An exploration of the causes of tuberculosis stigma in an urban district in Ghana.

SETTING: Shama Ahanta East Metropolitan District, Ghana.
OBJECTIVES: To explore tuberculosis (TB) stigma and to elucidate how it operates in community settings and within the health care system to affect case finding and treatment adherence.
DESIGN: Individual interviews and focus groups with TB patients, health care workers and community members. RESULT: Ten causes of TB stigma emerged from the data: fear of infection, physical frailty, association with human immunodeficiency virus/acquired immune-deficiency syndrome, perceived causes and spread of TB, outdated societal beliefs and practices about TB, public health practice and discourse, health staff's own fear of TB, self-stigmatisation by TB patients, judgement, blaming and shaming TB patients, and past experiences with TB. Fear of infection was identified as the main cause of TB stigma, with an element of fear recognised in all the other nine causes, named the 'moderating elements'. The moderating elements enhance the fear of infection, and fear of infection enhances the moderating elements.
CONCLUSION: The fear attached to TB underlies the beliefs, attitudes, actions and behaviours of the whole community when interacting with patients. These findings will be used to advocate for complete integration of TB services into the general health care system and involvement of community members in TB services in the district.