Article by : Rutuja Tope (M.Sc. Health Sciences), Nutritionist at Interactive Research School For Health Affairs (IRSHA), India
Perception of stigma towards tuberculosis patients: Tuberculosis (TB) has existed for millennia and remains a major global health problem. It is in one of the top ten causes of death worldwide, among infectious diseases. The stigma associated with tuberculosis has been identified as a major barrier to health care and quality of life in TB management. Stigmatization is a complex process involving interpersonal perceptions and communities. Hence it is recognized as an important social determinant of health and health disparities and the difficulties are in identifying, characterizing, measuring and tracking changes in stigmatization. Stigma is recognized as having a major impact on public health interventions and tends to produce social inequalities. TB related stigma is called a hidden burden of disease and it may interfere with treatment and control.
Both men and women share the burden of unfulfilled social responsibilities pertaining to their ‘normal’ gender roles, which provides evidence of a ‘hidden burden’ that stigma results in diminished self-esteem and depression. The nature and occurrence of stigma are likely to reflect gender roles, it shows, TB stigma is worse for women than men. Attention to gender should also help to explain known sex differences in accessibility and utilization of health care services and shows how social intentions influence stigma targeting people with TB.
Stigma is not a naturally occurring circumstance, but something created by people and as such it can be “undone” by those people as part of a collective which comprises society. For reducing TB stigma, interventions designed to directly address stigmatizing community norms about TB and it is essential to continue intervention like counseling to patients and screening in high prevalence groups to reduce TB stigma. TB patients face many stigma related problems and that implementation of programs should be improved and more focus needs to be placed on women and children.
Interventions that reduce the stigma attached to tuberculosis should target areas like respect to the patients, cultural sensitivity, community awareness and patient counseling on problems and emotional skills. A comprehensive package of interventions will be needed to address the multiple causes of discrimination identified. Basic population-wide health education is unlikely to be effective. Different cultures should be considered in the development of interventions aimed at decreasing stigma and improving treatment adherence.
Contextualized appreciation of stigma with reference to gender and its effect constitutes a challenge not only for TB but also for other infectious diseases and other stigmatized conditions. Gender-related differences and stigma which are linked together and it shows women were significantly more vulnerable to stigma than men. Many people had no correct information about TB and attitudes, knowledge and practice about TB was associated with women. Hence, the TB control strategy should include community awareness. The excessive stigma attached by medical and nursing students to patients with TB and greater knowledge of the disease would help to improve the clinical judgment of health professionals, the higher perception of stigma among them could influence their behavior towards their patients. There is a need for gender-specific intervention strategies to increase better access to TB services.
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