Understanding stigma as a barrier to accessing cancer treatment in South Africa: implications for public health campaigns

Abstract

IntroductionCancer contributes to significant illness burden in South Africa, with delayed diagnosis resulting from limited knowledge of cancer, lack of biomedical treatment and stigma. This study examines ways in which people are identified as having cancer through perspectives of traditional healing or the biomedical model. Additionally, we sought to understand the stigma associated with cancer, including stereotypes, anticipated discrimination and coping styles.MethodsLivestrong Foundation conducted 11 semi-structured focus groups with key community stakeholders in three South African townships. Interviews examined the negative consequences of being labeled with a cancer diagnosis as well as causes of, possible prevention of and barriers and methods to improve access to cancer treatment. Analyses were completed using directed content analysis.ResultsRevealed three main labeling mechanisms: physical appearance of perceived signs/symptoms of cancer, diagnosis by a traditional healer, or a biomedical diagnosis by a Western physician. Being labeled led to anticipated discrimination in response to prevalent cancer stereotypes. This contributed to delayed treatment, use of traditional healers instead of biomedical treatment and secrecy of symptoms and/or diagnosis. Further, perceptions of cancer were commonly conflated with HIV/TB owing to prior educational campaigns.ConclusionOur study deepens the understanding of the cancer labeling process in South Africa and the resulting negative effects of stigma. Future anti-stigma interventions should partner with traditional healers due to their respected community status and consider how previous health interventions may significantly impact current understandings of illness.

Acceptability of HPV screening among HIV-infected women attending an HIV-dedicated clinic in Abidjan, Côte d’Ivoire

“…The findings were similar to those in our study, with women worrying that being labeled a cancer patient would lead to further social isolation. Interestingly, these studies revealed a fear of change in healthcare workers' behaviorstigmatization, lack of interest in their case if it was judged fatalthat was not expressed in our study, suggesting that trust between women and caregivers may reduce this stigma [33][34][35]. Deepening the understanding of the relationship between women and caregivers through further studies would help to identify factors that could shape a trusting relationship and foster screening strategy implementation.…”

Model strategies to address barriers to cervical cancer treatment and palliative care among women in Zimbabwe: a public health approach

“…Lack of awareness has been reported as a barrier to cervical cancer screening uptake in low-income settings [ 23 ]. A South African study reported the importance of community outreach cancer education interventions involving traditional healers, churches and the youths to address stigma and other social ills associated with cervical cancer [ 11 ]. Researchers in the USA reported that collaboration of nations, international organizations and industry to develop and roll out workshops, courses and exchange programmes were key to improving health care knowledge and skills about cancer [ 7 ].…”

“…Geographical distances and cultural barriers were also cited as impediments to access and uptake of recommended diagnostic and treatment services for cervical cancer [ 10 ]. In South Africa, a recent study reported limited knowledge of cancer, lack of biomedical treatment and stigma as barriers to linkages to treatment and care by women with cervical cancer [ 11 ].…”

“…Societal barriers reported were lack of knowledge, fear of being diagnosed of cervical cancer, stigma (defined in our context as segregation or discrimination associated with having cervical cancer), misconceptions (defined as having incorrect view or opinion due to lack of knowledge), family influences, attitudes and beliefs, influence of traditional and spiritual healers [ 5 , 15 ]. Strategies suggested to fight against stigma in recent studies included involvement of traditional healers in interventions due to their community status [ 11 , 16 ]. Kuguyo et al [ 8 ] suggested increased funding for cervical cancer screening and community health education to promote early detection of the disease as some of the urgent interventions in Zimbabwe.…”

First brachytherapy treatment of prostate cancer in Nigeria using low dose rate radioactive iodine 125

“…Cancer can be curable when the patient presents early, but once it is advanced the chances of cure is slime. We have got to educate the public to get over the stigma of the disease, seek treatment and not to be shy about it [10]. Prostate cancer is typically a disease that is ignored at the early stage most especially when it is asymptomatic and most men may not present early either for lack of awareness or they see it as a form of social embarrassment, which is often detrimental to their health and quality of life [11,12].…”