Tb/hiv...from Killing, To Caring And Curing

TB/HIV...From Killing to Caring and Curing... 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 China

Vietnam

Myanmar Laos Chiang Rai

Bangkok Cambodia

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

TB treatment outcome of some pulmonary TB patients by HIV status 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

Killing…despite HIV-Negative TB “I had been coughing for a year but I just bought anti cough syrup from the drug stores, this did not have any effect. Eventually, my sisters begged me to have a blood test. They accompanied me to a private laboratory. I didn’t dare to listen to the blood test result myself. My sisters went there for me. They were extremely delighted to tell me that the result was ”negative”. Of course, I didn’t believe them...I expected they thought it was best to lie to me about the results because they were afraid of me committing suicide. Even when they bought 2 boxes of beer to cerebrated the good news with my family, I still couldn’t believe them. Only later when they tested me for the second time, the results convinced me. The doctor said I had tuberculosis but not HIV. ”

Attitude of health staff regarding TB/HIV ...We have a lot of work to do in the health centers. Usually TB/HIV patients die soon after a few weeks of TB treatment. Eventually they would die on AIDS anyway. So we are unable to help them. They are not our priority. (Focus Group Discussion with health center staff.)

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. My 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

I miss my daughter… Unfortunately, my daughter died shortly after she was cured from TB because poor patients could not pay for anti-retrovirus drugs. But now several TB/HIV patients in my community can survive, they can live with their family and can help feed the family. I miss my daughter….

I survived… and so my children will survive!

I survived and so my mother will survive!

Caring…Promoting VCT for TB patients

15

What will happen if there would be a strong collaboration between AIDS and TB programs?

TB/HIV patient

AIDS program

TB program

TB/HIV From Killing to Caring and Cure

TB cured, HIV managed, and lives saved.…