1. Jintana Ngamvithayapong-Yanai, PhD. JSPS-Fellow, Research Institute of Tuberculosis, Japan TB/HIV Research Foundation, Chiang Rai, Thailand 7 th International Congress on AIDS in Asia and Pacific, Kobe, Japan July 1-5, 2005

2. 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.

3. Chiang Rai, Thailand Cambodia Myanmar China Laos Vietnam Bangkok Chiang Rai New TB rate by HIV status per 100,000 persons 1987-2002

4. Age and sexHIV status TB treatment outcome 44 – MNegativeCured 21-MNegativeCured 19- MNegativeCured 26-FNegativeCured 29-FNegativeCured 34-FNegativeDied after 1 month 28-MPositiveDied after 3 months 22-MPositiveDied after 3 weeks. 33-MPositiveDied after 1 month 36-MPositive Died after 7 months 35-FPositive Died after 7 months 42 –FPositiveCured 34- FPositiveCured TB treatment outcome of some pulmonary TB patients by HIV status

5. Killing…despite HIV-Negative TB “ I have been coughing for a year but I just bought anti cough syrup from the drug stores. Eventually, my sisters begged to me to have a blood test. They accompanied me to a private laboratory. I dared not to listen to the test result by myself. My sisters did that for me. They were extremely delighted to tell me that my blood was” negative”. I did not believe them...I thought they were afraid that I would commit suicide...so they lied to me. Even when they went to buy 2 dozen of beers and cerebrated with my family, I still hardly believed them. Only when the second test was done in the hospital, I became convinced. Doctor said I have tuberculosis not AIDS. ”

6. Attitude of health staff regarding TB/HIV...We have many works that we have to do in the health center. TB/HIV patients usually died soon after a few weeks of TB treatment. Finally,they would die because of AIDS anyway. We can not help them. They are less priority. (Focus Group Discussion with health center staff.) TB/HIV Research Project(RIT-JATA)

7. 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)

8. AIDS stigma and fatalism No hope…No motivation to take TB medicine

9. TB/HIV… Caring but still killing

10. Knowledge… Hope… Strength… for Curing TB

11. “Love” can increase adherence I LOVE my mom and dad. 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

12. Unfortunately, my daughter died after TB was cured because no poor patients could pay for anti-retrovirus drugs. But now several TB/HIV patients in my community can survive, they can live with their family and can feed the family. I missed my daughter…. I miss my daughter…

13. I am survived… and my children will survive

14. I am survived and my mother will survive

15. Caring … Promoting VCT for TB patients

16. What will happen if there is a strong collaboration between AIDS and TB programs? AIDS program TB program TB/HIV patient TB/HIV Research Project(RIT-JATA)

17. TB/HIV From Killing to Caring and Cure TB cured, HIV managed, and lives saved.…