Stigma surrounding tuberculosis keeps patients from services, worsens health risks, but remains largely unmeasured, unaddressed

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Interviews in Kenya, Tanzania and Namibia health facilities found that the more staff knew about patients’ rights, the likelier they were to recognize — and report — discrimination against people with tuberculosis. A study in Lesotho found links between stigma surrounding HIV and TB and increased rates of depression and alcohol use among co-infected patients. Studies in Malawi and Tanzania found that perceptions around the physical and economic impacts of tuberculosis affect men and women differently. And analyses of 15 Demographic and Health Surveys indicate that increasing awareness of how tuberculosis is spread, and that it is curable reduces patients’ fears of isolation and rejection if they are diagnosed with the disease.

In short, a special issue of the International Journal of Tuberculosis and Lung Disease shows, stigmatizing stereotypes, fears and realities associated with TB add to the misery of a disease requiring lengthy and debilitating treatment, lead health workers to make inappropriate and unnecessary referrals, interfere with contact tracing, deprive patients of community support,  and discourage people at risk for disease — including health workers — from accessing services they need. At the same time, while the concept of “stigma” remains loosely defined and unquantified, its impacts remain largely unconfronted, the authors of a series of articles and studies argue.

Together the articles show how attitudes about tuberculosis compromise  care at every level — from detection, to diagnosis, to treatment,  and to access to the newest, and for many patients, last resort treatments, but also that these attitudes and their impacts can be methodically reversed, with efforts to identify its manifestations, and address them.

And while these articles look forward to how information on stigma can be gathered and used, a commentary in BMJ Global Health by Amrita Daftary, Mike Frick, Nandita Venkatesan and Madhukar Pai examines how HIV activism rallied against stigma with a focus on science.

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