Gender and community views of stigma and tuberculosis in rural Maharashtra, India

Abstract

Stigma associated with tuberculosis (TB) is often regarded as a barrier to health seeking and a cause of social suffering. Stigma studies are typically patient-centred, and less is known about the views of communities where patients reside. This study examined community perceptions of TB-related stigma. A total of 160 respondents (80 men and 80 women) without TB in the general population of Western Maharashtra, India, were interviewed using Explanatory Model Interview Catalogue interviews with same-sex and cross-sex vignettes depicting a person with typical features of TB. The study clarified features of TB-related stigma. Concealment of disease was explained as fear of losing social status, marital problems and hurtful behaviour by the community. For the female vignette, heredity was perceived as a cause for stigmatising behaviour. Marital problems were anticipated more for the male vignette. Anticipation of spouse support, however, was more definite for men and conditional for women, indicating the vulnerability of women. Community views acknowledged that both men and women with TB share a psychological burden of unfulfilled social responsibilities. The distinction between public health risks of infection and unjustified social isolation (stigma) was ambiguous. Such a distinction is important for effective community-based interventions for early diagnosis of TB and successful treatment.

Keywords:

• gender
• stigma
• TB
• people without TB
• India

Acknowledgements

Financial support of the Swiss Agency for Development and Cooperation is gratefully acknowledged. We also thank the following persons for their assistance and contributions to the research: Dr N.F. Misty, Director, FRCH, for encouragement throughout; Dr Sheela Rangan for her valuable input throughout the study; Ms Deepali Deshmukh; Dr Nishi Suryawanshi and Mr Omprakash Patil for input in the initial field research activities; Dr M.W. Uplekar, Medical Officer, WHO Stop TB Programme, for input in developing the study. We appreciate the cooperation of the State and District TB officers, health staff and community respondents.

Notes

1. Hypothetical representation of typical male and female TB cases in EMIC interviews as described in Appendix 1.