Experiences of Thai-Muslim patients regarding inconsistent antiretroviral therapy adherence: An exploratory descriptive qualitative study.

Background: Antiretroviral therapy (ART) has played a crucial role in saving countless lives of patients with HIV/AIDS across the world. However, despite its effectiveness, ART adherence still falls short globally, and non-adherence remains the primary cause of treatment failure. In the rural areas of southern Thailand, where the population is predominantly conservative Muslims, there has been an observed increase in ART non-adherence. Objective: This study aimed to explore experiences of inconsistent ART adherence among Thai-Muslim patients with HIV/AIDS (PWHAs) in southern Thailand. In addition, the perspectives of healthcare providers were also sought. Methods: Data were collected by conducting semi-structured in-depth interviews with ten Thai-Muslim PWHAs and five healthcare providers at a Voluntary Counseling-and-Testing Clinic. A content analysis approach was utilized to analyze the data. Results: Inconsistent ART adherence was reported. Religion/spiritual imperatives, forgetfulness, inadequate knowledge (of drug side effects and drug regime), misunderstandings (about being symptom-free and feeling well), boredom from long-term drug-taking regimes, as well as poor transportation and lack of family support (arising from non-disclosure of one's HIV-serostatus due to HIV stigma) were emergent themes derived from the interviews with Thai-Muslim PWHAs. The healthcare providers' interview data revealed their need for the integration of Islamic beliefs to provide better care. Conclusion: It is essential for healthcare teams to work collaboratively with patients' religious beliefs to enhance ART adherence. Clinical nurses can contribute to the promotion of HIV-care services by integrating Islamic beliefs and Muslim culture into their practice, thus increasing patients' knowledge and motivation for ART adherence. This could entail utilizing Islamic prayer rituals as drug reminders, elaborating on Islamic moral beliefs concerning sickness and healing, and integrating the cultural imperatives of self-care in the Muslim community into ongoing care delivery. Cross-cultural nursing education and specialized training in HIV care should incorporate knowledge about Islamic and Muslim cultural beliefs.

Collaborative Approaches to Promote Family Caregiving for Thai-Muslim Older Adults.

This action research study aimed to develop, implement and evaluate the feasibility of an Islamic-based intervention program that included three main Islamic tenets and concept of family collaboration to promote comprehensive homebound care for Thai-Muslim older adults in southern Thailand. Using action research cycles, interviews with five dyads of healthcare recipients (Thai-Muslim older adults and their family primary caregivers) and with seven Thai-Muslim healthcare professionals (five clinical nurses, a physician and a pharmacist) were undertaken alongside participant observations. Inadequate knowledge, insufficient skills, low family involvement, poor negotiation skills, and the need for better integration of Islamic doctrines were identified. Satisfaction was expressed with the program components and activities, with a qualitative audit data revealed that family primary caregivers felt that they had gained more self-confidence, increased their caregiving knowledge and improved their skills. All stakeholders expressed a desire to further engage and maintain this collaborative program. Engaging with Islamic doctrines and concepts of family collaboration support improvements in homebound care for Muslim older adults. Using on core values of Islamic moral belief systems provides an important and culturally sensitized framework for engaging healthcare providers and family members in the Muslim older adults' comprehensive homebound care.

Family Participation to Promote Medication Adherence Among Thai-Muslim Older Adults With Hypertension: Action Research Study.

INTRODUCTION: Nonadherence to antihypertensive medications has been found increasingly prevalent in Thailand, yet the critical cultural resources of Islamic belief systems and family support are seldom mobilized to support adherence. Our study aimed to develop, implement, and evaluate an Islamic-based intervention program to promote medication adherence among Muslim older adults with uncontrolled hypertension in southern Thailand. METHOD: An action research with codesign and family participation principles was utilized. Within action research cycles, interviews with Thai-Muslim older adults, family primary caregivers, and health care professionals were undertaken alongside participant observations. RESULTS: A qualitative audit demonstrated an improved medication adherence with all stakeholders expressing their desire to further engage and maintain the new intervention program. DISCUSSION: Engaging with Islamic doctrine and concepts of family participation could support an improvement in antihypertensive medication adherence for Muslim older adults. Codesigning enables recognition of community belief systems, forming an important step toward improving community-based medication adherence.

The Thai HIV/AIDS epidemic at 15 years: sustained needle sharing among southern Thai drug injectors.

To explore perceptions and attitudes towards needle sharing among clinic-based injecting drug abusers (IDUs) at a drug-treatment clinic in Hat Yai City, Songkla Province, Southern Thailand. Qualitative methods were used to gather data, including: in-depth interviews with 17 active IDUs and with three nurses, participant observation, review of the IDUs' files, and validation after interview completion to ensure data triangulation. A form of comparative content analysis, including thematic analysis, was used for data analysis. After 15 years of the Thai HIV/AIDS epidemic, most southern Thai IDUs still occasionally engaged in needle sharing although they reported reductions in sharing frequency. Withdrawal symptoms and craving were most commonly cited as compelling reasons to share. Misconceptions about how to determine "healthy" from the "sick" was another key factor underlying sharing. Pooling money for drugs (with subsequent cost-savings) was given priority over purchasing new needles/syringes among disadvantaged IDUs. Receiving HIV voluntary counseling and testing (VCT), however, promotes reduced sharing. Our findings suggest that southern Thai IDUs remain at high risk of acquiring HIV infection, primarily through needle sharing. Harm reduction strategies, such as, providing VCT to all IDUs and promoting needle exchange programs might be beneficial approaches to curbing the rapid spread of HIV.

Sexual risks among southern thai drug injectors.

Sexual risks for HIV transmission among injection drug users (IDUs) in Thailand are not well characterized. We surveyed 272 male IDUs about their background, sexual behaviors, and drug use at drug treatment clinics in southern Thailand. HIV seroprevalence was determined using enzyme immunoassay. Fifty-six percent of participants were sexually active, of whom 88% had sex mostly with a noninjecting regular partner (wife or steady girlfriend), reporting low rates (34%) of condom use. Among sexually active IDUs, 43% were HIV infected and only a few were aware of their HIV serostatus. Condom use was associated with history of HIV voluntary counseling and testing (VCT) and poor perceived health status in multivariate analysis. Unprotected sex with regular sexual partners is frequent among IDUs in southern Thailand, where most IDUs have not sought VCT services. AIDS prevention efforts should address access to VCT and condom promotion to sexually active couples to prevent sexual transmission of HIV.

Risk factors for HIV infection among drug injectors in southern Thailand.

BACKGROUND: To determine HIV sero-prevalence and risk factors for HIV infection among injecting drug users (IDU) in southern Thailand. METHODS: Using a cross-sectional HIV sero-prevalence and behavioral survey, 272 active IDU were interviewed about background, life-style, drug use patterns, and sexual behaviors at six drug-treatment clinics in southern Thailand. RESULTS: Ninety-one percent reported lifetime needle sharing; 96% had tried HIV risk-reduction by either stopping/decreasing visits to sex workers and/or stopping/decreasing needle sharing. Only 5% knew that bleaching needles could reduce transmission risks. Overall, 51% tested HIV-positive (43% ethnic Thai vs. 64% ethnic Malay). HIV seropositivity among ethnic Thai was independently correlated with past history of needle sharing (OR 6.95; 1.89-25.58), injecting immediately at drug onset (OR 2.53; 1.25-5.13), and starting first injection at younger age (OR 2.61; 1.31-5.22). Injecting immediately at drug onset (OR 4.32; 1.23-15.14) and not carrying new needles (OR 4.47; 1.27-15.69) were risk factors among minority ethnic Malay. CONCLUSION: A high rate of HIV infection persists among southern-Thai IDU. HIV-infected individuals may act as a bridge of HIV transmission to their sex partners. AIDS prevention efforts should more intensely focus on minority ethnic Malays, discouraging needle sharing and increasing protected sex with regular sexual partners.

Needle sharing among southern Thai drug injectors.

AIM: To examine factors associated with needle sharing among injecting drug users (IDU) in southern Thailand. DESIGN: Using a cross-sectional survey, 272 active IDU were interviewed about their socio-economic background, needle sharing and drug use patterns at six drug-treatment clinics in southern Thailand. FINDINGS: Ninety-one per cent of IDU gave a past history of ever sharing injecting equipment: of these, 23% currently injected but did not share and 68% still shared. Only 5% of participants knew that bleaching needles could reduce HIV transmission risks. Recent needle sharing was correlated with number of IDU friends (OR 12.23; CI, 5.24-28.51), engaging in illegal jobs (OR 2.74; CI, 1.13-6.67), being unable to use new needles at all times (OR 2.89; CI, 1.17-7.14) and believing that cleaning contaminated shared needles with at least plain water could reduce HIV transmission (OR 3.32; CI, 1.16-6.68). CONCLUSIONS: Our data suggest that AIDS prevention efforts should focus on approaches to reduce needle sharing. Needle exchange programs, HIV counseling and testing and bleach distribution may reduce levels of needle-sharing risks.