Tuberculosis and COVID-19 related stigma: Portuguese patients experiences.

Abstract

Stigmatization of tuberculosis (TB) patients is well-documented, and several health-related organizations have also reported the stigmatization of COVID-19 patients. Because stigmatization can have many adverse consequences, we performed a qualitative study to evaluate the stigmatization of TB and COVID-19 patients. We examined changes in stigmatization throughout the pandemic; perceptions of stigmatization by patients with these diseases before and during COVID-19 pandemic; and differences in stigmatization perceived by individuals who had both diseases. A semi-structured interview was developed based on the available literature, and was administered to a convenience sample during April 2022. All participants were adults who have/had pulmonary TB and/or COVID-19, and were from a single Portuguese Outpatient TB Center. All participants provided written informed consent. Patients who had latent TB, asymptomatic TB, or asymptomatic COVID-19 were excluded. Data were analyzed using thematic analysis. We interviewed 9 patients (6 females and 3 males; median age: 51±14.7 years-old). Three had TB and COVID-19, 4 had TB alone, and 2 had COVID-19 alone. Interviews allowed to identify 8 main themes: knowledge and beliefs, with several misconceptions identification; attitudes towards the disease, from social support to exclusion; knowledge and education, assumed to be very important; internalized stigmatization, with self-rejection; experience of stigmatization, with discrimination episodes; anticipated stigmatization, with modifying actions for prevention; perceived stigmatization, in which judgment by others prevailed; and temporal changes in stigmatization. Individuals who had TB or COVID-19 reported they were stigmatized. De-stigmatization of these diseases is crucial for improving the well-being of affected patients.