Reducing TB-associated stigma in India

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Tuberculosis (TB) is a devastating disease with significant health, economic, and sociopolitical consequences, especially in developing countries such as India. According to the WHO, over 20% of world’s tuberculosis cases occur in India, causing over 330,000 deaths in 2006. In India, TB is widely considered to be a lower-class disease, so the disease carries substantial social stigma, creating barriers to both diagnosis and treatment.

TB-associated stigma disproportionately affects Indian females, especially those who fear social isolation if they seek medical care. Many women worry that their betrothed will discover that they are infected, leading to failed marriage proposals. As the video below demonstrates, more and more Indian women are being thrown out of their homes by their husbands for contracting TB. Although TB is treatable, much of the Indian population is ignorant of this fact or willfully chooses to ignore it.

TB-associated stigma is magnified among middle class Indians, who often deny their condition and fail to seek treatment because they fear losing social standing. There have been increasing calls for celebrities, especially Bollywood stars, to admit positive TB status because their unique social prominence could drastically change Indians’ perception of the disease.

The Indian Ministry of Health has partnered with many organizations, including a consortium of aid groups called the Partnership for TB Care and Control, to decrease TB-associated stigma. In fact, the Partnership recently organized a meeting in New Delhi to discuss strategies to improve TB awareness and dispel its stigma. A number of other countries, such as Nepal and Ghana, have also experienced the challenges of TB-associated stigma, and recently Andrew Courtwright and Abigail Norris Turner have identified particular areas for further research that could help address TB-associated stigma. We believe that the Partnership should adopt this evidence-based approach to reduce TB-associated stigma.

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5 Responses to “Reducing TB-associated stigma in India”

  1. mjberley Says:

    I really enjoyed this post because I was unaware that this was an issue. Although I know that TB still has a slight stigma in some areas in the US I don’t feel that it keeps individuals from getting care. You are very right that something must be done to help those infected individuals in India, but unfortunately stigma is so difficult to combat and change. I do agree that bollywood stars admiting to be infected would make a huge impact. We saw this same tactic work in the US when major stars and sports figures came out as being HIV positive.

  2. reyneriosepelanoymd Says:

    While it is true that tuberculosis is treatable, its eradication is being hampered by numerous factors. Stigma is a crucial one and I commend you for this post. While most anti-TB efforts focus on case detection and treatment, the social aspects of the disease has not been fully addressed. TB is also a big problem in my country (Philippines) and I suspect stigma plays a role as to why patients fail to get proper treatment. One of the stigma-reduction strategies mentioned in your table is an enhanced screening policy, much like what they do for HIV in the US. While this is quite effective for HIV, I am wondering if this is also true for TB. Most TB cases are symptomatic and I believe only these cases should treatment be started. Latent (asymptomatic) tuberculosis however can only be detected by PPD testing. And if one is from an area with high prevalence for TB, then the likelihood for positivity is also high. In the US, latent TB cases are treated per protocol. But I suspect that this is because even latent TB is an uncommon disease. The question therefore is this: if we start screening (universally) for latent tuberculosis in high prevalence areas, are we capable of providing these cases adequate and appropriate medications?

  3. oyuguero Says:

    I really like this post. At this moment, in the Center I worked we are doing an study evaluating the adherence to the treatment. We have seen that an important part of the people don’t follow the treatment adequatly due to the fears of being identified as TB patients. I imagine that if this situation is occuring in Spain, in India would be an important problem. I think that the actions established, like the presence of famous actors, will be really importance in the reduction of the stigma, and the control of TB in India.

  4. ophezm Says:

    Regrettably, every year, 1.8 million persons develop tuberculosis (TB) in India, of which about 800,000 are infectious; and, until recently, 370,000 died of it annually —1,000 every day. The disease is a major barrier to social and economic development. An estimated 100 million workdays are lost due to illness. Society and the country also incur a huge cost due to TB—nearly US$ 3 billion in indirect costs and US$ 300 million in direct costs. In terms of population coverage, India now has the second largest DOTS (Directly Observed Treatment, Short course) program in the world. However, TB in India is still a big challenge.

    One important issue that has to be addressed in India as priority is to re-educate its society (citizens, authorities, professionals at different levels, among others) about TB. This country still keeps (unofficially) archaic and divisive concepts like the caste system, patriarchal system among others. Social context is the key to understand how stigma works and consequently how health providers deal with female population and TB in India.
    It seems that social prejudices are not helping with the eradication of TB in India. TB is a historical disease; it had a past, has a present, and probably is going to have a future in countries like India because TB is a stigmatized disease. Stigma and discrimination against Indian females with TB have a devastating social and psychological impact. Stigma often prevents people from seeking health care attention which constitute a direct public health threat to the community. If people from Bollywood (Hindi Hollywood) are getting TB, then is time to come out, be public and show Indian citizens that TB is an infectious disease that can affect anyone and still be treated for it. Ultimately, those famous actors can help in TB prevention campaigns. Women with TB are often seen as responsible for becoming infected. It is crucial that health care professionals understand the determinants and dynamic of stigma to ensure that human rights are not going to be violated.

    Authorities need to be aware of the stigma that Indian females may currently face and how health services can unintentionally reinforce it.

  5. The urban poverty paradox: It’s good for you. Why won’t you do it? Says:

    […] people may not take them as directed. But the second issue is both less obvious and more powerful: TB carries a huge social stigma, so many people would (quite literally) rather die of the disease then let people know that they […]

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