Buddhism and HIV Stigma in Thailand: An Intervention Study

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Project Summary/Abstract Thailand has the highest HIV prevalence rate in the Asian-Pacific region, with an estimated 1.2% of its adult population infected. Currently there are 0.5 million of PLWH living in Thailand, with a handful of populations more vulnerable to HIV, including men who have sex with men (MSM) (9.2-40%), transgender individuals (12%), sex workers (1-16%), and substance users (19%). Also, the overall mortality rate among Thai PLWH was 3.56%. This high mortality rate explained the notable HIV treatment cascade issues in Thailand. An important reason is HIV-related stigma still poses significant barriers for Thai PLWH to access healthcare and carry out health-protective behaviors to engage in care, including adherence to medications. The purpose of this study is to culturally adapt and evaluate the feasibility of a 4 weekly 2-hour group-based stigma reduction intervention protocol to promote health engagement. The scientific premise is, Buddhist-Thai culture provides a unique cultural context for Thai PLWH to understand HIV stigma and sufferings. Our hypothesis is that Thai PLWH will display lower internal stigma and more care engagement following the intervention. This study addresses the critical need to optimize care engagement through addressing HIV stigma within the local cultural contexts. Our long-term goal is comprehensive, culturally-sensitive stigma reduction intervention for Thai PLWH. We will conduct a mixed-methods study with two study phases. In Phase 1, we will collect qualitative data through conducting 30 in-depth interviews with Thai PLWH to revise our cultural conceptualization of stigma process. In Phase 2, we will conduct a pilot randomized-controlled trial (RCT) to test the feasibility, acceptability, and preliminary efficacy of the adapted stigma reduction intervention among 80 Thai PLWH. Innovations include: 1. proposing a cultural approach to examining HIV stigma and intervention, to increase feasibility and acceptability for PLWH in Thailand, and allow for generalizability of findings to other PLWH populations in countries influenced by Buddhist culture; and 2. contributing to further expanding the toolbox of interventions for HIV stigma reduction, given many modern interventions have adapted principles of Buddhist philosophy. Aims are to: 1. Follow the ADAPT-ITT model to culturally adapt an evidence-based stigma reduction intervention (Phase 1). 2. Evaluate the feasibility, acceptability, and preliminary efficacy with a randomized-controlled trial among 80 Thai PLWH and assess outcomes with both subjective and objective measures (Phase 2). 3. Revise and finalize the study protocols for future project operation by documenting emerging difficulties and solutions throughout this pilot project implementation. Culturally-sensitive stigma reduction intervention is a promising intervention to assist Thai PLWH in decreasing internal stigma and promoting health engagement, and hence help address HIV epidemics in this underserved population.