Thailand - Stop TB Partnership

Stigmatization of TB patients
Even people who . . . are educated still have fears and stigmatizing
attitudes. So we need to think about how to conduct prevention
efficiently—how to provide information without scaring people. It is
important to emphasize that TB is curable.
—Rev. Sanan Wutti, The Church of Christ in Thailand 45
Nongovernmental organizations report that community activists “lack academic skills” and
knowledge about TB themselves, and therefore “don’t feel confident” in conducting awareness-raising
efforts in their communities. 46 And where communities lack a clear understanding
of how TB is spread and treated, stigmatization of persons who have TB and
TB/HIV is common. Some TB patients report satisfaction both with services received in
community hospitals and with levels of support from family members and neighbors. 47 But
fear of stigmatization presents a significant barrier to treatment. Enhanced support for community
education and stigma reduction activities could create a more enabling environment
for people to access rather than avoid diagnostic and treatment services. 48
Both women and men report experiencing stigmatization upon being diagnosed
with TB. However, there are some indications that women are affected more severely. For
example, one recent assessment carried out in Kanchaburi found that TB is perceived as
a “male” disease, associated with high-risk lifestyle and behaviors such as working in an
unsanitary environment, drinking, smoking, and overindulging in nightlife activities. Thus,
women infected with TB are seen as being at odds with social norms and expectations of
“female” behavior, intensifying the level of stigmatization they experience. 49
Some community activists have warned that lack of information about the interaction
between TB and HIV/AIDS is particularly severe, and noted that providing effective
communication about TB/HIV without adding to stigmatization is a particular challenge. 50
This makes it extremely important for the NTP and the National AIDS Control Programme
to develop and disseminate materials that provide accurate and accessible information about
TB as well as about the interaction between TB and HIV, including through close partnership
with civil society organizations based in the most affected and high-risk communities.
NGOs and community-based groups generally can and should play a more active
role in mobilizing and educating the public and those at high risk of TB infection, as the
experience with HIV/AIDS demonstrates. Since the 1990s, HIV/AIDS NGOs and community-based
groups have played a vital role in advocating for drug and clinical trials, training
health care workers, and providing outreach to marginalized populations such as injection
drug users, sex workers, migrant workers, and men who have sex with men. 51 Given their
record of success in communications and advocacy work in particular, HIV/AIDS NGOs
44
TB POLICY IN THAILAND