Tuberculosis and Stigmatization: Pathways and Interventions

Abstract

The institutional and community norms that lead to the stigmatization of tuberculosis (TB) are thought to hinder TB control. We performed a systematic review of the literature on TB stigma to identify the causes and evaluate the impact of stigma on TB diagnosis and treatment. Several themes emerged: fear of infection is the most common cause of TB stigma; TB stigma has serious socioeconomic consequences, particularly for women; qualitative approaches to measuring TB stigma are more commonly utilized than quantitative surveys; TB stigma is perceived to increase TB diagnostic delay and treatment noncompliance, although attempts to quantify its impact have produced mixed results; and interventions exist that may reduce TB stigma. Future research should continue to characterize TB stigma in different populations; use validated survey instruments to quantify the impact of TB stigma on TB diagnostic delay, treatment compliance, and morbidity and mortality; and develop additional TB stigma-reduction strategies.

Health care seeking behavior and patient delay in tuberculosis diagnosis

“…However, the patients in our study demonstrate a lack of knowledge about TB, once almost one half did not know how the disease was transmitted. Misconceptions about TB transmission have been reported in other studies 33 , and it is related to delays in diagnosis and treatment non-adherence 33,34,35,36 . We could not show an association between patient delay and lack of knowledge about TB, but is important to develop strategies to improve patient education about their illness in the TB services, since it can have implications in treatment adherence.…”

Social Impact of Stigma Regarding Tuberculosis Hindering Adherence to Treatment: A Cross Sectional Study Involving Tuberculosis Patients in Rajshahi City, Bangladesh

“…This study demonstrated that stigma levels were very high in uneducated, poor villagers, and patients belonging to village communities experienced greater stigma relative to that observed in town dwellers, which may have occurred due to a lack of appropriate knowledge regarding TB in people living in village areas. There was a misconception among villagers that TB is a punishment from God for the moral failing of the infected person (24), and poor health education in such communities is responsible for this type of belief (25). The present study also demonstrated that greater stigma was experienced by pulmonary patients.…”

Preliminary validation of an instrument to assess social support and tuberculosis stigma in patients' families

“…We therefore suggested that complementary, transversal, analytical and quantitative studies are necessary to advance the investigation. 17 The use of reliable, validated instruments is a challenge to the realisation of quantitative studies on family TB support and stigma, as no instruments have been formally validated and adapted to Brazilian settings. The present study aimed to construct and validate a preliminary scale to investigate social support and stigma among families of TB patients.…”