazards faced by members of this vulnerable social group as the result of the use of non-medically
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  Full Terms & Conditions of access and use can be found athttps://www.tandfonline.com/action/journalInformation?journalCode=tchs20 Culture, Health & Sexuality An International Journal for Research, Intervention and Care ISSN: 1369-1058 (Print) 1464-5351 (Online) Journal homepage: https://www.tandfonline.com/loi/tchs20 From silicone and hormone injecting to sexreassignment surgery: the precarious roadto becoming female of transgender funeralperformers in Ho Chi Minh City, Vietnam Huong Thu Nguyen To cite this article:  Huong Thu Nguyen (2019) From silicone and hormone injecting tosex reassignment surgery: the precarious road to becoming female of transgender funeralperformers in Ho Chi Minh City, Vietnam, Culture, Health & Sexuality, 21:9, 999-1011, DOI:10.1080/13691058.2018.1533144 To link to this article: https://doi.org/10.1080/13691058.2018.1533144 Published online: 07 Jan 2019.Submit your article to this journal Article views: 143View related articles View Crossmark dataCiting articles: 1 View citing articles  From silicone and hormone injecting to sex reassignmentsurgery: the precarious road to becoming female of transgender funeral performers in Ho Chi MinhCity, Vietnam Huong Thu Nguyen Department of Anthropology, Vietnam National University of Hanoi, Hanoi, Vietnam ABSTRACT  This paper examines aspects of feminisation among a group of transwomen funeral performers in Ho Chi Minh City, Vietnam. Ithighlights the health hazards faced by members of this vulnerablesocial group as the result of the use of non-medically prescribedhormone therapy, silicone injection and sex reassignment surgeryin the absence of legal provision regulating these practices. Theanalysis is conducted against the backdrop of overlapping dis-courses of sex and gender identity, class, medicalisation and polit-ics, both locally and globally. ARTICLE HISTORY Received 14 April 2018Accepted 3 October 2018 KEYWORDS Sex reassignment surgery;hormone therapy;transgender women; genderdiversity; Vietnam Introduction I will fight for equality for transgender people. Everyone wants to be happy, and so dotransgender people. We all want a good life where we are treated like everyone else andnot discriminated against.  These are the words of Vietnamese singer Nguyen Huong Giang to the jury before beingcrowned winner of the Miss International Queen (transgender) beauty pageant in Pattaya, Thailand on 9 March 2018 ( Vietnamnet   2018). She later declared she had no regrets what-soever about her decision to become a transsexual person ( BBC Vietnamese , 21 March2018). Back in Vietnam the media hailed her success as a source of inspiration for thetransgender community. 1 However, behind this media blitz and the aura of glamour sur-rounding Vietnam ’ s new international celebrity are the stark realities of the transition pro-cess facing many of her ordinary trans sisters, particularly the transwomen funeralperformers of Ho Chi Minh City as revealed in this preliminary qualitative study. From the global to the local: some theoretical perspectives  The concept of   ‘ transgender ’  entered public discourse in the early 1990s in the USA,along with the creation of transgender organisations and the emergence of  CONTACT  Huong Thu Nguyen huongethno@gmail.com   2018 Informa UK Limited, trading as Taylor & Francis Group CULTURE, HEALTH & SEXUALITY2019, VOL. 21, NO. 9, 999 – 1011https://doi.org/10.1080/13691058.2018.1533144  transgender theory (Stryker 2006, 5). According to the Yogyakarta Principles on theApplication of International Human Rights Law in relation to Sexual Orientation andGender Identity, gender identity may be defined as, each person ’ s deeply felt internal and individual experience of gender, which may or maynot correspond with the sex assigned at birth, including the personal sense of the body …  and other expressions of gender, including dress, speech and mannerisms. (TheYogyakarta Principles 2007, 6) Persons whose gender identity does not correspond with the sex assigned at birthare transgender persons  –  a term which, according to the Diagnostic and StatisticalManual of Mental Disorders (DSM-5) of the American Psychiatric Association, refers to ‘ the broad spectrum of individuals who transiently or persistently identify with a gen-der different from their gender at birth ’  in contrast to transsexual, which  ‘ refers to anindividual who seeks, or has undergone, a social transition from male to female orfemale to male ’ , which  ‘ involves a physical transition through cross-sex hormone treat-ment and genital surgery ’  (American Psychiatric Association 2013).In Vietnam, the concept of transgender seems foreign even to members of thetransgender population themselves (UNDP and USAID 2014). As Susan Stryker (2006, 14) remarks,  ‘ transgender is a category of First World srcin currently being exportedfor Third World consumption ’ . The concept of sex as being biologically determinedand gender as socially constructed are recent imports from the West, widely used byinternational organisations and local non-governmental organisations (NGOs) to pro-mote equal rights for sexual and gender minorities in Vietnam and elsewhere (Horton,Rydstrøm and Tonini 2015; Horton 2014; Newton 2014). In Vietnamese culture, various terms have been used to characterise those who dif-fer from binary gender norms. Vernacular expressions such as  la : i c   ai   (effeminate), b  ong  (shadow) and  d  -^ ong  (spirit medium) are used to describe effeminate men, someof whom may cross-dress (Nguyen 2016). When transgender women are pointed outto foreigners and named in English, phrases such as  ‘ half man half woman ’  or  ‘ half boy half girl ’  are used, or terms such as  ‘ gay ’  or  ‘ gay boys ’  (UNDP and USAID 2014). Inspecific ritual contexts the Vietnamese generally tolerate individuals who engage innon-normative sex/gender behaviours without intervening to punish or penalise them(Salemink  2015; Endres 2015; see Hossain 2017 for a parallel account in Bangladesh), and a few Vietnamese transgender persons choose to refer to themselves as  gi  ớ  i th ứ   ba  (third gender) (Nguyen 2016). There is ample evidence that sexual and gender non-conforming persons are sub- jected to social stigmatisation and discrimination by family and friends, at school, inthe community and in the media (Pham 2017; UNDP and USAID 2014). Particularly severe discrimination makes transgender persons the most vulnerable among thosegender and sexual minorities (Nguyen 2016; Newton 2014). The queer visibility shown by transgender youth often gives rise to unfavourable reactions and even open hostil-ity from others (Nguyen et al. 2013). This situation not only reinforces deeply rootedsocial prejudice, but also makes it even more difficult for members of this group togain access to jobs and social and health services (Hoang and Oosterhoff  2016).In recent years the National Assembly of Vietnam (NAV) has made a number of legal statements (NAV 2017, 2015b, 2014) affecting members of the non-heterosexual, 1000 H. T. NGUYEN  queer and non-binary population; the most important of these is a Bill to recognisetransgender people ’ s rights and allow those who have undergone reassignment toregister under their new sex (NAV 2015a). This is considered a landmark developmentfor the transgender community while fulfilling the state ’ s commitment to protect thecivil rights of all its citizenry. In search of a fitting female body Southern Vietnam during the decade following reunification was a difficult place fortransgender people in the wake of a social and cultural campaign to eliminate deca-dent Western influences and life styles left over from the war (Taylor 2001). As societychanged with economic openness and rising incomes in the  -D ^ oi M  o  ı  (Reform) era, theopportunity came for people in Vietnam to purchase products such as motorbikes andcosmetic surgery, and participate in the cinema and caf   e culture that in the immediatepost-war years had been branded as decadent and bourgeois (Earl 2013; Vann 2012; Leshkowich 2008). As Gordene MacKenzie (1994, 24) points out, since the mid-1950s the human body has become ever  ‘ more colonised by bipolar gender ideology ’ . Butmedicalisation also enables persons who believe they were born  ‘ in the wrong body ’ to strive to have the body that they desire. There is evidence that cosmetic surgery was practised in South Vietnam in the1960s and the 1970s by private doctors before the fall of Saigon (the former name of Ho Chi Minh City) (Barsky 1970; Kaplan et al. 1974). However, there are no reports of  sex reassignment surgery in capitalist Saigon before 1975. Regionally, the first male-to-female sex reassignment surgery reportedly took place at the ChulalongkornUniversity Hospital in Bangkok in 1975 (Chokrungvaranont et al. 2014). Since then,Bangkok has become an important destination for those who seek transition surgicalintervention. It is estimated that 90% of the transsexual patients operated on in Thailand in the 2010 – 2012 period were foreigners (Chokrungvaranont et al. 2014).In Vietnam, while the Bill recognising transgender rights passed in 2015 still has tobe worked out in practical detail, transgender persons who wish to alter their sex andwho can afford to do so continue to seek surgical intervention abroad. Thailandremains the favourite destination for Vietnamese transgender people since the costsare much lower than in the West or other Asian destinations like Korea or Hong Kong(Chokrungvaranont et al. 2014). The feminisation process among a specific group of transwomen funeral performersin Ho Chi Minh City examined here is therefore conducted against the background of overlapping discourses of sex and gender identity, class, medicalisation and politics,both locally and globally. It highlights the health hazards faced by members of thisvulnerable social group through the use of unsupervised hormone therapy, siliconeinjection and sex reassignment surgery in the absence of legal provision to regulatethese practices. While this paper focuses on transwomen, transgender men also makea lot of effort  –  financially and otherwise  –  to transition in Vietnam. However, theirexperiences are not the same, given that the gender order itself is hierarchical, with aconsistently higher value being placed on masculinity than on femininity (Schilt andWestbrook 2009). CULTURE, HEALTH & SEXUALITY 1001  Study background  The participants in this study were transwomen (assigned male at birth but who iden-tify as female) working as funeral entertainers in some of the popular districts of HoChi Minh City. Transgender funeral performers derive from the old tradition of the  k   eph  at   (actor/male singer) who performed in classical theatre productions called  h  at b ^ o : i  ,providing entertainment both for the living guests and for recently departed familymember at funerals in Southern Vietnam (Nguyen 2018). The ceremony re-emerged inthe 1990s in a revised form whereby  h  at b ^ o : i   was replaced by a repertoire of trad-itional songs and dance mixed with modern numbers including pop songs, fire danc-ing and even striptease. The funeral show provides a public space for transwomen toearn a living, while allowing them to live out their preferred gender identity for ashort time. The data analysed in this paper were collected as part of a two-year study of trans-women funeral performers in Southern Vietnam. The study involved participant obser-vation at funerals, shows and street performances, for example during the festivitiescelebrating Christmas Day in District 1 st of Ho Chi Minh City in 2017. In total, the studyteam conducted 45 in-depth, unstructured interviews and two focus group discussionswith transwomen performers in Ho Chi Minh City during fieldwork conducted in 2017and early 2018. Participants were purposefully sampled based on inclusion criteria stip-ulating that potential participants must be at least 18years of age and transgenderwomen. The first transwoman participant was introduced to us by the Ho Chi MinhCity based G3VN organisation which promotes the interests of, and provides healthcare services to, men who have sex with men and transgender communities. Theremainder of the sample was recruited using snowball sampling strategy after initialparticipants introduced others to us. This approach suited our purpose because bynarrowing our sample size we were able to concentrate on the particular  habitus  and hexis  –  to use Bourdieu ’ s concepts (Adkins and Skeggs 2004)  –  of a specific group of transwomen performers as part of a research project on the intersectionality of reli-gion, culture and gender variance as embodied in the funeral performance of these transwomen.Approval for the study was given by the Institutional Review Board of the HanoiSchool of Public Health. This study was conducted in line with sensitivity, whichincluded ensuring the research team conducted the project ethically, being non-judge-mental and maintaining strict confidentiality, while responding sensitively to potentialparticipant concerns. Informed consent was obtained from all potential participantsbefore any data collection began. Participants ’  confidentiality was protected by notrecording any names, identifying information sources or specific locations in researchreports; informed consent forms were filed separately from any study data or reports.Among the 45 transwomen respondents, the oldest was 67, and the youngest was22 and the only one attending university. Three respondents had migrated with theirfamilies from the Western provinces of Southern Vietnam; the rest were born andgrew up in Ho Chi Minh City  –  mostly in 4 th , 8 th and 10 th districts or in the outlyingB  ı nh Ch  anh and H  oc M ^ on Districts. At the time of the research, 10 of the respondentswere living with their families, while the rest were living on their own. All respondents 1002 H. T. NGUYEN
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