TB’s AIDS link stigma stopping people seeking treatment in Kenya

The taboo subject of TB infection being linked to AIDS and HIV is a major obstacle to persuading people to seek early diagnosis and treatment in Kenya warn health experts.

Eleven per cent of Kenyans say they would want a family member's TB infection kept secret because of stigma, according to the Kenya AIDS Indicator Survey,The East African country ranks 13th on the United Nations World Health Organisation's list of 22 high-burden TB countries in the world, and is the fifth highest in Africa. In 2008, the country had about 132,000 new cases.

When Dorothy, a single mother of five, told her neighbours in the capital, Nairobi, she had tuberculosis (TB), she found herself so severely ostracized, she felt she had to move out. "The kind of discrimination I faced from my neighbours made me regret [sharing] my condition with them,” she told the United Nations news service, IRIN. “I could not even share the [communal] sink. Yes, tuberculosis is very infectious, but those who have it are not death traps."

Many people in Kenya still believe only people with HIV have tuberculosis and for this reason they shy away from seeking diagnostic tests for TB, believing if they are found to have it, then it automatically means they are also HIV-positive. But by those infected not seeking treatment due to stigma, everybody is at greater risk and dropping out of treatment can be expensive because it makes the patient more likely to become drug resistant. Some of the main causes of TB-related stigma were: fear of infection; TB's association with HIV; health staff's own fears; self-stigmatization by TB patients; and the blaming and shaming of TB patients by the public, found research carried out in Ghana in 2008.

While Kenya has successfully integrated HIV and TB services at the testing level, TB counselling still trails behind counselling for HIV. "We have done well in offering HIV testing and counselling and diagnosis of TB, but not much has happened in trying to offer counselling services to people with TB," said Nicholas Muraguri, head of the National AIDS and Sexually Transmitted Infections Control Programme. "This is crucial and possible because it can easily be done within the voluntary testing and counselling facilities."

Education about TB is crucial to provide a better understanding of the disease and improve people’s likelihood of seeking treatment early on, say experts. And with proper counselling, people are better placed to understand their own situation and that of others.

By Hayley Jarvis for SOS Children