Thailand - Stop TB Partnership

arrier; reportedly, Tanzanian women often have to “choose between traveling [to a clinic]
and getting their medications or buying food for the family” 36 —and often opt against accessing
TB care.
There are strong indications that TB is a serious health threat among migrants
to Thailand from neighboring Burma, Laos, and Cambodia. Unable to read or speak Thai,
lacking official documentation, and fearing deportation if they come into contact with public
authorities, many are hesitant to seek treatment. Those who do seek treatment move so frequently
that their treatment is often interrupted, raising serious concerns about MDR-TB.
TB is having a devastating impact on other vulnerable groups as well, including
prisoners, refugees, and minority groups. Yet some NTPs have failed either to conduct the
necessary monitoring and data analysis themselves or to support the collaborative research
with academic institutions and NGOs that would allow them to identify vulnerabilities
and to develop appropriately targeted programs and services. For example, in Brazil, since
Brazilians of African descent are overrepresented among the poor, it seems likely that Afro-
Brazilians—and particularly Afro-Brazilian women—also suffer higher rates of TB, yet there
has been little research on this issue. 37 Where such data exists, as with regard to prisoners
in Thailand, the government has been able to design and implement effective outreach
programs.
TB and poverty
There is abundant evidence that poverty increases vulnerability to TB. The malnutrition,
overcrowding, poor air circulation, and unhygienic sanitation facilities commonly experienced
by the poor all increase the probability of TB infection. People living in poor communities
are also harder hit by the hidden costs of diagnosis and treatment and are therefore
less likely to access TB services. One recent government study in Bangladesh found that
70 percent of patients at DOTS centers were below the poverty line. 38 TB prevalence
and mortality rates in Brazil reflect broader socioeconomic patterns, with poor and disadvantaged
communities suffering most.
TB, in turn, can make patients more vulnerable to poverty. TB treatment and associated
costs are relatively higher for poor people. TB decreases an individual’s mental and
physical capacity to work, further adding to the financial burden of treatment and multiplying
the extent and impact of poverty. As 90 percent of Bangladeshi TB patients are in the
most economically productive age group (15–54 years), the economic and social burden to
their families is massive. According to a document prepared by the Bangladeshi government,
the economic impact associated with TB and TB coping strategies is credited with
pushing 30 percent of nonpoor patients below the poverty line. 39
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TB POLICY IN THAILAND