Social Stigma and Knowledge of Tuberculosis and HIV among Patients with Both Diseases in Thailand

Abstract

IntroductionDisease-related stigma and knowledge are believed to be associated with patients' willingness to seek treatment and adherence to treatment. HIV-associated tuberculosis (TB) presents unique challenges, because TB and HIV are both medically complex and stigmatizing diseases. In Thailand, we assessed knowledge and beliefs about these diseases among HIV-infected TB patients.MethodsWe prospectively interviewed and examined HIV-infected TB patients from three provinces and one national referral hospital in Thailand from 2005–2006. At the beginning of TB treatment, we asked patients standardized questions about TB stigma, TB knowledge, and HIV knowledge. Responses were grouped into scores; scores equal to or greater than the median score of study population were considered high. Multiple logistic regression analysis was used to identify factors associated with scores.ResultsOf 769 patients enrolled, 500 (65%) reported high TB stigma, 177 (23%) low TB knowledge, and 379 (49%) low HIV knowledge. Patients reporting high TB stigma were more likely to have taken antibiotics before TB treatment, to have first visited a traditional healer or private provider, to not know that monogamy can reduce the risk of acquiring HIV infection, and to have been hospitalized at enrollment. Patients with low TB knowledge were more likely to have severe TB disease, to be hospitalized at enrollment, to be treated at the national infectious diseases referral hospital, and to have low HIV knowledge. Patients with low HIV knowledge were more likely to know a TB patient and to have low TB knowledge.DiscussionWe found that stigma and low disease-specific knowledge were common among HIV-infected TB patients and associated with similar factors. Further research is needed to determine whether reducing stigma and increasing TB and HIV knowledge among the general community and patients reduces diagnostic delay and improves patient outcomes.

Social Impact of Stigma Regarding Tuberculosis Hindering Adherence to Treatment: A Cross Sectional Study Involving Tuberculosis Patients in Rajshahi City, Bangladesh

“…These indicators included``discriminated against while eating meals with family members,''``neglected by family members,''`n eglected by neighbors,''``neglected in the workplace,'' and``facing problems in taking part in social programs'' and were experienced by 51.4z, 15.4z, 45.9z, 61.9z, and 79.5z of patients, respectively. A study conducted in Thailand considered similar indicators and found that approximately 40.0z of patients could not eat meals with their families (15), which was a similar proportion to that observed in the present study. Another study conducted in Nepal found that 43.3z of TB patients were neglected by others, and 36.7z were asked to stay away from work (23).…”

“…Two decades into the TB pandemic, stigma remains a significant challenge for TB control programs across the prevention-to-care continuum. In Bangladesh and many other developing countries, TB-related stigma has been introduced at different levels (11,12,(14)(15)(16)(17). Studies conducted in various countries have reported that stigma affecting TB patients is influenced by several socioeconomic variables (18).…”

A systematic review of global cultural variations in knowledge, attitudes and health responses to tuberculosis stigma

“…9,10,[25][26][27]30,31,34,35,[37][38][39][40]42,49,55,58,71,[74][75][76][77][78] Patients with TB often consult traditional healers in Gambia, 74 South Africa, 40 Uganda, 10 Thailand, 77 Malaysia 76 and the Philippines. 78 Traditional herbal medicine is used by Samoans in the United States.…”

Social Networking in Tuberculosis: Experience in Colombia

“…Poverty predisposes individuals to TB through multiple mechanisms, such as malnutrition (Rocha et al 2011, Cegielski & McMurray 2004, and TB worsens poverty as it increases expenses and reduces income (Rocha et al 2011, Kemp et al 2007, Lonnroth et al 2007, Rajeswari et al 1999. Furthermore, poor TB-affected households often experience stigmatization; adding barriers to TB control (Rocha et al 2011, Atre et al 2011, Dhingra & Khan 2010, Pungrassami et al 2010, Jittimanee et al 2009. Poor people at the greatest risk of TB are therefore, in many settings, also the least able to access TB care (Rocha et al 2011).…”