title: An exploration of the social stigma of tuberculosis in five "municipios" of Nicaragua to reflect on local interventions.
abstract: OBJECTIVE
  The social stigma of tuberculosis is much less studied than those of other diseases such as AIDS or mental problems. However, it has important implications on the affected person's well being and on the epidemic's control. Our study aims at exploring this social stigma in five local health systems of Nicaragua, prior to implementing interventions to reduce it.
  
  
  METHODS
  Through in-depth interviews and focus groups involving stakeholders in the care of people affected by tuberculosis (PATBs), we analysed interactions between PATBs and family members, first line government health services' personnel, and community members.
  
  
  RESULTS
  According to our results, the interaction between stakeholders and PATBs can be described as the intersection between two sets of contradictory feelings and attitudes: (a) feelings of affection and supportive attitudes toward PATBs opposed to the fear of being infected or that PATBs will infect others and, (b) confidence in PATBs considered to be unlucky opposed to mistrust of PATBs considered to be negligent. PATBs react against this mainly by hiding their condition which leads them to a, loss of confidence and depression. This intricate group of feelings and attitudes is influenced by two sets of determinants related to domination and power between stakeholders and issues of knowledge and information.
  
  
  CONCLUSIONS
  Analysing tuberculosis-related social stigma as a social process enabled us to better understand some key social structural factors of health care system's organisation and identify locally acceptable interventions to reduce such stigma. The fact of analysing, in a more thorough study, some interventions in the currently changing social structural context of health care systems in Nicaragua will give us a better insight into the relevance of our analysis and the interventions' effectiveness in reducing the social stigma of tuberculosis.
authors.affiliation: ESP-ULB, Health Policy and Systems, Bruxelles, Belgium. jean.macq@ulb.ac.be
authors.forename: Jean
authors.initials: J
authors.lastname: Macq
authors.forename: Alejandro
authors.initials: A
authors.lastname: Solis
authors.forename: Guillermo
authors.initials: G
authors.lastname: Martinez
authors.forename: Patrick
authors.initials: P
authors.lastname: Martiny
authors.forename: Bruno
authors.initials: B
authors.lastname: Dujardin
mesh_terms: D000328:Adult; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D009111:Local Government; D008297:Male; D009527:Nicaragua; D013240:Stereotyping; D014376:Tuberculosis