Intersectional dimensions of stigma in neglected tropical diseases: a systematic review of evidence and implications for equity-based health policy.

BACKGROUND:

Neglected tropical diseases (NTDs) are profoundly rooted in social inequalities, yet limited works have explored how intersecting identities and structural conditions jointly shape stigma and its consequences. This review combined qualitative and mixed-method studies to explore the interaction between social identities such as gender, ethnicity, caste, migration status, disability, and socioeconomic status to produce compounded stigma among affected people by NTDs, and the implications for health-seeking behaviour, social inclusion, and equity-oriented policy design. This systematic review was synthesised to explore how intersecting social identities compound stigma and influence health-seeking behaviour, social exclusion, and policy needs among people affected by NTDs.

METHODS:

Thematic synthesis was conducted using a detailed data extraction table that captured authorship, theoretical frameworks, intersecting identities, stigma mechanisms, health-seeking trajectories, social participation, and policy recommendations across the included studies. A comprehensive search across major electronic databases, including PubMed, CINAHL, PsycINFO, Scopus, and Global Health, complemented by manual searches and citation tracking process, identified relevant studies. After conducting a multi-stage screening process, thirty studies met the eligibility criteria. An inductive coding was performed, followed by integration with an intersectional analytic lens to identify cross-cutting patterns. Themes were developed cyclically and summarised into four higher domains.

RESULT:

Stigma was consistently constructed in the interplay between multiple social identities and structural constraints. This review identified distinct, intersecting barriers that defined the experience of stigma, such as gendered expectations, cultural beliefs of illness as impurity or immorality, caste and ethnic hierarchies, migration status, grade of disability, and poverty. All these combined to compound the stigma that resulted in delayed or avoided care, discriminatory provider interactions, reduced social participation, and emotional distress.

CONCLUSION:

Stigma related to NTDs is best understood as a product of intersecting identities embedded within broader social and structural conditions. To address its effects, it is necessary to move beyond individual-level interventions toward multisectoral, structurally informed, equity-focused strategies that engage with gender norms, poverty, discrimination, and health-system barriers.