Breaking the silence: Quantifying tTuberculosis-related stigma through a mixed-methods community study to advance equitable and sustainable TB elimination in the Himalayan region of India
1
Department of Community Medicine, Indira Gandhi Medical College Shimla, Shimla, India
Popul. Med. 2026;8(Supplement Supplement 1):A493
ABSTRACT
INTRODUCTION:
Tuberculosis (TB) continues to pose a major public-health challenge in India despite strengthened programmatic efforts. Stigma—often invisible yet powerful—remains a critical barrier to early diagnosis, adherence, and social reintegration. This study quantified the magnitude and determinants of TB-related stigma and explored its social and structural correlates in Himachal Pradesh.
METHODS:
A cross-sectional, mixed-methods study was conducted in 20 clusters across Shimla and Kinnaur districts. Using standardized stigma scales, 380 respondents (120 patients, 120 family members, 120 community residents, 20 health-care workers) were surveyed; qualitative insights were obtained through 24 in-depth interviews and 8 focus-group discussions. Data were analyzed using Epi Info 7 and ATLAS.ti.
RESULTS:
Overall stigma prevalence was 11.3% (95% CI 7.9–15.8) among all respondents. Anticipated stigma: 12.5% (95% CI 7.6–19.8), highest during diagnosis and care-seeking. Self-stigma: 8.3% (95% CI 4.4–15.0), largely among women (17.5% vs 14.2% men; OR 1.13, p = 1.00). Secondary (family) stigma: 9.2% (95% CI 5.0–16.1). Enacted stigma: 6.7% (95% CI 3.2–13.2). Lower education (≤secondary) showed nearly 1.8-fold higher odds (19.7% vs 11.9%; p = 0.32). Urban residents reported stigma twice as often as rural participants (25.0% vs 13.9%; p = 0.39). Qualitative data revealed fear of contagion, gender-based discrimination, and lack of legal/job protection as core themes.
CONCLUSIONS:
Although overall stigma levels were modest, significant fear and misinformation persist at early stages of the TB-care continuum. Integrating stigma indicators into National TB Elimination Program monitoring, strengthening counseling for women and youth, and scaling community dialogue campaigns are essential to ensure equity, inclusion, and sustainability in TB control within mountainous regions.
Tuberculosis (TB) continues to pose a major public-health challenge in India despite strengthened programmatic efforts. Stigma—often invisible yet powerful—remains a critical barrier to early diagnosis, adherence, and social reintegration. This study quantified the magnitude and determinants of TB-related stigma and explored its social and structural correlates in Himachal Pradesh.
METHODS:
A cross-sectional, mixed-methods study was conducted in 20 clusters across Shimla and Kinnaur districts. Using standardized stigma scales, 380 respondents (120 patients, 120 family members, 120 community residents, 20 health-care workers) were surveyed; qualitative insights were obtained through 24 in-depth interviews and 8 focus-group discussions. Data were analyzed using Epi Info 7 and ATLAS.ti.
RESULTS:
Overall stigma prevalence was 11.3% (95% CI 7.9–15.8) among all respondents. Anticipated stigma: 12.5% (95% CI 7.6–19.8), highest during diagnosis and care-seeking. Self-stigma: 8.3% (95% CI 4.4–15.0), largely among women (17.5% vs 14.2% men; OR 1.13, p = 1.00). Secondary (family) stigma: 9.2% (95% CI 5.0–16.1). Enacted stigma: 6.7% (95% CI 3.2–13.2). Lower education (≤secondary) showed nearly 1.8-fold higher odds (19.7% vs 11.9%; p = 0.32). Urban residents reported stigma twice as often as rural participants (25.0% vs 13.9%; p = 0.39). Qualitative data revealed fear of contagion, gender-based discrimination, and lack of legal/job protection as core themes.
CONCLUSIONS:
Although overall stigma levels were modest, significant fear and misinformation persist at early stages of the TB-care continuum. Integrating stigma indicators into National TB Elimination Program monitoring, strengthening counseling for women and youth, and scaling community dialogue campaigns are essential to ensure equity, inclusion, and sustainability in TB control within mountainous regions.
| eISSN: | 2654-1459 |
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