02308nas a2200349   4500000000100000008004100001653001700042653002200059653001600081653001400097653000900111653001100120653001000131653001100141653001100152653001300163653001500176100001200191700001500203700001200218700001100230700001200241700001100253700001600264700001500280700001400295245010700309300001100416490000700427520151000434022001401944       2008                            d10aTuberculosis10aSocial Perception10aSex Factors10aPrejudice10aMale10aMalawi10aIndia10aHumans10aFemale10aColombia10aBangladesh1 aSomma D1 aThomas B E1 aKarim F1 aKemp J1 aArias N1 aAuer C1 aGosoniu G D1 aAbouihia A1 aWeiss M G00aGender and socio-cultural determinants of TB-related stigma in Bangladesh, India, Malawi and Colombia.  a856-660 v123 a<p><strong>SETTING: </strong>Tuberculosis (TB) control programmes in Bangladesh, India, Malawi and Colombia.</p>

<p><strong>OBJECTIVE: </strong>Assess indicators of TB-related stigma and socio-cultural and gender-related features of illness associated with stigma.</p>

<p><strong>DESIGN: </strong>Semi-structured Explanatory Model Interview Catalogue (EMIC) interviews were administered to 100 or more patients at each site, assessing categories of distress, perceived causes and help seeking. Indicators of self-perceived stigma were analysed individually and in a validated index, which was compared across sites and between men and women at each site. Cultural epidemiological explanatory variables for stigma and interactions with female sex were analysed at each site. Qualitative illness narratives were examined to explain the role and context of explanatory variables.</p>

<p><strong>RESULTS: </strong>The overall stigma index was highest in India, lowest in Malawi and greater for women in Bangladesh. In India and Malawi, women were more likely to be concerned about impact on marital prospects. Associations with HIV/AIDS were linked to TB stigma in Malawi, where sexual contact as a perceived cause was more associated with stigma for men and less for women.</p>

<p><strong>CONCLUSION: </strong>Stigma both influences and indicates the effectiveness of TB control. Cultural epidemiological methods clarify cross-cutting and local features of stigma and gender for TB control.</p>
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