Stigma and Confidentiality

Community HIV stigma was the strongest and most consistent correlate of community TB stigma. More than half of people living with HIV globally report experiencing stigma, according to a 2014 systematic review. The association between HIV stigma and TB stigma differed by community type. HIV-related stigma operates through externalised and internalised pathways. Parents often encouraged participants not to disclose their HIV status at school. Fear of being seen as contagious contributed to concealment strategies. TB and HIV stigma are linked partly because TB is socially conflated with HIV in South Africa. Gender shaped confidentiality concerns, including fears about paternal reactions and marriage prospects. Stigma and shame were prominent in participants' accounts. Externalised stigma produces discrimination, social isolation, and fear of judgement or rejection. Internalised stigma is associated with maladaptive coping, self-blame, loneliness, rumination, reduced resilience, diminished control, and lower life satisfaction. Stigmatised attitudes and discriminatory practices among some healthcare providers can reduce care quality, quality of life, and ART adherence. Secrecy was the…