Social Stigma of the New Tuberculosis

描述(申请人提供)：在20世纪的大部分时间里，结核病(TB)呈下降趋势，但自20世纪80年代中期以来，这一趋势发生了逆转，目前全球结核病病例数量继续增加。“新”结核病的特征是HIV/-I-B混合感染和多重耐药结核病。在世界大多数地区，结核病和艾滋病毒流行病有着千丝万缕的联系，需要对这一双重流行病采取综合办法。在发展中国家，结核病是艾滋病毒/艾滋病感染者中最常见的机会性感染，结核病是艾滋病相关死亡的主要原因。人们害怕结核病，因为它经常预示着以前未被怀疑的艾滋病毒感染。与“新”结核病有关的社会耻辱现在与与艾滋病毒/艾滋病有关的社会耻辱交织在一起。更好地了解结核病不断变化的社会方面对于改进疾病控制至关重要。 结核病和艾滋病毒之间的临床、生物和流行病学相互作用已被广泛研究，但对艾滋病毒感染者结核病的心理社会复杂性或艾滋病毒/艾滋病流行地区社区对结核病的社会反应知之甚少。 在这项研究项目中，一个在行为科学、流行病学、社会学、人种学、人类学、传染病和伦理学领域具有临床和操作研究经验的多学科团队建议开发和验证结核病污名量表，用于在泰国最南部地区对结核病污名进行基于人口的评估，泰国是一个艾滋病毒/艾滋病和结核病双重流行的地区。我们将利用最新开发的研究工具，更好地了解结核病相关污名的关键决定因素。我们将在一组活动性结核病患者中测量结核病患者所经历的污名程度，并将污名分数与寻求健康行为和坚持结核病治疗相关联，这是结核病控制的两个关键因素。 该项目是对艾滋病毒流行地区结核病污名的定性和定量研究的首次尝试。该项目还将启动两所大学(美国北卡罗来纳大学和泰国宋卡亲王大学)之间的合作，以建立在具有全球重要性的主题上的研究能力。

DESCRIPTION (provided by applicant): For most of the 20th century, tuberculosis (TB) was in decline but since the mid 1980s, the trend has reversed and the number of TB cases globally now continues to increase. The "new" TB is characterized by HIV/-I-B co-infection and multiple drug resistant TB. In most parts of the world, TB and HIV epidemics are inextricably linked and call for an integrated approach of this dual epidemic. In developing countries, TB is the most frequent presenting opportunistic infection in people living with HIV/AIDS and TB is the leading cause of AIDS-related deaths. People fear TB, as it frequently heralds previously unsuspected HIV infection. The social stigma associated with the "new" TB is now compounded with the social stigma associated with HIV/AIDS. A better understanding of the changing social aspects of TB will be crucial for improved disease control. Clinical, biological and epidemiological interactions between TB and HIV have been studied extensively, but little is known about the psychosocial complexity of TB in HIV-infected individuals or about the social response of communities to TB in HIV/AIDS endemic areas. In this research project, a multidisciplinary team with clinical and operational research experience in the fields of behavioral science, epidemiology, sociology, ethnography, anthropology, infectious diseases and ethics propose to develop and validate a TB stigma scale for population-based assessment of TB stigma in the most southern part of Thailand, an area with a dual HIV/AIDS and TB epidemic. We will use the newly developed research instrument to obtain a better understanding of the key determinants of TB related stigma. We will measure the level of stigma experienced by TB patients in a cohort of active TB patients and correlate the stigma score to health-seeking behavior and adherence to TB therapy, two crucial elements of TB control. This project is the first attempt to integrate qualitative and quantitative research on stigma of TB in HIV endemic areas. The project will also initiate the collaboration between two universities (University of North Carolina, USA, and Prince of Songkla University, Thailand) to build research capacity on a subject of global importance.