Ignite Creation Date:
2024-05-06 @ 5:49 PM
Last Modification Date:
2024-10-26 @ 2:36 PM
Study NCT ID:
NCT05446064
Status:
RECRUITING
Last Update Posted:
2023-05-11
First Post:
2022-06-24
Brief Title:
Buddhism Beliefs and HIV Stigma in Thailand
Sponsor:
University of California Los Angeles
Organization:
University of California Los Angeles
Study Overview
Official Title:
Buddhism Beliefs and HIV Stigma in Thailand An Intervention Study
Status:
RECRUITING
Status Verified Date:
2024-07
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Thailand remains one of the countries with the largest population of people living with HIV PLWH It is estimated that 30 Thai provinces account for 75 of the HIV infections in that country with ChiangMai as the most prevalent province in northern Thailand Also HIVAIDS remains among the top 10 most common causes of death in Thailand This high mortality rate may be partially explained by the notable HIV treatment cascade in Thailand Among all the Thai PLWH only 74 were retained in care while 68 received ART and roughly 50 reached viral suppression An important reason for this is that HIV-related stigma still poses significant barriers for Thai PLWH to access healthcare and carry out health-protective behaviors including adherence to medication schedules to manage their HIV In Thailand substance use including use of tobacco alcohol and other emerging recreational drugs is a pressing health concern In the HIV population in Thailand it was found that 15 use tobacco 70 use alcohol and 2 use recreational drugs In addition among Thai HIV alcohol drinkers about 13-22 were heavy drinkers and 40 had sex under the influence of alcohol Although the literature evaluating prevalence of substance use among Thai HIV individuals is emerging the knowledge remains very limited regarding their risk and protective factors for substance use Self-management interventions typically include training modules for symptom management skills and coping strategies In Buddhist-Thai culture the goal of self-management may become assisting PLWH to find the peace and harmony within themselves by gradually letting go of those strong desires for certain materials or status that contribute to the uncertainty in lives Therefore this project aims to further the investigators knowledge about self-management behaviors in HIV substance users in the context of Buddhist-Thai culture The investigator aims to 1 Explore how PLWH experience and interpret substance use mental health and self-management and identify key social-cultural factors that influence these factors 2 Test the associations among mental health substance use self-management health outcomes and selected key social-cultural factors among PLWH using a partial correlation network model The results will be used for development of a culturally tailored evidence-based self-management intervention to promote better health outcomes among Thai PLWH
Detailed Description:
HIV Stigma and Health among People Living with HIV PLWH
Stigma is a primary risk factor affecting the well-being and survival of PLWH in particular PLWH who are marginalized by society HIV has long been a highly stigmatized disease and researchers have made great efforts to study various dimensions of HIV stigma resulting in an established body of literature HIV stigma is conceptualized as a collection of adverse attitudes beliefs and actions of others against PLWH external stigma which may result in internalized beliefs or actions taken by PLWH internal stigma leading to negative health outcomes Three decades of research have converged demonstrating that HIV stigma both external and internal can negatively impact the well-being and survival of PLWH across the globe through multiple pathways Populations that have been socially marginalized such as women ethnic minorities and sexual and gender minorities are particularly vulnerable to the negative impact of HIV stigma HIV stigma is a huge barrier to accessing social support and health services with negative impacts on PLWHs mental health and optimal self-management of their HIV such as adherence to medication For PLWH in Asia HIV stigma negatively impacts mental health and HIV self-managing behaviors leading to deteriorated subjective well-being physical health and survival
HIV Epidemic and AIDS Care System in Thailand
Thailand has the highest HIV prevalence rate in the Asian-Pacific region with an estimated 12 of its adult population infected Because of this high prevalence rate Thailand remains one of the countries with the largest number of people living with HIV PLWH in the Asia-Pacific region Thailand only follows India China and Indonesia in number of PLWH although its population size is ranked 11th in the region Currently there are 05 million PLWH living in Thailand Although historically HIV affected mostly female sex workers and their clients in Thailand the HIV epidemic has changed drastically due to proactive interventions in the 1990s Recently the HIV epidemic has come to resemble those in other developed countries with men who have sex with men MSM 92-40 transgender individuals 12 sex workers 1-16 and substance users 19 sharing the increasing burdens of HIV Additionally due to unequal distributions of vulnerable populations and risk factors for HIV infection it is estimated that 30 Thai provinces account for 75 of the countrys HIV infections with Chiang Mai being one of the provinces having the highest prevalence
As part of its response to the HIV epidemic the Thai government began to provide free antiretroviral treatment ART for PLWH with impaired immune functions CD4 350 cellmm3 in the early 2000s It then expanded the program to all PLWH regardless of their immune function in 2014 This policy has enabled high ART accessibility in Thailand making it one of the few countries in Asia-Pacific region that has more than 50 of PLWH to be on ART Due to high ART coverage Thailand experienced success in reducing HIV mortality an estimated 196000 deaths were averted between 2001 and 2014 In addition Thai PLWH increased their life expectancy to 71 years old or longer which is close to that of the general Thai population Despite these important gains however the number of PLWH has constantly decreased by approximately 10000 per year over the past decade which could be attributed to high mortality rates that surpassed incidence rates In 2016 it was estimated that while there were 6400 new HIV cases there were 16000 HIV-related deaths resulting in an overall mortality rate of 356 Compared with the 06 mortality rate in the United States during the same period the mortality rate in Thailand remained 5 times higher Indeed HIV still remains one of the top 10 most common causes of death in Thailand This high mortality rate may be partially explained by the notable HIV treatment cascade in Thailand among all Thai PLWH 74 were retained in care 68 received ART and only roughly 50 reached viral suppression An important reason for the low viral suppression rate is that HIV remains a highly stigmatized disease in Thailand HIV-related stigma still poses significant barriers for Thai PLWH to access healthcare and carry out health-protective behaviors to manage their HIV including adherence to medications
HIV Stigma among People Living with HIV in Thailand
As Thailand was one of the early epicenters of HIV in Asia stigma associated with HIV has attracted research attention since the late 1980s A significant amount of research and resources were invested in documenting the types and frequency of stigma events and their negative impacts as well as in policy programming to address the stigma against PLWH and their families especially through mass education providing basic HIV information Three decades later however stigma remains rampant in Thai society although stigma decreased to some extent after the introduction of ART in early 2000 A recent study drawing on a representative sample of 10522 adults across Thailand shows that nearly 60 of the population meet the criteria for discriminatory attitudes toward PLWH based on the UNAIDS global indicator More specifically close to 70 of the respondents agree that PLWH suffer from stigma and the participants anticipate discriminatory events to happen close to 60 report a fear of HIV infection when in contact with PLWH and close to 40 indicate the participants would feel ashamed if they tested positive In healthcare settings more than 80 of the staff members are found to have negative attitudes toward PLWH As a result PLWH across genders sexualities age cohorts and ethnic groups still report experiences of stigma in their daily lives as well as constant fear and anxiety for possible repercussions once their serostatus is divulged leading to suboptimal physical and mental health outcomes Moreover those PLWH who belong to marginalized groups such as transgender women attribute their suffering to their own personal characteristics and behaviors rather than to the unjust social institutions prejudices of mainstream society and cultural norms of Thailand A key contributing factor for this slow progress is that the existing interventions often fail to consider the fact that both stigma and discrimination are deeply rooted in local culture values and follow fault lines in communities as concluded by Graham Fordham a medical anthropologist who has conducted ethnographical HIV research in Thailand since the 1990s and extensively reviewed the results of Thai HIV studies published before 2010 Fordham advocated that for stigma reduction interventions to be efficacious studies need to obtain a deeper understanding of the culturally specific knowledge used in the generation of stigma and discrimination as well as a deeper appreciation of the cultural meanings of its concomitants such as isolation and loneliness As such this study will emphasize the role of Thai culture more specifically Buddhist culture when addressing the stigma and suffering experienced by Thai PLWH
Buddhist Understanding of HIV Stigma in Thai Culture
Culture in Thailand is heavily influenced by Buddhism Similar to other countries in Southeast Asia Buddhism laid the foundation of Thai culture before the formation of the modern Siamese-Thai state Buddhism in particular Theravada Buddhism as an encompassing ideology and civic religion has provided a unified underlying symbolic system for people in Thailand to interpret and organize their day-to-day lives Indeed it is estimated that 94 of the Thai population identifies themselves as Buddhists and nearly all domains of social life have been shaped by Buddhist worldviews
As influenced by Buddhist concepts of karma it is thought that poor choices of health include not recognizing and letting go of strong feelings vedana which engender craving for and attachment to certain drsti ideas eg stigma and status or kama things eg addicting substances resulting in a sense of dukkha suffering To liberate themselves from suffering individuals are advised to develop insights into the transient nature of the material world including their face or status and to practice the Noble Fivefold Path makka which includes meditation and mindfulness in hope of reaching a state of enlightenment Women as well as members of gender and sexual minorities are particularly encouraged to practice to grow their spirituality During the process individuals become less attached to those strong desires and grow in compassion and acceptance toward themselves and others Meanwhile doing actions to accumulate merit such as practicing good self-management and providing support for others in need may also help to reduce bad karma and suffering in future lives As such within Buddhist culture the goal of HIV reduction interventions may be assisting PLWH in finding peace and harmony within themselves by gradually letting go of those strong desires for status that contribute to their suffering from HIV stigma Although Buddhist influences in PLWHs experiences and reactions to stigma have been documented in countries such as Thailand and Cambodia the existing literature focuses on how karma beliefs deter PLWH from seeking help This study by contrast treats Buddhist philosophy as a part of the cultures resources in this regard and seeks to leverage these cultural factors to promote PLWHs coping and resilience
Conceptualizing Influences of Buddhism on HIV Stigma Among Thai PLWH
To further contextualize this study the investigators propose a working conceptual model adapted from a cognitive-behavioral therapy CBT model of stigma the Threat Identification Model to situate the HIV stigma experienced by PLWH within the social and cultural environment of Thailand This model highlights how Buddhist philosophy and practice may influence the universal cognitive-behavioral process of HIV stigma Negative interpretations or attributions of events to ones HIV status reinforces negative attitudes toward oneself or internal stigma PLWH also experience elevated physical or emotional reactions as a response to external adverse events or negative attributions and interpretations of those events These physical or emotional reactions can further reinforce negative appraisals about themselves The internal stigma can then in turn interfere with the self-care engagement of PLWH although care engagement could also be directly shaped by the external stigma such as discrimination Within this framework the notion of nonattachment to transient social status also alters the results of cognitive appraisals of the stigma and decreases the threat to PLWH themselves Meditation and mindfulness practices promote PLWHs awareness of changes to physical and emotional states and assists in better managing these reactions The growing self-compassion and acceptance that can result due to Buddhist practices also help PLWH revise negative attitudes due to HIV status and may serve as better motivation to engage in care
Adaptation of an Evidence-Based Stigma Reduction Intervention
To achieve the investigators goal of developing a tailored stigma reduction intervention the investigators will adapt the intervention developed by Bogart and colleagues by integrating Buddhist teachings and other Myanmar sociocultural factors into it The investigators selected Bogart and colleagues intervention because of the optimal match of its underlying CBT theoretical model to the projects goals
Stigma is a primary risk factor affecting the well-being and survival of PLWH in particular PLWH who are marginalized by society HIV has long been a highly stigmatized disease and researchers have made great efforts to study various dimensions of HIV stigma resulting in an established body of literature HIV stigma is conceptualized as a collection of adverse attitudes beliefs and actions of others against PLWH external stigma which may result in internalized beliefs or actions taken by PLWH internal stigma leading to negative health outcomes Three decades of research have converged demonstrating that HIV stigma both external and internal can negatively impact the well-being and survival of PLWH across the globe through multiple pathways Populations that have been socially marginalized such as women ethnic minorities and sexual and gender minorities are particularly vulnerable to the negative impact of HIV stigma HIV stigma is a huge barrier to accessing social support and health services with negative impacts on PLWHs mental health and optimal self-management of their HIV such as adherence to medication For PLWH in Asia HIV stigma negatively impacts mental health and HIV self-managing behaviors leading to deteriorated subjective well-being physical health and survival
HIV Epidemic and AIDS Care System in Thailand
Thailand has the highest HIV prevalence rate in the Asian-Pacific region with an estimated 12 of its adult population infected Because of this high prevalence rate Thailand remains one of the countries with the largest number of people living with HIV PLWH in the Asia-Pacific region Thailand only follows India China and Indonesia in number of PLWH although its population size is ranked 11th in the region Currently there are 05 million PLWH living in Thailand Although historically HIV affected mostly female sex workers and their clients in Thailand the HIV epidemic has changed drastically due to proactive interventions in the 1990s Recently the HIV epidemic has come to resemble those in other developed countries with men who have sex with men MSM 92-40 transgender individuals 12 sex workers 1-16 and substance users 19 sharing the increasing burdens of HIV Additionally due to unequal distributions of vulnerable populations and risk factors for HIV infection it is estimated that 30 Thai provinces account for 75 of the countrys HIV infections with Chiang Mai being one of the provinces having the highest prevalence
As part of its response to the HIV epidemic the Thai government began to provide free antiretroviral treatment ART for PLWH with impaired immune functions CD4 350 cellmm3 in the early 2000s It then expanded the program to all PLWH regardless of their immune function in 2014 This policy has enabled high ART accessibility in Thailand making it one of the few countries in Asia-Pacific region that has more than 50 of PLWH to be on ART Due to high ART coverage Thailand experienced success in reducing HIV mortality an estimated 196000 deaths were averted between 2001 and 2014 In addition Thai PLWH increased their life expectancy to 71 years old or longer which is close to that of the general Thai population Despite these important gains however the number of PLWH has constantly decreased by approximately 10000 per year over the past decade which could be attributed to high mortality rates that surpassed incidence rates In 2016 it was estimated that while there were 6400 new HIV cases there were 16000 HIV-related deaths resulting in an overall mortality rate of 356 Compared with the 06 mortality rate in the United States during the same period the mortality rate in Thailand remained 5 times higher Indeed HIV still remains one of the top 10 most common causes of death in Thailand This high mortality rate may be partially explained by the notable HIV treatment cascade in Thailand among all Thai PLWH 74 were retained in care 68 received ART and only roughly 50 reached viral suppression An important reason for the low viral suppression rate is that HIV remains a highly stigmatized disease in Thailand HIV-related stigma still poses significant barriers for Thai PLWH to access healthcare and carry out health-protective behaviors to manage their HIV including adherence to medications
HIV Stigma among People Living with HIV in Thailand
As Thailand was one of the early epicenters of HIV in Asia stigma associated with HIV has attracted research attention since the late 1980s A significant amount of research and resources were invested in documenting the types and frequency of stigma events and their negative impacts as well as in policy programming to address the stigma against PLWH and their families especially through mass education providing basic HIV information Three decades later however stigma remains rampant in Thai society although stigma decreased to some extent after the introduction of ART in early 2000 A recent study drawing on a representative sample of 10522 adults across Thailand shows that nearly 60 of the population meet the criteria for discriminatory attitudes toward PLWH based on the UNAIDS global indicator More specifically close to 70 of the respondents agree that PLWH suffer from stigma and the participants anticipate discriminatory events to happen close to 60 report a fear of HIV infection when in contact with PLWH and close to 40 indicate the participants would feel ashamed if they tested positive In healthcare settings more than 80 of the staff members are found to have negative attitudes toward PLWH As a result PLWH across genders sexualities age cohorts and ethnic groups still report experiences of stigma in their daily lives as well as constant fear and anxiety for possible repercussions once their serostatus is divulged leading to suboptimal physical and mental health outcomes Moreover those PLWH who belong to marginalized groups such as transgender women attribute their suffering to their own personal characteristics and behaviors rather than to the unjust social institutions prejudices of mainstream society and cultural norms of Thailand A key contributing factor for this slow progress is that the existing interventions often fail to consider the fact that both stigma and discrimination are deeply rooted in local culture values and follow fault lines in communities as concluded by Graham Fordham a medical anthropologist who has conducted ethnographical HIV research in Thailand since the 1990s and extensively reviewed the results of Thai HIV studies published before 2010 Fordham advocated that for stigma reduction interventions to be efficacious studies need to obtain a deeper understanding of the culturally specific knowledge used in the generation of stigma and discrimination as well as a deeper appreciation of the cultural meanings of its concomitants such as isolation and loneliness As such this study will emphasize the role of Thai culture more specifically Buddhist culture when addressing the stigma and suffering experienced by Thai PLWH
Buddhist Understanding of HIV Stigma in Thai Culture
Culture in Thailand is heavily influenced by Buddhism Similar to other countries in Southeast Asia Buddhism laid the foundation of Thai culture before the formation of the modern Siamese-Thai state Buddhism in particular Theravada Buddhism as an encompassing ideology and civic religion has provided a unified underlying symbolic system for people in Thailand to interpret and organize their day-to-day lives Indeed it is estimated that 94 of the Thai population identifies themselves as Buddhists and nearly all domains of social life have been shaped by Buddhist worldviews
As influenced by Buddhist concepts of karma it is thought that poor choices of health include not recognizing and letting go of strong feelings vedana which engender craving for and attachment to certain drsti ideas eg stigma and status or kama things eg addicting substances resulting in a sense of dukkha suffering To liberate themselves from suffering individuals are advised to develop insights into the transient nature of the material world including their face or status and to practice the Noble Fivefold Path makka which includes meditation and mindfulness in hope of reaching a state of enlightenment Women as well as members of gender and sexual minorities are particularly encouraged to practice to grow their spirituality During the process individuals become less attached to those strong desires and grow in compassion and acceptance toward themselves and others Meanwhile doing actions to accumulate merit such as practicing good self-management and providing support for others in need may also help to reduce bad karma and suffering in future lives As such within Buddhist culture the goal of HIV reduction interventions may be assisting PLWH in finding peace and harmony within themselves by gradually letting go of those strong desires for status that contribute to their suffering from HIV stigma Although Buddhist influences in PLWHs experiences and reactions to stigma have been documented in countries such as Thailand and Cambodia the existing literature focuses on how karma beliefs deter PLWH from seeking help This study by contrast treats Buddhist philosophy as a part of the cultures resources in this regard and seeks to leverage these cultural factors to promote PLWHs coping and resilience
Conceptualizing Influences of Buddhism on HIV Stigma Among Thai PLWH
To further contextualize this study the investigators propose a working conceptual model adapted from a cognitive-behavioral therapy CBT model of stigma the Threat Identification Model to situate the HIV stigma experienced by PLWH within the social and cultural environment of Thailand This model highlights how Buddhist philosophy and practice may influence the universal cognitive-behavioral process of HIV stigma Negative interpretations or attributions of events to ones HIV status reinforces negative attitudes toward oneself or internal stigma PLWH also experience elevated physical or emotional reactions as a response to external adverse events or negative attributions and interpretations of those events These physical or emotional reactions can further reinforce negative appraisals about themselves The internal stigma can then in turn interfere with the self-care engagement of PLWH although care engagement could also be directly shaped by the external stigma such as discrimination Within this framework the notion of nonattachment to transient social status also alters the results of cognitive appraisals of the stigma and decreases the threat to PLWH themselves Meditation and mindfulness practices promote PLWHs awareness of changes to physical and emotional states and assists in better managing these reactions The growing self-compassion and acceptance that can result due to Buddhist practices also help PLWH revise negative attitudes due to HIV status and may serve as better motivation to engage in care
Adaptation of an Evidence-Based Stigma Reduction Intervention
To achieve the investigators goal of developing a tailored stigma reduction intervention the investigators will adapt the intervention developed by Bogart and colleagues by integrating Buddhist teachings and other Myanmar sociocultural factors into it The investigators selected Bogart and colleagues intervention because of the optimal match of its underlying CBT theoretical model to the projects goals
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None