TB Stigma

What is TB stigma anyways?

TB stigma is making unfair judgements against a person or groups of people (houses or villages) simply because they have TB. These judgements are usually based on not understanding TB and/or a fear of the disease. TB stigma often involves creating false stories about how a person got TB or how they're acting about having TB.

Stigma or stigmatizing behaviours might not be meant in a mean way. Unfortunately, stigma can make a person feel bad about themselves or about having TB.

In general, TB stigma focuses the attention and puts blame on the person rather than properly focusing on the TB bacteria and the difficulty in screening for and treating TB.

Some common examples of TB stigma: Saying someone got TB because they drink and party. Saying someone doesn't care about their health because they have trouble coming to the clinic for their appointments.

Some common examples of TB stigma:

• Saying someone got TB because they drink and party.

• Saying someone doesn't care about their health because they have trouble coming to the clinic for their appointments.

De-stigmatizing things you can SAY and DO as a PHO

Stigma can make a person feel shame, fear, and isolation.

These feelings can impact if a person feels comfortable to come for TB screening, treatment, or follow ups.

As the PHO, you can use de-stigmatizing ways of saying things and ways of doing things to help the person feel respected, empowered, and not alone.

TB is Hard – say it. We need to make it normal to say that TB can be a difficult disease to understand, diagnose or treat. Doing this can help people feel encouraged to ask questions, to come in for screening or to keep taking their treatment.

Blame the Bacteria. Stigma involves focusing on the person when we really should be focusing on the bacteria. If someone starts talking about blame (themselves or other people), you can try to redirect the conversation to the TB bacteria.

Lean on the Facts. Stigma involves imagining false connections. You can counter these with the facts about TB.

Be Real. Taking TB treatment isn't fun. But as much as it isn't fun, taking the pills is the only way to get rid of TB from the body.

Use Person-First Language. Person-first language means separating the person from TB. This kind of language avoids placing blame or describing a person only by their TB. Ex: we would want to use "person with TB", not "TB-infected person".

Having TB isn't a Crime. If a word sounds like it belongs at a crime scene, try to avoid using it when talking about TB. Ex: we would want to use "someone who might have TB", not "TB suspect" or "TB case".

Anytime you see this symbol in the Info Guide, it means to look out for opportunities to de-stigmatize!

People facing stigma from other people

It's important here as the PHO not to take on too much

• it's okay that you can't solve everything for the person. You can:

• thank the person for being honest and reassure them. Ex: "thanks for telling me, it's not fun to hear those things".

• remind them of the approaches above such as
  "Lean on the Facts" and "Blame the Bacteria".

Often people appreciate the opportunity to be listened to and heard.

People stigmatizing themselves or other people

You can think about this like an 'infection origin story' where the person might be guessing at who, what, when, where, why, and how they got TB. This is a normal response, and you might hear lots of these stories in your work. You:

• don't need to say that a person is right or wrong.

• can listen and thank the person for being honest.

• can redirect the conversation back on the bacteria. Ex: "it's really no one's fault, the TB bacteria can get anyone".

These 'infection origin stories' can be part of a person's coping mechanism (trying to make sense of what happened to them).