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.
 New TB rate by HIV status per 100,000
Chiang Rai, Thailand persons 1987-2002

China Vietnam

Myanmar Laos
Chiang Rai

Bangkok
Cambodia
 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 TB program
program
TB/HIV From Killing to Caring and Cure

TB cured,

HIV managed,

and lives saved.…