Authors: Somma, D.¹; Thomas, B.E.²; Karim, F.³; Kemp, J.⁴; Arias, N.⁵; Auer, C.¹; Gosoniu, G.D.¹; Abouihia, A.¹; Weiss, M.G.¹

Source: The International Journal of Tuberculosis and Lung Disease, Volume 12, Number 7, July 2008 , pp. 856-866(11)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: Tuberculosis (TB) control programmes in Bangladesh, India, Malawi and Colombia.

OBJECTIVE: Assess indicators of TB-related stigma and socio-cultural and gender-related features of illness associated with stigma.

DESIGN: Semi-structured Explanatory Model Interview Catalogue (EMIC) interviews were administered to 100 or more patients at each site, assessing categories of distress, perceived causes and help seeking. Indicators of self-perceived stigma were analysed individually and in a validated index, which was compared across sites and between men and women at each site. Cultural epidemiological explanatory variables for stigma and interactions with female sex were analysed at each site. Qualitative illness narratives were examined to explain the role and context of explanatory variables.

RESULTS: The overall stigma index was highest in India, lowest in Malawi and greater for women in Bangladesh. In India and Malawi, women were more likely to be concerned about impact on marital prospects. Associations with HIV/AIDS were linked to TB stigma in Malawi, where sexual contact as a perceived cause was more associated with stigma for men and less for women.

CONCLUSION: Stigma both influences and indicates the effectiveness of TB control. Cultural epidemiological methods clarify cross-cutting and local features of stigma and gender for TB control.

Keywords: tuberculosis; stigma; gender; DOTS treatment; cultural epidemiology

Document Type: Regular paper

Affiliations: 1: Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland 2: Tuberculosis Research Centre, Chennai, India 3: Bangladesh Rural Advancement Committee (BRAC) Research and Evaluation Division, Dhaka, Bangladesh 4: Equi-TB Knowledge Programme, Liverpool School of Tropical Medicine, Liverpool, UK 5: Centro Internacional de Entrenamiento e Investigaciones Medicas, Cali, Colombia

Publication date: 2008-07-01

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