Myassa Kjaerem
Senior Global Medical Advisor, MD. PhD.
According to WHO, an estimated 10.8 million people fell ill with tuberculosis (TB) in 2023, with a total of 8.2 million diagnosed since global monitoring began in 1995 which represented a whole time highest recorded number.
Even though tuberculosis is preventable and treatable, it continues to be one of the world’s deadliest infectious diseases, causing over 1 million deaths every year (1.25 death in 2023 including 161 000 people with HIV) (WHO Tuberculosis report 2024). While advances in diagnostics and treatment have made significant progress, one critical barrier to seeking medical attention remains the: stigma around this infectious disease.
As highlighted in the recent report “Stigma Kills – Why Medicine Alone Won’t End Tuberculosis”, published by, a UK based organization, stigma can delay diagnosis, reduce adherence to treatment, and undermine recovery. This barrier must be addressed alongside preventive and therapeutic medical interventions if we are to improve TB outcomes. The same observations are made by the agency on TB awareness “TB alert” (Stigma and myths - TB AlertTB Alert).
What is stigma and how does it occur?
Stigma can present itself under different forms namely anticipated (fear of being judged/excluded), experienced (actual discrimination, internalized (adopting negative believe but because of a disease) and/or structural (when system or policies unintentionally reinforced barriers to care) tuberculosis patients can experience negative interaction with their community due to fear, misinformation, outdated perceptions or all the above. It can create a feeling of shame, silence, and ultimately prevent people from seeking timely care.
For instance in some regions, such as South Africa, TB stigma is driven and facilitated by fear of disease coupled with an understanding that tuberculosis and HIV are often associated and manifests as anticipated and internalized stigma (DeSanto, 2023).
In other instances, systems or politics in place need implementation of efficient interventions for a better understanding of the reasons behind stigmatization in a community. This is one of the main motivations behind the highlighted commitments and requests at the second UN high-level meeting on TB in 2023 which encouraged “intensification of national efforts to create enabling legal and social policy frameworks to combat inequalities, and to eliminate all forms of TB-related stigma, discrimination and other human rights barriers and violations” (Global tuberculosis report 2023).
A recent study analyzing the relationship between social support and experiencing stigma, showed that “stigmatization level is found to be significantly higher in individuals whose support from family, friends and significant others in their life decreased” (Polat, 2024). This also underlines the importance of the deployment of information campaigns and workshop involving the stigmatized individual and the stakeholders involved in the stigmatisation.
The clinical impact of stigma
In clinical settings, stigma influences health behaviors (Ibrahim, 2025). When people fear being judged or excluded, they may delay stepping in a clinic or hospital and in infectious disease, delays can lead to a more complicated disease management and to increased mental health issues such as anxiety and depression (Saeed, 2020). Multiple health care stakeholders emphasised that psychosocial consequences of stigma reduce access to treatment and should therefore be considered as important social determinant of health (Paterson, 2025).
Patients affected by tuberculosis stigma can impact in several ways:
People may hide symptoms for fear of discrimination, avoid the available screening programs or
stay away from health care centers if they feel not supported by health care providers.
Infectious diseases such as tuberculosis, which can also be latent (asymptomatic but present and infectious), the risk for increasing disease burden is higher.
Even when medical solutions exist, stigma can keep them out of reach and even with the dedication of healthcare professionals uniquely placed to dismantle stigma by their non-biased, empathetic, fact-based approach cannot always reverse or impact the consequence of stigma (Healy, 2022).
In health facilities, the manifestations of stigma are widely documented, ranging from outright denial of care to more subtle forms, such as making certain people wait longer or passing their care off to junior colleagues (Nyblade, 2019).
Improving healthcare professionals’ behavior and improving communication skills can open the door to better understanding (Nyblade, 2009; Ross, 2009; Dodor, 2009).
Nyblade and peers have concluded in an article that draws upon a 2017 international workshop on stigma research and global health and the assessment of 728 peer-reviewed, that “An improved understanding of how health condition stigma is currently addressed in health facilities is needed to identify gaps and areas for investment in stigma reduction, as well as to explore the possibility of concurrently addressing more than one health condition stigma with a joint intervention” (NyBlade, 2019).
Conclusion
In conclusion, clear, accurate language that educates without labelling
Normalize testing and treatment
Encourage open dialogue that positions tuberculosis as a health issue, not a moral failing and understanding the risk management associated with exposition to tuberculosis and finally approaches including policies changes, and facility restructuring are all important considerations to support any stigma prevention intervention.