Geographic displacement, stigma, and ART uptake: Perspectives from ethnic Shan–Burmese migrants and healthcare professionals in Northern Thailand

OBJECTIVE: To investigate factors which influence antiretroviral therapy (ART) uptake among Shan–Burmese ethnic migrants living with HIV in Northern Thailand. BACKGROUND: Extant literature suggests the ethnic Shan population bears a disproportionate burden of HIV infection compared to other ethnic groups fleeing conflict in Myanmar. Few studies have assessed both barriers and facilitating factors which may influence ART uptake among migrant populations living in Northern Thailand. METHODS: Qualitative methods (open coding, category development, axial/thematic coding) were applied to data yielded from direct observation and two structured interview guides which obtained socio–demographic information, perceptions of HIV, conflict, and migration, and factors relevant to HIV diagnosis and ART uptake. The study sample included a nursing unit of Thai healthcare professionals (n=5) working in an HIV/AIDS ward, and Shan–Burmese migrants living with HIV (n=16). RESULTS: A number of barriers and enabling factors to ART uptake emerged among Shan migrants and Thai healthcare professionals. Emergent obstacles to ART uptake included: pervasive fear of arrest and deportation, language, notions of being “misunderstood” or marginalized, inaccurate perceptions of HIV transmission/prognosis, and lack of finances to afford ART. Emergent facilitating factors for ART uptake included: Hospital–based migrant registration programs which provided affordable/sustainable ART comparable to Thai nationals, and Shan community outreach efforts involving mobilization of Shan therapy groups, chain–referral practices, and community radio broadcasts. CONCLUSION: Findings underscore the necessity of culturally tailored migrant–focused programs which facilitate ART uptake. Access to ART for Shan migrants in Thailand helps ensure the continued success of Thailand's HIV Prevention and Control Program.