Thai & ethnic minority HIV antiretroviral therapy (ART) awareness in northern Thailand

Objective: To better understand HIV antiretroviral therapy (ART) awareness among Northern Thailand's Thai and ethnic communities. Background: Thailand's Project Accept data were used to determine ART levels of knowledge, awareness and understanding. Methods: Qualitative methods (open and focused coding, theme development, memoing and integrative-memoing, conceptual framework construction) were applied to semi-structured in-depth interviews 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: ART awareness levels varied greatly but ethnic minorities suffered from greater ART unawareness. Inaccurate but widespread ART definitions included: herbal tea/forest herbs, bitter gourd/bitter cucumber, chicken bile, vaginal suppository, injection, or tablets from traveling salesmen. Inaccurate ART efficacy perceptions included: pain reducer, worsens HIV progression, prevents all viral infections, ineffective on Asians, and prevents or cures HIV. Barriers to ART uptake included: stigma associated with taking ART, perception ART caused more side-effects than benefits, ART perceived only available to Thais or wealthy, and perceptions one must experience physical manifestations of AIDS before commencing ART. Conclusion: Although ART provision is available to most in Northern Thailand (ethnic minorities are not recognized as citizens and unable to access healthcare/treatment), misperceptions and lack of ART awareness will greatly impede timely/ever ART uptake. ART health education should be provided at the community level, recognizing different community educational needs. Education for ethnic minorities, unable to access governmentally-provided ART, should include information on non-governmental sources of ART.