Clinical Ramifications of TB Stigma in Baguio City, Philippines

Mary Ann J. Ladia1 and Ann V. Millard2

1Institute of Clinical Epidemiology, National Institutes of Health,
University of the Philippines Manila
2McAllen Campus, School of Public Health, Texas A&M Health Science Center

Objective. Stigmatization due to a disease is a complex process, particularly in the case of tuberculosis (TB) in Baguio City, Philippines. This article reveals findings important to healthcare professionals in the outpatient setting. Complex aspects of stigma vary among people and healthcare professionals in different roles and settings, facilitating behavior that controls TB in some cases and spreads it in others.

Methods. With ethnographic and historical methods, Ladia analyzed a wide range of understandings of 36 healthcare providers and 14 persons affected by TB (PATB). These understandings shape clinical behavior with significant implications for patient outcomes and community health. TB treatment and control historically established concepts and behavioral patterns that have a significant bearing on public understanding today. Comparisons with national survey data supported the analysis.

Results and Conclusions. Sources of varied understandings of TB include the history of sanitaria, poverty, and incomplete dissemination of current scientific information. While some behavior related to stigma could benefit the health of PATB and their household members, the struggle against stigma leads to counterproductive behavior in a number of cases, sometimes spreading disease and sometimes resulting in unnecessary labor and expense. Healthcare providers can provide accurate, accessible, detailed information to address patients’ problems.

Key Words: infectious disease, stigma, tuberculosis, Philippines