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  • Stigma and Discrimination towards TB Patient

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    Stigma is when someone sees you in a negative way.

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    Discrimination is when someone treats you in a negative way.

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    TB patients face various forms of stigma and discrimination in the community

    Figure: Stigma towards TB Patients in the community


     

  • Effects of Stigma on TB Patients

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    At Individual Level

    • Lack of self-esteem and confidence
    • Increased sense of emotional isolation, feeling of guilt and anxiety
    • Physical as well as financial debilitation
    • People, more often women, are forced to leave their homes
    • Concealing symptoms and hesitancy in seeking medical care making disease management more difficult
    • Delayed diagnosis, interrupted treatment that can lead to further transmission and DRTB
    • Vulnerability increases, can lead to suicidal thoughts due to isolation and shame

     

    At Family and Community Levels

    • Loss of household earnings
    • Exposure of caregivers to the risk of infection that lowers productivity and cycle of poverty further gets perpetuated
    • Isolation and stigmatization of infected persons often by people of their community
    • Deep-rooted lack of knowledge and misconceptions among the affected and infected within their cultural and religious environment
    • Loss of status and negative impact on those with the disease, their caregivers, family, friends and communities
    • Perceived and internalized stigma of the community due to socio-cultural values that TB is punishment for sins or transgression

  • Gender Aspects of TB

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    Although more men are affected by TB, women and transgender persons experience the disease differently. Gender differences and inequalities play a significant role in how people of all gender access and receive healthcare services.

    Gender difference in Men Women
    Incidence of TB
    • Higher proportion of men(approximately- 2:1) are diagnosed with TB than women
    • More likely to have microbiologically confirmed Pulmonary TB
    • More likely to have Clinically diagnosed pulmonary TB and extra – pulmonary forms of TB
    • Prevalence of HIV-TB co-infection is higher among women who live in overcrowded houses and consume alcohol
    • High Risk for developing TB – Pregnant women and women in the postpartum period
    Exposure, Risk & Vulnerability
    • Smoking and alcohol consumption among men
    • High risk for developing TB - employment in mining, quarrying, metals and construction industries
    		 Undernutrition, their role as caretakers and the use of solid fuel for cooking puts women at risk for TB
    Health Seeking & Health system factors
    • Fear of loss of income and the consequences of absence from work hinder care seeking.
    • Women face difficulties due to perceived stigma, prioritization of household chores, lack of money or financial dependence
    Treatment Outcomes
    • Pressure to get back to work and lifestyle habits such as smoking or consumption of alcohol influence discontinuation of treatment in men
    • Migrant workers, mostly men, often face difficulties in adherence to treatment in the face of extreme poverty and issues of daily survival
    • Women tend to have better adherence and treatment outcome as compared to men
    • Stigma and discrimination are major impediments to treatment adherence, mainly among unmarried women, newly married women and the elderly

    Transgender population often has low literacy, low education levels and are poor. A high proportion of transgender persons are known to smoke, consume alcohol and use drugs. All these factors make them vulnerable to TB.

  • Addressing Gender Inequalities

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    Broad principles to address gender inequalities in TB care

    1. Confidentiality of patient needs to be maintained
    2. Non-discrimination and non-stigmatising behaviour to be promoted
    3. Respect for all to be ensured
    4. Informed consent and informed treatment
    5. Accountability to be fixed for actions and inactions
    6. Access for all health services
    7. Rights-based approach
    8. Empowered communities - Ensure representation of women, men and transgender persons in all forums
    9. Work in partnership - Strengthen linkages between program, private sector and communities