Brüggemann Rhea, Schlumberger Fabian, Chinshailo Firuza, Willis Matthew, Kadyrov Abdullaat, Kalmambetova Gulmira, Chen Mo, Unterkircher Sophie Cw, Moidunova Nestan, Sydykova Altynai, Fastenau Anil
Department of Health Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6211 LK, The Netherlands.
National Tuberculosis Program Kyrgyzstan (NTP), Akhunbayeva Street 90a, Bishkek, 720020, Kyrgyzstan.
Int J Equity Health. 2025 Jul 1;24(1):185. doi: 10.1186/s12939-025-02566-4.
The Republic of Kyrgyzstan is among the 30 countries with the highest burden of multidrug-resistant Tuberculosis worldwide. One of the reasons is widespread stigmatization and discrimination. As previous research has shown, particularly women experience stigma while its impact on their life and (mental) health is even greater than for men. This is the first phenomenological study to explore women's lived experiences of TB-related stigmatization in Kyrgyzstan. This study aims to raise awareness about the gender-specific impact of stigmatization and discrimination.
Descriptive phenomenology was used. 15 semi-structured in-depth interviews with female TB-patients were conducted between 28th May and 14th June 2024. Themes were stigma experiences, their consequences and coping strategies. Participants were recruited from two TB Hospitals and two Family Medical Centers (primary health care units) in Bishkek through purposive sampling. The data analysis followed a thematic approach based on a combination of deductive and inductive coding.
14 of 15 participants experienced stigmatization and discrimination in one way or another. Anticipated stigma was very prominent, manifesting in non-disclosure of the diagnosis apart from close family. Enacted stigma mostly occurred within society or non-TB-specialized healthcare facilities. Self-stigmatization often followed anticipated and enacted stigma. Stigma experiences impacted daily and social life, marital prospects and access to educational and work opportunities but mainly led to mental health issues, which 12 of 15 participants reported.
and Conclusion. In contrast to previous research, this study did not find diagnostic delay nor non-adherence to treatment because of stigmatization and discrimination. However, experiences within the healthcare facilities impacted the perceived quality of care. Stigmatization within the family, mostly by in-laws, was anchored in the patriarchal and conservative attitudes of Kyrgyz society. Overall, key findings of this study were widespread lack of knowledge about the disease and its transmission as a reason for and mental health issues because of stigmatization and discrimination. The findings imply the need for intervention strategies and policies focusing on education about TB, integration of psychosocial support into treatment and improvements in quality of care. Altogether, this could contribute to the reduction of TB-related stigmatization and discrimination which would reduce the individual burden of TB.
吉尔吉斯斯坦共和国是全球耐多药结核病负担最高的30个国家之一。原因之一是普遍存在的污名化和歧视现象。正如先前的研究所表明的，尤其是女性遭受污名化，而其对她们生活和（心理）健康的影响甚至比对男性更大。这是第一项探索吉尔吉斯斯坦女性结核病相关污名化生活经历的现象学研究。本研究旨在提高对污名化和歧视的性别特定影响的认识。
采用描述性现象学方法。2024年5月28日至6月14日期间，对15名女性结核病患者进行了半结构化深度访谈。主题包括污名化经历、其后果和应对策略。通过目的抽样从比什凯克的两家结核病医院和两家家庭医疗中心（初级卫生保健单位）招募参与者。数据分析采用基于演绎和归纳编码相结合的主题方法。
15名参与者中有14名以某种方式经历了污名化和歧视。预期污名非常突出，表现为除了近亲之外不透露诊断情况。实际污名大多发生在社会或非结核病专科医院设施内。自我污名化往往紧随预期污名和实际污名之后。污名化经历影响了日常生活和社交生活、婚姻前景以及获得教育和工作机会，但主要导致了心理健康问题，15名参与者中有12名报告了这一情况。
与先前的研究不同，本研究未发现因污名化和歧视导致诊断延迟或不坚持治疗的情况。然而，医疗机构内的经历影响了对医疗服务质量的感知。家庭内部的污名化，主要来自姻亲，源于吉尔吉斯社会的父权制和保守态度。总体而言，本研究的主要发现是，由于污名化和歧视，普遍缺乏对该疾病及其传播的了解，以及心理健康问题。这些发现意味着需要制定干预策略和政策，重点是结核病教育、将心理社会支持纳入治疗以及提高医疗服务质量。总之，这有助于减少与结核病相关的污名化和歧视，从而减轻个人的结核病负担。
