OPINION: Stigma remains a major barrier in the battle to eradicate TB

South Africa’s eighth TB conference covered a variety of topics: the possibility of vaccine rollout in the next five years, the integration of TB and nutrition, human rights, issues around advocacy and genomics. But a recurring theme throughout the conference was the issue of TB stigma and its detrimental impact in care-seeking and treatment.

Stigma has had an impact on TB treatment for many decades. At the conference, participants heard how in the South African context, the cycle of stigma is one that begins in clinics, where health workers use derogatory language to refer to TB patients. This was covered at the opening plenary by David Macana, Director of Excellent Project 2030 (2030), who spoke of his own experience as a TB survivor and the language he came to hear being referred to TB patients.

The use of derogatory language in health facilities begins a negative cycle that shapes how community members understand and internalise TB, and go on to use such language to outcast those with the disease. Consequently, once a family member contracts the disease, the person is almost immediately ostracised because of the knowledge and association taught in medical facilities and communities.

In an effort to address stigma, the conference highlighted the importance of TB literacy and education. By educating communities we can equip communities with basic knowledge and skills to deal with the disease, thereby breaking the cycle of stigma.

Nosivuyile Vanqa from the Desmond Tutu TB centre noted that current interventions aimed at TB education are solely focused on patient counselling, and are often limited to a single session expecting patients to grasp all aspects of TB at once. But this approach is a missed opportunity for patients to learn about the disease, to ask questions and to share experiences.

In as much as health facilities in South Africa lack resources, TB cannot be solely eradicated through scientific measures but also requires TB support groups and family-centred counselling to be implemented. These are likely to reduce stigma  and equip families with the necessary skills to protect and support themselves.

The interventions would also increase shared responsibility and accountability in treating the disease.