Breaking TB Myths and Stigma through Village Health Workers and Civil Society in Zimbabwe

A Stop TB Partnership Technical Brief on Community, Rights and Gender notes that stigma and discrimination discourage the seeking and uptake of TB testing and treatment services. For people with HIV-TB co-infection, TB-related stigma may be exacerbated by HIV-related stigma. It adds that respect for the right to privacy and confidentiality of people with TB is key to combatting stigma and discrimination, particularly in health care, employment, and education.

Susan Alfansi, a resident of Harare, Zimbabwe, shared her experience, saying, “The local civil society and public health workers are educating us on how to take TB medicines for TB prevention and its benefits. They also address myths and misconceptions and conduct follow-up visits to check drug adherence in family households.” Susan’s journey began when her husband received a TB diagnosis.

Living in Harare, Susan, a 30-year-old homemaker, supports her family of four through small-scale vending to generate income. In October 2021, she was devastated to learn of her husband’s TB diagnosis, which triggered fear and anxiety due to the pervasive myths surrounding TB as a deadly and incurable disease.

However, government village health workers, conducting TB awareness and outreach programs in her community, played a vital role in dispelling these fears. They reassured Susan that her husband could be cured and that TB was not a death sentence, contrary to the rumours circulating in her community. They also educated Susan about the benefits of TB preventive therapy, including regimens such as isoniazid preventive therapy (IPT) and newer short-course regimens like 3HP.

Susan shared, “The moment I heard that my husband was diagnosed with TB, I was very afraid that he was going to die. But thanks to the village health workers who educated our family, I am no longer afraid of the disease and now understand that it is preventable. Health workers guided and initiated me on INH (isoniazid) so that TB does not spread further to the children.” She mentioned that while she experienced dizziness as a side effect of INH, she was determined to complete the treatment by April 2022.

Despite her newfound knowledge and courage, Susan remains concerned about the stigma and myths surrounding TB, which are prevalent in Zimbabwean communities and households. These myths, including the belief that one should not share utensils or a room with a TB patient, continue to hinder efforts to prevent TB at the household level and negatively impact those eligible for TB preventive therapy.

“I too believed in those myths of not sharing a room with a TB patient. I moved out of the bedroom when my husband was diagnosed. Luckily, the village health workers advised me that this was not necessary and that my actions could seriously impact my husband’s treatment outcomes. Sometimes we do things unknowingly,” she shared.

Susan emphasizes the critical importance of TB preventive therapy for Zimbabwean TB household contacts, as it plays a crucial role in preventing the disease from spreading. She commends the efforts of community health workers and local NGOs, such as the Jointed Hands Welfare Organization (JHWO), for raising awareness about TB preventive therapy, particularly the use of shorter regimens like 3HP.

However, Susan points out that there are still challenges to address, including the lack of food, nutritional support, and money for transportation. She urges continued efforts to overcome these obstacles and expand TB preventive therapy access.

Facts: According to a Zimbabwe 2021 Country Operational Plan (COP) by the United States Presidential Emergency Plan for AIDS Relief (PEPFAR), during COP19, a total of 120,939 People Living with HIV (PLHIV) completed TPT in PEPFAR-supported districts, with a completion rate of 83.9%. This marked a significant increase from the 39,541 individuals who completed TPT in COP18. In 2014, a study conducted in Zimbabwe revealed that only half of patients received IPT due to inadequate advocacy, community sensitization, formally trained staff, education, and communication materials, and IPT stocks. These challenges persist today, emphasizing the need for comprehensive planning and addressing these components for successful TPT scale-up.