Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California, San Francisco, California, USA; Curry International Tuberculosis Center, University of California, San Francisco, California, USA.
Computational Epidemiology Group, Children's Hospital Informatics Program, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Int J Tuberc Lung Dis. 2017 Nov 1;21(11):42-48. doi: 10.5588/ijtld.16.0914.
Dar es Salaam, Tanzania.
To describe tuberculosis (TB) related stigma and to understand how it interacts with gender to affect access to care.
Eight focus group discussions were held among 48 TB patients and their household members, and a thematic content analysis was carried out.
The main components of stigma were fear, self-isolation, ostracization, loss of status in the community, and discrimination by providers. Participants described the cultural context in which stigma operated as characterized by a general lack of health knowledge, cultural beliefs about TB, and engendered beliefs about disease in general. Both genders described some similar effects of stigma, including relationship difficulties and specifically challenges forming new relationships, but many effects of stigma were distinct by gender: women described challenges including assumptions about promiscuity and infidelity, as well as rejection by partners, while men described survival challenges. Stigma acted as a barrier to care through a cyclical pattern of stigma and fear, leading to health-seeking delays, with resulting continued transmission and poor health outcomes that further reinforced stigma.
TB-related stigma is prevalent in this setting and operates differently for men and women. Interventions designed to increase case detection must address stigma and its interaction with gender.
坦桑尼亚达累斯萨拉姆。
描述与结核病（TB）相关的耻辱感，并了解其如何与性别相互作用影响获得治疗的机会。
对 48 名结核病患者及其家庭成员进行了 8 次焦点小组讨论，并进行了主题内容分析。
耻辱感的主要构成要素包括恐惧、自我隔离、排斥、在社区中失去地位，以及提供者的歧视。参与者描述了耻辱感运作的文化背景，其特点是普遍缺乏健康知识、对结核病的文化信仰以及对一般疾病的性别观念。男女双方都描述了一些类似的耻辱感影响，包括人际关系困难，特别是难以建立新的关系，但许多耻辱感的影响因性别而异：女性描述了一些挑战，包括对滥交和不忠的假设，以及伴侣的拒绝，而男性则描述了生存挑战。耻辱感通过耻辱感和恐惧的循环模式成为获得治疗的障碍，导致寻求治疗的延误，从而导致持续传播和健康状况不佳，进一步加剧了耻辱感。
在这种环境中，与结核病相关的耻辱感很普遍，并且对男性和女性的影响不同。旨在增加病例发现的干预措施必须解决耻辱感及其与性别的相互作用。
