knowledge...hope...strength for curing tb

1Knowledge...Hope...Strength for Curing TB

Knowledge...Hope...Strength forCuring TB

Printed byTB/HIV Research Foundation, Thailand and

The Research Institute of Tuberculosis,Japan Anti-TB Association

2 Knowledge...Hope...Strength for Curing TB

Knowledge...Hope...Strength for Curing TB

ISBN : 974-92320-3-8

Printed by : TB/HIV Research Foundation, Thailand (THRF) and The Research Instituteof Tuberculosis, Japan Anti-TB Association (RIT-JATA)

Supported by : Japanese Foundation for AIDS Prevention (JFAP)

Technical advisory team:Professor Chaivej Nuchprayoon (Thai Red Cross Society and Thai Anti-TBAssociation )Dr.Wat Uthaivoravit (Chiang Rai Regional Hospital)Dr.Pacharee Kantipong (Chiang Rai Regional Hospital)Dr. Charoen Chuchottaworn (Chest Disease Institute, Ministry of PublicHealth)Dr.Sriprapa Nateniyom (TB Cluster, Department of Disease Control,Ministryof Public Health)Dr.Pathom Sawanpanyalert (The National Institute of Health,Ministry of Public Health)Dr.Takashi Yoshiyama (RIT-JATA) Dr.Hideki Yanai (RIT-JATA)Dr.Norio Yamada (RIT-JATA) Dr.Kunihiko Ito (RIT-JATA)

Chief editor : Jintana Ngamvithayapong-Yanai

Author : Aurasri Ngamwittayaphong

Associate editors: Sarmwai Luangjina, Amornrat Wiriyaprasobchok

English editor : Lisa Imadzu

Printing coordination : Wholistic Management Institute Tel/Fax. +66-2-433 3752

First printing : July 2004 (10,000 copies)

Graphic : Busadee Meunphong

Cover design : Thaweeporn Thongkumbai

Illustrations : Thammasak Sittipongsud

Publisher : 21 Century Co.,Ltd.

Copy right 2004 by THRF: All rights reserved. No part of this book may be reproducedor utilized in any form or by any means, electronic or mechanical, including photocopying,recording, or by any information storage and retrieving system, without permission in writingfrom THRF.

The designations employed and the presentation of the material in this publication donot imply the expression or opinion whatsoever of TB/HIV Research Foundation, TheResearch Institute of Tuberculosis, Japan, Japanese Foundation for AIDS Preventionor the technical advisory team. The views expressed herein are solely the responsibility ofthe Chief editor.

C


Living with AIDSand TB with Hope

Scientists around the worldhave been spending theirendless efforts to help peoplewho are suffering fromAIDS. The outcome is quiteencouraging. Currently,people with AIDS can expectto live with the HIV viruswith a better prospect.

In the past It was thoughtthat there was not hope forpeople with AIDS. Theysuffered for a long time. Therewas no way to live longer andthey were accepting death.People with AIDS suffered alot not only psychologicallybut also physically, fromAIDS-related diseases

In the present days. Manypeople are living with AIDS ina much better condition byadhering to good healthpractice, i.e., nutritious diet,regular exercises, and also byreceiving psychological andphysical care and support.

Many mild symptoms suchas diarrhea, common cold andsome serious illness likes TBare curable.


*Read the true stories of thesepatients in the section

çHope and Strength for Curing TBé *


In the past AIDS used to beperceived as a deadly disease.People thought of death whenthey heard AIDS.

In the present days. AIDS isnow beginning to be consideredas a chronic disease. People withAIDS can live with the diseasefor longer period of time.

In the past People with AIDSoften suffered from manyopportunistic infections, as therewere no anti-retrovirus (ARV)medicines. At the early stage ofARV discovery, the medicineswere extremely expensive. Therewere no ways for poor patients toget the treatment.

In the present days. Advancedresearches around the worldcontinue to discover and producenew and cheaper ARV medicineswhich are affordable to poorpatients.


Today, people living withAIDS are living with hope!Having good knowledge aboutthe diseases that frequently attackpeople with AIDS will increasethe chances of them live longerand live a better life.

“Tuberculosis” (TB) is oneof the most important diseasesthat frequently attack AIDSpatients. Although TB is a curabledisease, one out of three peoplewith AIDS are sick with, and dieof TB.

We can fight TB by givingpeople good knowledge aboutTB and also psychologicallysupporting the patients and theirfamily.


TB is a communicable disease that can be passedon from humans to humans. It is caused by TBbacteria. TB is not the same as asthma, orpneumonia, and it is not a genetic disease.

TB can attack many parts of the body but the mostcommon site where it attacks is the lung, whichcan be infectious and transmissible to other people.

What is TB ?



Where do TB bacteria live?

How can TB bacteria enter human body?

❍ TB patients who do not receive treatment carry TB germs.

The patients can spread TB germs into the air by

coughing, spitting, speaking or laughing.

❍ TB germs are very tiny, which cannot be seen with naked

eyes. After the untreated TB patients coughs, TB germs

float in the air, especially in poorly-ventilated settings,

such as air-conditioned rooms, rooms with closed

windows or closed doors


❍ TB germs enter the human body through

respiration, i.e. people inhale the air contain

ing TB germs.

❍ Although many people have TB germs in their

body, they do not have any symptoms because

human immunity can control the germs not

to be active and not to make people become

sick. These people are TB infected persons

but they are not sick and they cannot spread

TB to others.

❍ Human immunity can be weakened by many

reasons, such as HIV infection, diabetes

mellitus, aging. Especially in these people,

the TB germs which live silently in human

body can become active and attack lungs

or other organs, which make these people

become sick with TB. These people are TB

patients who have TB symptoms. Without

treatment, TB patients can spread TB germs

to others.

Doctors say that among 100 people who are infected byTB, only 10 of them would become sick with TB. The

other 90 people will remain as TB infected persons whoare not sick and will not spread TB to others.



What are the symptomsof lung TB?

Patients usually have persistent or recurrent coughfor 3 weeks or cough with bloody sputum, fever, nightsweating, chest pain, loss of appetite and weight loss.

The ways to prove whether or not a person is sickwith lung TB are to use a microscopy to examine thepatients’ sputum, to culture the sputum and toexamine the patient’s lung by chest x-ray.

If an HIV-infected person becomes infected and sickwithTB, do we have to treat TB? Is there any benefit to treatingTB? Isn’t it a waste of time?

❍ Of course we must treat TB! We should treat TB because AIDS is

just one of chronic diseases. There are many ways for peoplewith AIDS to live longer and live a better life, and treating TB isone of them. So treating TB is not a waste of time for peoplewith AIDS!

❍ Treating TB is also important because by doing so, patients can

protecting others from getting TB. After taking 3 weeks of TBmedicine, TB patient will no longer transmit TB germs to others


How do you avoid beingattacked by TB?

For TB with AIDS patients:❍ Patients should understand that TB is curable.

❍ Patients should have adequate knowledge aboutthe disease

❍ Patients should be encouraged to treat TB

❍ Patients have to be patient in taking the TBmedicine for at least 6 months. Patients shouldunderstand that if they do not complete themedicine, the TB germ will become resistantto the medicine and they bear the chance ofbeing attacked by TB again.

For HIV infected patients who have never beensick with TB:

❍ Avoid being in close contact with persons havingchronic cough and TB patients who do not receive treatmentor who have only been taking the TB medicine for lessthan 3 weeks.

❍ Avoid being in close contact with TB patients in apoorly ventilated and limited space.

❍ Consult a doctor regarding TB preventive therapy

❍ Promptly seek medical consultation when TBsymptoms are suspected.


For everyone:

➤ Use handkerchief, tissue paper or your both hands to cover mouthand noses whenever you cough or sneeze. This is a desirablepractice not only for the sake of preventing TB transmission butalso for help prevent other respiratory diseases, such as commoncold and Severe Acute Respiratory Syndrome (SARS).

➤ Sun light effectively kills TB germs. Living places should beexposed to sunlight with good ventilation.

➤ Avoid staying long hours in places crowded with people, poorlyventilated, or in dark and damp environment.

➤ Avoid smoking, drinking, and using drugs because these behaviorsweaken your immunity against infectious diseases such as TBand other illnesses.

➤ Consult health staff or physician when you are coughing for morethan 2 weeks or when you are coughing with bloody sputum. Donot buy medication on your own or use medicine offered by otherpatients.

➤ People should understand that TB patients who take TB medicinefor more than 3 weeks are less likely to spread TB to others.Therefore, people should not shun TB patients who are undertreatment.


Coughing properly...for everybody’shealthy breath

Whenever you cough...pleaseremember that:

This kind of coughing looks polite but it is NOT SAFE! If persons have some contagious diseases, they may well be spreadingthe germs into the air and unintentionally passing them to other people.

This is the best coughing manner which is safe for everyone.Always use a cloth or a tissue paper to cover your mouth and nosewhen you cough. If you do not have anything, use both of your hands.


..Because TB and AIDS do not spread by eating together!

A team of doctors and nurses from Mae Chan Hospital, namely Drs.Sudanee,Nunthana, Chotipong and Ms.Wipaporn joined lunch with several people livingwith HIV, including a TB patient who were treated a few months ago. The healthcare team wanted to demonstrate that TB patients (regardless of HIV status) whohave been on TB treatment for more than 3 weeks and who show improved clinicalsymptoms do not transmit TB to others. Therefore, these patients should not beshunned by other people.

These doctors said that TB and AIDS are not transmitted by sharing food butthere are several diseases can be transmitted through saliva, such as hepatitis, herpeszoster, and oral ulcer.

Therefore, when people wish to share food with others, (like this photo),“serving spoons” MUST be used and every person MUST have his/her own spoonand a drinking cup. Let’s practice this eating behavior no matter who we areeating with...doctors, nurses, patients or general people.

Is it true that TB and HIV can be transmitted by eating together?Why did these doctors and nurse dare

to eat with these patients?


if TB germs enter human body?

What will happen


15Knowledge...Hope...Strength for Curing TB 15Knowledge...Hope...Strength for Curing TB


Take the medicine

Take the medicine

TB patients have to take their medicationcontinuously for at least 6 months. The most commonproblem is that patients forget to take the medicine,especially when they begin feeling better. The best wayto ensure that patients complete this long-term treatmentis for a health worker or a volunteer to bring the medicineto the patients’ home and to observe them take themedicine everyday. If this is not possible, some sort of amedicine reminder system can help the patient completehis or her medication. For example, several former TBpatients kept the medicine or a reminder message invisible locations that were related to their daily activities,such as where they ate, drank, slept or changed clothes.By this way, these patients were able to complete theirmedication and were treat TB.

Medicine reminder systems


Having the correct knowledge about TB and HIV/AIDScan give lives to many tuberculosis (TB) patients, who mayhave initially felt hopeless and discouraged because of thedisease. The following stories are patients’ real experiences(the names are in pseudonyms). These patients were not onlysuffering from TB but also from HIV infection and severalcomplications related to AIDS. Yet, they all managed tosuccessfully overcome TB!

There were many difficulties. Most of these patients werepoor and jobless, and some patients were socially isolatedand were forced to live alone. Anti-retro virus medicines forAIDS were not yet available at that time. So why were thesepatients cured from TB? Don’t you think there is much to belearnt from these patients’ stories?

We are extremely grateful to these patients who kindlyallowed us to publish their stories and photos. We admiretheir courage and good wills. They told us that they simplywanted to help other patients experiencing the samedifficulties overcome them.

Lastly, they wished to convey one message to otherpatients: “So long as you hold on to courage...your life willbe brightened with hope”. (We hope that this book will...)

17Hope and Strength


Ms.Nita....“No matter what diff treatment, I was pa

Ms.Nita (pseudonym) 28 years old

Nita got her HIV infection from herhusband, who passed away 5 years ago,leaving Nita and their two youngchildren, a son and a daughter, tostruggle on with their life. After herhusband’s death, Nita moved back to herhometown to live with her parents. Thedaughter lives with Nita while the sonlives with her husband’s relative. SoonNita developed fever, fatigue, shortbreath and massive coughing. Thecoughing were so severe that she couldnot even sleep. When she finally wentto the hospital, the doctor told her thatshe had a TB in her lung. Three weeksafter she started her TB treatment, Nitawas feeling better. Her coughingsubsided and her short breathdisappeared. Yet she strictly stuck withthe treatment and never forgot to takethe medicine on any one single day. Sheremembered that when she was firstlyadmitted to the hospital, she saw a TBpatient being given an injectioneveryday. She remembered the doctor

After completing the treatment

Before TB treatment

18 Hope and Strength


ficulties I faced during my TBatient for the sake of my children...”

saying that if TB patientsstart taking medic ineinconsistently, the chances ofdrug resistance developing willbe high and when that happens,patients will have to start a newtreatment course including dailyinjection.

Nita is an excellent example ofa TB patient with HIV infectionwho successfully completed theTB treatment, despite beingattacked by other opportunisticinfections such as oral thrush andmeningitis during the TB treatmentcourse. She told us that she heldher moral high and put all effortsto treating her TB. She wanted tolive in order to take care of herchildren. She told us that when shehad the oral thrush, it was sopainful whenever she tried toswallow the medicine. It was sopainful she found it even hard todrink water, let alone eat. During

the 5th month of her TB treatmentcourse, she suffered from severeheadache and repeatedlyvomited, often falling unconsciousafterwards. At that time, whenevershe tried to swallow the TBmedicine, she vomited it out. Shesaid that she really thought she wasgoing to die. But in the end, shedid not give into those physicalpains. She survived and shesuccessfully cured her TB.

Nita told us that she would liketo convey her good will and bestwishes to other patients who aresuffering from TB and AIDS. Shesaid that she will be more thanhappy if her story can encourageand support other patients.

19Hope and Strength

20 Knowledge...Hope...Strength for Curing TB¿“§°”≈—ß„®

Ms.Suda: “It took me an hou

but I was patient for the sake

Ms.Suda (pseudonym) 34 years old

Suda got her HIV infection andTB from her husband. Three monthsbefore her husband passed away, Sudadeveloped serious coughs, shortbreath, persistent fever, and fatigue.

she felt that she was going to die. Shewas admitted for 3 nights in a hospital,where a doctor told her that she hadTB with HIV infection. The doctorsaid she had to take TB medicine for

at least 6 months. After beingdischarged from the hospital, Sudamoved back to her home to live withher parents. According to Ms. Suda’s

memory, she was taking a medicinefor the first time since she became anadult. At the beginning of the TBtreatment, Suda spent an hour to takethe total 10 tablets of TB medicine

every day.

Photo after completingTB treatment



r to swallow the medicine...

of my beloved parents”.

“Not only TB, but I was also

suffering from fungal infection in

my mouth and my throat. I felt very

sick, I could not eat and I was so

weak. I felt I was going to die. But

I was encouraged to take all

medicines. My mom cheered me up

every night. It was so painful

whenever I swallowed the medicine

and water. Many times, I was

depressed when I thought about the

6 month treatment but at last I

completed it!”

Suda cured her TB and her

body weight increased from 33 to39 kg.. She was able to resume herwork. Suda said that she was ableto complete her TB treatment

because of the following reason:

“I know AIDS is not curable.I will die anyway. But I love dadand mom. Doctors told me that ifI take TB medicine I will notspread TB to the others. I wasdetermined to take medicine notfor myself but because I wasafraid my parents and otherswould get TB from me. I was

concerned for my parents. I do not

want them to be infected with TB.

I know how terrible it is to have

TB.”

21Hope and Strength


Sano lived with his father andelder sister in an urban community.Sano didn’t realize that he wasinfected by HIV until he became verysick and his family brought him to thehospital. After knowing about his HIVblood test result, Sano decided toleave the hospital and went backhome with some supportive medicine.After he left the hospital, other testresult showed that Mr. Sano also hadTB in his lung. Therefore, the homehealth care nurses visited Sano andbrought the TB medicine to serve himat his home. The nurses instructedSano’s sister and father to take careof Sano and ensure that he took hismedications. One week later, thenurses visited Sano’s home and foundhim sleeping alone in his room,depressed and hopeless.

Sano took the anti-TBmedicine for a few days but he feltthe medicines made his symptomsworse. He thus stopped taking the

Mr.Sano...Because of their

Mr.Sano (Pseudonym) 42 years old

After 3 months of TB treatment

Before TB treatment



r encouragement...I could stand again!

anti-TB medicine. He had nauseaand vomiting. He could not eatand he felt so weak. The nursesfound out that Sano was notmotivated to take the medicinebecause he had AIDS. He feltdiscouraged and hopeless and justwanted to die. He even appearedto accept that he was going to die.He did not feel that he wanted tostand again, or that he could standagain. His father and sister alsoappeared to accept the situationand just followed Sano’s wishesto do nothing and wait to die.However, the home health carenurses eventually managed toconvince Sano and his family toresume to the TB treatment. Andhow worth it was! Sano was curedfrom TB and he could stand again!He could even return to earningincome by riding his rickshaw(tricycles). He also ended upencouraging his neighbors who

had suspected TB symptoms to visitthe hospital and to get the treatmentlike him did.

Sano and his family wereencouraged by the power of themessage from the nursing team thatalthough AIDS was not curablebut TB was curable, and alsothat treating TB was not onlyimportant for the patient but alsofor the patient’s family andfriends, who otherwise mighthave caught the TB from thepatient.

23Hope and Strength


Ms.Patty...The little o

“Despite being isolated...I survived”

Ms.Patty (pseudonym) 11 years old

Patty is an eleven years old girl,whose parents passed away due toAIDS. Patty was also infected by HIV.After her parents died, she was invitedto live in her relative’s house. Oneday, Patty became sick; she hadpersistent fever and rash, she wasfeeling very weak, and she lostappetite. These symptoms lasted forone month. At last, Patty went to theprovincial hospital. The doctor toldher that she had TB. Her relative wasafraid of catching TB from her.Therefore,her relative built a smallhut for her to live in and providedfoods for her to eat in the hut.

Being isolated from others, littlePatty became determined that she hadto cope with the illness alone.However, she was determined not tolet fate take control of her life. Shewas determined to cure her TBbecause she did not want to spreadTB to others. She optimisticallythought that life can always be filled

Hope and Strength24


orphan who was never defeated!

with hope.“I took the TB medicine by

myself everyday. I never forgot to

take because the doctor said thatif I took the medicine inconsistently,

the TB germs will become resistantto the medicine and TB will not

cured.. I wanted cured TB...so Ialways reminded myself to take the

medicine. Sometimes my relativereminded me as well. Doctor saidthat if I take the TB medicine for 6

months I will be cured. Doctor alsosaid that HIV-infected persons can

be treated for other opportunisticdiseases and can then live longer.

I believed the doctor because I seean elder child in my village (whois HIV infected)...he is quite strong

now.”Three months into her TB

treatment, Patty started takinganti-retrovirus together with TBmedicine. At first, her body reactedto the anti-retro virus badly and she

suffered stomachache, nausea andfelt sick. But gradually, her bodyadjusted to the medicine.

Now, little Patty is a healthyand a lively girl who likes to talkwith other children similar to herage. Patty is living with her relative,who now understands that sheshould no longer be afraid ofgetting TB from Patty. Shecompletely understands the doctorwho told her that after 3 weeks ofTB treatment, patients are lesslikely to spread TB to others.

25Hope and Strength


When Chai’s relatives broughthim to the hospital, everybody thoughtthat Chai was going to die! At thattime, he was severely sick, he hadshort breath, severe coughs and he wasvery weak. The doctor said Chai hadTB in his lung. To make mattersworse, the blood test result showedthat he was also infected with HIV!At that time, no poor patients, likeChai, could afford the anti-retro virusmedicine for HIV. Chai decided toaccept the TB treatment. He did notthink that his life became hopelessbecause of HIV. He optimisticallythought that persons with HIV still hadthe chance survive. He wasdetermined to cope with TB and HIV.

Chai was discharged from thehospital with TB medicine. The doctoremphasized that he must not forget totake medicine and that he mustcomplete it. He must be patient withhimself for the long term TB

Mr.Chai (pseudonym) 34 years

Mr.Chai...Just think tha

Before TB treatment

After TB treatment



at you’re in the prison for 6 months!

treatment. Chai found that it wasnot easy at all to complete the TBmedication. During the treatmentcourse, he suffered severalundesirable symptoms. Wheneverhe took the TB medicine, he feltsick. He had skin rash and itching,nausea and vomiting and he couldnot eat. He felt very weak andmany times he wanted to quit TBtreatment and just die.

I felt discouraged...I feltterribly sick...and I thought that Iwas going to die. It was so hardto tolerate these symptoms. It wasso hard to complete the 6 monthTB medicine. Doctor said that it

must be 6 months...that I must notforget taking the medicine and Imust not miss any single doseotherwise TB germs will becomeresistant to the medication. But myfamily and friends warmlysupported me. They said that Ihave to be patient and told me tojust imagine that I am in a prisonfor 6 months.

Chai was encouraged tocontinue with the TB treatment. Hegradually gained body weight. Hewas only 40 kg when he started theTB treatment and his body weightreturned to 47 kg when hecompleted the TB treatment.

27Hope and Strength


Ms.Amporn...“Don’t worry...Do

Ms. Amporn (pseudonym) 29 years old

Amporn was born in thenorthern region. She followed herhusband to the southern coastalregion where her husband workedas a fisherman. One day, Ampornbecame seriously sick. She hadfever, cough with short breath,tiredness, and lost seven-kilograms. Yet, where she livedwith her husband, nobody tookcare of her. Therefore, she movedback to her hometown in thenorthern region, where she couldrely on some financial support ofher mother. There she visited acommunity hospital. The sputumexamination and chest x-rayshowed that Amporn had TB in herlung.

Amporn was actually alsoinfected with HIV. But she knewabout her HIV infection before shebecame sick with TB. Unlike mostpeople with HIV, Amporn was notdepressed with her HIV infection.

Before TB treatment

After TB treatment



n’t think too much...Only think about being cured!”

She always thought that she wasnot the only person infected withHIV. She did not care if otherpeople looked at her or thoughtabout her in a bad way. She thoughtthat every human being would dieany way, whether infected withHIV or not. If people shunned her,she just ignored them. Amporn feltthat having less stress and lessworry about HIV and about lifewere good to her health.

“I took medicine everyday.Doctor told me to take the

medicine, so I just followed thedoctor. The health staff gave

medicine to me and I just took them.I was not discouraged with thetreatment. I did not think ofanything. I just kept thinking...Iwill be cured...I will be cured...ORI must cure myself...I must curemyself....”

By having hope andencouragement, Amporn waseventually cured from TB and shecould resume to her many dailyactivities.

29Hope and Strength

If your story mirrors those that you havejust read...please remember that:

● You have hope as long as you have strength.

● TB is curable. You should have knowledge anddetermination to cure TB.

● AIDS cannot be cured but can be treated,just like any other chronic illnesses.We wish you all the best in having TB knowledge,having hope and having strength to fight againstthe diseases.


The following individuals, organizations and institutes kindlycontributed to the development and production of this book:

❍ The patients and their family kindly agreed to publishing their stories and photos.These patients have also dedicated themselves to supporting other patients.

❍ Japanese Foundation for AIDS Prevention (JFAP) supported the financial aspects ofprinting.

❍ Professor Chaivej Nuchprayoon, Dr.Wat Uthaivoravit, Dr.Pacharee Kantipong,Dr.Charoen Chuchottaworn, Dr.Sriprapa Nateniyom, Dr.Pathom Sawan panyalert,Dr.Takashi Yoshiyama, Dr.Hideki Yanai, Dr.Norio Yamada and Dr.Kunihiko Ito kindlyreviewed and provided comments for the clinical part of this book.

❍ Ms.Amornrat Wiriyaprasobchok, Chiang Rai Hospital contributed greatly to producingthe patient stories and photos.

❍ Mea Chan Hospital: Members of Mea Chan’s HIV Self-help Group participated in thepretest (preliminary review) of this book. Dr.Sudanee Buranabenjasatean, Dr.NunthanaPatthanakittikul, Dr.Chotipong Siripipattanamongkul, and Ms. Wipaporn Chaiarmkindly accepted the invitation to join lunch with people with HIV and TB patient andto have pictures taken.

❍ People from Ta Hor community, Ms.Sunun Mor-aud, Ms.Chanta Panjai, Ms.ChornBoonyuen, Ms.Chansom Pasamlee, Mr.Moon Doochuai, Mr.Pichai Boonrod participatedin reviewing the book and offered their comments. Their financial contribution (300Baht) for book printing is greatly appreciated.

❍ Staffs of RIT, Chiang Rai Office: Ms.Uthumporn Tabtimchai, Ms. Patcharin Duangkaew,Ms.Maleerat Samphantasit, Mr.Maitree Oo-Ngern, Ms.Saiyud Moolphaet, Ms.WoranootPramualkarn acted as the valuable communication channel between the patients andthe editorial team.

❍ Colleagues from Karolinska Institute, Stockholm, Sweden donated 5,300 Baht duringthe graduation party to support the printing cost.

❍ Institute of Wholistic Management, Bangkok coordinated the entire printing process.

❍ Staff from RIT, Japan have helped us decide on the English title of this book. Specialthanks to Dr.Toru Mori and Dr.Nobukatsu Ishikawa.

❍ Ms.Lisa Imadzu, Research Fellow, RIT devoted her time for English editing.

❍ Dr.Aurasri Ngamwittayaphong, Graduate Volunteer centre, Thammasat Universitydedicated her time for designing and writing the book in the popular language so thatthe book will be culturally sensitive.

Credibility of this book should honor to the above list. The chief editor alone barescomments, criticism and legal responsibility of this book.

Jintana Ngamvithayapong -YanaiChief EditorJune 2004


Who are we?

TB/HIV Research Foundation (THRF)Global Wisdom and Local Participation to Fight

Against TB and HIV/AIDSRegistered in Thailand # 222/2545

Tuberculosis and HIV/AIDS are global health emergencies and Thailandis not spared. In 1992, a group of Thai and Japanese doctoral students carriedout their multi-disciplinary dissertations on tuberculosis and HIV/AIDS inChiang Rai, the northernmost province in Thailand. They soon realized theimportance of research in providing knowledge as an effective tool forprevention and control of the diseases. After having worked in the field formore than 10 years in close collaboration with the Research Institute ofTuberculosis, Japan Anti-TB Association, they firmly believe that successfulprevention and control programs require not only research but also humanresources development and technical collaboration at community, nationaland international levels.

The Foundation was officially registered in Thailand in June 2002 as anon-profit organization, with the aim to drive research on tuberculosis andHIV/AIDS forward. It has since been conducting and supporting biomedical,health and social sciences research on tuberculosis, HIV/AIDS, and otherrelated problems. It has also supported human resources development andprovided consultations in the fields of tuberculosis and HIV/AIDS.

President: Jintana Ngamvithayapong-Yanai, B.N.(Hons.), M.A., PhD.Vice President: Pathom Sawanpanyalert, MD.(Hons.), Dr.PH.Ex Officio: Dares Chusri, B.N., MPH.Treasurer: Piyanoot Chatchawarat, B.Econ.Secretary: Saiyud Moolphate, B.N., MPH.

Foundation Members


❍ Bank name : KASIKORNBANK, Chiang Rai Office.Bank address: 537 Bunpaprakan Road, Muang District,Chiang Rai,THAILAND 57000.Phone: +66-53-752226 to 31 Fax:+66-53-714003SWIFT CODE: TFBSTHBKCHMTELEX: 82542, 84798, 84799Account name: TB/HIV Research FoundationAccount no.: 154-2-76033-4

This book was developed, we hope, to fill the knowledgegaps on tuberculosis and HIV/AIDS. We believe thatcorrect knowledge and sharing experiences abouttuberculosis and HIV/AIDS will help combat stigma andfatalism, encourage and empower patients, and helphealthcare workers cope with enormous pressure andburden of their work.

If you share similar beliefs and want to help disseminatethis book to others who need it, you can request copies ofthis book from the Foundation.

You can also help support the Foundation through donations:

❍ Direct contact with the Foundation at:TB/HIV Research Foundation (THRF)1050/2 Satarnpayabarn Road, Muang DistrictChiang Rai. 57000. Thailand.Phone. +66-53-752162, +66-1-764 2400Fax: +66-53-752448email: [email protected]

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