Tuberculosis (TB), a communicable disease caused by Mycobacterium tuberculosis, remains one of the top 10 causes of death worldwide. Known to spread from an infected person through the air, it is considered the leading cause of death from a single infectious agent, surpassing HIV/AIDS.
TB mainly affects the lungs and is curable using first-line antibiotics for six months. If diagnosed and treated promptly, most TB patients can get cured, and onward transmission of the disease can be prevented.
In 2019, the World Health Organization (WHO) reported that around 10 million people fell ill with TB globally. A third of whom remained undiagnosed or unreported, and 1.4 million have resulted in deaths. Although this disease affects people of different gender, age, or socio-economic status, the high incidence of TB is closely associated with poverty. The poor are at greater risk because they are in greater contact with patients due to overcrowding at home, workplace, and in public areas. Secondly, the poor most likely suffer from weakened immune systems due to poor nutrition.
Aside from addressing poverty-related issues, the occurrence of TB may also be reduced by driving down the prevalence of health-related risk factors such as smoking, drinking alcohol, HIV infection, and diabetes. Despite such efforts, the number of TB reports remains high because other factors like stigma and discrimination remain unexplored.
Being recognized as two of the most commonly identified human rights-related barriers that hinder the fight against the TB epidemic, stigma and discrimination should therefore be ended. In fact, WHO emphasized in its End TB Strategy that ending stigma and discrimination are essential to ending TB.
How stigma and discrimination affect TB patients
TB stigma persists in homes, workplaces, health facilities, and places of worship. In homes, family members avoid sharing utensils with the TB patient even if it is contagious only when a person coughs, spits, or sneezes and droplets are inhaled by another person. In some workplaces, employers terminate staff even if the employee with TB is no longer infectious after completing the treatment.
Depending on geographic location, stigmatization of TB may be caused by its associations with HIV, low social class, malnutrition, or disreputable behavior. Although it affects almost anyone, TB stigma has a greater impact on women and community members who are less educated—the same group susceptible to healthcare disparities.
This stigma perpetuates fear of being abandoned by their family members, being divorced by a spouse, losing a job, or being excluded from their community. These mental, social, emotional, and financial consequences are the drivers for delayed diagnoses, adverse treatment outcomes, and negative impact on the health of individuals with TB and their families.
The fear of being discriminated against results in people with TB symptoms not seeking out help immediately. Some people may attempt to see private doctors to try to avoid the stigma, but because private clinics require longer waits to take appointments, patients suffer from diagnostic delays and increased financial costs. As a result, they become more seriously ill and highly contagious. This is also the common perpetuator of the myth that TB treatment may cause death.
In addition, people with TB also become reluctant to adhere strictly to their treatment course. Some people don’t finish their treatment for fear of people around them finding out. If medication is taken irregularly, the TB-causing bacteria may develop resistance to the drug, making TB harder to cure. In 2013, 480,000 developed a multi-drug resistant TB which resulted in 210,000 deaths.
Ways to end TB stigma and discrimination
Reducing TB stigma is essential because it does not only affect TB patients on a personal level but may also affect the entire community by hindering contact tracing, outbreak investigations, and quality of care. With that being said, ending stigma requires a holistic approach involving everyone—TB patients, TB survivors, health workers, researchers, civil society organizations, policymakers, donors, and the general public.
Some of the interventions that may be done include:
- TB patients must undergo proper counseling and education about TB. As with other stigmatized health conditions like HIV and mental health problems, empowering individuals with TB to resist external judgments can be the most promising approach to reducing TB stigma.
- Engage TB survivors to share their experiences to raise awareness. This can also be a powerful tool to change community norms regarding TB.
- Health workers must give accurate information regarding the disease to the patients, health workers, and the public.
- Community groups and civil society organizations must also participate in educating communities about TB stigma and its impact through awareness campaigns and organizing community dialogues where TB patients and survivors can share their experiences.
- Researchers can further explore TB-related stigma and establish findings to urge policymakers and implementers to apply them to current policies.
- Policymakers should use these research data to design laws that target to mitigate stigma. Instead of implementing policies and practices that prioritize the collective public’s well-being, they should balance these priorities and focus on individual patients.
- Donors must also focus their donations on efforts to end the TB stigma.
- The general public may use their power to disseminate information geared toward ending TB stigma through social media and other platforms.
A successful fight against stigma and discrimination means:
- People with TB and the people close to them can live normally and have access to TB-related services without fear of being judged.
- Family members, friends, colleagues, and other people in the social circle of TB-infected persons do not fear living with people with TB. They are assured that it is a treatable disease, and they know how the transmission of this disease works, so their support for TB patients will result in early and better recovery.
- Community influencers contribute to and encourage building safe and inclusive environments. Their words and actions foster positive social behaviors towards TB-infected people.
- Healthcare workers and service providers practice standards for TB care and use their resources to help mitigate TB-related stigma.