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Stigma – A major hurdle in the fight against TB

According to the Global Tuberculosis Report 2020, an estimated 10 million people fell ill with tuberculosis (TB) worldwide in 2019 and 1.4 million people died from TB. TB is one of the top 10 causes of death and the leading cause of death from a single infectious agent, worldwide. 

Stigmatized people are often discredited, seen as a disgrace, perceived to have less value or worth, or even seen as a danger’ (Stop TB Partnership, 2019)TB is a stigmatised disease because it is often associated with Human Immunodeficiency Virus (HIV), poverty, drug and alcohol misuse, homelessness, being imprisoned or a  refugee. Some people believe that only a ‘certain kind of person can get TB’, when the truth is anyone that breathes can get TB as it is a bacteria that spreads through the air. 

Stigma is a barrier to accessing care which prevents people with TB symptoms being screened for TB or completing TB treatment (Cramm et al 2010; Datiko, Jerene & Suarez, 2020; Furin et al., 2020). By delaying seeking medical treatment, symptoms may worsen, making treatment more difficult, and the TB infection continues to spread in the community. Health workers can play an important role in treating people diagnosed with TB with compassion and respect, and avoid using stigmatizing language (for example calling someone a TB suspect or defaulter). “Stigma continues to be a major barrier to providing high quality person-centred TB care” – Phumeza Tisile, TB Proof member and XDR-TB survivor.

The Stop TB Partnership’s Global Plan to End TB 2018-2022 calls for a paradigm shift to accelerate the scale up of TB care and prevention with the goal of leaving no-one behind (Stop TB Partnership, 2019). Ending TB stigma is a global priority, as demonstrated through the political declaration signed by global leaders at the United Nations (UN) High-Level Meeting (HLM) on TB where commitments included “to promote and support an end to stigma and all forms of discrimination”. Addressing TB stigma, human rights- and gender-related barriers to accessing TB care are also national priorities for South Africa. The revised South African National Strategic Plan (NSP) emphasises the importance of reducing drop-offs throughout the care cascade (Department of Health (DoH), 2017) and grounding the TB response in human rights’ principles to reduce stigma among people living with HIV and TB by at least 50%. These approaches may include reducing stigma through community education and revitalising community-based support groups to address internalised stigma. The NSP further emphasises the need to consider social and structural factors such as poverty and gender inequality that increases one’s vulnerability to HIV, TB and STIs. Therefore, special consideration to remove human rights- and gender-related barriers to accessing high quality services is critical.  

In order to reach our dream of a TB-free world, we all need to help reduce the harmful effect of TB stigma in our communities by taking part in activities that break down false and unfair attitudes towards people with TB. 

5 Questions for the Twitter Chat:

  1. In what ways do you think stigma has contributed to TB incidence and mortality?

  2. What is the possible impact of COVID-19 on the already existing TB Stigma?

  3. Are there other settings that stigma exists that are still not prioritized in discussions around stigma?

  4. What are the plans of the global community towards mitigating against the impact of COVID-19 on the stigma related commitments of the UNHLM?

  5. What should be included in ‘patient centered care’ that could improve treatment adherence?

  6. What role do you think awareness and sensitization could play in reducing TB stigma and discrimination?

  7. What is the place of awareness on CRG/rights of people affected by TB in the reduction of TB stigma and improvement in TB case notification and treatment adherence?

CT: (Closing Thoughts): Is there anything you feel is important to add to this conversation?