In recent years renewed interest in health-related stigma has underscored the importance of better understanding the structural underpinnings of stigma processes. This study investigated the influence of sociocultural context on perceived components of tuberculosis-related stigma in non-affected persons by comparing Haitians living in South Florida, USA, with Haitians residing in Léogane Commune, Haiti. Using the methods of cultural epidemiology, a two-phase study based on fieldwork between 2004 and 2007 collected ethnographic data on the cultural context and components of tuberculosis (TB) stigma, and administered a stigma scale developed specifically for these populations. Thematic analysis of stigma components expressed in interviews, focus groups and observation revealed commonalities as well as distinctive emphases of TB stigma in the two comparison groups. Factor analyses of stigma scale scores confirmed the thematic differences revealed in ethnographic findings and highlight the influence of political and economic factors in shaping the meaning and experience of illness. Perceived components of TB stigma among Haitians in South Florida incorporated aspects of Haitian identity as a negatively stereotyped minority community within the larger society, while in Haiti, stigma was associated primarily with poverty, malnutrition, and HIV co-infection. Discussion of findings focuses on the social production of perceived and anticipated stigma as it is influenced by structural forces including the influences of politics, economics, institutional policies, and health service delivery structures. The findings also demonstrate the value of a transnational framework encompassing both sending and receiving countries for understanding TB-related stigma in immigrant communities. © 2010 Elsevier Ltd.

Cultural epidemiology Haitians Haiti Stigma Tuberculosis immigrant communities USA

information processing cultural anthropology perception immigrant social psychology Human immunodeficiency virus infection poverty Stereotyping Factor Analysis, Statistical human factor analysis epidemiology social isolation ethnic group controlled study ethnology cultural competence qualitative research Confidentiality Haiti attitude to illness United States Florida Humans psychology Cross-Cultural Comparison lung tuberculosis male Tuberculosis, Pulmonary female Socioeconomic Factors tuberculosis ethnography socioeconomics cultural factor stigma health services Article thematic analysis adult politics tuberculosis control malnutrition Florida [United States] Social Perception Anthropology, Cultural factorial analysis Leogane social discrimination fieldwork Focus Groups mixed infection health care delivery immigrant population