A closer look at TB and HIV in a Northern Thai community
by VV Singh, ACW Campaign, 1 September 2006
Tuberculosis (TB) is the leading infectious cause of death for people living with HIV (PLHIV). The resurgence of TB is fuelled by HIV in many countries of the world including Thailand, which ranks 17th on the World Health Organization (WHO) list of the 22 high TB burden countries.
Despite Thailand’s designation as a high burden TB country, the current response from the government does not appear to match the magnitude of the problem. According to Thai researcher Amara Soonthordhada, “the general perception among political leaders as well as in Thai society is that TB has been completely eradicated.”[1]
One reason for this may be the lack of integrated TB/HIV policies and programmes at the national and sub national levels. Closer coordination between national TB and HIV programmes and services is vital for controlling the dual epidemics. TB and HIV accelerate each other's progression. PLHIV infected with TB have much greater chances of developing active disease than HIV negative people, even at high CD4 counts. In Thailand, 60% of people living with HIV were diagnosed with TB, according to the WHO report 2005.[2]
Recently, AIDS-Care-Watch (ACW) visited a support group for people living with HIV in Chiang Dao district, a rural area in northern Thailand, with the TB Photovoice Thailand project (TBPV Thailand). TBPV Thailand works to bring awareness on TB/HIV issues at the community level by providing volunteer participants with a camera and writing skills training to enable them to document (through photos and writing) TB/HIV issues in their communities. All the participants of this project are living with TB and/or HIV.
According to the TBPV Thailand coordinator Kaewta Sangsuk, participants from the Chiang Dao community are well suited for this project because the region is ethnically diverse, with a large migrant population—meaning, groups of people who are often unable to access information on issues such as TB and HIV. TBPV Thailand provides a crucial medium for helping the community to learn and speak out on these issues in their own words.
While visiting the project, ACW interviewed the Chief of the PLHIV support group, Songran Boonyo, who identified the following key issues facing the community: diagnosis of TB/HIV for people living in distant rural areas; awareness among community members about TB and HIV; and access to care and treatment for migrant populations.
Because Chiang Dao hospital is located in the urban centre of Chiang Dao district, and is the only formal health facility providing diagnosis for TB and HIV, it is difficult for people living in rural areas to access health services. Songran reported that patients living in rural areas must commute as far as seventy kilometers to receive care, costing them nearly 300 Baht (approximately 8 USD) to reach the centre.
Furthermore, for those who do make it to the hospital and have a resultant positive diagnosis for either TB or HIV, it still remains a challenge for them to return for the monthly check up which is often required during the first phase of treatment.
Aside from access difficulties for rural residents, other challenges remain. Diagnosis of TB in people living with HIV is vital in order to provide appropriate treatment and care, reported Nipaporn Oopinjai, Chief of TB and HIV/AIDS Department of Chiang Dao hospital. Yet, for many, general awareness and understanding about these issues in the community is still quite low. Also, because the region has a diverse population, such as several distinct ethnic groups, as well as Burmese migrants, it makes it complicated for hospital staff and campaign groups to foster awareness when each group has its own traditional beliefs about TB and HIV.
Finally, epidemics do not identify with national boundaries and laws but rather with people. Because of this, addressing TB and HIV prevention, care, support and treatment is further complicated in this region because of its close border with Burma, making Chiang Dao a gateway for migrant populations who are not entitled to government sponsored health services.
While the director of Chiang Dao Hospital and the chief of TB/HIV department have agreed to help migrants within their financial capacities by providing them diagnosis and treatment, it is still costly. Therefore, the Thai government should incorporate strategies which enable migrant populations to receive care and treatment, regardless of their immigration status so that appropriate timely action is taken.
In conclusion, there is an urgent need for decisive governmental action to coordinate TB and HIV policies and programmes in the short-term as one solution for turning the tide against TB and HIV co-infection. Further, projects such as TB Photovoice Thailand are essential to provide an inside perspective on the realities of care and treatment for people living with TB and/or HIV, and to help raise awareness about these issues in rural communities with diverse populations.
For more information about the TB Photovoice project in Thailand visit http://www.tbphotovoice.org, please email Kaewta Sangsuk at kaewta@hdnet.org.
******
[1] Global Report on TB and HIV Shows Urgent Need for Action by Governments, NGOs, and Activists, Press Release August 8, 2006. http://www.soros.org/initiatives/health/focus/phw/news/global_20060808
Accessed on Aug, 27, 2006.
[2]Tuberculosis Control, WHO report 2005. http://www.wpro.who.int/NR/rdonlyres/0F032FB9-34CC-464A-B485-CF85554E8BDC/0/FinalTBreport_printerscopy.pdf
Tuberculosis (TB) is the leading infectious cause of death for people living with HIV (PLHIV). The resurgence of TB is fuelled by HIV in many countries of the world including Thailand, which ranks 17th on the World Health Organization (WHO) list of the 22 high TB burden countries.
Despite Thailand’s designation as a high burden TB country, the current response from the government does not appear to match the magnitude of the problem. According to Thai researcher Amara Soonthordhada, “the general perception among political leaders as well as in Thai society is that TB has been completely eradicated.”[1]
One reason for this may be the lack of integrated TB/HIV policies and programmes at the national and sub national levels. Closer coordination between national TB and HIV programmes and services is vital for controlling the dual epidemics. TB and HIV accelerate each other's progression. PLHIV infected with TB have much greater chances of developing active disease than HIV negative people, even at high CD4 counts. In Thailand, 60% of people living with HIV were diagnosed with TB, according to the WHO report 2005.[2]
Recently, AIDS-Care-Watch (ACW) visited a support group for people living with HIV in Chiang Dao district, a rural area in northern Thailand, with the TB Photovoice Thailand project (TBPV Thailand). TBPV Thailand works to bring awareness on TB/HIV issues at the community level by providing volunteer participants with a camera and writing skills training to enable them to document (through photos and writing) TB/HIV issues in their communities. All the participants of this project are living with TB and/or HIV.
According to the TBPV Thailand coordinator Kaewta Sangsuk, participants from the Chiang Dao community are well suited for this project because the region is ethnically diverse, with a large migrant population—meaning, groups of people who are often unable to access information on issues such as TB and HIV. TBPV Thailand provides a crucial medium for helping the community to learn and speak out on these issues in their own words.
While visiting the project, ACW interviewed the Chief of the PLHIV support group, Songran Boonyo, who identified the following key issues facing the community: diagnosis of TB/HIV for people living in distant rural areas; awareness among community members about TB and HIV; and access to care and treatment for migrant populations.
Because Chiang Dao hospital is located in the urban centre of Chiang Dao district, and is the only formal health facility providing diagnosis for TB and HIV, it is difficult for people living in rural areas to access health services. Songran reported that patients living in rural areas must commute as far as seventy kilometers to receive care, costing them nearly 300 Baht (approximately 8 USD) to reach the centre.
Furthermore, for those who do make it to the hospital and have a resultant positive diagnosis for either TB or HIV, it still remains a challenge for them to return for the monthly check up which is often required during the first phase of treatment.
Aside from access difficulties for rural residents, other challenges remain. Diagnosis of TB in people living with HIV is vital in order to provide appropriate treatment and care, reported Nipaporn Oopinjai, Chief of TB and HIV/AIDS Department of Chiang Dao hospital. Yet, for many, general awareness and understanding about these issues in the community is still quite low. Also, because the region has a diverse population, such as several distinct ethnic groups, as well as Burmese migrants, it makes it complicated for hospital staff and campaign groups to foster awareness when each group has its own traditional beliefs about TB and HIV.
Finally, epidemics do not identify with national boundaries and laws but rather with people. Because of this, addressing TB and HIV prevention, care, support and treatment is further complicated in this region because of its close border with Burma, making Chiang Dao a gateway for migrant populations who are not entitled to government sponsored health services.
While the director of Chiang Dao Hospital and the chief of TB/HIV department have agreed to help migrants within their financial capacities by providing them diagnosis and treatment, it is still costly. Therefore, the Thai government should incorporate strategies which enable migrant populations to receive care and treatment, regardless of their immigration status so that appropriate timely action is taken.
In conclusion, there is an urgent need for decisive governmental action to coordinate TB and HIV policies and programmes in the short-term as one solution for turning the tide against TB and HIV co-infection. Further, projects such as TB Photovoice Thailand are essential to provide an inside perspective on the realities of care and treatment for people living with TB and/or HIV, and to help raise awareness about these issues in rural communities with diverse populations.
For more information about the TB Photovoice project in Thailand visit http://www.tbphotovoice.org, please email Kaewta Sangsuk at kaewta@hdnet.org.
******
[1] Global Report on TB and HIV Shows Urgent Need for Action by Governments, NGOs, and Activists, Press Release August 8, 2006. http://www.soros.org/initiatives/health/focus/phw/news/global_20060808
Accessed on Aug, 27, 2006.
[2]Tuberculosis Control, WHO report 2005. http://www.wpro.who.int/NR/rdonlyres/0F032FB9-34CC-464A-B485-CF85554E8BDC/0/FinalTBreport_printerscopy.pdf
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