Stigma and Tuberculosis in Haitian Populations: A cross-national study of the impact of stigma on patient experience and clinical outcomes in Haiti and the United States, 2003-2008

Tuberculosis (TB) is a public health problem of global magnitude. In the United States its victims are primarily the poor, foreign immigrants, and persons with AIDS. Efforts to control the disease are severely handicapped by the effects of social stigma and further compounded by issues of race, social class, ethnic stereotypes, immigrant status, and HIV coinfection. The study investigated the social dynamics of stigma in relation to TB in two populations particularly affected by all of these issues, Haitians in the United States and in Haiti. The theoretical framework of the study was cultural epidemiology, which combines quantitative and qualitative measures to study experience, meaning, and behavior in subpopulations of interest. The study design enabled important comparisons across national settings that highlight the differential effects of political-economic context, differences in stigma dynamics for active disease compared to latent infection, and measured the impact of stigma on adherence to preventive therapy. Study components included an ethnography of TB stigma, a cross-cultural epidemiologic study, and a community trial of adherence to preventive therapy. Study sites were South Florida, United States, and Leogane, Haiti. The study aimed to investigate: (1) differences in the degree and components of stigma across different sociocultural settings and comparison groups (community members, health care providers, patients); (2) differential stigma effects in a public vs. private, culturally competent clinic; (3) correlates of TB-related stigma; and (4) the influence of perceived stigma on adherence to latent tuberculosis therapy. Data were collected between 2003-2006 in three phases: Phase I Ethnographic Research; Phase II Cultural Epidemiologic Study; and Phase III Adherence Study. A total of 768 persons were interviewed, including 408 women (53 percent) and 360 men (47 percent). All study aims were completed with the exception of No. 2, which was not possible due to the closure of the Haitian Community Clinic in South Florida. The study consists of data from community, patient, and provider interviews. Demographic variables include sex, age, primary language, education level, employment status, marital status, and religion.