Nature of HIV stigma & discrimination in northern Thailand: Public health & human rights implications

Objective: To obtain a deeper understanding of the nature of perceived and enacted HIV stigma and discrimination in Northern Thailand. Background: HIV stigma and discrimination, as described by Thai and ethnic minority participants, was elicited using Thailand's Project Accept qualitative data. Methods: Qualitative research methods (open and focused coding, theme development, memoing and integrative-memoing, conceptual framework construction) were applied to semi-structured in-depth interview transcripts using Atlast.ti and Microsoft Office software. Study sample (n=117, aged 18-32 years) included Thai (n=81) and ethnic minorities (n=36) representing Chinese, Pakistani, Thai-Yai, Black/Red Lahu, Lisu, Hmong, Akha, Karen, Zam and Kon-Muang ethnicities. Results: HIV stigma and discrimination was prevalent in study communities. Examples of perceived stigma included: fears of associating with a person living with HIV (PLHIV) and being perceived as a PLHIV. (Perceived stigma was so intense many participants stated they would commit suicide if ever diagnosed HIV positive, regardless of access to HIV care). Enacted stigma/discrimination included PLHIV isolation by family/friends/communities (even unto death), inability to participate in community activities, including purchasing or eating in the market. HIV stigma overlapped with stigmas and prejudices toward traditionally marginalized groups (LGBT persons, sex workers, substance users and ethnic minorities) and further perpetuated blame of PLHIV. Intense fear of stigma and discrimination can affect uptake of HIV testing, seeking antiretroviral therapy when needed, and human rights. Conclusion: HIV-related stigma and discrimination in Northern Thailand affects both PLHIV (and those perceived to be PLHIV), resulting in serious public health and human rights consequences which must be addressed.