Medina-Marino Andrew, de Vos Lindsey, Daniels Joseph
Desmond Tutu HIV Centre, University of Cape Town, 3 Woodlands Road, Woodstock, Cape Town, 7925, South Africa.
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
BMC Glob Public Health. 2025 Jun 5;3(1):50. doi: 10.1186/s44263-025-00166-6.
In 2022, an estimated 10.6 million people developed tuberculosis (TB) globally, with men bearing a greater burden of disease compared to women. In South Africa specifically, men experience higher risks of poor outcomes and TB-related mortality than women. Stigma and isolation among people living with tuberculosis (PLWTB) are well documented. The gendered pathways through which TB-related stigma leads to isolation or impacts access to resources during one's illness-to-health journey are poorly understood.
We interviewed PLWTB receiving treatment at government clinics in Buffalo City Metro Health District, Eastern Cape Province, South Africa. Semi-structured guides explored TB symptom experiences, access to care, treatment motivation, key supporters, and access to mental and tangible resources (MTRs) during illness. Open coding was done inductively, with MTR domains informed by the Network-Individual-Resource Model. Findings were analyzed through a cyclic, iterative, and deductive process using social isolation and exclusion as interpretive lenses. Memos and pathway mapping examined gendered differences in stigma, isolation, and access to networked MTRs.
One hundred forty-two PLWTB (men = 86; women = 56) were interviewed. PLWTB described pervasive TB stigma and isolation. Women described self-isolating in response to enacted and anticipated stigma. Men described active exclusion by friends and family. Women's maintenance of familial ties facilitated access to MTRs while ill. Men's systematic exclusion (e.g., deliberate or forced by peers or family) reduced their agency to access resources. Men and women described regaining physical strength and recovery of social networks through treatment, but also the sustained impacts of post-treatment stigma.
We identified gendered pathways through which TB stigma and isolation affect access to MTRs. For women, stigma led to social isolation, but familial networks helped maintain access to MTRs, fostering resilience. Men experienced social exclusion, reduced agency to access MTRs, and increased vulnerability during illness. Findings can guide gender-responsive interventions to reduce the impact of TB stigma on health outcomes.
2022年，全球估计有1060万人患上结核病（TB），男性相比女性承担着更重的疾病负担。具体到南非，男性比女性面临更差的治疗结果和与结核病相关的死亡风险。结核病患者（PLWTB）遭受的耻辱感和被孤立的情况有充分记录。然而，人们对与结核病相关的耻辱感在患者从患病到康复过程中导致孤立或影响获取资源的性别化途径知之甚少。
我们采访了在南非东开普省布法罗市地铁卫生区政府诊所接受治疗的结核病患者。半结构化指南探讨了结核病症状体验、获得治疗的情况、治疗动机、关键支持者以及患病期间获得精神和物质资源（MTRs）的情况。采用归纳法进行开放编码，MTR领域由网络-个体-资源模型提供信息。通过以社会孤立和排斥为解释视角的循环、迭代和演绎过程对研究结果进行分析。通过备忘录和路径图研究耻辱感、孤立感以及获取网络化MTRs方面的性别差异。
共采访了142名结核病患者（男性=86名；女性=56名）。结核病患者描述了普遍存在的结核病耻辱感和孤立感。女性描述因实际遭遇和预期的耻辱感而自我孤立。男性描述被朋友和家人主动排斥。女性维持家庭关系有助于在患病期间获得MTRs。男性被系统性排斥（例如被同龄人或家人故意排斥或强迫排斥）降低了他们获取资源的能力。男性和女性都描述了通过治疗恢复体力和重建社交网络，但也提到了治疗后耻辱感的持续影响。
我们确定了结核病耻辱感和孤立感影响获取MTRs的性别化途径。对女性而言，耻辱感导致社会孤立，但家庭网络有助于维持获取MTRs的机会，增强恢复力。男性经历了社会排斥，获取MTRs的能力降低，患病期间脆弱性增加。研究结果可为针对性别的干预措施提供指导，以减少结核病耻辱感对健康结果的影响。
