HIV/AIDS, STIs & TB Program, Human Sciences Research Council, Durban, South Africa.
School of Life & Medical Sciences, University College London, London, UK.
Int J Tuberc Lung Dis. 2017 Nov 1;21(11):26-33. doi: 10.5588/ijtld.16.0925.
Urban Blantyre, Malawi.
To understand why men with tuberculosis (TB) in the community remain undiagnosed.
A multi-method qualitative study applying a modified grounded theory approach. Data were gathered from March 2011 to March 2012 from 134 men and women taking part in 1) focus group discussions with community members (n = 6) and health care workers (n = 2), and 2) in-depth interviews with TB patients (n = 20, females n = 14) and chronic coughers (n = 20, women n = 8). Data were analysed inductively to identify, refine and consolidate, and verify emerging concepts and themes.
Two emerging themes highlighting compound stigma in this high human immunodeficiency virus (HIV) prevalence, low-income setting are presented. First, cough or any illness that portended a 'serious' condition were accompanied by portrayals of cough, TB and HIV as being interchangeable. Chronic coughers and TB patients described their illness in ways that foregrounded bodily decimation and rupture of social life and masculine identity. Second, 'resistance strategies' entailed resisting classification as (seriously) ill by evading or ambivalently approaching health care, or acknowledging the 'ill' status then actively pursuing health-appropriate behaviours, including changing lifestyle or adopting non-normative gender roles.
Managing patients requires 1) going beyond syndromic management based on vital signs and clinical indicators to recognising and intervening on health care-seeking related tensions to retain individuals in care, and 2) understanding and addressing TB stigma as it manifests and affects men and women differently in specific settings.
马拉维布兰太尔市区。
了解社区中为何有结核病（TB）的男性患者未被诊断。
一项采用改良的扎根理论方法的多方法定性研究。2011 年 3 月至 2012 年 3 月，从参与 1）社区成员（n = 6）和卫生保健工作者（n = 2）焦点小组讨论，以及 2）TB 患者（n = 20，女性 n = 14）和慢性咳嗽者（n = 20，女性 n = 8）的深入访谈的 134 名男性和女性中收集数据。使用归纳法对数据进行分析，以识别、精炼和整合，并验证新兴概念和主题。
在这个高人类免疫缺陷病毒（HIV）流行率、低收入环境中，出现了两个突出复合耻辱感的新兴主题。首先，咳嗽或任何预示着“严重”疾病的疾病都伴随着咳嗽、TB 和 HIV 可互换的描述。慢性咳嗽者和 TB 患者以突出身体毁灭和社会生活及男性身份破裂的方式描述他们的疾病。其次，“抵抗策略”包括通过回避或模棱两可地接近卫生保健来避免或模棱两可地避免被归类为（严重）疾病，或者承认“疾病”状态，然后积极采取健康适当的行为，包括改变生活方式或采用非规范的性别角色。
管理患者需要 1）超越基于生命体征和临床指标的综合征管理，认识和干预与寻求医疗保健相关的紧张局势，以保持个人接受护理，以及 2）理解和解决 TB 耻辱感，因为它在特定环境中以不同的方式影响男性和女性。
