Structural forces and the production of TB-related stigma among Haitians in two contexts

Abstract

In recent years renewed interest in health-related stigma has underscored the importance of better understanding the structural underpinnings of stigma processes. This study investigated the influence of sociocultural context on perceived components of tuberculosis-related stigma in non-affected persons by comparing Haitians living in South Florida, USA, with Haitians residing in Léogane Commune, Haiti. Using the methods of cultural epidemiology, a two-phase study based on fieldwork between 2004–07 collected ethnographic data on the cultural context and components of tuberculosis (TB) stigma, and administered a stigma scale developed specifically for these populations. Thematic analysis of stigma components expressed in interviews, focus groups and observation revealed commonalities as well as distinctive emphases of TB stigma in the two comparison groups. Factor analyses of stigma scale scores confirmed the thematic differences revealed in ethnographic findings and highlight the influence of political and economic factors in shaping the meaning and experience of illness. Perceived components of TB stigma among Haitians in South Florida incorporated aspects of Haitian identity as a negatively stereotyped minority community within the larger society, while in Haiti, stigma was associated primarily with poverty, malnutrition, and HIV co-infection. Discussion of findings focuses on the social production of perceived and anticipated stigma as it is influenced by structural forces including the influences of politics, economics, institutional policies, and health service delivery structures. The findings also demonstrate the value of a transnational framework encompassing both sending and receiving countries for understanding TB related stigma in immigrant communities.

Social and cultural determinants of anticipated acceptance of an oral cholera vaccine prior to a mass vaccination campaign in Zanzibar

“…Cultural epidemiological studies have been particularly useful in examining the link between the distribution of socio-cultural features of illness and designated outcomes of importance for disease control and public health for infectious and chronic illnesses. [19][20][21][22] This study was performed in Zanzibar within a project managed by the WHO. The project's main objective was to vaccinate community residents in selected cholera hotspots on both islands of Zanzibar to assess the effectiveness of OCV under real-life conditions.…”

Reaching Haitian Americans Living With HIV/AIDS: Met and Unmet Health Care Needs

“…Other researchers who explored these cultural characteristics as they relate to tuberculosis and cancer have found similar results (Coreil et al, 2010;Gany, Herrera, Avallone, & Changrani, 2006). One study found that being Haitian was related to higher rates of refusal of routine HIV testing at urgent care centers (Liddicoat, Losina, Minhee, Freedberg, & Walensky, 2006).…”

Defining the research agenda to measure and reduce tuberculosis stigmas

“…37,38 Some argue that TB stigma is hard to distinguish from xenophobia, elitism and racism. 9,39 Other researchers suggest it is so bound up with HIV stigma that trying to tease them apart may be a fool's errand. 13,[40][41][42] Specific drivers may depend on the type of stigma, setting, population and type of TB.…”