Social stigma and knowledge of tuberculosis and HIV among patients with both diseases in Thailand.

INTRODUCTION: Disease-related stigma and knowledge are believed to be associated with patients willingness to seek treatment and adherence to treatment. HIV-associated tuberculosis (TB) presents unique challenges because TB and HIV are both medically complex and stigmatizing diseases. In Thailand we assessed knowledge and beliefs about these diseases among HIV-infected TB patients. METHODS: We prospectively interviewed and examined HIV-infected TB patients from three provinces and one national referral hospital in Thailand from 2005-2006. At the beginning of TB treatment we asked patients standardized questions about TB stigma TB knowledge and HIV knowledge. Responses were grouped into scores; scores equal to or greater than the median score of study population were considered high. Multiple logistic regression analysis was used to identify factors associated with scores. RESULTS: Of 769 patients enrolled 500 (65%) reported high TB stigma 177 (23%) low TB knowledge and 379 (49%) low HIV knowledge. Patients reporting high TB stigma were more likely to have taken antibiotics before TB treatment to have first visited a traditional healer or private provider to not know that monogamy can reduce the risk of acquiring HIV infection and to have been hospitalized at enrollment. Patients with low TB knowledge were more likely to have severe TB disease to be hospitalized at enrollment to be treated at the national infectious diseases referral hospital and to have low HIV knowledge. Patients with low HIV knowledge were more likely to know a TB patient and to have low TB knowledge. DISCUSSION: We found that stigma and low disease-specific knowledge were common among HIV-infected TB patients and associated with similar factors. Further research is needed to determine whether reducing stigma and increasing TB and HIV knowledge among the general community and patients reduces diagnostic delay and improves patient outcomes.