Social impact of tuberculosis in southern Thailand: views from patients, care providers and the community.

BACKGROUND: There is growing recognition that attention to social and behavioral factors in tuberculosis (TB) control needs to complement biomedical emphasis on better drugs, vaccines and new diagnostic tools.

METHODS: Using qualitative methods, we conducted 10 focus groups and seven individual interviews to explore how TB is perceived or experienced in southern Thailand. Participants included male and female patients with TB, patients with AIDS, TB care providers, family members of patients with TB, religious leaders (Buddhist and Muslim), and unaffected community members.

RESULTS: Responses informed two conceptual frameworks on stigma and social support. The first model dichotomized the meaning of TB into 'good' and 'bad' factors related to social support and stigma, respectively. The second model identified three themes--disease severity, religion, and knowledge of TB--linked to either stigma, social support, or both.

CONCLUSION: Social support as a facilitator and stigma as a barrier are diametrically opposed concepts that need to inform TB care and treatment. Interventions to reduce stigma and promote social support at the patient, household, community, and health care system levels should be part of future efforts in the control of TB in Thailand.