Jintana Ngamvithayapong-Yanai, PhD. • JSPS-Fellow, Research Institute of Tuberculosis, Japan

• TB/HIV Research Foundation, Chiang Rai, Thailand

7th International Congress on AIDS in Asia and Pacific,

Kobe, Japan July 1-5, 2005

Acknowledgement• TB/HIV patients and families

• Japanese Foundation for AIDS Prevention (JFAP) and Ministry of Health, Welfare and Labor, Japan supported the TB/HIV research conducted in Chiang Rai, Thailand.

Chiang Rai, Thailand

Cambodia

Myanmar

China

Laos

Vietnam

Bangkok

Chiang Rai

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1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

HIV negativeHIV unknown

HIV positive

New TB rate by HIV status per 100,000 persons 1987-2002

Age and sex HIV status

TB treatment outcome

44 – M Negative Cured

21-M Negative Cured

19- M Negative Cured

26-F Negative Cured

29-F Negative Cured

34-F Negative Died after 1 month

28-M Positive Died after 3 months

22-M Positive Died after 3 weeks.

33-M Positive Died after 1 month

36-M Positive Died after 7 months

35-F Positive Died after 7 months

42 –F Positive Cured

34- F Positive Cured

TB treatment outcome of some pulmonary TB patients by HIV status

Killing…despite HIV-Negative TB

“I have been coughing for a year but I just bought anti cough syrup from the drug stores. Eventually, my sisters begged to me to have a blood test. They accompanied me to a private laboratory. I dared not to listen to the test result by myself. My sisters did that for me. They were extremely delighted to tell me that my blood was” negative”. I did not believe them...I thought they were afraid that I would commit suicide...so they lied to me. Even when they went to buy 2 dozen of beers and cerebrated with my family, I still hardly believed them. Only when the second test was done in the hospital, I became convinced. Doctor said I have tuberculosis not AIDS. ”

Attitude of health staff regarding TB/HIV

Attitude of health staff regarding TB/HIV

...We have many works that we have to do in

the health center. TB/HIV patients usually died soon after a few

weeks of TB treatment. Finally,they would die

because of AIDS anyway. We can not

help them. They are less priority. (Focus Group

Discussion with health center staff.)

TB/HIV Research Project(RIT-JATA)TB/HIV Research Project(RIT-JATA)

Fatalism (accept to die) among people with HIV/AIDS before the era of ARV

“My relatives said, “Going to hospital does not help. You will not be cured. Don’t go. If you can live…you just live. If you can not live, just prepare for the next birth in the next world. Whatever will be will be… Let it be.” Many of my siblings and relatives (seven) have died of AIDS. I am the only remaining person! I accepted not to go to the hospital. Just die…just die.”

(a TB(HIV+) male patient having major TB drug reactions but nobody brought him to the hospital)

AIDS stigma and fatalism

No hope…No motivation to take TB medicine

TB/HIV… Caring but still killing

Knowledge…

Hope… Strength…

for Curing TB

“Love”can increase adherence

I LOVE my mom and dad. Doctor said if I take medicine, I will not spread TB. Therefore, I must take the medicine. I must prevent my parents from getting TB from me.A 35 years old TB(HIV+) patient

Unfortunately, my daughter died after TB was cured because no poor patients could pay for anti-retrovirus drugs. But now several TB/HIV patients in my community can survive, they can live with their family and can feed the family. I missed my daughter….

I miss my daughter…

I am survived… and my children will survive

I am survived and my mother will survive

Caring…Promoting VCT for TB patients

What will happen if there is a strong collaboration

between AIDS and TB programs?

AIDSprogram

TB program

TB/HIVpatient

TB/HIV Research Project(RIT-JATA)TB/HIV Research Project(RIT-JATA)

TB/HIV From Killing to Caring and Cure

TB cured,

HIV managed,

and lives saved.…