Stigma, Gender, and their Impact on Patients with Tuberculosis in Rural Bangladesh

In addition to marginalization by poverty and ethnicity, gender is likely to contribute to vulnerability to TB-related stigma affecting women. Stigma often contributes to psychosocial problems and emotional suffering, and it may hinder help seeking and treatment adherence. TB-related stigma and its gender-specific features have not been carefully studied in Bangladesh, and such research is needed to reduce adverse effects of stigma. This study assessed and compared stigma in women and men, and identified crosscutting and gender-specific features of TB-related stigma. To assess stigma and the context of TB-related illness experience, meaning and help seeking behavior from patients' perspectives, a cultural epidemiological study administered a locally adapted semi-structured EMIC interview to 50 women and 52 men with pulmonary TB in rural Bangladesh. Indicators of TB-related stigma were assessed individually and collectively in a validated index. They were compared by sex, and illness narratives elaborated features of stigma with reference to features of TB. The study showed that six indicators of TB-related stigma were more prominent in accounts of women and two were more prominent in men's interviews. Gender differences appeared somewhat less after adjusting for other sociodemographic variables, and age was most significantly inversely related to stigma. Features of stigma more prominent in the accounts of women included feeling shamed or embarrassed, thinking less of themselves and feeling that others refused to visit or avoided them. Men were less likely to disclose their condition to a confidant, stay away from work or report that their spouse refused sex because of TB. Effective public health information and counselling sensitive to gender-specific features of stigma are needed to protect TB patients from the adverse impact of avoidable stigma. Further research is needed to clarify effects of gender-specific features of felt and enacted stigma on help seeking and treatment adherence.