Living with "TB of the Bones": Health-Related Stigma in a HIV Prevalence Area Before and After Public Health Intervention

Abstract

Tuberculosis has been called “a social disease with a medical aspect,” yet the impact of behavioral change in combating its spread has not been fully explored (Fanning 2008). It is estimated that one-third of the world’s population is infected with tuberculosis (TB), an opportunistic infection that has become more widespread in countries that also carry a heavy HIV burden. This includes sub-Saharan countries, such as Zambia, which has one of the highest TB and HIV incidence rates in Africa. The combined presence of HIV and TB has a deleterious effect on the physical, social, and economic well-being of a population. Despite widespread medical interventions that exist to mitigate transmission of these diseases, sociocultural barriers caused by stigmatizing these diseases has prevented their diagnosis and treatment in low-resource settings. Based on fieldwork conducted in Lusaka, Zambia, this dissertation research provided the unique opportunity to examine the impact of a suite of intervention strategies pre- and post-intervention in two communities to determine the long-term efficacy of public health promotion targeting stigma. These intervention strategies and their effect on misconceptions of stigmatized diseases are explored in this research using a mixed methods approach combining spatial analysis, statistical modeling, and ethnographic data. This dissertation research highlights the need for on-going, multifaceted health promotion activities to combat stigmatized diseases in low-resource settings.