title: Social stigma and knowledge of tuberculosis and HIV among patients with both diseases in Thailand.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Thailand Ministry of Public Health, Nonthaburi, Thailand. sxj47@yahoo.com
authors.forename: Sirinapha X
authors.initials: SX
authors.lastname: Jittimanee
authors.forename: Sriprapa
authors.initials: S
authors.lastname: Nateniyom
authors.forename: Wanitchaya
authors.initials: W
authors.lastname: Kittikraisak
authors.forename: Channawong
authors.initials: C
authors.lastname: Burapat
authors.forename: Somsak
authors.initials: S
authors.lastname: Akksilp
authors.forename: Nopphanath
authors.initials: N
authors.lastname: Chumpathat
authors.forename: Chawin
authors.initials: C
authors.lastname: Sirinak
authors.forename: Wanchai
authors.initials: W
authors.lastname: Sattayawuthipong
authors.forename: Jay K
authors.initials: JK
authors.lastname: Varma
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D013240:Stereotyping; D013785:Thailand; D014376:Tuberculosis / Q000523:psychology*