Stigmatization and discrimination of female tuberculosis patients in Kyrgyzstan - a phenomenological study.

Introduction: The Republic of Kyrgyzstan is among the 30 countries with the highest burden of multidrug-resistant Tuberculosis worldwide. One of the reasons is widespread stigmatization and discrimination. As previous research has shown, particularly women experience stigma while its impact on their life and (mental) health is even greater than for men. This is the first phenomenological study to explore women's lived experiences of TB-related stigmatization in Kyrgyzstan. This study aims to raise awareness about the gender-specific impact of stigmatization and discrimination.

Methodology: Descriptive phenomenology was used. 15 semi-structured in-depth interviews with female TB-patients were conducted between 28th May and 14th June 2024. Themes were stigma experiences, their consequences and coping strategies. Participants were recruited from two TB Hospitals and two Family Medical Centers (primary health care units) in Bishkek through purposive sampling. The data analysis followed a thematic approach based on a combination of deductive and inductive coding.

Results: 14 of 15 participants experienced stigmatization and discrimination in one way or another. Anticipated stigma was very prominent, manifesting in non-disclosure of the diagnosis apart from close family. Enacted stigma mostly occurred within society or non-TB-specialized healthcare facilities. Self-stigmatization often followed anticipated and enacted stigma. Stigma experiences impacted daily and social life, marital prospects and access to educational and work opportunities but mainly led to mental health issues, which 12 of 15 participants reported.

Discussion: and Conclusion. In contrast to previous research, this study did not find diagnostic delay nor non-adherence to treatment because of stigmatization and discrimination. However, experiences within the healthcare facilities impacted the perceived quality of care. Stigmatization within the family, mostly by in-laws, was anchored in the patriarchal and conservative attitudes of Kyrgyz society. Overall, key findings of this study were widespread lack of knowledge about the disease and its transmission as a reason for and mental health issues because of stigmatization and discrimination. The findings imply the need for intervention strategies and policies focusing on education about TB, integration of psychosocial support into treatment and improvements in quality of care. Altogether, this could contribute to the reduction of TB-related stigmatization and discrimination which would reduce the individual burden of TB.