2011
Positive Partnership Project, 
New Phase
Endline Study Report
Kerry Richter
Ratana Nuankaew
Aparna Jain
Pakprim Oranop na Ayuthaya
Positive Partnership Project, 
New Phase: 
Endline Study Report 
November 2011
Principal Authors: 
Kerry Richter (IPSR) 
Ratana Nuankaew (PDA) 
Aparna Jain (ICRW) 
Pakprim Oranop na Ayuthaya (Pact) 
 Contributors: 
Nungruthai Mongkolvibolpol (PDA) 
 Aphichat Chamratrithirong (IPSR) 
Parichart Chantcharas (IPSR) 
Arunee Bunpabut (PDA) 
Rachada Tuvinun (PDA) 
Teerayuth Kukangwan (PDA) 
Tatcha Apichaisiri (Pact) 
Organizations: 
Population and Community Development Association (PDA), Thailand 
Pact Thailand/Greater Mekong Region 
Institute for Population and Social Research, Mahidol University, Thailand 
The International Center for Research on Women (ICRW), Washington, DC 
USAID/ Regional Development Mission/Asia 
page i
Acknowledgements 
This endline study report would not have been possible without the guidance and the help of several 
individuals who in one way or another contributed and extended their valuable assistance in the 
preparation and completion of this study. 
First and foremost, our utmost gratitude to Dr. Patchara Benjarattanaporn, the former Strategic 
Information Specialist of USAID Regional Development Mission for Asia, for her vision, unfailing 
support and commitment to the project. Dr. Benjarattanaporn recognized the need for 
comprehensive operations research to measure the outcomes of the second phase Positive 
Partnership Program (PPP) and initiated this study. Not only did she contribute to the study design 
and work closely with the PDA and Pact research team, but Dr. Benjarattanaporn also provided 
advice and support to program planning and implementation. 
We are deeply grateful to Dr. R. Cameron Wolf, the former Senior Regional HIV/AIDS Technical 
Advisor of USAID Regional Development Mission/Asia, who helped with the design of the second 
phase PPP in 2007 when he served as Pact’s consultant. After joining USAID in 2008, Dr. Wolf 
continued to provide close guidance to this study and the project. 
Our sincere thanks to Dr. Philip Guest for his technical inputs and advice in the development of the 
second phase PPP and the monitoring and evaluation system of the project. 
Technical inputs on stigma measurement and evaluation design have been provided by stigma 
specialists led by Dr. Anne Stangl from the International Center for Research on Women and Dr. 
Laura Nyblade (Global Health, RTI International and the Health Policy Project). 
We also sought guidance from experts from the Institute for Population and Social Research (IPSR), 
Mahidol University. We are grateful to Dr. Aphichat Chamratrithirong for his technical and moral 
support, and valuable research training. Our thanks to Parichart Chancharat for her technical inputs 
in the qualitative study analysis. Also, our appreciation to Pattama Yampeka for her kind support 
throughout our coordination with IPSR. 
Without leadership and support from Tharinee Sriruenthong, PDA Research and Evaluation 
Department, this study would have been a distant reality. We therefore thank her deeply. 
We very much appreciate the Community Health Bureau (CHB) of PDA which was responsible for 
implementing the PPP. Led by Urai Homtawee, Malee Sunsiri, and Ekachai Kumissara, staff in six 
project sites assisted the study team in linking them to project participants and facilitating the 
fieldwork. 
We would like to extend our thanks to Supol Singhapoom and Tatcha Apichaisiri from Pact who were 
behind the design of the baseline study. With his enthusiasm, Supol took part in baseline analysis 
and was mainly responsible for completing the baseline study report. 
Last but not least, we would like to thank David Dobrowolski, the Chief of Party of Pact Greater 
Mekong Region, for his leadership, encouragement, and support throughout the project and this 
study. 
page ii
Executive Summary 
The Positive Partnership Project (PPP), or Pa Thong Koe1
, was designed with the goal of increasing 
quality of life for people living with HIV/AIDS (PLHIV) and the twin objectives of increasing PLHIV’s 
level of income and reducing the stigma and discrimination they face. It is based on the principle of 
‘helping PLHIV to help themselves’ by providing an occupational loan to a pair of recipients who live 
in the same community: one HIV positive and one HIV negative ‘buddy’. Besides receiving loans to 
implement diverse income generation activities, buddy pairs are given skills training in marketing, 
accounting, and business management to ensure the success of their commercial activities. The 
program also conducts HIV/AIDS awareness and education activities in the communities where pairs 
live and operate their businesses. These activities address issues such as HIV prevention, care and 
support for people living with HIV, and reduction of stigma and discrimination. The buddy pairs also 
get to know each other through partnering on their business and on the community-based activities, 
which naturally results in greater understanding and reduced stigma. Through this, the community 
observes a model of ‘living and working together as normal’ between PLHIV and non-PLHIV. 
The project included seven key interventions: the buddy partnership; the low-interest loan; capacity
building activities organized by the Population and Community Development Association (PDA) such 
as training courses and site visits to other communities; the monthly meeting on banking day; the 
monthly HIV campaign activities; the Funfair edutainment activity; and the production of evidence￾based information, education and communication (IEC) materials. Two model variations were 
implemented: the village development bank (VDB) in rural communities and the PPP clubs (PPPC) in 
both rural and urban communities. In addition, PPPCs had two types, community-based and 
hospital-based; the hospital-based PPPCs included PLHIV and buddies who may not be from the 
same community. 
This report presents results of an endline study conducted from late 2010 to early 2011. The endline 
study used a mixed methods approach in order to gain a greater understanding of the impact and 
effectiveness of the intervention. The quantitative endline survey measured changes in HIV-related 
knowledge, stigma and discrimination of buddies, family and community members, as well as 
changes in economic status, internalized and experienced stigma and discrimination, self-esteem, 
self-efficacy, and quality of life of people living with HIV who were involved in the project. The 
qualitative part of the study investigated the effect of the project in more depth, including the 
reasons that some aspects and some models worked better than others. It also gained the 
perspectives of participants, communities and community leaders on the successes of and potential 
improvements in the project. 
Both the qualitative and quantitative data show significant change in key outcomes among PLHIV, 
buddies, their families, and the project communities. For PLHIV, these include disclosure of HIV 
status to an increased number of people, including an increased percentage disclosing to their 
community; reduced self-isolation and fear of stigma from family and the community; increased self￾esteem/self-efficacy; and increased quality of life. The multivariate analysis did not find significant 
relationships between participation in the program and change in the disclosure and stigma 
measures, but the small number of cases limited the analysis. Type of program model was found to 
 
1
Pa Thong Koe is a type of Thai fried doughnut in a “twinned” shape: two rectangular parts connected in 
the middle that can be pulled apart for dunking in hot soy milk or coffee. 
page iii
be significantly related to increases in quality of life: VDB participants and PPPC urban club members 
more likely to report increased quality of life than PPPC rural members. 
The buddy survey also found significant changes in HIV knowledge, fear-based and value-based 
stigma among the HIV-negative partners by the time of the endline survey. Qualitative interviews 
indicated that the community-based program models were more successful in maintaining buddies’ 
participation in the program, as it was difficult for buddies to join the activities when they live in 
different communities. Multivariate analysis showed that buddies’ discussion of HIV/AIDS with their 
PLHIV partner, participation in HIV informational campaigns, and the number of types of exposures 
to the program were significantly related to increased HIV/AIDS knowledge among buddies. 
Family members of PLHIV and buddies also saw increases in their HIV knowledge and reductions in 
the stigma measures. Finally, the community survey found significant change in HIV knowledge, fear￾based stigma and value based stigma. Multivariate analysis showed that increases in HIV knowledge 
were significantly related to the PPPC model and to the number of types of exposures to the 
program. The qualitative study also outlined how having a variety of platforms for IEC and for 
participation in program activities added to the strength of the program. The decrease in fear-based 
stigma was also related to the PPPC model and the number of types of exposure, while a decrease in 
value-based stigma regarding shame associated with PLHIV was significantly related to the number 
of types of exposure. These multivariate results, along with the explanatory power of the qualitative 
data, provide clear evidence that the program was successful in reducing stigma for PLHIV in their 
communities. 
The findings suggest that VDBs and PPPCs should be based in one local community to build a higher 
level of participation for the general population and focus efforts to reduce HIV/AIDS stigma and 
discrimination. However, the hospital-based PPPC model can reach a larger group of PLHIV, and is 
appropriate for those PLHIV who do not want to take the risk of disclosing their HIV status. Also, the 
results show that a combination of various interventions is recommended to reinforce information 
to reduce fear and shame. The best results were found among those who were exposed to a variety 
of program activities and messages. The schematic framework of addressing internalized (self) 
stigma among PLHIV, and then moving to people around PLHIV and community members to address 
external stigma and discrimination, was an important thematic concept for the program. Thus 
interventions should be implemented on a continuous basis among PLHIV, their intimate friends, 
buddies (HIV negative loan recipients), family members of PLHIV and community leaders, so that 
people surrounding PLHIV can act as change agents for the wider community. A longer 
implementation timeline than two and a half years is recommended for future replications of the 
program. 
The results also point to some program areas that could be improved and strengthened. Further 
research on approaches to reduce self-stigmatization of PLHIV should be conducted, as this was 
found to be a prevalent issue. Greater effort should be made for capacity building among HIV 
negative loan recipients (buddies) on providing emotional support to PLHIV and disseminating HIV 
knowledge to others. Finally, the program should focus on developing the community’s in-depth HIV 
knowledge and understanding of risk behaviors. In addition, it is important to also address stigma for 
at-risk populations such as sex workers and MSM. Causes of blame stigma (believing that PLHIV are 
promiscuous) should also be analyzed further to tackle it more effectively. 
page iv
Table of Contents 
Acknowledgements ................................................................................................................................................ i
Executive Summary ............................................................................................................................................... ii
Table of Contents ................................................................................................................................................. iv
List of Figures ....................................................................................................................................................... vi
List of Tables ........................................................................................................................................................vii
Abbreviations ...................................................................................................................................................... viii
1. Introduction and Research Objectives .............................................................................................................. 1
2. Project Background ........................................................................................................................................... 2
3. Research Methodology ..................................................................................................................................... 5
3.1 Study design for quantitative surveys ........................................................................................... 5
3.2 Qualitative study design ............................................................................................................... 7
3.3 Data Analysis ................................................................................................................................. 7
Scales ............................................................................................................................................... 7
Impact analysis ................................................................................................................................ 8
3.4 Schematic framework ................................................................................................................... 8
4. People Living with HIV .................................................................................................................................... 10
4.1 Profile of Respondents ................................................................................................................10
4.2 Participation in and exposure to the PPP project .......................................................................11
Involvement with buddies ............................................................................................................12
Support from buddies ...................................................................................................................13
Participation in project activities ..................................................................................................14
4.3 Disclosure of HIV status ..............................................................................................................15
4.4 Stigma Results for PLHIV .............................................................................................................18
Internalized Stigma .......................................................................................................................18
Fear of stigma and enacted stigma ...............................................................................................20
4.5 Self-esteem and self-efficacy ......................................................................................................24
4.5 Quality of life ...............................................................................................................................27
5. Buddies ............................................................................................................................................................ 31
5.1 Profile ..........................................................................................................................................31
5.2 Program exposure .......................................................................................................................32
5.3 HIV Knowledge ............................................................................................................................35
5.4 Fear and Value-Driven Stigma.....................................................................................................36
6. Family of PLHIV and Buddies........................................................................................................................... 38
6.1 Profile ..........................................................................................................................................38
6.2 Program exposure .......................................................................................................................39
6.3 HIV/AIDS knowledge ...................................................................................................................40
6.4 Fear and value driven stigma ......................................................................................................41
page v
7. Community ...................................................................................................................................................... 42
7.1 Profile ..........................................................................................................................................43
7.2 Exposure to the PPP program .....................................................................................................44
7.2 HIV/AIDS Knowledge ...................................................................................................................46
7.3 Fear-driven, Value-driven and Enacted Stigma ..........................................................................47
8. Impact Analysis ............................................................................................................................................... 50
8.1 PLHIV ...........................................................................................................................................51
8.2 Buddy ..........................................................................................................................................52
8.3 Family ..........................................................................................................................................54
8.4 Community ..................................................................................................................................56
Fear-Driven Stigma ........................................................................................................................56
Value-Driven Stigma......................................................................................................................58
HIV knowledge ..............................................................................................................................60
9. Summary and discussion ................................................................................................................................. 61
10. Recommendations ........................................................................................................................................ 61
References .......................................................................................................................................................... 61
Appendix ............................................................................................................................................................. 61
page vi
List of Figures 
Figure 3.1: Schematic diagram of research framework ..........................................................................9 
Figure 4.1: PLHIV reports of how often they talked to their buddy by model .....................................12
Figure 4.2: PLHIV reports of material support received from buddies in the past six months ............13
Figure 4.3: PLHIV reports of other support received from buddies in past 6 months .........................14
Figure 4.4: PLHIV exposure to PPP intervention activities by type of model .......................................14
Figure 4.5: PLHIV exposure to IEC materials by type of model.............................................................15
Figure 4.6: PLHIV internalized stigma item results at baseline and endline .........................................19
Figure 4.7: Change in internalized stigma scales, PLHIV .......................................................................20
Figure 4.8: Change in scale items measuring fear of stigma from family/friends, PLHIV .....................21
Figure 4.9: Change in scale items measuring fear of stigma from the community, PLHIV ...................22
Figure 4.10: Change in scales measuring fear of family/friends stigma and community stigma, PLHIV
..............................................................................................................................................................23
Figure 4.11: Change in scale items measuring enacted stigma from family and friends at baseline and 
endline, PLHIV .......................................................................................................................................23
Figure 4.12: Change in scale items measuring enacted community stigma at baseline and endline, 
PLHIV .....................................................................................................................................................24
Figure 4.13: Self-efficacy at baseline and endline ................................................................................25
Figure 4.14: Self-esteem at baseline and endline .................................................................................26
Figure 4.15: Self-esteem/self-efficacy results at baseline and endline ................................................26
Figure 4.16: Mean response on Physical Quality of Life Items (N=95) .................................................28
Figure 4.17: Mean response on Psychological Quality of Life Items (N=95) ........................................28
Figure 4.18: Mean response on Social Quality of Life Items (N=95) .....................................................29
Figure 4.19: Mean response on Environmental Quality of Life Items (N=95) ......................................29
Figure 4.20: Quality of life scales at baseline and endline ....................................................................30
Figure 5.1: Buddy reports of how often they talked to their PLHIV partner by model ........................32
Figure 5.2: Support given and received by buddies ..............................................................................33
Figure 5.3: Buddies’ exposure to PPP intervention activities ...............................................................34
Figure 5.4: Buddies’ exposure to IEC materials ....................................................................................34
Figure 5.5: Buddies’ knowledge of HIV at baseline and endline ...........................................................36
Figure 5.6: Change in buddies’ fear of HIV transmission ......................................................................37
Figure 5.7: Change in buddies’ agreement with shame Statements ....................................................37
Figure 5.8: Change in buddies’ agreement with blame Statements.....................................................38
Figure 6.1: Family exposure to PPP intervention activities ..................................................................40
Figure 6.2: Family exposure to IEC materials ........................................................................................40
Figure 6.3: Family knowledge of HIV at baseline and endline .............................................................41
Figure 6.4: Change in family members’ fear of HIV transmission.........................................................42
Figure 6.5: Change in family members’ agreement with shame statements .......................................42
Figure 6.6: Change in family members’ agreement with blame statements .......................................43
Figure 7.1: Community exposure to PPP intervention activities ..........................................................44
Figure 7.2: Community exposure to IEC materials ...............................................................................45
Figure 7.3: Community knowledge of HIV at baseline and endline .....................................................47
Figure 7.4: Change in community members’ fear of HIV transmission ................................................48
Figure 7.5: Change in community members’ agreement with shame statements ..............................49
Figure 7.6: Change in community members’ agreement with blame statements...............................49
page vii
List of Tables 
Table 2.1: Program monitoring data on numbers of participants in PPP project by type of model and 
urban status, 2009 and 2010 .................................................................................................................. 4 
Table 3.1: Number and distribution of communities selected ...............................................................5
Table 3.2: Number of original PLHIV and buddies interviewed for endline survey ................................5
Table 3.3: Total number of respondents to endline survey ...................................................................6
Table 3.4: Respondents to qualitative study ..........................................................................................7
Table 4.1: Profile of PLHIV respondents (in percents)..........................................................................10
Table 4.2: Occupation and income of PLHIV by urban status (all endline participants).......................11
Table 4.3: Model by urban status (all endline respondents) ................................................................11
Table 4.4: Disclosure of HIV status to others, baseline and endline (percent yes) ..............................16
Table 4.5: Percent of PLHIV reporting they have disclosed their status to the community and would 
advise others to disclose by model type at endline..............................................................................18
Table 4.6: Reliability analysis for WHOQOL subscales with PLHIV dataset (N=107) ............................30
Table 5.1: Profile of buddy respondents (in percents) .........................................................................31
Table 6.1: Profile of family members of PLHIV and buddies at baseline and endline ..........................39
Table 7.1: Profile of community members at baseline and endline .....................................................43
Table 8.1: Results of linear regression of level of exposure to project activities on Quality of Life, 
PLHIV Survey .........................................................................................................................................51
Table 8.2: Results of linear regression of level of exposure to project activities on HIV knowledge 
score, buddy survey ..............................................................................................................................52
Table 8.3: Results of linear regression of level of exposure to project activities on shame-related 
value-driven stigma, buddy survey .......................................................................................................53
Table 8.4: Results of linear regression of level of exposure to project activities on fear-driven stigma, 
family survey ......................................................................................................................................... 55 
Table 8.5: Results of linear regression of level of exposure to project activities on shame-related 
value-driven stigma, family survey .......................................................................................................55
Table 8.6: Results of linear regression of level of exposure to project activities on fear-driven stigma, 
community survey................................................................................................................................. 56
Table 8.7: Results of linear regression of level of exposure to project activities on shame, community 
survey ....................................................................................................................................................58
Table 8.8: Results of linear regression of level of exposure to project activities on HIV knowledge, 
community survey................................................................................................................................. 60
Table 9.1: Summary table for PLHIV analysis ........................................................................................61
Table 9.2: Summary table for buddy, family and community multivariate analysis ............................ 63 
page viii
Abbreviations 
AIDS Acquired Immune Deficiency Syndrome
HIV Human Immune Deficiency Virus
ICRW International Center for Research on Women
IEC Information, education and communication
IPSR Institute for Population and Social Research
IRB Institutional Review Board
MSM Men who have sex with men
na Not applicable
n.s. Non-significant
PDA Population and Community Development Association
PLHIV People living with HIV
PPP Positive Partnership Project
PPPC PPP club
QOL Quality of Life
S&D Stigma and Discrimination
SPSS Statistical Package for the Social Sciences
STATA Data Analysis and Statistical Software Package
UNAIDS Joint United Nations Programme on HIV/AIDS
USAID RDMA United States Agency for International Development Regional 
Development Mission for Asia
VDB Village Development Bank
WHO World Health Organization
WHOQOL World Health Organization Quality of Life Assessment
page 1
1. Introduction and Research Objectives 
The Positive Partnership Project (PPP), or Pa Thong Koe2
, was designed with the goal of increasing 
quality of life for people living with HIV/AIDS (PLHIV) and the twin objectives of increasing PLHIV’s 
level of income and reducing the stigma and discrimination they face. The project has been 
implemented since 2002 and in 2007 was documented by UNAIDS as a ‘Best Practice’ (UNAIDS, 
2007). It is based on the principle of ‘helping PLHIV to help themselves’ by providing an occupational 
loan to a pair of recipients who live in the same community: one HIV positive and one HIV negative 
‘buddy’. 
Under the program, ‘buddy pairs’ receive loans to implement diverse income generation activities, 
and are also given skills training in marketing, accounting, and business management to ensure the 
success of their commercial activities. The program also conducts HIV/AIDS awareness and 
education activities in the communities where pairs live and operate their businesses. These 
activities address issues such as HIV prevention, care and support for people living with HIV, and 
reduction of stigma and discrimination. 
Besides improving the livelihoods of PLHIV and their buddies, the partnership of an HIV positive 
recipient with another community member has the added benefit of reducing HIV/AIDS-related 
stigma and discrimination. This comes about in several ways. The partnership provides an 
opportunity for the HIV negative loan recipient (buddy) to increase related knowledge and 
understanding about HIV/AIDS through project activities, as the buddies are required to disseminate 
HIV/AIDS knowledge to others in the community. The buddy pairs also get to know each other 
through partnering on the business and community-based activities, which naturally results in 
greater understanding and reduced stigma. They provide mutual support to each other—not one￾sided support from the buddy only—which may include material, emotional and occupational 
support. Besides the interaction between the buddy pairs themselves, the community observes a 
model of ‘living and working together as normal’ between PLHIV and non-PLHIV. Through 
observation of the model, the community is likely to reduce HIV/AIDS stigma and discrimination.
In 2008, USAID RDMA tasked Pact Thailand to provide funding to PDA to carry out a new phase of 
the PPP project as a pilot program for future scale-up. Under this funding, two enhanced variations 
of the model were implemented and tested: village development banks (VDB) and PPP clubs (PPPC), 
which were support groups of both HIV positive and negative partnerships. Loans were managed 
and disbursed through these community channels. The project duration was April 2008–September 
2010 for this phase. 
Several research components were built into this phase of the project. A baseline survey was 
completed in early 2009, with the results published at the end of that year (Jain et al, 2009). This 
study assessed the baseline levels of economic status, business skills, internalized and experienced 
stigma and discrimination, self-esteem, self-efficacy and quality of life of the people living with HIV 
who were participating in the project. It also surveyed the buddies, family members of the buddy or 
PLHIV, and community members residing in the intervention communities about HIV knowledge, 
attitudes towards people living with HIV, and actionable drivers of stigma and discrimination. The 
 
2
Pa Thong Koe is a type of Thai fried doughnut in a “twinned” shape: two rectangular parts connected in 
the middle that can be pulled apart for dunking in hot soy milk or coffee. 
page 2
results of the baseline study were used to develop information, education and communication (IEC) 
materials addressing HIV stigma and discrimination issues that were used throughout the rest of the 
project. 
This report presents results of an endline study conducted from late 2010 to early 2011. The endline 
study used a mixed methods approach in order to gain a greater understanding of the impact and 
effectiveness of the intervention. The quantitative endline survey captured the same information as 
the baseline: HIV knowledge, internalized and experienced stigma and discrimination, self-esteem, 
self-efficacy, economic status, and quality of life of people living with HIV who were involved in the 
project, as well as HIV stigma and discrimination of buddies, family and community members. The 
endline survey also measured exposure to project interventions in order to analyze the effect of the 
PPP interventions on change in stigma, discrimination and quality of life. The qualitative part of the 
study investigated the effect of the project in more depth, including the reasons that some aspects 
and some models worked better than others. It also gained the perspectives of participants, 
communities and community leaders on the successes of and potential improvements in the project. 
2. Project Background 
The new phase of the project was implemented in six provinces, divided into rural and urban sites as 
follows: 
 Urban: Chiang Mai, Chonburi, and Bangkok 
 Rural: Chiang Rai, Nakhon Ratchasima, and Khon Kaen. 
Under this phase of the project, PDA established 11 PPP clubs (PPPC) and 12 village development 
banks (VDBs). Both entities were responsible for managing banking activities such as collecting 
savings, selecting loan recipients, administering the loans, and conducting HIV awareness-raising 
activities in their communities. Both were chiefly managed by the target group themselves with 
concrete and continuous support from PDA. Through the new models, key interventions in 
disbursing loans and reducing HIV/AIDS stigma and discrimination at the community level were 
implemented by the buddy pairs and community members themselves. Community leaders also 
helped the buddy pairs organize HIV/AIDS campaign activities. 
As described briefly below, the project included seven key interventions: 
1. The Buddy Relationship, as described above: one PLHIV and non-PLHIV individual form a 
partnership to receive a loan and to create a platform to provide mutual support. The 
partnership role also includes disseminating HIV/AIDS knowledge to the community. 
2. The low-interest loan for the purpose of occupational activities, given to loan recipient 
partnerships through the VDB and PPPCs. The loan amounts did not exceed 12,000 Thai 
baht3
per person with an interest rate of Baht 0.50 per month. 
3. Capacity building activities organized by PDA such as training courses and site visits to other 
communities; knowledge and skills conveyed included VDB/PPPC management, accounting, 
basic occupational skills, HIV/AIDS, the role of PPP loan pair, etc. PDA also conducted 
 
3
 Approximately US$400. 
page 3
training for community leaders in order to encourage stronger community involvement in 
reducing HIV stigma in the community. Community leaders were also trained on financial 
skills, as they often paid an important role in loan management, particularly for VDBs.
4. The monthly meeting on banking day, organized by the VDB and PPPC. These were an 
important mechanism to mobilize community resources on a continuous basis. Key activities 
during the monthly meeting included financial activities, such as deposits, loan repayment, 
loan disbursement, and financial reporting; discussion on progress of the VDB/PPPC; 
HIV/AIDS related activities such as quiz games and planning for information dissemination; 
and monitoring visits by project staff to follow up and provide suggestions to improve the 
management of VDB and PPPC.
5. Monthly HIV campaign activities: VDB and PPPC were required to conduct at least one 
HIV/AIDS campaign activity per month in the community. These included games, radio 
dramas, household radio programs, exhibitions, posters and billboards, condom and IEC 
material distribution, and motto (key message) distribution. 
6. Funfair (Edutainment activity on HIV/AIDS): The PPPC that are not based in the community 
found it difficult to organize HIV/AIDS campaign activities on a monthly basis as required by 
the project. For this reason the Funfair was invented and co-organized by PDA, the PPPC and 
community leaders. These were conducted every six months and communicated through 
edutainment activities organized in different stations such as quiz games, darts, exhibitions, 
role play, etc. Though the VDBs were not required to organize Funfairs, some joined those 
organized by other PPPCs or organized their own when they realized their effectiveness. 
7. Production of Evidence-based IEC Materials: The project developed three types of IEC 
materials based on needs or gaps found through data analysis of the project regarding 
HIV/AIDS stigma and discrimination reduction of the community and PLHIV. Those materials 
included posters, radio dramas and slips of paper with HIV/AIDS-related mottos that were 
distributed in the community. All of those three materials were aimed to deliver key 
messages of the project that directly link to reduction of HIV/AIDS stigma and discrimination. 
It should be noted that there were some design differences in the two model variations during this 
new phase. Urban project sites all had the PPP club (PPPC) model, whereas the rural sites could have 
either a VDB or a PPPC. For VDB (all in rural sites) the monthly meeting/banking day and all HIV/AIDS 
campaign activities were organized in the community where the VDB office was located. PPP clubs 
(PPPC) had two types, community-based and hospital-based. The community-based PPPC were 
originated by PPP loan recipients (both PLHIV and buddies) and the general population who resided 
in the community where the PPPC office is located. The monthly meeting on banking day as well as 
HIV/AIDS campaign activities were organized in that community. The hospital-based PPPC, however, 
were originated by PLHIV-buddy partnerships that existed previous to the beginning of the new 
phase. In the hospital-based clubs the PLHIV were receiving ARV treatment at the same hospital, and 
most were from different communities. Non-PLHIV members or buddies may also not be from the 
same community. The monthly meeting or banking day was organized at the hospital. Since the 
buddy pairs in the hospital-based clubs did not have ties to the community where the hospital was 
located, HIV/AIDS campaign activities were organized at a selected community where there was at 
least one PLHIV club member who was willing to lead the activities and where stigma and 
page 4
discrimination towards PLHIV still exists, as informed by a community assessment prior to program 
startup. 
Program monitoring data provides additional detail about the number of people reached by the 
project (Table 2.1). The number of VDB participants is much higher than the PPPC participants; the 
VDBs had 2,150 participants by September 2010 whereas the rural PPPCs had only 150 and the 
urban PPPCs 340. Also, the number of PPPC members increased only slightly from 2009 to 2010 
while there was a 15% increase in the VDBs. In urban areas, more PPPC members were in 
community-based clubs whereas in rural areas the hospital-based members out-numbered the 
community-based members. 
Table 2.1: Program monitoring data on numbers of participants in PPP project by type of model 
and urban status, 2009 and 2010 
As of 30 September 2009 As of 30 September 2010
No. of total 
members/savers
No. of PPP 
loan recipients 
(PLHIV/ non￾PLHIV)
No. of total 
members/savers
No. of PPP loan 
recipients 
(PLHIV/non￾PLHIV)
URBAN PPP 287 160 340 186
Community based 201 90 240 102
Hospital based 86 70 100 84
RURAL PPP 132 41 150 43
Community based 33 10 28 10
Hospital based 99 31 122 33
RURAL VDB 1884 54 2150 63
TOTAL 2303 255 2640 292
page 5
3. Research Methodology 
As mentioned above, the endline study used both qualitative and quantitative methods to 
investigate the impact of the program. This section describes the methodologies used in more detail. 
3.1 Study design for quantitative surveys 
The endline surveys followed the same study design as the baseline surveys. They were conducted 
among four main target groups, namely people living with HIV, buddies, family members of people 
living with HIV and/or their buddies, and finally community members. These surveys were 
conducted in the same communities as the baseline survey. The selection of communities was based 
on three criteria: 1) at least one person living with HIV was living in the community; 2) people living 
with HIV implemented interventions in the community; and 3) a PPP club (PPPC) was already 
established before the baseline survey started (in communities implementing the PPPC model). 
Geographic distribution was also one of key considerations taken into account for the selection of 
communities (Table 3.1). 
Table 3.1: Number and distribution of communities selected 
PPP Club Model VDB Model
Province/Region Total Number Sample Total Number Sample
Bangkok and vicinities 4 2 0 0
Chonburi/Middle 2 1 0 0
Chiang Mai/North 2 1 0 0
Chiang Rai/North 1 1 4 2
Khon Kaen/Northeast 1 0 4 2
Nakhon Ratchasima/Northeast 1 1 4 1
Total 11 6 12 5
Eleven communities were selected, comprised of 6 communities using the PPPC model and 5 using 
the VDB model. 
In the baseline survey, all program participants living with HIV in the sampled communities were 
successfully interviewed (N=107), and nearly all of the buddies (N=105) (two buddies declined to 
participate in the baseline survey). In the endline survey, 95 of the original 107 PLHIV were 
successfully interviewed and 75 of the original 105 buddies (Table 3.2). The loss to follow-up was 
11.2% and 28.6% respectively. However, an additional 36 PLHIV who had not been interviewed for 
the baseline survey were interviewed at endline, as well as an additional 44 buddies (see Table 3.3). 
Table 3.2: Number of original PLHIV and buddies interviewed for endline survey 
Respondents Baseline Endline Loss to follow-up
PLHIV 107 95 11.2% (12)
Buddies 105 75 28.6% (30)
The family member survey interviewed the family members of people living with HIV and their 
buddies where 1) the PLHIV or the buddy agreed to have their family members interviewed, 2) the 
page 6
family member agreed to be interviewed and 3) the family member was not younger than 15 years 
old. In total, for the baseline survey N=95 family members of people with HIV representing N=52 
people living with HIV (48.6%) were interviewed and N=103 family members of buddies representing 
50 buddies (47.6%) were interviewed. At endline, N=67 of the baseline family members were re￾interviewed and N=82 new family members were interviewed for a total of N=149. 
Systematic random sampling was employed to recruit community members in the selected 
communities for the community survey. A listing of households was completed to construct the 
sampling frame, including mapping, and a census of all community members aged 15 and older was 
conducted before the household sampling process. The targeted number of households and 
respondents in each selected community was based on the census, with households randomly 
selected. Interviews included all family members aged 15 years old and over who agreed to 
participate in the survey. The same number of community members were interviewed at baseline 
and endline (N=560). 
A summary of the total number of respondents interviewed for the endline survey is shown in Table 
3.3. 
Table 3.3: Total number of respondents to endline survey 
Respondents Baseline Endline
PLHIV 107 131
Buddies 105 119
Family 198 149
Community 560 560
Data collection was carried out from November 2010 to January 2011. The data collection team 
consisted of ten staff with research experience of more than 10 years from the Research and 
Evaluation Department of PDA and 6 university students. PDA provided a two-day training, including 
practice in the community for all data collectors before data collection started. PPP program staff 
helped the data collection team with fieldwork logistics such as informing the target groups and 
communities, coordination, and making appointments.
The baseline and endline study design was reviewed and approved by Mahidol University’s 
Institutional Review Board (IRB). To comply with ethical safeguards and procedures, all people living 
with HIV and buddies signed the informed consent form prior to the interviews. Due to the large 
sample size and the inconvenience of obtaining official signatures of all respondents, only verbal 
consent was obtained and documented among family and community members. All interviews of 
people living with HIV and buddies were conducted by PDA staff familiar with program 
implementation, with strong relationships to the community. The time and place of the interview 
was scheduled by respondents at their convenience and in order to maintain confidentiality 
throughout the process. 
page 7
3.2 Qualitative study design 
Qualitative methods were used to supplement the information collected in the impact survey. This 
data is used to provide context and meaning for the results, to explain the ‘how’ and ‘why’ of the 
findings. Three methods were used in the qualitative part of the study. In-depth interviews were 
conducted with project beneficiaries, namely the PPP loan pair (HIV positive and negative loan 
recipients). Focus group discussions using a semi-structured guide were conducted among other key 
informants such as community leaders and the VDB and PPPC committee members. The number and 
type of respondents in this part of the study are shown in Table 3.4. 
Table 3.4: Respondents to qualitative study 
Target group Methodology Number
1. PPP loan pair (HIV positive and 
negative loan recipients)
In-depth interview 22 pairs (44 persons)
2. Community leaders, VDB and 
PPPC committee members
Focus group discussion 7 groups
The qualitative study also included document reviews. Researchers reviewed project-related 
documents such as progress reports, monitoring visit reports, minutes of the technical working 
group meetings, and records written by researchers through observation and discussion with target 
group members in the field. 
The data collected and compiled through the in-depth interviews, focus group discussions and 
document review were triangulated to verify and coordinate data drawn from different sources. A 
qualitative analysis workshop was held to analyze the linkages between project interventions and 
outcomes. The workshop included researchers, project staff and external academicians providing 
technical assistance in order to discuss, exchange and draw conclusions on the project results. 
In the report, qualitative and quantitative data are intermingled by topic area in order to provide a 
multidimensional perspective on the study results. 
3.3 Data Analysis 
Scales 
Several sets of scaled questions were used to measure stigma, self-efficacy, self-esteem and quality 
of life. Descriptions of the scales and their use in previous research are given in the findings sections 
where they are discussed. Several steps were used to analyze the scale data. First, individual items 
were examined to analyze whether there was change over time between the baseline and endline 
surveys. Paired T-tests were used for this analysis. Second, confirmatory factor analysis was 
conducted to confirm factors established at baseline and to reduce the number of items into 
subscales. The sub-scales were then analyzed for reliability as measured by Cronbach’s alpha. An 
alpha of at least 0.7 is generally accepted as signifying a scale that is internally consistent (DeVellis, 
2003). Third, paired T-tests were used to examine whether there was change over time in the scales 
page 8
and sub-scales. For those scales that changed significantly, results on the type of PPP model were 
compared to investigate if some models worked better than others. 
For the community survey only, the scales were standardized so that scores ranged from 0 to 100, 
with a mean of 50 and a standard deviation of 10 (Nyblade et al., 2008). Each point on the scale 
represents one-tenth of a standard deviation. Point differences of three to five on the scale are 
considered significant based on standard guidelines for interpreting psychosocial indices (Cohen, 
1988). These scales were used in the impact analysis described below.
Impact analysis 
The goal of the multivariate analysis is to examine the association of exposure to PPP project 
interventions and change in the outcome variables of interest. Ordinary least squares regression was 
employed. Exposure measures were used as independent variables while controlling for respondent 
background characteristics (e.g. age, sex, exposure to media, educational attainment). Baseline 
measures were also included in the analysis to control for an individual levels of stigma at baseline. 
For the PLHIV survey, the dependent variables are disclosure, stigma and quality of life. For the 
buddy, family and community surveys, the dependent variables are HIV knowledge, fear-driven 
stigma, and value-driven stigma. In some data sets, however, the number of cases was too small to 
run full regressions and measures of exposure were tested one by one, as discussed further in the 
text.
Principal components factor analysis, internal consistency reliability checks, and linear regressions 
were conducted both in STATA version 10 and SPSS version 13. 
3.4 Schematic framework 
Figure 3.1 depicts the logical order of the presentation of the research findings. First the findings on 
the PLHIV themselves are presented. Subsequent sections present the findings from the buddies, 
family members and community member surveys, ordered from the perspective of their contextual 
distance from the PLHIV. The project created one-on-one relationships between PLHIV and their 
buddies, and these are presumed to be the most adjacent and thus most prominent effect of the 
project. The effect of the project on family members, because of their closeness to the PLHIV, are 
presented next. Finally the results for the community members are presented last. 
page 9
Figure 3.1: Schematic diagram of research framework
PLHIV 
Buddies 
Family members 
Community 
members 
page 10
4. People Living with HIV 
4.1 Profile of Respondents 
Table 4.1 shows the profiles of individuals living with HIV interviewed at endline (N=131) and those 
who were interviewed at baseline and endline (N=95). . Among all respondents interviewed at 
endline, the majority are female (60%) live in urban communities (65%), and are married 
(57%).Nearly half are in their 40s (47%) and the mean age is 43.4 years. Over forty percent (42%) 
completed at least some secondary school. 
Table 4.1: Profile of PLHIV respondents (in percents) 
All Endline
Both Baseline and 
Endline
Gender 
 Male 39.7 35.8
Female 60.3 64.2
Residence 
 Urban 64.9 63.2
 Rural 35.1 36.8
Marital Status 
Married 57.3 61.1
Single/divorced/widowed 42.7 38.9
Age 
18-39 34.3 30.5
40-49 47.3 50.5
50+ 18.3 18.9
Mean age 43.4 43.9
Median age 43 43
Education 
None/primary 58.0 61.1
Second/high/vocational 36.6 31.6
University/B.A. 5.3 7.4
(N) (131) (95)
Respondents in urban areas were employed as small business owners such as vendors (37%) and as 
day laborers (52%) (Table 4.2). A large proportion of rural respondents are farmers (39%) and 
laborers (35%). Average monthly incomes are substantially higher in urban areas; fully 63% of rural 
respondents made less than 5,000 baht on average while 47% of urban residents made 7,000 baht or 
page 11
more. Median monthly income was 6,000 baht in urban areas and 4,000 baht in rural areas 
(approximately US$200 vs. US$133). 
Table 4.2 Occupation and income of PLHIV by urban status (all endline participants) 
Urban Rural Total
Occupation
Farmer 0.0 39.1 13.7
Own business 36.5 23.9 32.1
Employee 4.7 0.0 3.1
Laborer 51.8 34.8 45.8
None 7.1 2.2 5.3
Average monthly income (Baht) 
 <5000 28.2 63.0 40.5
 5000-6999 24.7 17.4 22.1
 7000+ 47.1 19.6 37.4
Median income 6000 4000 6000
(N) (85) (46) (131)
Table 4.3 shows the type of intervention model that endline respondents participated in. All urban 
respondents belonged to a PPP club (PPPC) whereas rural respondents were evenly split between 
the village development bank (VDB) and PPPC. With regard to the type of PPPC, urban residents 
were about evenly split between community-based and hospital-based clubs whereas only a few 
rural respondents (13%) belonged to community-based PPP clubs (PPPC). 
Table 4.3: Model by urban status (all endline respondents) 
Program Model Urban Rural Total
 VDB 0.0 50.0 17.6
PPPC 100.0 50.0 82.4
(PPP-club community based) (55.3) (13.0) (40.5)
(PPP-club hospital based) (44.7) (37.0) (42.0)
(N) (85) (46) (131)
4.2 Participation in and exposure to the PPP project 
In this section respondents’ reports of their involvement and exposure to the project is presented, 
followed by an examination of the differences in participation by project model. 
page 12
Involvement with buddies 
When asked about their involvement with their buddies, almost half (48%) of PLHIV said that they 
talked to their buddy every day. The degree of involvement varied by type of model: VDB members 
talked to their buddies most often (70% every day) with members of the community-based PPPC 
least often (32% every day) (Figure 4.1). About two-thirds (66%) of respondents said they had talked 
about HIV/AIDS with their buddy in the past six months. Additional analysis showed that those in the 
hospital-based PPP clubs talked to their buddies more often than their community-based PPPC 
counterparts (55% vs. 32%, p=.01). While the same is true for both rural project intervention types 
(82% for hospital vs. 67% for community) and urban areas (42% vs. 28%), the differences are not 
significant when urban status is taken into account (p>.10). 
Figure 4.1: PLHIV reports of how often they talked to their buddy by model 

2
 =22.4, p<.05 
The qualitative study presents insights on how the type of intervention model affected involvement 
of buddies. In the hospital-based PPPC, many buddy pairs only met at the monthly meetings. Some 
of the HIV-negative buddies and other non-PLHIV PPPC members expressed the feeling that they 
were not an important component of the club, as the PLHIV tended to have the important roles in 
managing the club. This is illustrated in the following statement: 
We should let PLHIV members to develop a plan to conduct HIV activities themselves, since 
suggestions from us (buddies) may not be accepted by PLHIV anyway. In addition, our 
available schedule may sometimes be different from PLHIV’s, so we cannot join the 
activities planned and conducted by PLHIV. (Buddy, PPPC)
As a result, most hospital-based PPPC activities did not receive sufficient non-PLHIV participation, as 
non-PLHIV individuals did not feel ‘ownership’ over the club. The above statement indicates that 
buddies sometimes did not perceive themselves as important members in the PPPCs. On the other 
70%
32%
55%
17%
9%
11%
4%
2%
4%
9%
11%
21%
11%
4%
28%
11%
0%
20%
40%
60%
80%
100%
VDB (N=23) PPP-Community 
(N=53)
PPP-Hospital (N=55)
< once a month
Once a month
2-3 times a month
Once a week
> once a week
Everyday
page 13
hand, PLHIV perceived the buddies as not fully understanding their important role in the club, as 
illustrated by one PLHIV member who also offered an explanation: 
I feel that HIV negative loan partners (buddies) are not aware of their important roles 
towards the PPP club. They just come to join the PPP club’s activities as required by the 
project. It may be that living in different communities may be a key difficulty preventing 
them from participating in the club’s activities often. (PLHIV, PPPC) 
The qualitative study also found that HIV/AIDS campaign activities conducted by PPPCs (both those 
in hospitals & communities) were not as cohesive as those conducted by VDBs. This could be 
because members of the PPPCs were living in different communities than that where the club is 
located and where intervention activities took place. The quantitative findings also suggest that the 
urban PPPC community-based club members had much less contact with their buddies than either 
the urban hospital-based clubs or the rural participants for all models (Figure 4.1 and discussion 
below). This finding suggests that buddies living in a different community created a barrier to 
communication, as was common in the urban PPPCs. This finding is discussed further below. 
Support from buddies 
Figure 4.2 shows the material support that PLHIV reported receiving from their buddy in the past six 
months. Most (63%) received some type of support; health care, financial support and food were the 
most common. 
Figure 4.2: PLHIV reports of material support received from buddies in the past six months 
Non-material types of support from buddies were reported more frequently by PLHIV (Figure 4.3). 
Fully 82% said they received some emotional support from their buddies, and 61% received support 
for the HIV educational campaigns. A high percentage (88%) said that their relationships with their 
buddies had improved through participation in the program. When examining whether support from 
buddies varied by model type, the results showed that only material support varied significantly. 
Those in hospital-based PPPCs (urban or rural) were more likely to receive support with clothing and 
food than those in other models. 
40.5% 38.9%
32.1%
23.7%
37.4% 33.6%
46.0%
36.6%
0%
20%
40%
60%
80%
100%
Healthcare Finance Occupation Clothes Food Taking care 
of family 
members
Others None
page 14
Figure 4.3: PLHIV reports of other support received from buddies in past 6 months 
Participation in project activities 
HIV positive respondents were asked about their exposure and participation in the various PPP 
activities in the past 12 months. Figure 4.4 contrasts the level of exposure for PPPC and VDB 
members. Attendance at a monthly meeting was high for both PPPC and VDB members (84% and 
78% respectively), and a high percentage participated at least one activity (94% and 87%). However, 
PPP-club members were significantly more likely to participate in the HIV campaigns, PDA trainings 
and community Funfairs. Only about half of VDB members participated in these activities. 
Figure 4.4: PLHIV exposure to PPP intervention activities by type of model 
***p<.001, **p<.01, *p<.05, +p<.10 
87.0%
52.2%
52.2%
78.3%
52.2%
93.5%
76.9% * 
78.7% **
84.3%
75.0% *
0% 20% 40% 60% 80% 100%
At least one PPP 
intervention activity
Funfairs
HIV campaign activities
Meetings
Trainings
PPP 
(N=108)
VDB 
(N=23)
82.4%
61.1%
87.8%
0%
20%
40%
60%
80%
100%
Received any emotional or 
moral support from buddy
Received any support on 
educating community on 
HIV/AIDS
Have a better relationship 
with buddy
page 15
In analysis not shown here, no difference was found between the community-based PPPC and 
hospital-based PPPC in terms of exposure to intervention activities. 
Figure 4.5 shows differences by model for exposure to IEC materials. The ‘slips of paper’ messages 
had the highest rate of exposure for both VDB and PPPCs (83% and 92%). Posters also had a high 
level of exposure (78% and 88%) with dramas somewhat less so (61% and 83%). A high percentage 
(87% and 94%) had seen at least one of these IEC materials; however, the PPPC members were 
significantly more likely to say they had seen the dramas. 
Figure 4.5: PLHIV exposure to IEC materials by type of model 
***p<.001, **p<.01, *p<.05, +p<.10 
4.3 Disclosure of HIV status 
Disclosure of one’s HIV status is sometimes considered as a proxy indicator of the level of stigma 
present in the community. However, disclosure to a close friend or a family member is qualitatively 
different then disclosure to the wider community. Research suggests that stress and social support 
resulting from disclosure varies according to who is disclosed to; friends may provide more support 
than family and female family members are disclosed to more often (Kalichman et al., 2003). It is 
often assumed that an individual who is open about HIV status to an entire community is dealing 
better with internalized stigma than an individual who has disclosed to a single person. Therefore 
investigating who, to how many, and under what conditions disclosure occurs for people living with 
HIV is of great interest. 
People living with HIV were asked if they disclosed their status to anyone besides their buddy or the 
VDB/PPP club, and if so to whom. At baseline, nearly all said that they had disclosed to someone else 
(98%), and at endline 100% of those who were re-interviewed said they had done so. This represents 
two people (of the 95 who were re-interviewed) who newly disclosed to someone between baseline 
and endline. In addition to these two people who newly disclosed, it should be noted that the PLHIV 
who were re-interviewed disclosed to a significantly larger number of categories of people in the 
time between surveys (average of 7.3 vs. 6.0) (Table 4.4). A significant increase was found in the 
percentage disclosing for all categories of people, including close relatives, other relatives, friends, 
87.0%
82.6%
60.9%
78.3%
94.4%
91.7%
83.3% *
88.0%
0% 20% 40% 60% 80% 100%
At least one IEC meterial
At least 1 message
At least 1 drama
At least 1 poster
PPP 
(N=108)
VDB 
(N=23)
page 16
neighbors and the wider community. Of particular interest is that the percentage who said they 
disclosed to the community increased significantly, from 39% to 51% (p<.01). 
Table 4.4: Disclosure of HIV status to others, baseline and endline (percent yes) 
Baseline Endline Significance of 
T-test
(N)
To anyone 97.9 100.0 n.s. (95)
Current partner (of those with 
partner) 98.6 97.0 n.s. (67)
Former partner 36.8 57.9 *** (95)
Mother 61.3 67.4 * (95)
Father 49.5 55.8 + (95)
Children 59.1 67.4 * (95)
Sister 73.1 82.1 ** (95)
Brother 59.1 71.6 *** (95)
Other relatives 54.8 72.6 *** (95)
Friends 62.4 74.7 *** (95)
Neighbors 43.0 54.7 ** (95)
Community 38.7 50.5 ** (95)
Would advise other PLHIV to 
disclose 91.6 86.3 n.s. (95)
Number of types of people 
disclosed to 6.0 7.3 *** (95)
*** p<.001, **p<.01, *p<.05, +p<.10, n.s. not significant 
A lower percentage at endline, however, reported that they would advise other PLHIV without 
symptoms to disclose to others (91% at baseline vs. 86% at endline, though this was not significant 
(p=.167)). Further examination of the sample shows that four people (4%) changed their mind in 
favor of disclosure between baseline and endline, but that nine people (10%) changed their mind 
against advising other PLHIV to disclose. Those who changed their mind against disclosure had 
themselves disclosed to only a few people. The small number of cases used in the analysis makes it 
difficult to investigate this issue further, but it may be an issue for further qualitative investigation. 
The qualitative study provides further insight on the issue of disclosure, on both sides of the issue. 
Those who were members of the hospital-based clubs said that the model was appropriate for PLHIV 
who are not ready to disclose their HIV status to the community. 
For those who have already disclosed their HIV status, they may feel nothing. But in 
Bangkok, if others know about our HIV status, they will not remain friends with us 
anymore. If our HIV status is disclosed, we may not be able to leave our houses and we may 
lose our job. (PLHIV, PPPC)
page 17
If community members know who a PLHIV is, they will not get close to them. Therefore, 
normally PLHIV are truly careful about HIV disclosure and avoid any actions that may cause 
unintentional disclosure of their status. Some community members still do not accept 
PLHIV, so it is difficult for PLHIV to disclose themselves to the community as it may cause 
problems to their lives. (PLHIV, PPPC)
Interviews with PLHIV PPP-club members revealed that those club committee members who did not 
disclose their own status were afraid to accept new members who are non-PLHIV. They do not 
believe that non-PLHIV can keep confidentiality regarding the members’ HIV status, and indeed do 
not accept the underlying principles of the PPP project. 
My PPP club manager does not want anyone knowing about the HIV status of all of us. She 
does not want us (PLHIV) to even mention or disclose our HIV status in any circumstances. 
She is afraid that non-PLHIV cannot keep the secret as agreed. She does not even tell about 
her HIV status to her family. She feels that non-PLHIV will never understand and reduce 
HIV stigma and discrimination. She thinks that non-PLHIV only participate in activities with 
PLHIV as required by the project to receive the PPP loan. Although the level of acceptance 
of non-PLHIV towards PLHIV may be increased, it cannot significantly increase resulting in a 
positive result towards the life of PLHIV. (PLHIV, PPPC) 
I know that the project aims to reduce HIV stigma and discrimination, but PLHIV do not 
want non-PLHIV knowing their HIV status. I think the project should reconsider this issue. In 
addition, it is so difficult to find an HIV negative loan partner because we never know who 
we can trust. We cannot be sure who will not reveal our secret. We, PLHIV do not want 
anyone knowing our HIV status. We do not want non-PLHIV to become PPP club members.
(PLHIV, PPPC) 
I am happy to continue and sustain the project, but I just hope that there should be only 
PLHIV in the project to avoid any problems. For HIV/AIDS campaign activities, we can 
organize by ourselves as in the past just a few non-PLHIV collaboratively organize the 
activities anyway. (PLHIV, PPPC) 
It should be noted that the findings show throughout the study that fear of being stigmatized and 
discriminated against is a key factor leading to self-stigmatization (internalized stigma) of PLHIV. 
Furthermore, not accepting one’s HIV status and shutting down their world from others affects the 
psychological well-being of PLHIV. 
Others expressed the positive impact of disclosure and of interaction with other community 
members ‘as normal’. One good example is the case of one PLHIV who finally decided to disclose her 
HIV status to the community, after learning through the project that others do not stigmatize and 
discriminate PLHIV like she thought. Therefore, she wanted the relief of not covering up her HIV 
status anymore. 
At first I felt that I am stigmatized, but after the HIV training conducted by the project for 
both PLHIV and non-PLHIV, I found that indeed non-PLHIV do not stigmatize PLHIV, but they 
never know us before. I am so happy when one of participants at the training who is non￾PLHIV offered me a ride home. It is so good that disclosing my HIV status does not cause 
any negative effects to me. (PLHIV, PPPC) 
Before I was not sure how many people knew about my HIV status. However, when the VDB 
is started I was invited to join and I now feel that they do not stigmatize PLHIV. Currently I 
page 18
feel more relieved and happy because all community members know about my HIV status 
already and I do not have to think about keeping it a secret anymore. (PLHIV, VDB) 
The quantitative findings show significant differences in disclosure to the community by type of 
model; 94% of those in VDB clubs have disclosed their status vs. 40% in the PPPCs (p<.001) (Table 
4.5.) No differences were found by model type and by PPPC location (community-based vs. hospital￾based) for whether the PLHIV would advise other PLHIV to disclose. 
Table 4.5: Percent of PLHIV reporting they have disclosed their status to the community and would 
advise others to disclose by model type at endline 
Disclosed HIV 
status to 
community
Would advise 
other PLHIV to 
disclose
(N)
VDB 94.4 94.4 (18)
PPP 40.3 84.4 (77)
Signif. of chi-square ***
PPP community-based 37.1 77.1 (35)
PPP hospital-based 42.9 90.5 (42)
Signif. of chi-square n.s. n.s.
All 50.5 86.3 (95)
***p<.001, **p<.01, *p<.05, +p<.10, n.s. not significant 
4.4 Stigma Results for PLHIV 
Previously validated scales measuring stigma were used to capture the domains of internalized 
stigma, disclosure, fear of experiencing stigma and enacted stigma (or discrimination) for PLHIV 
(Tanzania Stigma-Indicators Field Test Group, 2005). Each is described in more detail below. 
Internalized Stigma 
In both the baseline and endline surveys, respondents were asked if they have ever had thoughts or 
feelings of internalized stigma as a result of their HIV status. Internalized stigma is self-stigmatization 
that can lead to feelings of depression, suicide, low self-worth, and shame. These feelings are often 
manifested into self-isolation from family and friends or a reduction in ability to work or deal with 
life’s challenges. They also can have a profound effect on HIV prevention, treatment and care. 
People living with HIV manage internalized stigma at various levels; and one of the goals of the 
intervention was to reduce these feelings through PLHIV normal interactions with their buddies and 
the community (Brouard & Wills, 2006; Leickness et al., 2007) 
A series of questions were asked to people living with HIV in both surveys about whether they 
avoided certain situations or activities because of their HIV status. At baseline, nearly one third of 
respondents reported some type of internalized stigma. As shown in Figure 4.6, all of the items 
affected a reduced percentage of PLHIV at endline, though only “not like meeting friends/meet 
friends less frequently” reduced significantly (p<.01). 
page 19
Figure 4.6: PLHIV internalized stigma item results at baseline and endline 
***p<.001, **p<.01, *p<.05 
Principal components factor analysis of the internalized stigma items yielded two factors, 
representing self-isolation and reduction in ability to cope. The sub-scales had a Cronbach’s alpha of 
at least 0.68 at both baseline and endline. The resulting sub-scales were compared at baseline and 
endline using paired T-tests.4
 While scores on both sub-scales declined at endline, only the self￾isolation score declined significantly. This result indicates that participants of the program felt less 
internalized stigma after participating in the PPP project (Figure 4.7). Further investigation showed 
that there was no difference in the decline by PPP model for the self-isolation sub-scale. 
 
4
The scales were constructed by summing the number of “yes” items and dividing by the total number of 
items. The resulting scale ranges from 0 to 1.
8.4%
7.4% **
13.7%
24.2%
22.1%
14.7%
21.1%
21.1%
29.5%
25.3%
0% 20% 40% 60% 80% 100%
Want to isolate yourself from family 
Not feel like meeting friends or 
contact friends less frequently 
Not want to socialize or meet others
Feel as if your work ability has 
reduced
Feel as if your ability to cope with 
problems in life has reduced 
Baseline 
(N=95)
Endline 
(N=95)
page 20
Figure 4.7: Change in internalized stigma scales, PLHIV
 ***p<.001, **p<.01, *p<.05, +p<.10, 
Qualitative data also supports the finding that PLHIV became less isolated and self-stigmatized 
through participation in the program. Project documents reveal that some PLHIV likely do not 
accept their HIV status and are mistrustful about their HIV status being disclosed accidently. The 
feeling links to a lack of self-confidence of PLHIV. However, the qualitative study shows that 
through implementation of PPPC and VDB activities and the role of the PPP loan pair, PLHIV have a 
broader chance to interact with non-PLHIV. Such interaction has taken PLHIV out of their isolated 
world and allowed them to be less preoccupied with their HIV status. Later, they have increased 
self-confidence and are able to attend more social activities. 
Through the project, I receive mental support from my neighbors and community. Before I 
felt guilty for getting HIV infection, but my buddy (HIV negative loan partner) kept telling 
me that there is nothing to be embarrassed about. My buddy encouraged me to feel better 
and he always will be there for me. (PLHIV) 
Another PLHIV confirmed that the PPP implementation has made PLHIV become aware of their 
self-value. 
Before I was very afraid to talk about HIV/AIDS with the community or to hear the words 
‘HIV/AIDS’ or ‘PLHIV’ as it causes me pain. But after I joined the project, I feel that there 
are still many people caring about me. Consequently, I am now able to accept and live with 
my HIV and able to tease or talk about HIV/AIDS with others. (PLHIV) 
Fear of stigma and enacted stigma 
Previous studies have shown that the fear of being stigmatized is more frequent among PLHIV than 
the actual experience of stigma (Tanzania Stigma-Indicators Field Test Group, 2005). In addition, 
individuals tend to have more extreme feelings about the fear of stigma than about the stigma they 
actually experience. In this survey, PLHIV respondents were asked about the stigma and 
0.098 +
0.232
0.189
0.274
0.0 0.2 0.4 0.6 0.8 1.0
Self-Isolation
Reduction in ability
Baseline (N=95)
Endline (N=95)
page 21
discrimination they had experienced from their family, friends and community in the past 6 months, 
and also about their fear of experiencing such stigma. 
Two scales were constructed to measure fear of stigma, one for fear of stigma from family and 
friends and one for fear of stigma from the community. Figures 4.8 and 4.9 show the decline in 
PLHIV’s agreement with the individual items in the two scales. While all of the items declined, only 
one from each scale declined significantly: “fear of abandonment” by the family and “fear of being 
gossiped about” by the community.
Figure 4.8: Change in scale items measuring fear of stigma from family/friends, PLHIV 
***p<.001, **p<.01, *p<.05 
8.4%
9.5%
9.5%
12.6% *
14.7%
14.7%
14.7%
14.7%
14.7%
25.3%
16.8%
15.8%
0% 20% 40% 60% 80% 100%
Excluded from family meal / given 
different set of cutlery
Isolated from family to stay in a 
separate room
Isolated by family (in the same house)
Ignored/abandoned by family 
members
No longer/less frequently visited by 
relatives
No longer/less frequently visited by 
friends
Baseline 
(N=95)
Endline 
(N=95)
page 22
Figure 4.9: Change in scale items measuring fear of stigma from community, PLHIV 
***p<.001, **p<.01, *p<.05 
Confirmatory factor analysis was conducted on two baseline scales representing fear of stigma. The 
scales at both baseline and endline had alpha values of above 0.9. A t-test of the change in the two 
scales between baseline and endline shows that results for both scales declined significantly at the 
p<.01 level (Figure 4.10).5
 Thus fear of stigma, both from family/friends and from the community, 
showed significant declines for PLHIV between baseline and endline. 
 
5
The scales were constructed by summing the number of “yes” items and dividing by the number of 
items. The resulting scale ranges from 0 to 1. 
29.5% *
24.2%
18.9%
24.2%
13.7%
17.9%
36.8%
28.4%
22.1%
42.1%
29.5%
27.4%
32.6%
21.1%
23.2%
36.8%
31.6%
28.4%
0% 20% 40% 60% 80% 100%
Been gossiped about
Been treated differently by other 
community members
Been checked out to see how they 
are
Lost trust/respect from community
Rarely have someone to talk 
to/communicate with
Been Denied community gatherings 
and events 
Lost customers to buy food PLHIV 
make or sell
Lost customers to buy 
products/goods PLHIV sell
Been teased, insulted, or sworn at
Baseline 
(N=95)
Endline 
(N=95)
page 23
Figure 4.10: Change in scales measuring fear of family/friends stigma and community stigma, 
PLHIV 
The results for experienced or enacted stigma—which is also known as discrimination—are shown in 
Figures 4.11 and 4.12. In Figure 4.11, it is seen that while all of the items measuring stigma 
experienced from family and friends declined, none changed significantly. Three items measuring 
discrimination experienced within the community did decline significantly. These were “being 
checked out to see how you are”, “being gossiped about” and “being insulted, teased or sworn at.”
Figure 4.11: Change in scale items measuring enacted stigma from family and friends at baseline 
and endline, PLHIV 
2.1%
2.1%
0.0%
2.1%
3.2%
4.2%
3.2%
3.2%
6.3%
5.3%
0% 20% 40% 60% 80% 100%
Excluded from family meal / 
given different set of cutlery
Isolated from family to stay in a 
separate room
Ignored/abandoned by family 
members
No longer/less frequently 
visited by relatives
No longer/less frequently 
visited by friends
Baseline 
(N=95)
Endline 
(N=95)
0.116
0.245
0.168
0.308
0 0.2 0.4 0.6 0.8 1
Fear of family, friends 
stigma
Fear of community stigma
Baseline (N=95)
Endline (N=95)
page 24
Figure 4.12: Change in scale items measuring enacted community stigma at baseline and endline, 
PLHIV
***p<.001, **p<.01, *p<.05, +p<.10 
Principal components analysis of items measuring the experience of facing stigma and discrimination 
from family friends and community revealed three factors at baseline, measuring experiences of 
family isolation, family abandonment, and community stigma. At endline, these scales had reliability 
of =.66 for family isolation, =.89 for family abandonment and =.88 for community stigma. 
However, none of the scales showed significant change from baseline to endline.
In-depth interviews with the buddy pairs revealed how their interactions in working as financial 
partners and in working on the HIV campaigns had reduced stigma and discrimination. 
On banking day, we work together with PLHIV. We ordered food to be shared and eaten 
together with everyone. We did not order separate lunch box; as a result, other community 
members have realized that we will not get HIV infection by sharing food with PLHIV. At the 
present, most of community members do not express any actions indicating stigmatizing or 
discriminating towards PLHIV at all. Some also join lunch with PLHIV as well. (Buddy) 
Eating and sharing food with PLHIV is an effective model to emphasize that living and working 
together, and touching and sharing food, does not cause HIV infection. Sometimes, provision of HIV 
knowledge only cannot take away a ‘feeling of fear’ towards PLHIV, but knowledge together with 
observing a model of ‘living and working together as normal’ between PLHIV and non-PLHIV does. 
4.5 Self-esteem and self-efficacy 
A 3-item scale measuring self-efficacy and an 8-item scale measuring self-esteem were also included 
in the PLHIV survey. The three questions measuring self-efficacy were taken from the HIV Self￾Efficacy (HIV-SE) questionnaire (Lorig et al., 1996). Four of the items measuring self-esteem were 
20.0% **
7.4%
14.7% **
5.3%
5.3%
4.2%
35.8%
11.6%
29.5%
10.5%
9.5%
5.3%
0% 20% 40% 60% 80% 100%
Been gossiped about
Been treated differently from other 
community members
Been checked out to see how they are
Lost trust/respect from community 
members 
Rarely have someone to talk 
to/communicate with
Been denied community gatherings 
and events 
Baseline 
(N=95)
Endline 
(N=95)
page 25
conceptually based on Rosenberg’s self-esteem scale, and the other 4 questions were developed by 
the research team for measuring PLHIV’s feelings about their financial burdens (Rosenberg, 1965). 
Change in the individual self-efficacy and self-esteem items between baseline and endline are shown 
in Figures 4.13 and 4.14. Many of the individual items show significant increases over time. PLHIV 
felt better equipped to ask for emotional and other types of support from family and friends after 
participating in the PPP project. There were also increases in the items measuring whether the PLHIV 
could provide financial support for their family, that they had things to be proud of, and that they 
felt useful to their community. 
Figure 4.13: Self-efficacy at baseline and endline 
***p<.001, **p<.01, *p<.05, +p<.10
3.47 *
3.45 ***
2.77
3.23
3.13
2.89
0 1 2 3 4
Able to seek support from family 
and friends 
Able to seek emotional support 
from family and friends
Able to seek emotional support 
from the community
Baseline (N=95)
Endline (N=95)
page 26
Figure 4.14: Self-esteem at baseline and endline 
***p<.001, **p<.01, *p<.05, +p<.10
Although the questions measuring self-efficacy (3 items) and self-esteem (8 items) were intended to 
measure two separate constructs, reliability testing at baseline showed that the two sets of items 
did not yield reliable scales. Principal components analysis revealed that, when merged the 11 items 
loaded on one factor, forming a single scale with good reliability for both the baseline and endline 
data (Cronbach’s α=.72 and .73). The single self-esteem/self-efficacy scale showed significant change 
between baseline and endline (p<.00) (Figure 4.15). On a scale ranging from 1 “strongly 
unconfident” to 4 “strongly confident”, the average score for PLHIV increased from 3.23 to 3.42. 
Figure 4.15: Self-esteem/self-efficacy results at baseline and endline 
***p<.001, **p<.01, *p<.05, +p<.10
The qualitative study also found evidence that the PPP project increased feelings of self-worth for 
the PLHIV who participated. PLHIV members of the PPPC or VDB said that they felt proud of
3.59 *
3.48 **
3.60 *
3.62 **
3.57
3.07
3.65 **
3.34 **
3.29
3.25
3.43
3.34
3.36
3.18
3.37
3.01
0 1 2 3 4
I don't think I'm worthless for my 
family.
I am proud that I am useful for my 
community.
I can perform activities/do things 
just like others.
I have things to be proud of. 
I am able to stand on my own feet.
My family will have financial 
problem without me.
I am proud that I can help provide 
income to my family.
I feel guilty that I can’t provide 
financial support to my family. 
(Reversed)
Baseline 
(N=95)
Endline 
(N=95)
3.42 ***
3.23
0 1 2 3 4
Self-esteem/ Self-efficacy
Baseline 
(N=95)
Endline 
(N=95)
page 27
themselves because they realized their self-value through their contributions to the community. One 
PLHIV who is on a VDB committee stated: 
Half of community members have known already that I am a PLHIV; after joining the VDB 
committee, I have become well-known and receive respect from others as I am a person 
who contributes (a giver) to the community. (PLHIV, VDB committee) 
Likewise a community leader expressed how he considers PLHIV to be valuable persons to the 
community: 
As I see it, I feel that PLHIV in the community are now more accepted by the community. I 
observed that in the past PLHIV were not welcome to join the community’s activities. But 
when this project’s activities are implemented regularly such as HIV Funfair events, PLHIV 
are encouraged to join or sometimes lead those activities for the community. Therefore, the 
community feels that PLHIV have contributed to the community and later they are viewed 
as valuable person. The project gave PLHIV a chance, a channel to prove themselves as 
normal persons to the community. I feel that PLHIV also view themselves as valuable 
persons as they can help prevent new HIV infection in the community. (Community leader) 
By improving self-value through joining and contributing to the PPPC or VDB, PLHIV have increased 
their level of confidence in living and interacting with non-PLHIV. As well, they have learned that 
they are not actually stigmatized or discriminated by others like they thought; as a result; some 
PLHIV later decided to disclose their HIV status to the community even though it is not required by 
the project. Such HIV disclosure makes them feel comfortable since they do not have to worry about 
unintentional or accidental exposure anymore. 
I now feel happy and proud of myself, although others have known about my HIV status. I 
think that it is good as I want to let them realize that although I have HIV I still can work 
and have knowledge of HIV to be disseminated to them. We have to accept ourselves, be 
confident and interact with others, so they will learn about HIV from us. (PPPC member) 
4.5 Quality of life
The PLHIV survey also included the WHO Quality of Life assessment (WHOQOL). The WHOQOL was 
developed and field-tested in 15 countries including Thailand, and thus the Thai version of the scale 
has been validated with many populations (Sakthong et al., 2007; Silpakit & Silpakit, 2003). The 
WHOQOL-BREF, which is the 26-item abbreviated version of the assessment, was pre-tested by PDA 
before the baseline survey. The pre-test was conducted with N=40 PLHIV who were not included in 
the baseline or endline survey. T-tests were calculated between high and low scorers on each item 
to determine whether the items had discriminatory power. From this analysis, five of the WHOQOL￾BREF items were eliminated. One item, on family support, was added.
The remaining 22 Quality of Life items were used in both the baseline and endline PLHIV surveys. At 
baseline, the PLHIV surveyed had very high scores on the quality of life items; most scores had an 
average of 3.5 on a scale of 5. Yet the endline survey revealed that quality of life still improved 
significantly for the PLHIV participating in the PPP program. Figures 4.16-4.19 show the average 
scores on individual items within each subscale. The PLHIV respondents rated all of the items 
measuring physical and psychological quality of life significantly higher on average at endline. Only 
one of the social quality of life items significantly improved (the ability to socialize and make 
page 28
friends). Of the eight items measuring environmental quality of life, three were rated significantly 
higher. 
Figure 4.16: Mean response on Physical Quality of Life Items (N=95) 
***p<.001, **p<.01, *p<.05, + p<.10 
Figure 4.17: Mean response on Psychological Quality of Life Items (N=95) 
***p<.001, **p<.01, *p<.05, + p<.10 
4.20 *
3.95 +
4.37 *
4.22 +
4.54 **
3.97
3.74
4.16
4.03
4.24
0 1 2 3 4 5
Enough energy to perform 
work/typical activities
Satisfied with sleep
Satisfied that they can perform daily 
activities
Satisfied that they can perform work as 
usual
Able to travel/commute
Baseline 
(N=95)
Endline 
(N=95)
4.01 *
4.11 +
4.20 +
4.13 +
4.32 +
3.79
3.92
4.03
3.94
4.16
0 1 2 3 4 5
Satisfied with life, e.g. happy, 
peaceful, hopeful
Can concentrate on work
Satisfied with self
Able to accept physical appearance
Feel that life is meaningful
Baseline 
(N=95)
Endline 
(N=95)
page 29
Figure 4.18: Mean response on Social Quality of Life Items (N=95) 
***p<.001, **p<.01, *p<.05, + p<.10 
Figure 4.19: Mean response on Environmental Quality of Life Items (N=95) 
***p<.001, **p<.01, *p<.05, + p<.10 
The sub-scales that were developed from the original WHOQOL scale were tested for reliability. All 
four sub-scales (physical, psychological, social and environmental) were found to have internal 
consistency reliability, with Cronbach’s alpha scores above 0.7 (Table 4.6). Two of the items (the 
item on overall quality of life and the added item on family support) were dropped from this 
analysis. 
4.19 *
3.83
3.98
3.76
1 2 3 4 5
Able to socialize and make friends
Satisfied with support/help from friends
Baseline (N=95)
Endline (N=95)
3.61
3.81
3.04
4.03
3.91 *
3.49
4.08 ***
4.06 ***
3.66
3.71
3.14
3.91
3.64
3.39
3.73
3.67
0 1 2 3 4 5
Feel that daily life is secured and stable
Satisfied with condition of house
Have enough money 
Satisfied that they can acquire necessary 
health services
Keeping abreast of news&information
Able to rest or relieve stress
Good environment for health
Satisfied with way of 
travelling/commuting
Baseline (N=95)
Endline (N=95)
page 30
Table 4.6: Reliability analysis for WHOQOL subscales with PLHIV dataset (N=107) 
Subscale Cronbach’s α Number of 
Baseline Endline items
Physical .80 .85 5
Psychological .81 .81 5
Social .72 .78 2
Environmental .77 .79 8
(N) (107) (95)
The individual items are averaged to construct the overall quality of life scale and the four subscales 
(Figure 4.20). The overall quality of life scale increased from 3.83 to 4.00 (p< .00) and the physical 
(4.03-4.25, p< .00), psychological (3.97-4.15, p< .00) and environmental (3.61-3.76, p< .02) subscales 
also significantly improved by the time of the endline survey. There was no significant change in the 
social sub-scale. 
Figure 4.20: Quality of life scales at baseline and endline 
***p<.001, **p<.01, *p<.05, + p<.10 
The PLHIV interviewed in the qualitative study discussed how the availability of the PPP loans 
increased their quality of life by creating security in their livelihood. Although the loan is regarded as 
only an additional amount for occupational investment, it is very important in improving the 
financial liquidity of PLHIV. PLHIV are able to make a living continuously and feel secure to know 
where they can seek financial support when needed. With the low interest-PPP loan, PLHIV also 
benefit by avoiding the need to borrow from ‘loan sharks’ with high interest. This is particularly 
important because PLHIV usually face limitations in getting a loan through official financial 
institutions, because they are not trusted to make repayment or are required to provide mortgage 
securities. Although the maximum PPP loan disbursement of 12,000 baht is not sufficient to cover all 
expenses in one occupation, it is considered a needed cushion in for financial security. 
The PPP loan does not help in earning a lot more income, but it reduces a lot more troubles. 
4.25 ***
4.15 **
4.01
3.76 *
4.00 **
4.03
3.97
3.87
3.61
3.83
0 1 2 3 4 5
Physical QOL
Psychological QOL
Social QOL
Environment QOL
Overall
Baseline (N=95)
Endline (N=95)
page 31
It does not matter how much maximum we can borrow, but that when we have a financial 
problem we know where to get a loan with low interest. 
It is so difficult to borrow money from others as they are afraid that I as PLHIV cannot make 
a repayment. However, through the PPP loan, I do not have to worry about that problem 
anymore. 
5. Buddies 
5.1 Profile 
As detailed above, while N=119 buddies were interviewed in the endline survey, only N=75 of these 
respondents had also been interviewed in the baseline survey. The majority of buddies who joined 
the PPP project at endline are female (70%) and live in urban communities (60%) (Table 5.1). While 
these characteristics are similar to those of the PLHIV counterparts, a higher percentage of buddies 
are married (77% vs. 57%). Also, buddies tend to be somewhat older than the PLHIV, with more than 
one-third in their 50s (39%) and a mean age of 45.6 vs. 43.4 years for PLHIV. Similar to the PLHIV, 
over forty percent (44%) completed some secondary school or higher. 
Table 5.1: Profile of buddy respondents (in percents) 
All Endline Both Baseline and 
Endline
Gender 
 Male 30.3 28.3
Female 69.7 76.7
Residence 
 Urban 59.7 56.0
 Rural 40.3 44.0
Marital Status 
 Married 76.5 78.7
 Single/div/widow 23.5 21.3
Age 
 18-39 27.7 25.3
 40-49 33.6 28.0
 50+ 38.7 46.7
Mean age 45.6 47.0
Median age 46 49
page 32
All Endline Both Baseline and 
Endline
Education 
None/primary 56.3 58.7
Second/high/vocational 33.6 32.0
University/B.A. 10.1 9.3
(N) (119) (75)
5.2 Program exposure 
Buddies were asked a series of questions about their participation in the PPP program. When asked 
how often they interacted with their PLHIV partners, the results closely paralleled the responses 
given by PLHIV (Figure 5.1). VDB buddies and PPP-hospital buddies had significantly more contact 
than PPP-community buddies. A check of reports of matched PLHIV buddy pairs showed that the 
partners agreed about the amount of contact 60% of the time. In 22% of the cases PLHIV said that 
they met more often than buddies reported, while in 18% buddies reported more contact. This 
result is probably due to normal recall bias rather than any systematic misstatements by either 
PLHIV or buddies. 
Figure 5.1: Buddy reports of how often they talked to their PLHIV partner by model 
A majority of buddies reported that they both gave and received material and emotional support 
from their PLHIV partners (Figure 5.2). While 68% said that they participated in disseminating HIV 
information through the program, 82% said that they informally gave HIV information to community 
members. By model, the VDB and PPP-hospital buddies were significantly more likely to give and 
receive material support than the PPP-community buddies (p<.05); this finding is in line with the 
52%
31%
51%
22%
10%
19%
7%
7%
12%
7%
4%
27%
2%
7%
20% 21%
0%
20%
40%
60%
80%
100%
VDB (N=27) PPP-Community 
(N=49)
PPP-Hospital (N=43)
< once a month
Once a month
2-3 times a month
Once a week
> once a week
Everyday
page 33
qualitative findings discussed above. However, the VDB and PPP-community based buddies were 
more likely to participate in the HIV campaigns than their PPP-hospital counterparts. This is likely 
because the hospitals are not located in the same communities as the campaigns, as discussed 
above. 
Figure 5.2: Support given and received by buddies 
Buddies were also asked about their exposure to PPP project activities, and as seen in Figures 5.3 
and 5.4 some significant differences were found by model type. While nearly all VDB buddies had 
attended a monthly meeting (96%), only two-thirds of PPPC members had done so (67%). VDB 
buddies were also more likely to have participated in a training (85% vs. 60%). A fairly high level of 
exposure was found for the IEC materials, especially for the “slips of paper” messages for both 
models (93% for VDB and 90% for PPP). All VDB buddies (100%) and 93% of PPP buddies were 
exposed to at least one IEC message. 
88.9%
81.5%
96.3%
77.8% 77.8%
92.6%
57.1%
53.1%
81.6% 79.6%
75.5%
83.7%
79.1%
76.7%
86.0% 83.7%
53.5%
74.4%
0%
20%
40%
60%
80%
100%
Gave material 
support to PLHIV
Received 
material support 
from PLHIV
Gave emotional 
support to PLHIV
Received 
emotional 
support from 
PLHIV
Disseminated 
HIV knowledge 
to the 
community
Conveyed HIV 
messages to the 
community
VDB (N=27) PPP-Community (N=49) PPP-Hospital (N=43)
page 34
Figure 5.3: Buddies’ exposure to PPP intervention activities 
***p<.001, **p<.01, *p<.05 
Figure 5.4: Buddies’ exposure to IEC materials 
The qualitative study provided further insight into how the relationship between buddies and PLHIV 
developed successfully. The project required that HIV/AIDS campaign activities be organized by 
VDB/PPPC committees and loan pairs. This created a mechanism for PLHIV and non-PLHIV to 
collaborate with each other, and created a feeling of self-value to both HIV positive and negative 
loan recipients. While the primary motivation of the buddy is to be eligible for the loan, after 
participating in the project for a period of time they develop a higher level of motivation. Besides 
82.6%
58.7%
55.4%
67.4%
59.8%
93.3%
59.3%
74.1%
96.3% **
85.2% *
0% 20% 40% 60% 80% 100%
At least one PPP 
intervention activity
Funfairs
HIV campaign activities
Meetings
Trainings
VDB 
(N=27)
PPP 
(N=92) 
93.5%
80.4%
73.9%
90.2%
100.0%
92.6%
81.5%
92.6%
0% 20% 40% 60% 80% 100%
At least one IEC 
material
At least 1 poster
At least 1 drama
At least 1 message
VDB 
(N=27)
PPP 
(N=92) 
page 35
being proud of themselves for providing benefits to others, they feel that they are fortunate to have 
a chance to experience and understand their PLHIV partner. Qualitative respondents stressed that 
‘buddy’ is viewed as a meaningful role for them, as it means “care and support for both physical and 
psychological aspects”. 
I meet and talk with my HIV positive loan partner almost every day. If I find what support I 
can give, I will not hesitate to do it. For example, her occupation is cassava growing, so I 
helped her to find a best young plant to grow and also always give consultation if needed. 
(Rural buddy)
I feel that I have contributed and sacrificed my time and effort to help PLHIV and the 
community by educating about HIV/AIDS to others. (Buddy respondent) 
The qualitative study also identified that community leaders were particularly effective as buddies, 
especially in disseminating knowledge and understanding related to HIV/AIDS to community 
members. Since these leaders were already accepted and respected by community members, as a 
buddy they had better skills and opportunities to educate HIV to others. Since HIV is not in itself an 
interesting topic, unlike issues related to making a living or economic well-being, it is not easily 
discussed in routine life. However, for buddies in a position of community leadership, their skills in 
conveying HIV knowledge through many existing channels such as the village meeting and household 
radio made the project a success. 
I paired up with a PLHIV as I want to help PLHIV to get the PPP loan and I also want to 
provide other types of support to my loan partner. My HIV positive loan partner is one of 
my village members. I also provide support to other PLHIV in my village who may be loan 
partners or not. When PLHIV in the community plan to organize HIV campaign activities, 
he/she will request my support in disseminating HIV knowledge to the community. Since I 
am a village headman, I have authorization to use household radio. (Buddy respondent) 
However, the buddy relationship did not develop in the same way for models where the buddies 
lived in different communities. For some, the buddies only saw each other at the monthly banking 
meeting, and some buddies did not fulfill their roles of participating in the information campaigns. 
Buddies who did not perform these roles often stated that they do not know how to act or talk to 
their PPP loan partner (PLHIV) as they are afraid of performing any actions or words that are 
unintentionally inappropriate. For example, buddies reported being afraid to ask about their PLHIV 
partner’s health, as they may be hurt or distressed to think about their health condition. Another 
example given was that they feel that if they offer help to their partner, they could feel insulted by 
such an offer. Indeed, many PLHIV stressed that they did not want any material support from their 
buddy, only understanding and acceptance; they want others to view PLHIV as normal people like 
them. 
5.3 HIV Knowledge 
A comparison of HIV knowledge at baseline and endline for buddies who answered both surveys 
shows significant increases in some knowledge items, including mother-to-child transmission, 
sharing personal items, and judging HIV status by appearance (Figure 5.6). The index of correct HIV 
knowledge significantly improved among buddies from 4.9 to 6.2 of 9 total items (p<.00); no 
significant difference was found by program model. 
page 36
Figure 5.5: Buddies’ knowledge of HIV at baseline and endline 
***p<.001, **p<.01, *p<.05, +p<.10 
5.4 Fear and Value-Driven Stigma 
One of the key outcomes expected by the PPP project is that the partnership with a PLHIV will 
reduce feelings of stigma in the buddies. Moreover, as negative loan partners, buddies should play a 
significant role in advocating to reduce stigma and discrimination at both the family and community 
levels. 
Buddies were asked the same questions about their fears of contracting HIV in the baseline and 
endline surveys. As seen in Figure 5.6, most of the fear related items declined at endline. The 
percent reporting fear of contracting HIV from sharing personal items with PLHIV, which was most 
frequently mentioned at baseline, declined significantly from 76% to 45% (p<0.00). The overall scale 
measuring fear-driven stigma among buddies declined significantly from 0.118 to 0.080 on a scale of 
1.0 (p<.01) (not shown).
65.3%
77.3% ***
92.0%
40.0%
49.3%
58.7% ***
64.0% ***
81.3%
96.0% *
58.7%
52.0%
86.7%
33.3%
36.0%
29.3%
30.7%
72.0%
86.7%
0% 20% 40% 60% 80% 100%
Reducing sexual interactions cannot 
prevent HIV
Having sex with those looking clean 
cannot prevent HIV
There are medicines that can inhibit HIV
Being infected is not different from being 
sick with AIDS
HIV is not transmitted among IDUs, SWs 
and MSM only.
Sharing personal items, e.g. nail cutter 
cannot transmit HIV
Not all babies get HIV from a HIV positive 
mother
Exposure to sweat/saliva of PLHIV cannot 
transmit HIV
Exposure to PLHIV's skin cannot transmit 
HIV
Baseline 
(N=75)
Endline 
(N=75)
page 37
Figure 5.6: Change in buddies’ fear of HIV transmission 
***p<.001, **p<.01, *p<.05, +p<.10 
Buddy responses on shame statements measuring value-driven stigma also declined significantly, 
although few expressed agreement with these statements at baseline (Figure 5.7). The overall 
shame scale declined significantly from 0.222 to 0.107 on a scale of 1.0 (p<.00) (not shown). For 
blame statements (Figure 5.8), although the proportion of buddies who agreed with the statements 
decreased at endline, none of the reductions were significant. The average score on the overall 
blame index declined from 0.400 to 0.320, which is weakly significant (p<.10) (not shown).
Figures 5.7: Change in buddies’ agreement with shame statements 
***p<.001, **p<.01, *p<.05, +p<.10 
22.7%
5.3%
45.3% ***
2.7%
5.3%
30.7%
13.3%
76.0%
5.3%
5.3%
0% 20% 40% 60% 80% 100%
Exposed to saliva of PLHIV
Exposed to sweat of PLHIV
Sharing personal items
Sharing a bedroom with PLHIV
Taking care of PLHIV
Baseline 
(N=75)
Endline 
(N=75)
13.3% *
2.7%
16.0% **
24.0%
10.7%
32.0%
0% 20% 40% 60% 80% 100%
PLHIV should be ashamed of 
themselves
I would feel ashamed if someone in my 
family had HIV
I would feel ashamed if I was infected 
with HIV
Baseline 
(N=75)
Endline 
(N=75)
page 38
Figure 5.8: Change in buddies’ agreement with blame statements 
In qualitative interviews, buddies expressed directly how getting to know their PLHIV partner had 
helped reduce their feelings of stigma about HIV. 
I was terribly afraid of PLHIV. I did not want to get close with them at all. But after joining 
the project, I had a chance to attend the HIV training and meetings with PLHIV. My fear is 
gone and I do not stigmatize and discriminate PLHIV anymore. (Buddy respondent) 
However, the qualitative study found that HIV/AIDS campaign activities conducted by PPPCs were 
not as cohesive as those conducted by VDBs. Since members of the club are living in different 
communities, it was quite difficult to get full participation from buddies to conduct HIV/AIDS 
activities in the selected community on a monthly basis as required by the project. Travelling to the 
selected community may cause problems regarding the cost of travel, absence from the job (lost 
income), and other difficulties. Therefore, for some selected communities, PLHIV were sometimes 
the only ones in the PPPC in organizing the activities, and the effort was not sufficient to run the 
campaign activities continuously and intensively enough to successfully address stigma and 
discrimination. 
6. Family of PLHIV and Buddies 
6.1 Profile 
As discussed in the methods section, some family members who were interviewed at baseline were 
re-interviewed at endline (N=67), while some family members were newly recruited for the endline 
survey (N=82). For the full sample, the profile of the respondents did not change significantly 
between baseline and endline according to the characteristics shown in Table 6.1 (all chi squares 
p>.10). For this reason, and to utilize the maximum number of cases available, the full family sample 
is used in the analysis rather than the sub-sample who were interviewed for both surveys. Family 
members interviewed were fairly evenly split between members of PLHIV and families of buddies. 
The mean age was approximately 37 at both baseline and endline. 
32.0%
32.0%
41.3%
38.7%
0% 20% 40% 60% 80% 100%
Promiscuous men spread HIV in your 
community.
Promiscuous women spread HIV in 
your community. Baseline 
(N=75)
Endline 
(N=75)
page 39
Table 6.1: Profile of family members of PLHIV and buddies at baseline and endline 
Baseline Endline
Relationship to project participants
PLHA Family 48.0 46.3
Buddy Family 52.0 53.7
Gender 
 Male 50.0 42.3
Female 50.0 57.7
Residence 
 Urban 42.9 47.0
 Rural 57.1 53.0
Marital Status 
Married 63.6 58.4
Single/divorced/widowed 36.4 41.6
Age 
15-29 39.4 37.6
30-39 13.1 18.1
40-49 17.7 18.1
50+ 29.8 26.2
Mean age 37.7 37.2
Median age 36 37
Education 
None/primary 51.5 46.3
Second/high/vocational 43.4 47.7
University/B.A. 5.1 6.0
(N) (198) (149)
6.2 Program exposure 
Through the creation of personal relationships between PLHIV and buddies, the PPP program aimed 
to reduce stigma and discrimination among families. The expectation was that the buddy pairs 
would share their positive relationships and convey information about HIV to their family members. 
It was also anticipated that family members would be exposed to PPP’s informational campaigns and 
activities, especially if family members lived the intervention communities. Family members were 
asked about their participation in PPP program activities, as seen in Figure 6.1. Many family 
page 40
members took part in PPP meetings, though the percentage was considerably higher for those in the 
VDB model (42% vs. 26%). Over 40% of family members said that they participated in HIV campaign 
activities. Family members who were related to a PPPC member were much more likely to say that 
they attended a Funfair (35% vs. 6%). Overall, 61% of family members related to a VDB member and 
53% of family members related to a PPPC member participated in at least one program activity. 
Figure 6.1: Family exposure to PPP intervention activities 
***p<.001 **p<.01 *p<.05, +p<.10 
The vast majority of family members reported exposure to at least one of the project’s IEC 
materials—nearly all families of VDB members (98%) and 85% of families of PPPC members. Posters 
were seen by more than 70% of families of both models, while the dramas and ‘slips of paper’ were 
mentioned more often by VDB families (more than 70%, vs. 49-59% for PPPC).
Figure 6.2: Family exposure to IEC materials 
***p<.001 **p<.01 *p<.05, +p<.10 
61.1%
5.6% 
46.3%
42.6% *
52.6%
35.8% ***
42.1%
26.3%
0% 20% 40% 60% 80% 100%
At least one PPP 
intervention activitiy
Funfairs
HIV campaign activities
Meetings
PPP 
(N=95)
VDB 
(N=54)
98.1% *
70.4% *
77.8% *
77.8%
85.3%
53.7%
58.9%
73.7%
0% 20% 40% 60% 80% 100%
At least one IEC 
material
At least 1 message
At least 1 drama
At least 1 poster
PPP 
(N=95)
VDB 
(N=54)
page 41
6.3 HIV/AIDS knowledge 
The HIV knowledge items were compared for family members at baseline and endline (Figure 6.3). 
Of the nine items, three increased significantly from baseline to endline (HIV among risk groups, 
sharing personal items, and mother-to-child transmission. A t-test comparing the overall knowledge 
scores of family members showed that knowledge improved significantly, from 4.6 to 5.5 (p<.00) 
(not shown).
Figure 6.3: Family knowledge of HIV at baseline and endline 
***p<.001 **p<.01 *p<.05, +p<.10 
6.4 Fear and value driven stigma 
As seen in Figure 6.4, fewer family members agreed with each of the fear statements at endline. 
Only two statements declined significantly however: sharing personal items and exposure to saliva. 
Overall, the fear scale declined for family members significantly (from 0.159 to 0.109, p=.03) (not 
shown).
57.0%
63.1%
88.6%
36.2%
34.9% **
58.4% ***
47.7% *
72.5%
88.6%
54.5%
59.1%
84.3%
30.8%
21.7%
27.3%
34.8%
64.6%
83.8%
0% 20% 40% 60% 80% 100%
Reducing sexual interactions cannot 
prevent HIV
Having sex with those looking clean 
cannot prevent HIV
There are medicines that can inhibit HIV
Being infected is not different from being 
sick with AIDS
HIV is not transmitted among IDUs, SWs 
and MSM only.
Sharing personal items, e.g. nail cutter 
cannot transmit HIV
Not all babies get HIV from a HIV positive 
mother
Exposure to sweat/saliva of PLHIV cannot 
transmit HIV
Exposure to PLHIV's skin cannot transmit 
HIV
Baseline 
(N=198)
Endline 
(N=149)
page 42
Figure 6.4: Change in family members’ fear of HIV transmission
***p<.001 **p<.01 *p<.05, +p<.10 
As seen in Figures 6.5 and 6.6, family members’ agreement with the statements about value-driven 
stigma also declined significantly. Overall the blame scale declined significantly from 0.533 to 0.362 
(p<.01), and the shame scale score declined from 0.310 to 0.278, which was significant (p<.01). 
Figure 6.5: Change in family members’ agreement with shame statements
***p<.001 **p<.01 *p<.05, +p<.10 
24.8% **
10.1%
50.3% ***
8.6%
9.4%
6.7%
10.1%
39.4%
14.1%
74.7%
4.0%
12.1%
10.6%
10.6%
0% 20% 40% 60% 80% 100%
Exposed to saliva of PLHIV
Exposed to sweat of PLHIV
Sharing personal items
Sharing a bedroom with PLHIV
Taking care of PLHIV
Having meal with PLHIV (food 
sharing)
Carrying PLHIV
Baseline 
(N=198)
Endline 
(N=149)
16.8% *
8.1%
27.5% **
27.8%
14.6%
43.4%
0% 20% 40% 60% 80% 100%
PLHIV should be ashamed of 
themselves
I would feel ashamed if someone in 
my family had HIV
I would feel ashamed if i was infected 
with HIV
Baseline 
(N=198)
Endline 
(N=149)
page 43
Figure 6.6: Change in family members’ agreement with blame statements
***p<.001, **p<.01, *p<.05, +p<.10 
7. Community 
7.1 Profile 
As mentioned above, the community baseline and endline surveys followed a repeated cross￾sectional design. A comparison of sociodemographic characteristics at baseline and endline (Table 
7.1) found no significant differences between the two samples. The endline sample contained more 
women than men (59%) and the median age is 45. About one-quarter of the sample is factory 
workers or day laborers, and about one-fifth are farmers. 
Table 7.1: Profile of community members at baseline and endline 
Baseline Endline
Gender 
 Male 41.4 41.3
Female 58.6 58.8
Residence 
 Urban 50.0 50.0
 Rural 50.0 50.0
Marital Status 
Married 79.5 75.4
Single/div/widow 20.5 24.6
Age 
15-29 22.5 20.0
30-39 17.3 19.5
40-49 23.0 23.2
50+ 37.1 37.3
Mean age 43.0 43.7
Median age 44 45
37.6% **
34.9% ***
53.0%
53.5%
0% 20% 40% 60% 80% 100%
Promiscuous men spread HIV in your 
community
Promiscuous women pread HIV in your 
community Baseline 
(N=198)
Endline 
(N=149)
page 44
Baseline Endline
Education 
None/primary 58.0 55.5
Secondary/high/vocational 33.9 36.6
University/B.A. 8.0 7.9
Occupation
Farmer 23.9 20.7
Small business owner 17.5 17.0
Private/govt. employee 10.0 12.0
Factory worker/casual laborer 26.1 25.9
Student 5.5 6.8
No occupation/housewife 17.0 17.7
(N) (560) (560)
7.2 Exposure to the PPP program 
Measures of community recognition and participation in the program are a key indicator of success 
in raising awareness of HIV issues. More than one-third of the sample reported that they 
participated in at least one PPP activity, and there was no difference in overall participation by 
program model (Figure 7.1). Community members living in PPPC areas were much more likely to 
participate in the Funfairs (25% vs. 5%), which as mentioned earlier were developed for the PPPC 
model communities. Between 25-29% of respondents were aware of the program’s HIV campaigns, 
with a smaller percentage saying they had attended a PPPC meeting. 
Figure 7.1: Community exposure to PPP intervention activities 
***p<.001, **p<.01, *p<.05, +p<.10 
36.0%
4.5% 
29.5% 
16.0% **
39.4%
25.3% ***
25.0%
8.1%
0% 20% 40% 60% 80% 100%
At least one PPP 
intervention activity
Funfairs
HIV campaign activities
Meetings
PPP 
(N=360)
VDB 
(N=200)
page 45
Community members reported a high degree of recognition of the IEC materials; 92% of 
respondents living in VDB model communities and 85% of respondents living in PPPC model 
communities said they had seen at least one of the IEC materials (Figure 7.2). VDB community 
members were particularly likely to say that they had seen a project drama (77%) while for PPP￾model communities the posters were most widely known (61%). 
Figure 7.2: Community exposure to IEC materials 
***p<.001, **p<.01, *p<.05, +p<.10 
Qualitative respondents cited that some non-tangible factors, such as community leaders’ 
willingness to participate and positive attitude towards the project, were a primary key to the 
program’s success in implementing activities for the communities. With community leaders’ buy-in 
to the project, any activities could be implemented smoothly and also received a good response 
from community members. 
Money may be important for community members to manage the project, but it is not all. 
To gain collaboration from community members, leaders should have a people-personality 
and be well respected and trusted by community members. The issue of HIV/AIDS 
sometimes is not easily accepted by everyone, but with the positive personality and 
qualifications of leaders, other community members are likely to listen and follow what 
their leaders believe. (PPP committee member)
The committee is a very important group who leads VDB to success. Therefore, they should 
be honest, sincere, trustable, open-minded and sympathetic. Community members always 
believe in their leaders. If leaders say ‘yes’, they will say ‘yes’ too. (VDB member) 
The variety of communication activities is also cited as an important factor in the program’s success, 
including the integrated types of IEC materials. This variety helped in reaching more members of the 
target groups and in increasing the campaign’s intensity. 
HIV knowledge must be conveyed through several types of activities. [If there is] only one 
type of activity it may not help people to remember what they learn. Importantly, IEC 
92.0% *
68.5% ***
77.0% ***
64.0%
85.3%
53.3%
58.9%
61.4%
0% 20% 40% 60% 80% 100%
At least one IEC 
material
At least 1 message
At least 1 drama
At least 1 poster
PPP 
(N=360)
VDB 
(N=200)
page 46
materials distributed to the audience are also very important as family members who did 
not join the HIV campaign activities will be also benefit. Additionally, using only one type of 
activity or IEC material may cause an unexcited feeling to the audience and they may not 
want to come back to participate in the activities any more. The varied types of activities 
and IEC materials give a better result for HIV campaign. (PPP committee member) 
Moreover, the qualitative study found that each target group decided to access different types of 
materials and activities depending on their individual interest. Some people like reading, so they 
were likely to access posters more than those who are not skillful in reading. For some groups who 
cannot read properly, they were likely to listen to radio dramas through household radio. Apart from 
individual interest, some obstacles prevented the target groups to access the project’s material and 
activities. For example, household radio transmission of some villages was not strong enough to 
provide coverage of the radio drama to all areas in the village. 
7.2 HIV/AIDS Knowledge 
The community survey found significant changes in many of the questions measuring HIV 
knowledge, as seen in Figure 7.3. These included the questions about personal contact with PLHIV, 
mother-to-child transmission, and AIDS treatment drugs. The overall knowledge score of community 
members increased significantly from baseline to endline, 3.3 to 4.0 on a scale of 0 to 9 (p<.00). 
Respondents to the qualitative study also commented on the increase in knowledge of community 
members in program communities. 
The level of HIV knowledge of community members has been recently increased and 
important community members become more aware about HIV prevention. For example, I 
never carried a condom with me before as I felt being judged by others. But now I am more 
comfortable to carry a condom and other young people in the community are also more 
comfortable to request condoms. (Community leader) 
I was afraid before as I believed (from what I heard before) that having a haircut at the 
same shop with PLHIV or using a nail cutter with PLHIV will cause HIV infection. But now I 
do not fear anymore, because I understand clearly about how HIV can be transmitted to 
others. 
page 47
Figure 7.3: Community knowledge of HIV at baseline and endline 
***p<.001, **p<.01, *p<.05, +p<.10 
The qualitative study also highlighted the success of the Funfair edutainment activity for improving 
the level of HIV knowledge of the community through enjoyable and memorable approaches. The 
Funfair included activities such as quiz games, darts and role plays. Each Funfair received a high level 
of participation from community members including youth, the district health office, the Tambon 
Administration Office (TAO) and the municipality. Participants receive both knowledge and 
entertainment at the same time, with prizes and food provided to participants as important 
components. Most people interviewed strongly emphasized that Funfair is an outstanding strategy 
as part of the HIV campaign. 
Funfair is an activity raising participation from considerable numbers of people. They like 
the quiz game and are happy to receive a prize. Amazingly if the audience cannot give the 
correct answer, they will go around learning from the exhibition board or discussing with 
their friends to get the answer. (PPP committee member)
7.3 Fear-driven, Value-driven and Enacted Stigma 
Community members were asked about different aspects of stigma and discrimination using the 
same items that were used in the baseline survey. As seen in Figure 7.4, fears of contracting HIV 
through casual contact declined significantly among community members. Scores on the overall 
fear-driven stigma scale declined from 0.470 to 0.388 (p<.00) (not shown). The qualitative interviews 
also provided insight about how fear-driven stigma declined in the PPP communities. 
49.3%
53.4%
76.6% **
22.5%
15.9%
30.5% ***
26.4% ***
50.2% ***
72.3% ***
46.8%
47.7%
69.6%
18.6%
15.9%
15.2%
15.5%
38.8%
63.4%
0% 20% 40% 60% 80% 100%
Reducing sexual interactions cannot 
prevent HIV
Having sex with those looking clean cannot 
prevent HIV
There are medicines that can inhibit HIV
Being infected is not different from being 
sick with AIDS
HIV is not transmitted among IDUs, SWs 
and MSM only.
Sharing personal items, e.g. nail cutter 
cannot transmit HIV
Not all babies get HIV from a HIV positive 
mother
Exposure to sweat/saliva of PLHIV cannot 
transmit HIV
Exposure to PLHIV's skin cannot transmit 
HIV
Baseline 
(N=560)
Endline 
(N=560)
page 48
Before I felt uncomfortable being friends with PLHIV. If I saw PLHIV, I will try to go in 
another direction. But after I joined and conducted HIV activities myself I learned and now 
understand that PLHIV are just normal as we are. They have the capacity to work and 
contribute to the community. We now sit and eat food together. One PLHIV is also a 
member of the VDB committee. When community members observe the relationship 
between buddies and PLHIV, they have an increased level of acceptance and understanding 
towards PLHIV. (VDB committee member). 
Figure 7.4: Change in community members’ fear of HIV transmission
***p<.001, **p<.01, *p<.05, +p<.10 
Other types of stigma examined in the community survey include value-driven stigma subscales of 
shame and blame. Though all the shame items declined from baseline to endline, only one item 
declined significantly: community members were less likely to say they would feel ashamed if they 
contracted HIV (Figure 7.5). However, the overall shame scale did decline significantly (from 0.507 to 
0.448, p<.01). Agreement with the two blame statements, relating HIV to promiscuity, stayed 
virtually the same as at baseline, as did the overall blame scale (from 0.577 to 0.571, p=.82) (Figure 
7.6). Previous research has shown that shifting attitudes associated with blame is difficult because it 
is deep-rooted and changes in these attitudes may require more time and more one-on-one 
interactions. 
55.9% ***
33.6% ***
43.9% ***
34.5%
27.3% *
37.7%
67.0%
45.4%
56.8%
37.0%
32.7%
43.2%
0% 20% 40% 60% 80% 100%
Exposed to saliva of PLHIV
Exposed to sweat of PLHIV
Sharing cutlery items with PLHIV 
Taking care of PLHIV
Having meal with PLHIV (food 
sharing)
Carrying PLHIV
Baseline 
(N=560)
Endline 
(N=560)
page 49
Figure 7.5: Change in community members’ agreement with shame statements
***p<.001, **p<.01, *p<.05, +p<.10 
Figure 7.6: Change in community members’ agreement with blame statements
***p<.001, **p<.01, *p<.05, +p<.10 
The qualitative study found that the community-based clubs, whether VDB or PPP, were more 
successful in reducing stigma, for two reasons. One is that it was more convenient and feasible for 
these clubs to conduct more frequent HIV/AIDS campaign activities in the community. But also, the 
model of ‘living and working together as normal’ between PLHIV and non-PLHIV can be observed 
clearly by the community when the club is based there. The qualitative study also found the rural 
programs to be more effective, as the culture of rural community (where people are relatives of 
each other) was a primary factor. The study revealed that the VDB and community-based PPPCs 
were likely to be operated sustainably, leading to a better result in increasing quality of life of PLHIV 
and reducing stigma and discrimination 
In the past when PLHIV purchased stuff from my shop, I just never touch or get close to him. 
I can talk to him, but I did not feel comfortable talking with him. After the project, I feel 
more comfortable talking with him. (Community member) 
Community members have learned from the project how to provide mutual support 
between PLHIV and non-PLHIV. It can say that the project has reduced a gap of such two 
43.2%
35.2%
55.9% ***
47.0%
39.8%
65.2%
0% 20% 40% 60% 80% 100%
PLHIV should be ashamed of 
themselves
I would feel ashamed if someone in my 
family had HIV
I would feel ashamed if i was infected 
with HIV
Baseline 
(N=560)
Endline 
(N=560)
57.3%
56.8%
58.4%
57.0%
0% 20% 40% 60% 80% 100%
Promiscuous men spread HIV in your 
community.
Promiscuous women spread HIV in your 
community. Baseline 
(N=560)
Endline 
(N=560)
page 50
groups through several activities promoting living and working together as normal between 
two groups. (Community leader) 
Respondents to the qualitative study said that implementing the PPP project in the community has 
created an environment for community members to talk and learn more about HIV/AIDS, which is 
not normally discussed in routine life. However, HIV/AIDS campaign activities enable community 
members including young people to discuss about HIV/AIDS prevention and also to learn to accept 
PLHIV. This environment has created a sense of understanding that HIV infection may happen to 
anyone, therefore PLHIV should not feel ashamed, and likewise others should also accept PLHIV.
PLHIV were viewed as bad or promiscuous people before. But community members now 
understand better that HIV infection does not mean those infected are promiscuous, since 
they now learn that for some woman who just stay at home and have sex with her husband 
only may also get HIV infection. PLHIV who take a good care of themselves can sometimes 
live longer than others. Since this message has been delivered to community members 
regularly, the level of stigma and discrimination in the community is reduced. (VDB 
committee member)
8. Impact Analysis 
As described in the methodology section, multivariate analysis was conducted to examine whether 
exposure to the project had a significant impact on change in the key outcomes of interest. Key 
independent variables are as follows: 
1) For the stigma models, whether the respondent personally knows someone living with HIV is 
a measure of proximity to the disease. It is assumed that by personally knowing someone 
who is living with HIV like a family member, close friend, or colleague, an individual is less 
likely to have stigmatizing attitudes and behaviors. This is one of the key tenets of the PPP 
program. 
2) For the stigma models, knowledge of HIV transmission, prevention, and care is presumed to 
reduce stigma. It is measured by an index of correct responses to nine questions that range 
from basic to in-depth knowledge. 
3) For all models, the intervention model is used as an independent variable to investigate 
whether some models were more effective than others. The project model interventions 
examined were: 1) PPPC model in urban areas; 2) VDB club model in rural areas; and 3) PPPC 
model in rural areas. A measure of whether the PPPC was community- or hospital-based 
was also included. 
4) For all models, exposure to project interventions are examined separately; but also the 
‘dosage’ of the intervention exposure is measured by combining participation in four project 
interventions: monthly HIV activities conducted by VDBs/PPPCs or ‘campaigns’, IEC materials 
(drama, poster, or pieces of paper presenting key messages), PPPC or VDB meetings on 
banking days, and the Funfair event. 
All the models are controlled for respondent characteristics including sex, marital status, age, 
education, personal income, occupation, and media exposure to HIV messaging. The results are 
described below. 
page 51
8.1 PLHIV 
Unfortunately the small number of PLHIV who were interviewed at both baseline and endline (N=95) 
precluded doing extensive impact analysis on this sample. Multivariate analyses were conducted: (1) 
to show significant changes between baseline and endline on all project outcomes; and (2) to 
explore if exposure to the program was significantly related to changes between baseline and 
endline. For the first analysis the outcomes that changed significantly over time were disclosure of 
HIV status, self-isolation (internalized stigma), fear of stigma from family/friends and the 
community, self-esteem/self-efficacy, and quality of life. 
No significant change was found for the regression models of disclosure, the stigma scales, or self￾esteem/self-efficacy. For quality of life, as seen in Table 8.1, the type of model that the PLHIV was 
exposed to had a significant impact. Belonging to a rural PPPC had the most positive impact on 
quality of life, followed by the urban PPPC and finally the VDB. This may be a reflection of the fact 
that PLHIV in rural areas had more interaction with community members in participating in the 
interventions, and thus greater improvement in their well-being as a result. There was no significant 
impact on quality of life for whether the PPPC was community-based or hospital-based. None of the 
other measures of exposure (contact with the buddy; material support from the buddy; attending 
monthly meetings; participation in HIV campaigns or Funfair; or exposure to IEC materials) had any 
significant effect on quality of life. 
Table 8.1: Results of linear regression of level of exposure to project activities on Quality of Life, 
PLHIV Survey 
β coef. s.e. signif.
Gender
Male ref
Female -0.060 0.10
Marital Status
Single/divorced/widow ref
Married -0.268 0.10 **
Age
15-39 ref
40+ -0.118 0.11
Education
None/primary/secondary ref
University/BA/MA -0.516 0.19 **
Income (continuous) 0.008 0.00 *
Baseline Quality of Life score 0.484 0.09 **
Implementation model
PPP club in rural area ref
VDB in rural area -0.592 0.17 **
PPP club in urban area -0.246 0.12 +
Hospital based club
no ref
yes 0.054 0.11
page 52
Constant 2.593 0.39
R
2
0.486
***p<.001, **p<.01 *p<.05 +p<.10 
8.2 Buddy 
Like the PLHIV sample, the buddy survey contained a small number of cases; only 75 were 
interviewed at both baseline and endline. Multivariate analysis was conducted on the outcome 
measures which changed significantly between baseline and endline, which include: HIV knowledge, 
fear-driven stigma and shame-driven value-driven stigma. In the base model, sociodemographic 
variables measured at endline were included as control variables along with the outcome variable 
measured at baseline. In the next models, non-significant control variables were dropped and 
measures of exposure were added one by one. 
Table 8.2 presents the results for HIV knowledge for buddies interviewed at both baseline and 
endline. The results show that participating in PPP project activities, discussing HIV/AIDS with the 
PLHIV partner, and participating in HIV campaigns in the community were significantly related to 
increases in the HIV knowledge score. Other measures of participation such as frequency of talking 
to the PLHIV partner, providing material support to the partner and exposure to IEC materials were 
not significantly related. These findings indicate that direct participation with the PPP project and 
specific discussions about HIV with the partner had the greatest impact on HIV knowledge for 
buddies. 
Table 8.2: Results of linear regression of level of exposure to project activities on HIV Knowledge 
score, buddy survey 
β coef. s.e. signif.
Base model
Education
None/primary ref
Secondary/university/BA/MA 0.822 0.48 +
Baseline HIV knowledge score 0.287 0.11 *
Constant 4.506 0.59 **
R
2
0.135
Exposure measures added singly to base model
Ever talked to buddy about HIV
No ref
Yes 1.185 0.19 *
R
2
0.190
Participation in disseminating HIV knowledge to 
community
No ref
Yes 0.933 0.52 +
R
2
0.172
Number of types of exposures to PPP project (0-
4)
page 53
β coef. s.e. signif.
Including IEC, meetings, trainings, 
campaigns, funfair
0.361 0.18 *
R
2
0.182
Independent variables found to be not significant: implementation model (VDB/PPP); community 
based model (yes/no); exposure to radio drama (yes/no); exposure to slips of paper messages 
(yes/no); frequency of talking to buddy (daily/less often); giving material support to buddy (yes/no); 
conveyed HIV knowledge (yes/no).
***p<.001, **p<.01 *p<.05 +p<.10 
Using the same type of analysis, many of the exposure measures were found to be significantly 
related to the decrease in shame-related value-driven stigma (Table 8.3). Participating in HIV 
campaigns, seeing a poster, hearing a radio drama, seeing the slips of paper messages all were 
related to lower shame scores at endline. The number of types of exposures—including participating 
in activities and exposure to IEC—also was significantly related, indicating that being exposed to a 
variety of program activities was important. 
Table 8.3: Results of linear regression of level of exposure to project activities on shame-related 
value-driven stigma, buddy survey 
β coef. s.e. signif.
Base model
HIV knowledge score -0.026 0.01
Baseline fear-driven stigma 0.279 0.67 **
Constant 0.208 0.69 **
R
2
0.261
Exposure measures added singly to base model
Ever saw poster
No ref
Yes -0.009 0.00 *
R
2
0.305
Ever heard radio drama
No ref
Yes -0.008 0.01 *
R
2
0.287
Ever saw slips of paper messages
No ref
Yes -0.011 0.19 *
R
2
0.310
Participation in disseminating HIV knowledge to 
community
No ref
Yes -0.119 0.05 *
R
2
0.327
page 54
β coef. s.e. signif.
Number of types of exposures to PPP project (0-
4)
Including IEC, meetings, trainings, 
campaigns, funfair
-0.037 0.02 *
R
2
0.311
Independent variables found to be not significant: knowing someone with HIV (yes/no); 
implementation model (VDB/PPP); community based model (yes/no); frequency of talking to buddy 
(daily/less often); talked about HIV with buddy (yes/no); giving material support to buddy (yes/no); 
attended PDA training (yes/no); conveyed HIV knowledge (yes/no); attended Funfair (yes/no).
***p<.001, **p<.01 *p<.05 +p<.10 
8.3 Family 
Multivariate regression analysis was conducted among the family members interviewed at endline 
(N=149) for those outcome measure that improved significantly from baseline to endline. The same 
type of limited regression analysis was used, as conducted on the buddy dataset. Though the same 
family members were not all re-interviewed at baseline, a variable measuring the average outcome 
score for all family members interviewed within the same community at baseline was included as a 
proxy control. 
For HIV knowledge, first sociodemographic characteristics of family members were added as control 
variables, but none were found to be significant. Variables measuring the type of PPP model and 
exposure to the PPP program through participation in meetings, campaigns, the Funfair, or exposure 
to IEC materials were also not significantly related to increased knowledge. A variable measuring the 
number of types of exposures was also not significant. Exposure to other types of media information 
on HIV/AIDS was also not significant. 
Table 8.4 shows the regression results for fear-driven stigma among family members. None of the 
sociodemographic variables were found to be significant and were therefore were dropped from the 
model. Community-level fear at baseline was also not significant, but HIV knowledge significantly 
reduced fear based-stigma. Knowing someone with HIV was not related to fear for family members; 
nor was the type of PPP model that the family member of the respondent participated in. Several of 
the measures of exposure were found to be significant: exposure to any IEC materials, participation 
in HIV campaigns and attending a Funfair. The number of types of exposure was also significant in 
reducing fear. Thus for family members, those who showed a greater level of commitment and 
participation in the program showed greater reductions in fear-related stigma. 
page 55
Table 8.4: Results of linear regression of level of exposure to project activities on fear-driven 
stigma, family survey 
β coef. s.e. signif.
Base model
HIV knowledge score - 0.046 0.01 **
Baseline community fear-driven stigma 0.235 0.29
Constant 0.208 0.69 **
R
2
0.194
Exposure measures added singly to base model
Ever saw any IEC materials
No ref
Yes -0.172 0.00 **
R
2
0.240
Participation in disseminating HIV knowledge to 
community
No ref
Yes -0.082 0.04 *
R
2
0.221
Participation in Funfair
No ref
Yes -0.104 0.04 **
R
2
0.227
Number of types of exposures to PPP project (0-
4)
Including IEC, meetings, trainings, 
campaigns, funfair
-0.048 0.01 **
R
2
0.249
Independent variables found to be not significant: knowing someone with HIV (yes/no);
implementation model (VDB/PPP); community based model (yes/no); saw poster; heard radio drama; 
saw slips of paper; attended PPP meeting;
***p<.001, **p<.01 *p<.05 +p<.10 
Regression results for the domain shame under value-driven stigma also showed that the number of 
types of exposure was important for family members, as was participation in the HIV campaigns 
(Table 8.5). For blame-related stigma, no significant results were found. 
Table 8.5: Results of linear regression of level of exposure to project activities on shame-related 
value-driven stigma, family survey 
β coef. s.e. signif.
Base model
HIV knowledge score - 0.039 0.01 **
Baseline community shame-driven stigma -0.072 0.34
Constant 0.420 0.10 **
R
2
0.109
page 56
β coef. s.e. signif.
Exposure measures added singly to base model
Participation in disseminating HIV knowledge to 
community
No ref
Yes -0.087 0.04 *
R
2
0.133
Number of types of exposures to PPP project (0-
4)
Including IEC, meetings, trainings, 
campaigns, funfair
-0.035 0.02 +
R
2
0.130
Independent variables found to be not significant: knowing someone with HIV (yes/no); 
implementation model (VDB/PPP); community based model (yes/no); saw poster; heard radio drama; 
saw slips of paper; attended PPP meeting; attended funfair
***p<.001, **p<.01 *p<.05 +p<.10 
8.4 Community 
The community dataset included N=560 cases, and so full regression models were analyzed, as 
discussed in the methodology section. 
Fear-Driven Stigma 
Table 8.6 shows the results of linear regressions of level of exposure to project activities on fear￾driven stigma. Model I shows the beta coefficients and 95% confidence intervals of main predictors 
on fear-driven stigma, net of respondent characteristics and baseline average of fear at the 
community level. When compared to PPPC model in rural areas, fear of HIV transmission among 
respondents living in areas where the PPPC model was implemented in urban areas (-6.10; 95%CI: -
9.87 : -2.33), and the VDB model in rural areas (-3.76; 95%CI: -6.45: -1.08) scored significantly less on 
the fear-driven scale. When the model was re-run with PPPC model in urban areas as the reference 
category, no significant difference was observed in fear scores to VDB model in rural areas. 
Table 8.6: Results of linear regression of level of exposure to project activities on fear-driven 
stigma, community survey 
Model I Model II
Characteristics β coef. (95% CI) β coef. (95% CI)
Gender
Male ref ref
Female 1.37 (-0.36: 3.10) 1.37 (-0.36: 3.10)
Marital Status
Single/divorced/widow ref ref
Married 0.21 (-2.01: 2.42) 0.18 (-2.04: 2.40)
Age
15-29 ref ref
30-39 -1.70 (-4.68: 1.28) -1.65 (-4.64: 1.34)
page 57
Model I Model II
Characteristics β coef. (95% CI) β coef. (95% CI)
40-49 -0.82 (-4.00: 2.35) -0.74 (-3.92: 2.44)
50+ 0.32 (-2.79: 3.43) 0.32 (-2.81: 3.44)
Education
None/primary ref ref
Secondary/hs/vocation -1.77 (-3.89: 0.36) -1.79 (-3.94: 0.35)
University/BA/MA -2.96 (-6.48: 0.56) -2.87 (-6.40: 0.65)
Occupation
Farmer ref ref
Small business owner -1.63 (-4.62: 1.36) -1.59 (-4.59: 1.41)
Private/Government employee 0.05 (-3.56: 3.67) 0.11 (-3.51: 3.72)
Factory worker/casual labor -2.15 (-4.82: 0.52) -2.12 (-4.80: 0.56)
Student 2.17 (-2.64: 6.98) 2.23 (-2.60: 7.06)
Housewife/no occupation -2.62 (-5.62: 0.38) -2.50 (-5.55: 0.55)
Income
<3000 ref ref
3000-4999 0.58 (-2.19: 3.35) 0.63 (-2.16: 3.42)
5000-6999 -1.16 (-3.98: 1.65) -1.19 (-4.03: 1.66)
7000+ -1.78 (-4.47: 0.90) -1.75 (-4.46: 0.95)
Exposure to HIV messaging
TV 1.24 (-1.15: 3.64) 1.21 (-1.19: 3.62)
Radio -0.31 (-2.17: 1.54) -0.30 (-2.15: 1.56)
Newspaper -0.22 (-2.04: 1.59) -0.19 (-2.00: 1.62)
Posters -1.84* (-3.65: -0.02) -1.86* (-3.68: -0.04)
Personally know a PLHIV
no ref ref
yes -2.47** (-4.37: -0.57) -2.42** (-4.34: -0.51)
HIV/AIDS Knowledge
0-3 correct responses ref ref
4-9 correct responses -4.66*** (-6.30: -3.02) -4.71*** (-6.35: -3.07)
Implementation model
PPP club in rural area ref ref
PPP club in urban area -6.10** (-9.87: -2.33) -6.22** (-10.01: -2.44)
VDB in rural area -3.76** (-6.45: -1.08) -3.89** (-6.59: -1.19)
Baseline Fear†
Low community-level fear ref ref
High community-level fear -2.23 (-5.04: 0.58) -2.27 (-5.09: 0.55)
Intervention exposures
None or one ref
Two -0.99 (-2.96: 0.98)
Three or four -2.97** (-5.38: -0.55)
Intervention exposures
None or one ref
Two -0.98 (-2.95: 0.98)
Campaign/VDB or PPP club/IEC -2.86 (-6.82: 1.10)
Campaign/Fun fair/IEC -4.18** (-7.74: -0.63)
Four -1.70 (-6.44: 3.04)
page 58
Model I Model II
Characteristics β coef. (95% CI) β coef. (95% CI)
Constant 62.79*** (56.81: 68.76) 62.86*** (56.83: 68.89)
***p<.001, **p<.01 *p<.05 +p<.10 
Notes: †Baseline community fear is the average score of fear at baseline in each community surveyed. Across 
all communities, the score ranged from 44.5 to 54.1. Low community-level fear represents average scores less 
than 50, while high community-level scores and 50 and above. 
As hypothesized, respondents who reported that they personally know someone living with HIV 
scored significantly less on the fear scale when compared to those who did not know someone (-
2.47; 95% CI -4.37:-0.57). Higher HIV/AIDS knowledge at endline also predicted lower fear on the 
scale. Respondents who answered 4-9 correct questions scored 4.66 (95%CI: -6.30:-3.02) points 
lower on the fear scale than respondents who answered less than four questions correctly. In terms 
of intervention exposure, the effect of participating in three or four intervention activities 
significantly reduced fear on the scale by close to 3 points (95% CI: -5.38:-0.55) when compared to 
no intervention exposure or exposure to exactly one. This indicates that a combination of 
intervention types is necessary that reinforces information to reduce fear. 
Model II examines the combination of the three interventions that were responsible for reducing 
fear of HIV transmission. No respondents reported exposure to the following combination of 
activities: VDB or PPPC meetings and Funfair and IEC, therefore it does not appear in the model. 
From Model II, the intervention combination that was significantly contributed to reducing fear of 
HIV transmission was the campaign, Funfair, and IEC materials. Respondents who participated or 
were exposed to these three interventions scored 4.18 points (95% CI: -7.74: -0.63) less on the fear 
scale when compared to respondents who participated in exactly one or none of the interventions. 
Value-Driven Stigma 
Table 8.7 presents the linear regression models of intervention exposure on the shame scale, which 
showed significant change from baseline to endline. The analysis is controlled by baseline shame, 
calculated as an average score of community-level shame at baseline. In Model I it is seen that, as 
with the fear scale, respondents who personally know someone living with HIV (-1.94; 95% CI: -3.86:-
0.02) and with high knowledge of HIV/AIDS prevention, care, and treatment (-4.71; 95% CI: -6.35: -
3.07) scored significantly less on the shame scale. Moreover, respondents who reported exposure 
to at least three interventions scored 3.39 points (95% CI: -5.86: -0.93) lower on the shame scale 
than those exposed to exactly one intervention or none. 
Table 8.7: Results of linear regression of level of exposure to project activities on shame, 
community survey 
Model I Model II
Characteristics β coef. (95% CI) β coef. (95% CI)
Gender
Male ref ref
Female -2.25** (-4.00: -0.50) -2.17* (-3.92: -0.41)
Marital Status
Single/divorced/widow ref ref
page 59
Model I Model II
Characteristics β coef. (95% CI) β coef. (95% CI)
Married 1.62 (-0.64: 3.87) 1.72 (-0.53: 3.98)
Age
15-29 ref ref
30-39 1.48 (-1.55: 4.51) 1.38 (-1.66: 4.41)
40-49 0.93 (-2.30: 4.15) 0.99 (-2.25: 4.22)
50+ 3.33* (0.16: 6.50) 3.45* (0.27: 6.63)
Education
None/primary ref ref
Secondary/hs/vocation -0.57 (-2.75: 1.60) -0.50 (-2.69: 1.70)
University/BA/MA -1.06 (-4.64: 2.53) -0.81 (-4.40: 2.78)
Occupation
Farmer ref ref
Small business owner 1.16 (-1.88: 4.21) 1.42 (-1.64: 4.47)
Government employee 2.28 (-1.40: 5.95) 2.35 (-1.32: 6.02)
Factory worker 0.02 (-2.70: 2.73) 0.19 (-2.54: 2.91)
Student -2.22 (-7.10: 2.66) -1.96 (-6.86: 2.94)
Housewife/no occupation -1.18 (-4.24: 1.88) -0.95 (-4.06: 2.16)
Income
<3000 ref ref
3000-4999 -1.16 (-3.97: 1.66) -0.92 (-3.75: 1.91)
5000-6999 -1.23 (-4.08: 1.62) -0.96 (-3.85: 1.94)
7000+ -3.56* (-6.28: -0.84) -3.48* (-6.22: -0.74)
Exposure to HIV messaging
TV 1.72 (-0.72: 4.16) 1.85 (-0.59: 4.30)
Radio 0.68 (-1.20: 2.56) 0.63 (-1.25: 2.52)
Newspaper -0.96 (-2.80: 0.88) -1.00 (-2.84: 0.84)
Posters -2.76** (-4.61: -0.91) -2.69** (-4.55: -0.84)
Implementation model
PPP club in rural area ref ref
PPP club in urban area -2.17 (-4.89: 0.55) -2.04 (-4.78: 0.69)
VDB in rural area -2.23 (-4.82: 0.37) -2.51 (-5.12: 0.10)
Personally know a PLHIV
no ref ref
yes -1.94* (-3.86: -0.02) -1.78 (-3.72: 0.15)
HIV/AIDS Knowledge
0-3 correct responses ref ref
4-9 correct responses -4.71*** (-6.35: -3.07) -3.73*** (-5.40: -2.06)
Baseline Shame†
Low community-level shame ref ref
High community-level shame 1.77 (-0.63: 4.17) 1.88 (-0.53: 4.29)
Intervention exposures
None or one ref
Two -0.80 (-2.81: 1.22)
Three or Four -3.39** (-5.86: -0.93)
Intervention exposures
None or one ref
page 60
Model I Model II
Characteristics β coef. (95% CI) β coef. (95% CI)
Two -0.88 (-2.89: 1.14)
Funfair/Campaign/VDB or PPP 0.60 (-7.84: 9.04)
Funfair/Campaign/IEC -4.73** (-8.35: -1.11)
Campaign/VDB or PPP/IEC -1.11 (-5.13: 2.90)
Four -5.76* (-10.59: -0.94)
Constant 55.83*** (50.35: 61.31)
 
55.23*** (49.70: 60.75)
***p<.001, **p<.01 *p<.05 +p<.10 
Notes: †Baseline community shame is the average score of shame at baseline in each community surveyed. 
Across all communities, the score ranged from 43.0 to 57.0. Low community-level shame represents average 
scores less than 50, while high community-level scores and 50 and above. 
In Model II we ran the analysis to assess the combination of interventions that were reducing shame. 
As with fear-driven stigma, the results indicate that participation in the Funfair plus exposure to a 
campaign and to IEC materials significantly reduced shame. Respondents who reported participation 
and exposure to these three interventions scored 4.73 points (95% CI: -8.35:-1.11) lower on the 
shame scale when compared to respondents exposed to only one intervention or none. These were 
the same interventions that we found influenced the fear scale. Exposure to all four interventions is 
also associated with lower levels of shame in that respondents scored 5.76 points (95% CI: -10.59: -
0.94) lower when compared to respondents exposed to none or only one intervention. This suggests 
that programs with less resources can focus on three interventions only – funfair, IEC materials, and 
campaign. 
HIV knowledge 
The results of the regression on HIV knowledge are found in Table 8.8. The type and location of the 
PPP model was again found to be significant; those living in communities with VDB clubs or in urban 
communities with PPPCs were more likely have increased knowledge than those in rural 
communities with PPPCs. The number of types of exposure was also important; knowledge 
increased for those with two exposures or especially with three or four exposures. Further analysis 
to identify the types of activities with the greatest impact did not show significant results. 
Table 8.8: Results of linear regression of level of exposure to project activities on HIV knowledge, 
community survey 
Characteristics β coef. s.e. signif.
Gender
Male ref
Female 0.331 0.15 *
Marital Status
Single/divorced/widow ref
Married -0.338 0.20 +
Age
15-29 ref
30-39 0.753 0.26 **
40-49 0.625 0.28 *
50+ 0.808 0.27 **
page 61
Characteristics β coef. s.e. signif.
Education
None/primary ref
Secondary/hs/vocational 0.775 0.19 **
University/BA/MA 1.123 0.30 **
Personally know a PLHIV
no ref
yes 0.481 0.17 **
Implementation model
PPP club in rural area ref
PPP club in urban area 0.495 .22 *
VDB in rural area 0.509 .23 *
Intervention exposures
None or one ref
Two 0.111 .18
Three or four 0.522 .22 *
Constant 2.207 0.33 **
R
2
.092
***p<.001, **p<.01, *p<.05, +p<.10 
9. Summary and discussion 
Both the qualitative and quantitative data show significant change in key outcomes among PLHIV, 
buddies, their families, and the project communities. A summary of quantitative findings for PLHIV is 
shown in Table 9.1. Many of the outcome measures were shown to change significantly by the time 
of the endline survey. These include increased disclosure of HIV status, reduced self-isolation and 
fear of stigma from family and the community, increased self-esteem/self-efficacy and increased 
quality of life. It is interesting that PLHIV reports of their own feelings about stigma and their well￾being showed significant change while their reports of experienced discrimination did not. Since the 
fear of discrimination is usually found to be higher among PLHIV than the actual discrimination 
experienced, the program seems to have resulted in increasing the ability of PLHIV to feel more 
comfortable in their communities. This was achieved through the buddy partnership as well as the 
community campaigns. The multivariate analysis did not find significant relationships between 
participation in the program and change in the disclosure and stigma measures, but the small 
number of cases limited the analysis. For quality of life, type of program model was found to be 
significantly related: VDB participants and PPPC urban club members were more likely to report 
increased quality of life. The qualitative findings also provide background on the reasons that the 
community-based programs, particularly VDB, provide greater contact between buddies and PLHIV 
and a greater ability for community members to perceive PLHIV ‘working and living together as 
normal.’
Table 9.1: Summary table for PLHIV analysis 
PLHIV
Significant 
Change
Relationship to exposure
(Multivariate analysis)
Disclosure of status ** n.s.
Internalized stigma
Self-isolation * n.s.
Coping ability
page 62
Fear of stigma
Family ** n.s.
Community ** n.s.
Discrimination
Family isolation
Family abandonment
Community discrimination
Self-esteem/self-efficacy ** n.s.
Quality of life
Overall * Significantly related to the type of 
model: VDB and urban PPP clubs 
more effective than rural PPP
Physical ** na
Social na
Psychological * na
Environmental na
***p<.001, **p<.01, *p<.05, +p<.10, n.s. not significant 
The buddy survey also found significant changes in HIV knowledge, fear-driven and value-driven 
stigma among the HIV-negative partners by the time of the endline survey. The community-based 
program models were found to be more successful in maintaining buddies’ participation in the 
program in the qualitative survey, as it was difficult for buddies to join the activities when they live in 
different communities. Multivariate analysis showed that buddies’ discussion of HIV/AIDS with their 
PLHIV partner, participation in HIV informational campaigns, and the number of types of exposures 
to the program were significantly related to increased HIV/AIDS knowledge among buddies. The IEC 
materials were particularly effective in reducing shame-related stigma for buddies, as was the 
number of types of exposure. 
page 63
Table 9.2 Summary table for buddy, family and community multivariate analysis 
Buddy Family Community
Significant 
Change
Relationship to exposure Significant 
Change
Relationship to 
exposure
Significant Change Relationship to exposure
HIV Knowledge **  Discussing HIV/AIDS with 
PLHIV partner 
 Participating in HIV 
campaigns 
 Number of types of 
exposures
** n.s. **  Implementation model 
(PPP urban, VDB more 
effective than PPP rural)
 Number of types of 
exposures
Fear-driven stigma n.s. na *  Participating in HIV 
campaigns 
 Participation in 
Funfair
 Saw any IEC 
material
 Number of types of 
exposures
**  Implementation model 
(PPP urban, VDB more 
effective than PPP rural)
 Number of types of 
exposures
Value-driven stigma
Shame **  Participating in HIV 
campaigns 
 Seeing poster
 Hearing radio dramas
 Seeing slips of paper 
messages
 Number of types of 
exposures
*  Participating in HIV 
campaigns 
 Number of types of 
exposures
*  Number of types of 
exposures
Blame n.s. na ** n.s. n.s. na
***p<.001, **p<.01, *p<.05, +p<.10, n.s. not significant
page 64
Family members of PLHIV and buddies also saw increases in their HIV knowledge, and in the stigma 
measures. Multivariate analysis showed that the number of types of exposure were most important 
for both increasing knowledge and reducing fear-driven stigma and shame. Finally, the community 
survey had significant change in HIV knowledge, fear-driven stigma and value-driven stigma. 
Multivariate analysis showed that increases in HIV knowledge was significantly related to the PPP 
model and to the number of types of exposures to the program. The qualitative study also outlined 
how having a variety of platforms for IEC and for participation in program activities added to the 
strength of the program. The decrease in fear-driven stigma was also related to the PPP model and 
the number of types of exposure, while a decrease in value-driven stigma regarding shame 
associated with PLHIV was significantly related to the number of types of exposure. These 
multivariate results, along with the explanatory power of the qualitative data, provide clear evidence 
that the program was successful in reducing stigma for PLHIV in their communities. 
10. Recommendations 
1. Both the qualitative and quantitative evidence suggest that VDBs and PPPCs should be based in 
one local community. To replicate the PPPC and VDB models to other areas, both advantages 
and disadvantages of each model should be considered thoroughly. The community-based 
model can build a higher level of participation for the general population and reduce HIV/AIDS 
stigma and discrimination toward a larger group, compared to the hospital-based PPPC model. 
However, the hospital-based PPPC model can reach a larger group of PLHIV, and is appropriate 
for those PLHIV who do not want to take the risk of disclosing their HIV status. 
2. A combination of various interventions is recommended to reinforce information to reduce fear 
and shame. The best results were found among those who were exposed to a variety of program 
activities and messages 
3. The schematic framework of addressing internalized (self) stigma among PLHIV, and then 
moving to people around PLHIV and community members to address external stigma and 
discrimination, was an important thematic concept for the program. 
a. Campaigning on HIV/AIDS stigma and discrimination should not only be focused on stigma 
and discrimination of people around PLHIV, but also on self-stigmatization of PLHIV. The 
results indicate that the two efforts together--Increasing self-esteem and reducing self￾stigma of PLHIV, along with reducing HIV/AIDS stigma and discrimination among people 
around PLHIV—lead to an overall increased quality of life among PLHIV.
b. Interventions should be firstly implemented on continuous basis among PLHIV, their 
intimate friends, buddies (HIV negative loan recipients), family members of PLHIV 
and community leaders. In this way people surrounding PLHIV can act as change agents for 
the wider community. To become an effective change agent, these primary target groups
should be equipped with knowledge and information related to HIV/AIDS, awareness of 
stigma as well as discrimination, and especially with skills to transfer information to others.
4. A longer implementation timeline is recommended. Although the program yielded positive 
changes, there is still room for improvement in some areas. Extending the project period longer 
than two and a half years would ensure sustainable positive results, with strengthened 
management of PPPCs and VDB and continued participation of key target groups. 
5. The results point to some program areas that could be improved and strengthened.
page 65
a. Further research on approaches to reduce self-stigmatization of PLHIV should be 
conducted. The study showed a high degree of self-stigmatization among PLHIV, especially 
among PPPC members based in urban areas who are extremely sensitive about their HIV 
status. Besides investigating the types of interventions that can reduce self-stigmatization, 
the research should examine ways to increase self-esteem and self-confidence among PLHIV 
b. Greater effort should be made for capacity building among HIV negative loan recipients 
(buddies) on providing mental support to PLHIV and disseminating HIV knowledge to others. 
Most PLHIV stressed that the type of support they want most is mental or psychological 
support, but buddies need to be provided with skills to provide this support and awareness 
of PLHIV’s feelings. In addition, to perform the PPP role of disseminating HIV knowledge 
effectively, HIV negative loan recipients should be able to convey information to others 
effectively.
c. The program should focus on developing the community’s in-depth HIV knowledge and how 
to analyze risk behaviors. In addition, it is important to also address stigma to at-risk 
populations such as sex workers and MSM. Only 16% of community members understand 
that HIV is not transmitted within these risk groups only. Causes of blame stigma (believing 
that PLHIV are promiscuous) should also be analyzed further to tackle it more effectively. 
page 66
References 
Brouard, P. & Wills, C. 2006. A Closer Look: The Internalization of Stigma Related to HIV. USAID.
Cohen, J. 1988. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale: Lawrence 
Erlbaum Associates. 
DeVellis, R.G. 2003. Scale Development: Theory and Applications. 2nd edition. Thousand Oaks: Sage 
Publications Inc. 
Jain, A., Richter, K., Nuankaew, R., Mongkolvibolpol, N., & Singhapoom, S. 2009. Baseline Study for 
the Positive Partnership Program, Phase II at PDA in Thailand. Bangkok: Pact Thailand. 
Kalichman, S.C., DiMarco, M., Austin, J., Luke, W. & DiFonzo, K. 2003. Stress, Social Support, and HIV￾Status Disclosure to Family and Friends Among HIV-Positive Men and Women. Journal of 
Behavioral Medicine 26(4):315-332. DOI: 10.1023/A:1024252926930 
Leickness, C.S., Kalichman, S., Strebel, A., Cloete, A., Henda, N. & Mqeketo, A. 2007. Internalized 
stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape 
Town, South Africa. Social Science & Medicine 64(9):1823-1831.
Lorig, K., Stewart, A., Ritter, P., Gonzalez, V., Laurent, D., & Lynch, J. 1996. Outcome Measures for 
Health Education and Other Health Care Interventions. Thousand Oaks: Sage Publications.
Nyblade, L., Hong, K.T., et al. 2008. Communities Confront HIV Stigma in Viet Nam: Participatory 
Interventions Reduce HIV Stigma in Two Provinces. Washington, D.C.: International Center for 
Research on Women; Hanoi: Institute for Social Development Studies. 
Rosenberg, M. 1965. Society and the Adolescent Self-Image. Princeton, New Jersey: Princeton 
University Press. 
Sakthong, P., Schommer, J.C., Gross, C.R., Sakulbumrungsil, R. and Prasithsirikul, W. 2007. 
Psychometric properties of WHOQOL-BREF-THAI in patients with HIV/AIDS. Journal of the 
Medical Association of Thailand 90(11): 2449-60.
Silpakit, O. and Silpakit, C. 2003. Thai version of a health-related quality of life instrument for 
epilepsy. Neurological Journal of Southeast Asia 8:103–107A. 
Tanzania Stigma-Indicators Field Test Group. 2005. Measuring HIV stigma: Results of a Field-test in 
Tanzania. 2005. Washington, D.C.: Synergy. 
UNAIDS. 2007. The Positive Partnerships Program in Thailand: Empowering People Living with HIV. 
Geneva: UNAIDS Best Practice Collection.
page 67
Appendix 
PLHIV Endline Questionnaire 
Code P______________________ 
A1. Type of area: 1. Urban 2. Rural 
Section 1: General Information
Demographic
[100] Gender 1. Male 2. Female
[101] Marital status: 1. Single 2. Married/having partner 3.Divorced 
4. Widow 5.Other, specify………
[102] Education: 
0. No education/did not finish primary school
1. Primary school
2. Secondary school 
3. High school 
4. Vocational certificate
5. Vocational diploma 
6. Undergraduate diploma
7. Bachelor’s degree
8. Master’s degree 
9. Doctoral degree
[103] Total number of members in your household _______ persons (including yourself) 
[104] Do you have children? 
0. No 
1. Yes __________ person(s) (only those alive)
[105] Do you live with your family currently? 
0. No 
1 Yes105a) with whom do you live? _(Able to answer more than one answer) 
1. Spouse 2. Child(ren) <15 yrs. 3. Child(ren) 15 and over 4. 
Parents 5. Brothers 6.Sisters 
B. Program Participation
Section 2: Economic and Business Information
[201] What business(es)/occupation(s) do you do? 
[201.1] Main Business
(Select one only)
[201.2] Secondary Business
(Can select more than one)
Farmer 1 1
Vending/Retailing 2 2
Private employee 3 3
Factory worker 4 4
Casual laborer 5 5
Government/state enterprise 
employee
6 6
Student 7 7
No occupation/housewife 8
Other, please specify
Other, please specify...................
page 68
[202] Average monthly income 
[202.1] Your own income only (from all occupations) __________________ Baht
[202.2] Total household income (from all family members) __________________ Baht
[203] Do you have savings currently? 
 0. No 
 1. Yes  Amount_________________Baht 
[204] Do you have debt(s) currently? 
 0. No (skip to Q. 207) 
 1. Yes from which source: 
 
[204.1] Loan Sources Total
(Baht)
Interest Rate
(%)
1. Village Development Bank (through PPP), PPP club ___________ ___________
2. Other formal sources such as a cooperatives, village fund, 
saving group
___________ ___________
3. Informal loan e.g. a merchant, a loan provider ___________ ___________
[205.1-3] [206.1-3]
[207] Currently how much you monthly contribute for your family expenses such as food, clothing, child 
education, and other household expenses? _______________Baht (recheck with Q. 202)
[208] Currently how much are you monthly responsible for your own health care or related expenses
(such as transportation to a hospital)? _________________Baht (recheck with Q. 202)
[209] How much do you know and understand the following areas of business? 
Business Skill Very much Much Moderately Little Very little
[209.1] Business planning 5 4 3 2 1
[209.2] Preparations for 
production/business implementation 
for maximum benefits 5 4 3 2 1
[209.3] Capital and expense control for 
reasonable profit 5 4 3 2 1
[209.4] How to keep track of revenue 
and expenses from business 5 4 3 2 1
[209.5] How to proceed simple 
accounting 5 4 3 2 1
[209.6] How to select product for 
sales/how to make good 
quality/attractive products, to attract 
the your customers 5 4 3 2 1
[209.7] How to seek the markets/ 
marketing channels to increase sales 5 4 3 2 1
[209.8] Customer satisfaction skills 5 4 3 2 1
page 69
[210a] In the last 6 months, have you made any changes to your product/services? 
 0 No
 1 Yes [210b] How much did you change it? 
 0. Not at all 
 1. Somewhat 
 2. Moderately
 3. Quite much 
 4. Very much 
 [210c] Did this change improve your business? 
0. Not at all 
1. Somewhat 
2. Moderately
3. Quite much 
4. Very much 
[211] How often do you keep records of business revenue and expense?
0. Never 
1. Occasionally 
2. Often 
3. Consistently 
Section 3: Care and Treatment, and Disclosure of HIV Status
[301] Currently do you take ARV medication? 
0. No 
1. Yes  When did you start taking ARV medication? Month___ year___ [302.1-2] 
 [302] Currently do you have opportunistic infection(s)? 
 0. No (skip to Q. 304) 1. Yes 
[303] Currently do you take opportunistic infection medication? 
 0. No 1. Yes 
[304] Apart from PPP staff and your loan buddy, have you told anyone else that you are HIV positive? 
 
 0. Not at all 1. Yes 
[305] Have you told your current spouse/partner that you are HIV positive? 
1. Yes 2. No 3. Do not have current spouse/partner 
[306] Have you told your former spouse/partner that you are HIV positive? 
1. Yes 
2. NoBecause 
 1. Don’t want to know 2. Don’t have any contact currently 
 3. Former spouse/partner’s 4. Other specify____ 
 [307] Have you told your mother that you are HIV positive? 
1. Yes 
2. NoBecause 
 1. Don’t want to know 2. Don’t have any contact currently 
 3. Former spouse/partner’s 4. Other specify____ 
page 70
[308] Have you told your father that you are HIV positive? 
1. Yes 
 2. NoBecause 
 1. Don’t want to know 2. Don’t have any contact currently 
 3. Former spouse/partner’s 4. Other specify____ 
[309] Have you told your kid(s) that you are HIV positive? 
1. Yes 
1. Your kids age <15 2. Your kids age 15 and over 2. Both 
2. NoBecause 
1. Don’t want to know 2.Don’t have any contact currently 
3. Do not have any kid age <15 4. Do not have any kid age 15 and over 
5. Other specify____ 
[310] Have you told your sister(s) that you are HIV positive? 
1. Yes 
2. NoBecause 
1. Don’t want to know 2.Don’t have any contact currently 
3. Do not have any sister 4. Other specify____ 
[311] Have you told your brother(s) that you are HIV positive? 
1. Yes 
2. NoBecause 
1. Don’t want to know 2. Don’t have any contact currently 
 3. Do not have any brother 4. Other specify____ 
[312] Have you told your relatives that you are HIV positive? 
1. Yes 
2. NoBecause 
1. Don’t want to know 2.Don’t have any contact currently 
 3. Other specify____ 
[313] Have you told your friends that you are HIV positive? 
1. Yes 
2. NoBecause 
1. Don’t want to know 2.Don’t have any contact currently 
 3. Other specify____ 
[314] Have you told your neighbors that you are HIV positive? 
1. Yes 
2. NoBecause 
1. Don’t want to know 2.Don’t have any conversation 
 3. Other specify____ 
[315] Have you told your community members that you are HIV positive? 
1. Yes 
2. NoBecause 
1. Don’t want to know 2.Don’t have any conversation 
 3. Other specify____ 
[316] Would you advise PLHIV who is not symptomatic to disclose his/her status?
 1. Keep the status confidential by not disclosing to anyone even family members (skip to Part 4) 
 2. Disclose to someone  (Continue Question 317) 
page 71
(Ask this question with only those who answer “disclose to someone”)
[317] If answering “disclose to someone”, who would you advise PLHIV to disclose to? (Able to answer 
more than one answer)
 1. Current spouse/partner 2. Former spouse/partner 
 3. Mother 4. Father 
 5.1 Child/children age <15 5.2 Child/Children age 15+ 
 6. Sister(s) 7. Brother(s) 
 8. Other relative(s) 9. Friend(s) 
 10. Neighbor(s) 11. Other community members 
 12. Village development bank committee members 13. PPP club committee members 
 Other, please specify................ [317.1-14]
 
Section 4: Fear of Stigma and Discrimination
In the past 6 months do you have fear to the following statements as a result of your HIV status?
Statements Fear Not 
fear
Family, relatives, and friends
[401] Fear of exclusion from your family to have meals alone, or use a 
different set of food containers and cutlery from family members’
1 2
[402] Fear of isolation from your family to stay in a separate room or 
outside the house (but in the same compound)
1 2
[403] Fear of being isolated by your family (still live in the same house) 1 2
[404] Fear of being ignored/abandoned by your family members 1 2
[405] Fear of being ignored/abandoned by your spouse/partner 1 2
[406] Fear of being no longer visited or less frequently visited by relatives 1 2
[407] Fear of being no longer visited or less frequently visited by friends 1 2
Community
[408] Being gossiped about 1 2
[409] Being treated differently from other community members 1 2
[410] Being checked out to see how you are 1 2
[411] Lost trust/respect from community members 1 2
[412] Rarely have someone to talk to/communicate with/hang out 1 2
[413] Being denied community gatherings and events such as weddings, 
funerals, social meetings, and ceremonial events 
1 2
[414] Lost customers to buy food you make or sell 1 2
[415] Lost customers to buy produce/goods you sell 1 2
[416] Being denied/lost a job 1 2
[417] Your children/grand children are discriminated against; for example, 
not allowed to play with other kids in the community
1 2
[418] Being teased, insulted, or sworn at 1 2
Health Service Providers
[419] Being given poorer quality health services 1 2
 
page 72
Section 5: Enacted Stigma (Discrimination)
In the past 6 months have you ever experienced the following incidents as a result of your HIV status?
Incidents Yes No
Family, relatives, and friends
[501] Been excluded from your family to have meals alone, or use a 
different set of food containers and cutlery from family members’
1 2
[502] Been isolated from your family to stay in a separate room or outside 
the house (but in the same compound)
1 2
[503] Been isolated by your family (still live in the same house) 1 2
[504] Been ignored/abandoned by your family members 1 2
[505] Been ignored/abandoned by your spouse/partner 1 2
[506] Been no longer visited or less frequently visited by relatives 1 2
[507] Been no longer visited or less frequently visited by friends 1 2
Community
[508] Been gossiped about 1 2
[509] Been treated differently from other community members 1 2
[510] Been checked out to see how you are 1 2
[511] Lost trust/respect from community members 1 2
[512] Rarely have someone to talk to/communicate with/hang out 1 2
[513] Been denied community gatherings and events such as weddings, 
funerals, social meetings, and ceremonial events 
1 2
[514] Lost customers to buy food you make or sell 1 2
[515] Lost customers to buy produce/goods you sell 1 2
[516] Been denied/lost a job 1 2
[517] Your children/grand children are discriminated against; for example, 
not allowed to play with other kids in the community
1 2
[518] Been teased, insulted, or sworn at 1 2
Health Service Providers e.g. doctor, nurse
[519] Been given poorer quality health services 1 2
Section 6: Internalized (Self) Stigma
In the past 6 months have you ever done the followings as a result of your HIV status?
Yes No
[601] Avoid attending school classes, drop out of school, or deny 
scholarship(s) 
1 2
[602] Not apply for a job or deny job promotion 1 2
[603] Spend less time with your family 1 2
[604] Decide not to get married or have a sexual partner 1 2
[605] Decide not to have children or have more children 1 2
[606] Avoid traveling out of town or abroad 1 2
 In the past 6 months have you ever had the following thoughts/feelings as a result of your HIV status?
Yes No
[607] Want to isolate yourself from your family 1 2
[608] Not feel like meeting friends or contact friends less frequently 1 2
[609] Not want to socialize or meet others 1 2
[610] Feel as if your work ability has reduced 1 2
[611] Feel as if your ability to cope with problems in life has reduced 1 2
page 73
Section 7: Self-Worth and Self-Efficacy
The following statements are about your level of confidence in the past 6 months on support seeking. 
Please select the most suitable and realistic level of confidence you have on each statement. 
Strongly 
confident
Confi￾dent
Uncon￾fident
Strongly 
Unconfi￾dent
[701] Get family and friends to help you with the 
things you need (such as household chores, shopping, 
cooking, or transportation)
4 3 2 1
[702] Get emotional support (such as listening or 
talking over your problems) from friends and family?
4 3 2 1
[703] Get emotional support (such as listening or 
talking over your problems) from community 
resources other than friends or family?
4 3 2 1
The following statements are about your thoughts/feelings in the past 6 months. Please select your most 
suitable and realistic answer for each statement. 
Strongly 
confi￾dent
Confi￾dent
Uncon￾fident
Strongly 
unconfi￾dent
[704] I think I’m worthless for my family 4 3 2 1
[705] I am proud that I am useful for my community 4 3 2 1
[706] I can perform activities/do things just like 
others
4 3 2 1
[707] I don’t have anything to be proud of 4 3 2 1
[708] I am unable to stand on my own feet 4 3 2 1
[709] My family won’t have any financial problem 
even without me
4 3 2 1
[710] I am proud that I can help provide income to 
my family
4 3 2 1
[711] I feel guilty that I can’t provide financial 
support to my family
4 3 2 1
 
Section 8: Quality of Life
Instruction: Please assess yourself in the past 2 weeks and answer the following questions by selecting the 
level that is most suitable and realistic. 
Question Statements Very 
much
Much Moder
ately
Little Not at 
all
[801] Are you satisfied with your health now? 5 4 3 2 1
[802] Do you have enough energy to perform work or 
activities during a typical day?
5 4 3 2 1
[803] Are you satisfied with your sleep? 5 4 3 2 1
[804] How would you rate your satisfaction in your life 
such as being happy, peaceful and hopeful?
5 4 3 2 1
[805] How well do you concentrate on your work? 5 4 3 2 1
[806] How satisfied are you with yourself? 5 4 3 2 1
[807] Are you able to accept your physical appearance? 5 4 3 2 1
page 74
[808] Are you satisfied that you can perform regular 
daily activities?
5 4 3 2 1
[809] Are you satisfied with your ability to perform work 
as usual?
5 4 3 2 1
[810] Are you satisfied with your ability to socialize and 
make friends as usual?
5 4 3 2 1
[811] Are you satisfied with support or help from your 
friends?
5 4 3 2 1
[812] Do you feel that your daily life is secured and 
stable? 
5 4 3 2 1
[813] Are you satisfied with the condition of your 
current house?
5 4 3 2 1
[814] Do you have enough money to spend as 
necessary?
5 4 3 2 1
[815] Are you satisfied that you can acquire necessary 
health services?
5 4 3 2 1
[816] How much do you keep abreast of news and 
information necessary for your life?
5 4 3 2 1
[817] Are you able to rest or relieve your stress? 5 4 3 2 1
[818] Is the environment you live in good for your 
health?
5 4 3 2 1
[819] Are you satisfied with the way you travel or 
commute?
5 4 3 2 1
[820] Do you feel that your life is meaningful? 5 4 3 2 1
[821] Are you able to travel or commute by yourself? 5 4 3 2 1
[822] Are you satisfied with the relationships among 
your family members?
5 4 3 2 1
Section 9: Exposure to Project Interventions
[901a] In the past 12 months, have you participated in any of the Postive Partners Project (PPP) activities? 
(Spontaneous) 
0. No (Skip to Q. 901c) 
1. Yes 
[901b] Could you tell me about the activities? (Probe: anything else?) (circle all activities that are mentioned) 
PPP activities Spontaneous
VDB/Club meeting 1
HIV/AIDS campaign activities such as condom distribution… 2
Attended Population & Development Association training 3
Joined with Fun Fair Event 4
Others specify________ 5
page 75
[901c] In the past 12 months, have you ever participated in the following activities? (Read each activity out 
load. Respondent is allowed to provide multiple responses.) (Prompted) 
 
Interviewer: if respondent answered question 901b, then ask only those activities that they did not mention. 
If respondent mentioned all activities then skip to Q902. 
PPP activities Prompted
VDB/Club meeting 1
HIV/AIDS campaign activities such as condom distribution, … 2
Attended Population & Development Association training 3
Joined with Fun Fair Event 4
Others specify________ 5
Never participated 6
[902] In the past 12 months, have you ever seen the following posters? (Able to provide multiple answers) 
Interviewer: Show poster one at a time until complete all 13 posters 
List of Posters Yes No Not 
sure
1. Help PLHIV to be ready for returning to society 1 2 3
2. Though living with HIV, but not being social burden 1 2 3
3. Blame, Eyesight, Posture 1 2 3
4. PLHIV like us, sharing meals not being infected 1 2 3
5.Mother being aware of the fact, receive ARV during pregnancy 1 2 3
6. Types of career do not help if having risk behavior. 1 2 3
7. Care and treatment, ARV adherence 1 2 3
8. Living with HIV is still valuable, not consider yourself as disability. 1 2 3
9. Living with HIV, but not to suffer with it. 1 2 3
10.Forgive them whoever dislike you 1 2 3
11. No concern about, No distraction, No distress 1 2 3
12. Open our mind and help them open their mind, all can live happily 1 2 3
13. Don’t judge anyone else by your own notion 1 2 3
[903a] In the past 12 months, have you heard radio dramas about PLHIV through the community 
broadcasting? (Spontaneous) 
 0. No (Skip to Q. 903c) 
1. Yes 
[903b] If so, please tell me about the story you heard? (Spontaneous) 
 1._____________________________________________ 
 2._____________________________________________ 
 3._____________________________________________ 
 4._____________________________________________ 
 5._____________________________________________ 
page 76
[903c] In the past 12 months, have you ever heard the following radio dramas? (Able to answer more than 
one answer) 
Interviewer: turn on CD of radio drama one story at a time (not longer than 1 min./story) until complete all 11 
stories (Prompt) 
List of Radio Dramas Yes No Not
sure
1. Living with HIV without being shameful 1 2 3
2. Blame on PLHIV means to shorten their life 1 2 3
3. Care about your words, posture expressing to PLHIV 1 2 3
4. Understanding of AIDS 1 1 2 3
5. Understanding of AIDS 2 1 2 3
6. PLHIV are valuable, being able to work and solve the problems 1 2 3
7. PLHIV must be confident on your self-worth 1 2 3
8. PLHIV should understand, realize, and accept the situation 1 2 3
9. Don’t hastily decide to what others do 1 2 3
10. Abandon (anxieties) for love, encourage yourself 1 2 3
11.Together, jointly reduce S&D 1 2 3
[904a] In the past 12 months, have you ever seen strip of paper like this with caption about HIV/AIDS or 
PLHIV written on it ? Show the sample of paper strip as used in the campaigns 
0 No skip to 904c 
 1 Yes: 
[904b] What messages have you seen/read about? (Spontaneous) 
 1._____________________________________________ 
 2._____________________________________________ 
 3._____________________________________________ 
 4._____________________________________________ 
 5._____________________________________________ 
[904c] In the past 12 months, have you ever read the following messages on those slips of paper, as shown in 
this card? (Able to answer more than one answer) 
Interviewer: Hand message card to respondent, read out one by one (Prompted) 
List of Messages Yes No Not
sure
1. Being infected with HIV/AIDS is not shameful 1 2 3
2.PLHIV have rights as normal people 1 2 3
3.PLHIV are still valuable, being able to work and contribute to social 1 2 3
4.PLHIV able to recognize HIV status but need to all worries 1 2 3
5.PLHIV need to be open-minded person, don’t think by self that others 
dislike you
1 2 3
6.For those dislike PLHIV, forgive them 1 2 3
7.PLHIV should love and encourage themselves before requesting from
others
1 2 3
page 77
Section 10: Buddy’s Roles
[1001] In the past 6 months, how often have you talked to your buddy? 
 1. Less than once in a month 
 2. About once in a month 
 3. 2-3 times a month 
 4. About once a week 
 5. More than once a week 
 6. Every day 
[1002a] In the past 6 months, have you ever talked about HIV/AIDS to your buddy? 
 0 No  skip to 1003 1 Yes:
[1002b] In the past 6 months, how often have you talked about HIV/AIDS to your buddy? (Recheck with Q. 
1001- equal or less frequency than Q. 1001) 
 1. Less than once in a month 
 2. About once in a month 
 3. 2-3 times a month 
 4. About once a week 
 5. More than once a week 
 6. Every day 
[1003a] In the past 6 months, Have you received any financial or material support from your buddy? 
 0 No  skip to 1003c 1 Yes: 
[1003b] What type of support did you receive? (Multiple responses are okay)
 1. Health care 2. Finance 3. Occupation 
 4. Clothes 5. Food 6. Taking care of family member(s) 
 7. Others (specify)_______ 
 [1003c] Why did you not receive any support? 
[1003d] In the past 6 months, have you received any emotional or moral support from your buddy? 
 0. No 1. Yes 
[1003c] In the past 6 months, have you received support from your buddy for disseminating HIV knowledge 
in the community? 
 0. No 1. Yes 
[1004a] In the past 6 months, have you contributed any financial or material support to your buddy? 
 0. No  skip to 1004c 1. Yes: 
[1004b ] What type of financial or material support did you contribute? 
 1. Health care 2. Finance 3. Occupation 
 4. Clothes 5. Food 6. Taking care of family member(s) 
 7. Others (specify)_______ 
 [1004c] Why did you not contribute any financial or material support to your buddy? 
1.
2.
3.
page 78
[1004d] In the past 6 months, have you contributed any emotional or moral support to your buddy? 
 0. No because_________________________ 
 1. Yes 
[1004e] In the past 6 months, have you contributed disseminating HIV knowledge in the community? 
 0. No because_________________________ 
 1. Yes 
[1005] Do you and your buddy have better relationship since joining the project ? 
 0. No because_________________________ 
 1. Yes 
Thank You 
page 79
Buddy Endline Questionnaire 
Code B______________________ 
A1. Type of area: 1. Urban 2. Rural 
Section 1: General Information
Demographic
[100] Gender: 1. Male 2. Female 
[101] Marital status: 1. Single 2. Married/having partner 3. Divorce 
4. Widowed 5. Others: (please specify) ______
[102] Education: 
0. No formal education 5. Vocational diploma
1. Primary school 6. Undergraduate diploma
2. Secondary school 7. Bachelor’s degree
3. High school 8. Master’s degree
4. Vocational certificate 9. Doctoral degree
[103] Number of family members in a household (including you): ________________persons 
[104] Main occupation( Only one answer)
1 Famer 6 Government/state enterprise employee
2 Vending/Retailing 7 Student
3 Private employee 8 No occupation/housewife
4 Factory worker Other (please specify):
5 Casual laborer
[105] Average income per month 
[105.1] Your income (from all sources)__________________Baht
[105.2] Household income __________________Baht
[106] How long have you approximately lived in this village/community? 
All my life_____________ years_____________ months (if less than a year) 
Section 2: HIV/AIDS Knowledge
Please tell me whether you agree or disagree with the following statements (Read out each 
statement)
Agree Dis￾agree
Not 
sure
[201] Being exposed to skin of PLHIV will make you get infected 1 2 3
[202] Being exposed to sweat or saliva of PLHIV will make you get infected 1 2 3
[203] All babies will definitely get HIV if their mother is living with HIV 1 2 3
[204] Sharing personal items, such as nail cutter, toothbrush with PLHIV will 
make you get infected 
1 2 3
[205] HIV/AIDS is transmitted within a group of IDU, F/MSW and MSM only. 1 2 3
[206] Being HIV infected is not different from being sick because of AIDS 1 2 3
[207] Nowadays, there are more varieties of medicine that can inhibit HIV 1 2 3
[208] Having sex with the ones who look clean can prevent getting HIV 1 2 3
[209] Reducing the number of sexual interact can prevent getting HIV. 1 2 3
page 80
Section 3: Fear of HIV/AIDS Transmission 
Please tell me if you are worried or have fear about yourself contracting HIV in response to the 
following statement. 
Please tell me if you are worried or have fear about your children contracting HIV in response to the 
following statement. 
Have fear Do not 
have fear
[313] Your child playing with children living with HIV/AIDS 1 2
[314] Your child playing with PLHIV’s children 1 2
[315] Your child studying with teacher living with HIV/AIDS 1 2
Section 4: Stigma and Discrimination - Individual
Do YOU agree or disagree with the following statements? 
Have fear Do not 
have fear
[301] Being exposed to saliva of PLHIV 1 2
[302] Being exposed to sweat of PLHIV 1 2
[303] Having meal with PLHIV (food sharing) 1 2
[304] Using the same plate , spoons and forks with PLHIV 1 2
[305] Sharing personal items such as nail cutter, toothbrush with PLHIV 1 2
[306] Share a bedroom with PLHIV 1 2
[307] Taking care of PLHIV 1 2
[308] Carrying PLHIV 1 2
[309] Buying vegetable or fruits from PLHIV who are not showing
signs/symptoms
1 2
[310] Buying vegetable or fruits from PLHIV who are showing
signs/symptoms
1 2
[311] Consuming food cooked by PLHIV who are not showing
signs/symptoms
1 2
[312] Consuming food cooked by PLHIV who are showing signs/symptoms 1 2
Agree Disagree
[401] PLHIV should be ashamed of themselves 1 2
[402] I would feel ashamed if someone in my family had HIV/AIDS 1 2
[403] PLHIV are promiscuous 1 2
[404] It is the promiscuous men who spread HIV in your community 1 2
[405] It is the promiscuous women who spread HIV in your community 1 2
[406] HIV is a punishment from god (in Thai: result of bad Karma) 1 2
[407] I would feel ashamed if I was infected with HIV 1 2
[408] HIV is a punishment for bad behavior 1 2
[409] PLHIV are to be blamed for bringing disease to the community 1 2
page 81
Section 5: Awareness of PLHIV stigma
[501] Have you ever heard about PLHIV stigma? 
 0. Never (skip to question 601) 
1. Yes 
[502] What do you think “PLHIV stigma”, is/are? (Please do not read the answers) circle all that apply 
1. Separation PLHIV from others 
2. Feeling of PLHIV being different from general people; look strange from normal people 
3. Treating to PLHIV differently from general people 
4. Fear, being careful, or avoid to interact or touch PLHIV 
5. Blame on PLHIV such as insult, detest, blame that getting HIV infected is wrong, ashamed. 
6. Gossip about 
7. Have feeling PLHIV are bad such as being sex workers, drug users, or having inappropriate 
sexual behavior 
8. Not respect or rely on PLHIV 
9. Do not have good attitude to PLHIV such as dislike, do not want to associate with 
10. PLHIV have feeling of hating themselves such as feeling worthless, misconduct 
11. Respondent unable to explain or incorrectly explain 
12. Don’t know
13. Others (specify)__________ 
 
Section 6: Exposure to HIV/AIDS information
[601] In the past 12 months, from what sources have you been exposed to HIV/AIDS information? 
(Read out each answer) 
0 Not exposed at all 6 Community broadcasting
1 TV 7 Training
2 Radio 8 Board/bulletin
3 Newspaper 9. PDA staff
4 Leaflet/ brochure/ free books Others (specify)
5 Poster
[602] In the past 12 months, have____ (ask one by one) ____ talked with you about HIV/AIDS? 
Yes No
[602.1] Your family members 1 2
[602.2] Your friends 1 2
[602.3] Your neighbors 1 2
page 82
[701a] In the past 12 months, have you participated in any of the Positive Partners Project (PPP) 
activities? (Spontaneous) 
0. No (Skip to question 701c) 
1. Yes 
[701b] Could you tell me about the activities? (Probe: anything else?) (circle all activities that are 
mentioned) 
PPP activities Spontaneous
VDB/Club meeting 1
HIV/AIDS campaign activities such as condom distribution… 2
Attended Population & Development Association training 3
Joined with Fun Fair Event 4
Others specify________ 5
[701c] In the past 12 months, have you ever participated in the following activities? (Read each activity 
out load. Respondent is allowed to provide multiple responses.) (Prompted)
Interviewer: if respondent answered question 701b, then ask only those activities that they did not 
mention. If respondent mentioned all activities then skip to question702. 
PPP activities Prompted
VDB/Club meeting 1
HIV/AIDS campaign activities such as condom distribution… 2
Attended Population & Development Association training 3
Joined with Fun Fair Event 4
Others specify________ 5
Never participated 6
[702] In the past 12 months, have you ever seen the following posters? (Able to provide multiple 
answers) 
Interviewer: Show posters one at a time until complete all 13 posters 
List of Posters Yes No Not 
sure
1. Help PLHIV to be ready for returning to society 1 2 3
2. Though living with HIV, but not being social burden 1 2 3
3. Blame, Eyesight, Posture 1 2 3
4. PLHIV like us, sharing meals not being infected 1 2 3
5.Mother being aware of the fact, receive ARV during pregnancy 1 2 3
6. Types of career do not help if having risk behavior. 1 2 3
7. Care and treatment, ARV adherence 1 2 3
8. Living with HIV is still valuable, not consider yourself as disability. 1 2 3
9. Living with HIV, but not to suffer with it. 1 2 3
10.Forgive them whoever dislike you 1 2 3
11. No concern about, No distraction, No distress 1 2 3
12. Open our mind and help them open their mind, all can live happily 1 2 3
13. Don’t judge anyone else by your own notion 1 2 3
Part 7: Exposure to project interventions 
page 83
[703a] In the past 12 months, have you heard radio drama about PLHIV through the community 
broadcasting? 
0. No (Skip to question 703c) 1. Yes
[703b] If so, please tell me about the story you heard?(Spontaneous) 
 1._____________________________________________ 
 2._____________________________________________ 
 3._____________________________________________ 
 4._____________________________________________ 
 5._____________________________________________ 
[703c] In the past 12 months, have you ever heard the following radio dramas? (Multiple answers) 
Interviewer: turn on CD of radio drama one story at a time (not longer than 1 min./story) until complete 
all 11 stories (Prompted) 
List of Radio Dramas Yes No Not
sure
1. Living with HIV without being shameful 1 2 3
2. Blame on PLHIV means to shorten their life 1 2 3
3. Care about your words, posture expressing to PLHIV 1 2 3
4. Understanding of AIDS 1 1 2 3
5. Understanding of AIDS 2 1 2 3
6. PLHIV are valuable, being able to work and solve the problems 1 2 3
7. PLHIV must be confident on your self-worth 1 2 3
8. PLHIV should understand, realize, and accept the situation 1 2 3
9. Don’t hastily decide to what others do 1 2 3
10. Abandon (anxieties) for love, encourage yourself 1 2 3
11.Together, jointly reduce S&D 1 2 3
[704a] In the past 12 months, have you seen strip of paper like this with caption about HIV/AIDS or 
PLHIV written on it? Show the sample of paper strip as used in the campaigns 
0. No skip to 704c 1. Yes 
[704b] What messages have you seen/read about? (Spontaneous) 
 1._____________________________________________ 
 2._____________________________________________ 
 3._____________________________________________ 
 4._____________________________________________ 
 5._____________________________________________ 
[704c] In the past 12 months, have you ever read the following messages as shown in this card? (Able to 
answer more than one answer) 
Interviewer: Hand message card to respondent, read out one by one (Prompt) 
 List of Messages Yes No Not
sure
1. Being infected with HIV/AIDS is not shameful
2. HIV/AIDS like general disease, able to look after
3. Getting HIV infected is different from HIV/AIDS patient. 
4. PLHIV have rights as normal people
5. We should not blame PLHIV as not good, promiscuous persons
page 84
6. We should not blame PLHIV as being social burden
7. We should express dislikes to PLHIV with verbal, sight, and posture
8. We should treat PLHIV as our family members
9. HIV/AIDS is not transmitted within specific groups, all have 
opportunity getting infected
10.Touching, hugging, sweat, saliva, meal sharing, sharing toothbrush 
/nail cutter are not causing HIV/AIDS infection
11.Only few babies getting HIV/AIDS infected from mother
12.Having ARV during pregnancy help reducing HIV/AIDS 
13.infection rate of infant
14.Chance of becoming AIDS patient reduce if receiving care and 
treatment and ARV adherence 
15.PLHIV are still valuable, being able to work and contribute 
to social
[801] In the past 6 months, how often have you talked to your HIV positive buddy? 
1. Less than once in a month 
2. About once in a month 
3. 2-3 times a month 
4. About once a week 
5. More than once a week 
6. Every day 
[802a] In the past 6 months, have you ever talked about HIV/AIDS to your HIV positive buddy? 
 0. No  skip to 803a 1. Yes 
[802b] In the past 6 months, how often have you talked about HIV/AIDS to your HIV positive buddy? 
 (Recheck with Q. 801- equal or less frequency than Q. 801) 
1. Less than once in a month 
2. About once in a month 
3. 2-3 times a month 
4. About once a week 
5. More than once a week 
6. Every day 
[803a] In the past 6 months, have you received any financial or material support from your buddy? 
 0. No  skip to 803c 1. Yes 
[803b] What type of support did you receive? (Multiple responses are okay) 
1. Health care 2. Finance 3. Occupation 4. Clothes 
5. Food 6. Taking care of family member(s) 7. Others (specify)_______
[803c] Why did you not receive any support? 
 1._____________________________________________ 
 2._____________________________________________ 
 3._____________________________________________ 
Section 8: Buddy Role Performance 
page 85
[803d] In the past 6 months, have you received any emotional or moral support from you buddy? 
 0. No 1. Yes 
[803e] In the past 6 months, have you received support for disseminating HIV knowledge in the 
community 
 0. No 1. Yes 
[804a] In the past 6 months, Have you contributed any financial or material support to your HIV positive 
buddy? 
 0. No  skip to 804 1. Yes 
[804b] What type of financial or material support did you contribute? 
1. Health care 2. Finance 3. Occupation 4. Clothes 
5. Food 6. Taking care of family member(s) 7. Others (specify)_______
[804c] Why did you not contribute any financial or material support to your HIV positive buddy? 
 1._____________________________________________ 
 2._____________________________________________ 
 3._____________________________________________ 
[804d] In the past 6 months, have you contributed any emotional or moral support to your HIV positive 
buddy? 
 0. No 1. Yes 
[804e] In the past 6 months, have you contributed disseminating HIV knowledge in the community?. 
 0. No 1. Yes 
[805] In the past 6 month have you conveyed messages or knowledge regarding HIV/AIDS to others?-
 0. No (Close the interview) 1. Yes
[806] In the past 6 month how often did you convey messages or knowledge regarding HIV/AIDS to 
others? 
1. Less than once in a month 
2. About once in a month 
3. 2-3 times a month 
4. About once a week 
5. More than once a week 
6. Every day 
 [807] In the past 6 months, Who did you convey messages or knowledge regarding HIV/AIDS to? 
(Multiple answers)
1. My family members 
2. PLHA’s family members
3. Neighbors 
4. Other people in my village/community 
 Other, Specify________________ 
Thank You 
page 86
Community/Family Member Endline Questionnaire 
Name: ___________________ Surname: __________________________________ 
Address: house number ________ Moo: _____________ Village: _______________ 
Sub-district: _______________ District: _____________ Province: ______________ 
PDA Center: ________________________ 
Date of Interview: ___________________ Time: _______________ minutes 
Interviewer: ________________________________________
A1. Type of area: 1. Urban 2. Rural 
Section 1: General Information
Demographic
[101] Gender 1. Male 2. Female
[102] Age _____years Year of Birth: _________
[103] Marital status: 1. Single 2. Married/having partner 3. Divorce 
4. Widow 5. Other: (please specify) _______________________
[104] Educational level 
0. No formal education 5. Vocational diploma
1. Primary school 6. Undergraduate diploma
2. Secondary school 7. Bachelor’s degree
3. High school 8. Master’s degree
4. Vocational certificate 9. Doctoral degree
[105] Number of family members in a household (including you): _________________person (s) 
[106] Main occupation( Single answer) 
1 Farmer 6 Government/state enterprise employee
2 Vending/Retailing 7 Student
3 Private employee 8 No occupation/housewife
4 Factory worker Other (please specify): _______________
5 Casual laborer
[107] Average income per month
[107.1] Your own income (from all sources) __________________Baht
[107.2] Household income __________________Baht
[108] How long have you approximately lived in this village/community? 
__All my life_______ years ________ months (if less than a year) 
page 87
Section 2: HIV/AIDS Knowledge
Please tell me whether you agree or disagree with the following statement (read out each 
statement)
Agree Dis￾agree
Not 
sure
[201] Being exposed to skin of PLHIV will make you get infected 1 2 3
[202] Being exposed to sweat or saliva of PLHIV will make you get infected 1 2 3
[203] All babies will definitely get HIV/AIDS if their mother is living with HIV 1 2 3
[204] Sharing personal items, such as nail cutter, toothbrush with PLHIV will 
make you get infected 
1 2 3
[205] HIV/AIDS is transmitted within a group of IDU, F/MSW and MSM only 1 2 3
[206] Being HIV/AIDS infected is not different from being sick because of AIDS 1 2 3
[207] Nowadays, there are more varieties of medicine that can inhibit HIV 1 2 3
[208] Having sex with the ones who look clean can prevent getting HIV 1 2 3
[209] Reducing the number of sexual interact can prevent getting HIV/AIDS 1 2 3
Section 3: Fear of HIV Transmission 
Please tell me if you are worried or have fear about yourself contracting HIV in response to 
the following statement. 
Please tell me if you are worried or have fear about your children contracting HIV in response to the 
following statement. 
Have fear Do not 
have fear
[313] Your child playing with children living with HIV/AIDS 1 2
[314] Your child playing with PLHIV’s children 1 2
[315] Your child studying with teacher living with HIV/AIDS 1 2
Have fear Do not 
have fear
[301] Being exposed to saliva of PLHIV 1 2
[302] Being exposed to sweat of PLHIV 1 2
[303] Having meal with PLHIV (food sharing) 1 2
[304] Using the same plate , spoons and forks with PLHIV 1 2
[305] Sharing personal items, such as nail cutter, toothbrush with PLHIV 1 2
[306] Share a bedroom with PLHIV 1 2
[307] Taking care of PLHIV 1 2
[308] Carrying PLHIV 1 2
[309] Buying vegetable or fruits from PLHIV who are not showing
signs/symptoms
1 2
[310] Buying vegetable or fruits from PLHIV who are showing
signs/symptoms
1 2
[311] Consuming food cooked by PLHIV who are not showing
signs/symptoms
1 2
[312] Consuming food cooked by PLHIV who are showing signs/symptoms 1 2
page 88
Section 4: Stigma and Discrimination - Individual
Do YOU agree or disagree with the following statements? 
Section 5: Awareness of PLHIV stigma
[501] Have you ever heard about PLHIV stigma? 
 0. Never (skip to section 6) 1. Yes
[502] What do you think “PLHIV stigma”, is/are? (Please do not read the answers) circle all that apply 
1. Separation PLHIV from others 
2. Feeling of PLHIV being different from general people; look strange from normal people 
3. Treating to PLHIV differently from general people 
4. Fear, being careful, or avoid to interact or touch PLHIV 
5. Blame on PLHIV such as insult, detest, blame that getting HIV infected is wrong, ashamed. 
6. Gossip about 
7. Have feeling PLHIV are bad such as being sex workers, drug users, or having inappropriate 
sexual behavior 
8. Not respect or rely on PLHIV 
9. Do not have good attitude to PLHIV such as dislike, do not want to associate with 
10. PLHIV have feeling of hating themselves such as feeling worthless, misconduct. 
11. Respondent unable to explain or incorrectly explain 
12. Don’t know
13. Others (specify)__________ 
 
Section 6: PLHIV S& D experience in community
[601] Do you personally know someone living with HIV or AIDS? 
 0. No (Skip to question 603) 1. Yes
[602] How is this person related to you? (Multiple answers) 
1. Mother 7. Child
2. Father 8.Other Relative
3. Sister 9. Friend
4. Brother 10. Neighbor
5. Husband 11. Other people in community
6. Wife 12. Other Specify_________
Agree Disagree
[401] PLHIV should be ashamed of themselves 1 2
[402] I would feel ashamed if someone in my family had HIV/AIDS 1 2
[403] PLHIV are promiscuous 1 2
[404] It is the promiscuous men who spread HIV in your community 1 2
[405] It is the promiscuous women who spread HIV in your community 1 2
[406] HIV -is a punishment from god (in Thai: result of bad Karma) 1 2
[407] I would feel ashamed if I was infected with HIV 1 2
[408] HIV is a punishment for bad behavior 1 2
[409] PLHIV are to be blamed for bringing disease to the community 1 2
page 89
[603] Are there any PLHIV in your community? 
0. No (skip to question 701) 1. Yes
[604] In the past 12 months, have you known/heard that someone has experienced the following 
because they were known to have, or suspected of having HIV/AIDS?( Read out each statement)
Section 7: Exposure to HIV/AIDS information
[701] In the past 12 months, from what sources have you been exposed to HIV/AIDS information? 
(Read out each answer)
0 Not exposed at all 6 Community broadcasting
1 TV 7 Training
2 Radio 8 Board/bulletin
3 Newspaper 9 PDA staff
4 Leaflet/ brochure/ free books Others (specify)
5 Poster
[702] In the past 12 months, have____ (ask one by one) ____ talked with you about HIV/AIDS? 
Yes No
[705.1] Your family members 1 2
[705.2] Your friends 1 2
[705.3] Your neighbors 1 2
Yes No Don’t 
know
Family, relatives, and friends
[604.1] Been excluded from your family to have meals alone, or use a 
different set of food containers and cutlery from family members’ 1 2 3
[604.2] Been isolated from your family to stay in a separate room or 
outside the house (but in the same compound) 1 2 3
[604.3] Been isolated by your family members(still live in the same house) 1 2 3
[604.4] Been ignored/abandoned by family members 1 2 3
[604.5] Been ignored/abandoned by spouse/partner 1 2 3
[604.6] Been no longer visited or visited less frequently by relatives 1 2 3
[604.7] Been no longer visited or visited less frequently by friends 1 2 3
Community
[604.8] Been gossiped about 1 2 3
[604.9] Been treated differently from other community members 1 2 3
[604.10] Been checked out to see how they are 1 2 3
[604.11] Lost trust/respect from community members 1 2 3
[604.12] Rarely have someone to talk to/communicate with/hang out 1 2 3
[604.13] Been denied community gatherings and events such as weddings, 
funerals, social meetings, and ceremonial events 1 2 3
[604.14] Lost customers to buy food PLHIV make or sell 1 2 3
[604.15] Lost customers to buy products/goods PLHIV sell 1 2 3
[604.16] Been denied/lost a job 1 2 3
[604.17] PLHIV’s children/grand children are discriminated against; for 
example, not allowed to play with other kids in the community 1 2 3
[604.18] Been teased, insulted, or sworn at 1 2 3
page 90
[801a] In the past 12 months, have you participated in any of the Positive Partner Project (PPP) 
activities? (Spontaneous) 
0. No (Skip to question 801c) 1. Yes
[801b] Could you describe the activities? (circle all that apply) 
PPP activities Spontaneous
VDB/Club meeting 1
HIV/AIDS campaign activities such as condom distribution… 2
Joined with Fun Fair Event 4
Others specify________ 5
[801c] In the past 12 months, have you ever participated in the following activities? (Read each activity 
out loud. Respondent able to provide multiple answers)
Interviewer: if respondent answered question 801b, then ask only those activities that they did not 
mention. If respondent mentioned all activities then skip to question 802. 
PPP activities Prompted
VDB/Club meeting 1
HIV/AIDS campaign activities such as condom distribution… 2
Joined with Fun Fair Event 4
Others specify________ 5
Never participated 6
[802] In the past 12 months, have you ever seen the following posters? (Multiple answers) 
Interviewer: Show poster s; one poster at a time until complete all 13 posters (Prompted) 
List of Posters Yes No Not 
sure
1. Help PLHIV to be ready for returning to society 1 2 3
2. Though living with HIV, but not being social burden 1 2 3
3. Blame, Eyesight, Posture 1 2 3
4. PLHIV like us, sharing meals not being infected 1 2 3
5. Mother being aware of the fact, receive ARV during pregnancy 1 2 3
6. Types of career do not help if having risk behavior. 1 2 3
7. Care and treatment, ARV adherence 1 2 3
8. Living with HIV is still valuable, not consider yourself as disability. 1 2 3
9. Living with HIV, but not to suffer with it. 1 2 3
10.Forgive them whoever dislike you 1 2 3
11. No concern about, No distraction, No distress 1 2 3
12. Open our mind and help them open their mind, all can live happily 1 2 3
13. Don’t judge anyone else by your own notion 1 2 3
[803a] In the past 12 months, have you ever heard a radio drama about PLHIV through the community 
broadcasting on the community speakers? 
0. No (Skip to question 803c) 1. Yes
Section 8: Exposure to project interventions 
page 91
[803b]If so, please tell me what story about you ever heard? (Spontaneous) 
 1.______________________________________________ 
 2.______________________________________________ 
 3.______________________________________________ 
 4._______________________________________________ 
 5.___________________________________________________ 
[803c] In the past 12 months, have you ever heard the following radio dramas? (Able to answer more 
than one answer) 
Interviewer: turn on CD of radio drama; one story at a time (not longer than 1 min./story) until complete 
all 11 stories 
List of Radio Dramas Yes No Not
sure
1. Living with HIV without being shameful 1 2 3
2. Blame on PLHIV means to shorten their life 1 2 3
3. Care about your words, posture expressing to PLHIV 1 2 3
4. Understanding of AIDS 1 1 2 3
5. Understanding of AIDS 2 1 2 3
6. PLHIV are valuable, being able to work and solve the problems 1 2 3
7. PLHIV must be confident on your self-worth 1 2 3
8. PLHIV should understand, realize, and accept the situation 1 2 3
9. Don’t hastily decide to what others do 1 2 3
10. Abandon (anxieties) for love, encourage yourself 1 2 3
11.Together, jointly reduce S&D 1 2 3
[804a] In the past 12 months, have you ever seen strip of paper like this with caption about HIV/AIDS or 
PLHIV written on it ? Show the sample of paper strip as used in the campaigns 
 0 No skip to 804c 
 1 Yes: 
[804b] What messages have you seen/read about? (Spontaneous) 
 1._____________________________________________ 
 2._____________________________________________ 
 3._____________________________________________ 
 4._____________________________________________ 
 5._____________________________________________ 
page 92
[804c] In the past 12 months, have you ever read the following messages as shown in this card? (Able to 
answer more than one answer) (Prompted) 
Interviewer: Hand message card to respondent, read out one by one 
List of Messages Yes No Not
sure
1. Being infected with HIV/AIDS is not shameful 1 2 3
2. HIV/AIDS like general disease, able to look after 1 2 3
3. Getting HIV infected is different from HIV/AIDS patient. 1 2 3
4. PLHIV have rights as normal people 1 2 3
5. We should not blame PLHIV as not good, promiscuous persons 1 2 3
6. We should not blame PLHIV as being social burden 1 2 3
7. We should express dislikes to PLHIV with verbal, sight, and posture 1 2 3
8. We should treat PLHIV as our family members 1 2 3
9. HIV/AIDS is not transmitted within specific groups, all have 
opportunity getting infected
1 2 3
10.Touching, hugging, sweat, saliva, meal sharing, sharing toothbrush 
/nail cutter are not causing HIV/AIDS infection
1 2 3
11.Only few babies getting HIV/AIDS infected from mother 1 2 3
12. Having ARV during pregnancy help reducing HIV/AIDS infection 
rate of infant
1 2 3
13. Chance of becoming AIDS patient reduce if receiving care and 
treatment and ARV adherence 
1 2 3
14. PLHIV are still valuable, being able to work and contribute to social 1 2 3
Thank You