Ebola Stigma and Its Impact on Outbreak Control: Lessons From Key Informant Interviews in Central Uganda.

Objectives: The 2022 outbreak of Sudan ebolavirus in central Uganda was the country's largest in two decades. It was accompanied by reports of stigma towards affected individuals, households and communities. The objectives of this study were to (1) describe how Ebola disease stigma emerged and manifested during the 2022 Sudan ebolavirus outbreak in central Uganda, (2) examine its impacts, including on outbreak control and (3) identify insights that could inform stigma reduction strategies in future outbreaks.

Methods: We conducted qualitative in-depth interviews with 12 key informants involved in the Ebola disease outbreak response using Microsoft Teams. Participants included frontline healthcare workers, burial team members, psychosocial support staff, survivor programme staff, village health team members, local outbreak response leadership and Ebola survivors. Transcribed interviews were coded in NVivo Release 1.7.2 and analysed using framework analysis.

Results: Contextual drivers of stigma included mistrust of authorities, limited knowledge about the disease and conspicuous survivor follow-up. These drivers fuelled negative thoughts and emotions, predominantly blame and fear. Interviewees described how stigma manifested as negative attitudes, verbal and physical harm, unwarranted avoidance and structural disadvantage, which persisted beyond the outbreak itself. Stigma was seen to impact outbreak control by discouraging symptom reporting, delaying care-seeking and exacerbating workforce shortages in clinical centres. Factors that mitigated stigma included psychosocial support and survivor advocacy.

Conclusions: Ebola-related stigma complicates outbreak control and has adverse psychosocial effects that linger long after the outbreak is declared over. We provide a range of multilevel strategies for reducing stigma, including engagement with trusted community leaders, survivor-centred support systems and provision of psychological support for responders.