In this study, the authors identify opportunities for and challenges in reducing the risks of tuberculosi (TB) and HIV/AIDS transmission in Thailand. They carried out more than six repeated in-depth interviews with each of 13 participants who have been newly diagnosed with TB, 7 of whom were HIV positive, and their caregivers, until the patient recovered from TB or died. They performed extensive observations during relevant private and public activities and analyzed the data using grounded theory, focusing on behaviors affecting risk of transmission. Out of strong virtue, many caregivers felt a responsibility to care for their ill loved ones, thus putting themselves at risk of transmission. For the older generation, this was unimportant, as they had already completed their life cycle (“let it be”). However, strong human bonds encouraged the patients to complete TB treatment until cured or deceased. The authors discuss strategies to build on appropriate behaviors.
Assavanonda, A. (2001, April 25). Monks’ role in helping patients discussed: Right conduct can help fight infection (AIDS Forum). Bangkok Post, p. 14-14.
2.
Baker, S., Sudit, M., & Litwak, E. (1998). Caregiver characteristics and types of assistance provided by caregivers to minority women living with HIV/AIDS. Journal of Cultural Diversity, 5(1), 11-18.
3.
Blumberg, H. M. (2000). Tuberculosis infection control. In L. B. Riechman & E. S. Hershfield (Eds.), Tuberculosis: A comprehensive international approach(2nd ed., pp. 609-643). New York: Marcel Dekker.
4.
Brown M. A., & Powell-Cope, G. M. (1991). AIDS family caregiving: Transitions through uncertainty. Nursing Research, 40(6), 338-345.
5.
Carlisle, C. (2000). The search for meaning in HIV and AIDS: The carers’ experience. Qualitative Health Research, 10(6), 750-765.
6.
Celentano, D. D., Nelson, K. E., Lyles, C. M., Beyrer, C., Eiumtrakul, S., Go, V. F., et al. (1998). Decreasing incidence of HIV and sexually transmitted diseases in young Thai men: Evidence for success of the HIV/AIDS control and prevention program. AIDS, 12(5), F29-F36.
7.
Comstock, G. W., & Cauthen, G. M. (1993). Epidemiology of tuberculosis. In L. B. Riechman & E. S. Hershfield (Eds.), Tuberculosis: A comprehensive international approach(pp. 23-48). New York: Marcel Dekker.
8.
Crofton, J., Horne, N., & Miller, F. (1992) Clinical tuberculosis. Hong Kong: Macmillan.
9.
Glanz, K., Lewis, F. M., & Rimer, B. K. (1997). Health behavior and health education(2nd ed.). San Francisco: Jossey-Bass.
10.
Hays, R. B., Magee, R. H., & Chauncey, S. (1994). Identifying helpful and unhelpful behaviors of loved ones: The PWA’s perspective. AIDS Care, 6(4),379-392.
11.
Hopewell, P. C. (1986). Factors influencing transmission and infectivity of Mycobacterium tuberculosis: Implications for clinical and public health management. In M. A. Sande, L. D. Hudson, & R. K. Root (Eds.), Respiratory infections(pp. 191-216). New York: Churchill-Livingstone.
12.
Hopewell, P. C. (1993). Tuberculosis and infection with the human immunodeficiency virus. In L. Riechman & E. S. Hershfield (Ed.), Tuberculosis: A comprehensive international approach(pp. 369-394). New York: Marcel Dekker.
13.
Hudelson, P. (1999). Gender issues in the detection and treatment of tuberculosis. In J. D. H. Porter & J. M. Grange (Eds.), Tuberculosis: An interdisciplinary perspective(pp. 339-355). London: Imperial College Press.
14.
Jenkins, R. A., Manopaiboon, C., Samuel, A. P., Jeeyapant, S., Carey, J. W., Kilmarx, P. H., et al. (2002). Condom use among vocational school students in Chiang Rai, Thailand. AIDS Education and Prevention, 14(3), 228-245.
15.
Kanwanich, S. (2000, August 20). Suffer the innocent victims [Perspectives]. Bangkok Post, p. 14-14.
16.
Kilmarx, P. H., Limpakarnjanarat, K., Mastro, T. D., Saisorn, S., Kaewkungwal, J., Korattana, S., et al. (1998). HIV-1 seroconversion in a prospective study of female sex workers in northern Thailand: Continued high incidence among brothel-based women. AIDS, 12(14), 1889-1898.
17.
Kilmarx, P. H., Palanuvej, T., Limpakarnjanarat, K., Chitvarakorn, A., St. Louis, M. E., & Mastro, T. D. (1999). Seroprevalence of HIV among female sex workers in Bangkok: Evidence of ongoing infection risk after the “100% condom program” was implemented. Journal of Acquired Immune Deficiency Syndromes, 21(4), 313-316.
18.
Klovdahl, A. S., Graviss, E. A., Yaganehdoost, A., Ross, M. W., Wanger, A., Adams, G. J., et al. (2001). Networks and tuberculosis: An undetected community outbreak involving public places. Social Science & Medicine, 52, 681-694.
19.
Knodel, J., VanLandingham, M., Saengtienchai, C., & Im-em, W. (2001). Older people and AIDS: Quantitative evidence of the impact in Thailand. Social Science & Medicine, 52, 1313-1327.
20.
Leblanc, A. J., London, A. S., & Aneshensel, C. S. (1997). The physical costs of AIDS caregiving. Social Science & Medicine, 45, 915-923.
21.
Lertpiriyasuwat, C., Plipat, T., & Jenkins, R. A. (2003). A survey of sexual risk behavior for HIV infection in Nakhonsawan, Thailand, 2001. AIDS, 17(13), 1969-1976.
22.
Manopaiboon, C., Shaffer, N., Clark, L., Bhadrakom, C., Siriwasin, W., Chearskul, S., et al. (1998). Impact of HIV on families of HIV-infected women who have recently given birth, Bangkok, Thailand. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 18(1), 54-63.
23.
Marins, J. R., Jamal, L. F., Chen, S. Y., Barros, M. B., Hudes, E. S., Barbosa, A. A., et al. (2003). Dramatic improvement in survival among adult Brazilian AIDS patients. AIDS, 17, 1675-1682.
24.
Ngamvithayapong, J., Winkvist, A., & Diwan, V. (2000). High AIDS awareness may cause tuberculosis patient delay: Results from an HIV epidemic area, Thailand. AIDS, 14, 1413-1419.
25.
Ngamvithayapong, J., Yanai, H., Winkvist, A., & Diwan, V. (2001). Health seeking behavior and diagnosis for pulmonary tuberculosis in an HIV epidemic mountainous area of Thailand. International Journal of Tuberculosis and Lung Disease, 5(11), 1013-1020.
26.
Ngamvithayapong, J., Yanai, H., Winkvist, A., Saisorn, S., & Diwan, V. (2001). Feasibility of home based and health center based DOT: Perspectives of TB care providers and clients in an HIV epidemic area, Thailand. International Journal of Tuberculosis and Lung Disease, 5(8), 741-745.
27.
Ngamwittayaphong, A. (2004). Knowledge... hope... strength for curing TB(J. NgamvithayapongYanai, Ed.). Bangkok, Thailand: 21 Century. Retrieved July 27, 2005, from http://www.tbhiv.org/foundation/PUBLICTION/Knowledge_Hope_Strength_for_curing_TB.pdf
28.
Pavalko, E. K., & Woodbury, S. (2000). Social roles as process: Caregiving careers and women’s health. Journal of Health and Social Behavior, 41(1), 91-105.
29.
Pornsiripong, S. (1998). Social responses to the HIV/AIDS patients and family. In P. Boonmongkol, P. Pradubmook, & S. Ruangsorn (Eds.), State of the art review in socio-economic and behavioral research on AIDS(pp. 111-144). Nakornpathom, Thailand: Center for Health Policy and Social Welfare Study, Mahidol University.
30.
Rieder, H. L. (1998). Tuberculosis and HIV infection in industrialized countries. In P. D. O. Davies (Ed.), Clinical tuberculosis(pp. 347-363). London: Chapman & Hall.
31.
Rojanapithayakorn, W., & Hanenberg, R.(1996). The 100% condom program in Thailand. AIDS, 10(1), 1-7.
32.
Sangchart, B. (1998). Illness behaviors and problem encountered of people living with HIV/AIDS. In P. Boonmongkol, P. Pradubmook, & S. Ruangsorn (Eds.), State of the art review in socio-economic and behavioral research on AIDS(pp. 77-109). Nakornpathom, Thailand: Center for Health Policy and Social Welfare Study, Mahidol University, Thailand.
33.
Scambler, G. (1998). Stigma and disease: Changing paradigms. The Lancet, 352, 1054-1055.
34.
Songwathana, P., & Manderson, L. (1998). Perception of HIV/AIDS and caring for people with terminal AIDS in southern Thailand. AIDS Care, 10(Suppl. 2), S155-S165.
35.
Stajduhar, K. I. (1997). Loss and bereavement: HIV/AIDS family caregiving experiences. Canadian Journal of Nursing Research, 29(4), 73-86.
36.
Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory(2nd ed.). Thousand Oaks, CA: Sage.
37.
UNAIDS. (2004). 2004 report on the global AIDS epidemic(UNAIDS/04.16E). Geneva, Switzerland: Author.
38.
Unahalekhaka, A., Subpaiboongid, P., & Lueang-a-papong, S. (1999). Knowledge on prevention of infection among family members of AIDS and HIV infected persons. Thai AIDS Journal, 11(3), 142-150.
39.
Valenti, W. M. (1995). Infection control, human immunodeficiency virus, and home health care, II: Risk to caregiver. American Journal of Infectious Control, 23(2), 78-81.
40.
Van Griensven, G. J., Limanonda, B., Ngaokeow, S., Ayuthaya, S. I., & Poshyachinda, V. (1998). Evaluation of a targeted HIV prevention programme among female commercial sex workers in the south of Thailand. Sexually Transmitted Infections, 74(1), 54-58.
41.
Weitz, R. (1989). Uncertainty and the lives of persons with AIDS. Journal of Health and Social Behavior, 30(3), 270-281.
42.
Wight, R. G., Rotheram-Borus, M. J., Klosinski, L., Ramos, B., Calabro, M., & Smith, R. (2000). Screening for transmission behavior among HIV-infected adults. AIDS Education and Prevention, 12, 431-441.
43.
World Health Organization. (2004a). Interim policy on collaborative TB/HIV activities(WHO/HTM/TB/2004.330). Geneva, Switzerland: Author.
44.
World Health Organization. (2004b). Global tuberculosis control—Surveillance, planning, financing: WHO report 2004(WHO/HTM/TB/2004.331). Geneva, Switzerland: Author.
