End stigmatizing language in tuberculosis research and practice

Frick, Mike; Delft, Dalene von; Kumar, Blessina

doi:10.1136/bmj.h1479

Cited by 18 publications

(23 citation statements)

References 11 publications

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“…This raises ethical issues about the way communities are represented in research and in TB control programmes. [82][83][84] Few studies embraced a SDH framework to render legible the experiences of participants and there was a tendency to homogenize experiences of a diverse range of migrants, rather than theorize difference according to social positioning (e.g., gender). Despite a global consensus on the relevance of the social determinants of TB and the relevance and recognition of a SDH framework across many research disciplines, including the global policy world, they are often not effectively translated into policy and action.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis stigma as a social determinant of health: a systematic mapping review of research in low incidence countries

Craig

Daftary

Engel

et al. 2017

International Journal of Infectious Diseases

182

134

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Tuberculosis (TB)-related stigma is an important social determinant of health. Research generally highlights how stigma can have a considerable impact on individuals and communities, including delays in seeking health care and adherence to treatment. There is scant research into the assessment of TB-related stigma in low incidence countries. This study aimed to systematically map out the research into stigma. A particular emphasis was placed on the methods employed to measure stigma, the conceptual frameworks used to understand stigma, and whether structural factors were theorized. Twenty-two studies were identified; the majority adopted a qualitative approach and aimed to assess knowledge, attitudes, and beliefs about TB. Few studies included stigma as a substantive topic. Only one study aimed to reduce stigma. A number of studies suggested that TB control measures and representations of migrants in the media reporting of TB were implicated in the production of stigma. The paucity of conceptual models and theories about how the social and structural determinants intersect with stigma was apparent. Future interventions to reduce stigma, and measurements of effectiveness, would benefit from a stronger theoretical underpinning in relation to TB stigma and the intersection between the social and structural determinants of health.

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Section: Discussionmentioning

confidence: 99%

Tuberculosis stigma as a social determinant of health: a systematic mapping review of research in low incidence countries

Craig

Daftary

Engel

et al. 2017

International Journal of Infectious Diseases

182

134

View full text Add to dashboard Cite

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“…Terms such as ‘TB suspect’ and ‘default’ have criminal connotations 49 and there has been an increasing emphasis on avoiding the use of such stigmatizing terminology. Goffman’s definition of stigma 50 was reworked and applied to HIV by Alonzo and Reynolds 51 who described stigma as being a ‘powerful discrediting and tainting social label that radically changes the way individuals view themselves and are viewed as persons.’ This definition also introduces the concepts of external and internal stigma.…”

Section: Challengesmentioning

confidence: 99%

Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis

Nathavitharana

Bond²,

Dramowski

et al. 2017

La Presse Médicale

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Healthcare workers (HCWs) play a central role in global tuberculosis (TB) elimination efforts but their contributions are undermined by occupational TB. HCWs have higher rates of latent and active TB than the general population due to persistent occupational TB exposure, particularly in settings where there is a high prevalence of undiagnosed TB in healthcare facilities and TB infection control (TB-IC) programmes are absent or poorly implemented. Occupational health programmes in high TB burden settings are often weak or non-existent and thus data that record the extent of the increased risk of occupational TB globally are scarce. HCWs represent a limited resource in high TB burden settings and occupational TB can lead to workforce attrition. Stigma plays a role in delayed diagnosis, poor treatment outcomes and impaired wellbeing in HCWs who develop TB. Ensuring the prioritization and implementation of TB-IC interventions and occupational health programmes, which include robust monitoring and evaluation, is critical to reduce nosocomial TB transmission to patients and HCWs. The provision of preventive therapy for HCWs with latent TB infection can also prevent progression to active TB. Unlike other patient groups, HCWs are in a unique position to serve as agents of change to raise awareness, advocate for necessary resource allocation and implement TB-IC interventions, with appropriate support from dedicated TB-IC officers at the facility and national TB programme level. Students and community health workers (CHWs) must be engaged and involved in these efforts. Nosocomial TB transmission is an urgent public health problem and adopting rights-based approaches can be helpful. However, these efforts cannot succeed without increased political will, supportive legal frameworks and financial investments to support HCWs in efforts to decrease TB transmission.

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“… 9 10 The risk and fear of transmission of the airborne infection are often raised in defence of policies and practices that prioritise the well-being of the collective public over that of individual patients. 11 Persons with TB or presumed to have TB continue to be subjected to stigmatising language (eg, ‘TB suspects’, ‘defaulters’), mandatory screening, testing and disease notification systems that lack privacy, contact investigations that label index patients, airborne respiratory isolation that prolongs their social isolation, directly observed treatment (DOT) that impedes individual autonomy, and in rare but relevant cases, legal detention and even incarceration of those who refuse or stop treatment. 7 11 12 As these practices continue to be applied in biomedical, public health-oriented ways, they fuel the social exclusion of people with TB, and reify assumed conflicts between public health and patient rights.…”

mentioning

confidence: 99%

Fighting TB stigma: we need to apply lessons learnt from HIV activism

Daftary

Frick

Venkatesan³

et al. 2017

BMJ Glob Health

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End stigmatizing language in tuberculosis research and practice

Abstract: Terms that invoke metaphors of transgression and punishment cause harm, say Mike Frick, Dalene von Delft, and Blessina Kumar

Cited by 18 publications

References 11 publications

Tuberculosis stigma as a social determinant of health: a systematic mapping review of research in low incidence countries

Tuberculosis stigma as a social determinant of health: a systematic mapping review of research in low incidence countries

Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis

Fighting TB stigma: we need to apply lessons learnt from HIV activism

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