Tuberculosis is a public health problem of global magnitude. In the U.S. its victims are primarily the poor, foreign immigrants and persons with AIDS. Efforts to control the disease are severely handicapped by the effects of social stigma, and further compounded by issues of race, social class, ethnic stereotypes, immigrant status and HIV co-infection. We will investigate the social dynamics of stigma in relation to TB in two populations particularly affected by all of these issues, Haitians in the U.S. and in Haiti. The study design will enable important comparisons across national settings that highlight the differential effects of political-economic context, as well as comparisons of stigma in a traditional public health clinic and an innovative culturally competent clinic. It will identify differences in stigma dynamics for active disease compared to latent infection, and will measure the impact of stigma on adherence to preventive therapy. Results of the study will enlarge our understanding of the role of social context on stigma enactment, and will help improve illness management strategies. An innovative study design applies the methodology of cultural epidemiology in an interactive quantitative-qualitative approach to developing locally valid measures of illness concepts and behavior. The approach combines the strengths of ethnography with traditional epidemiologic research. We will conduct an ethnography of TB stigma, a cross-cultural epidemiologic study, and a community trial of adherence to preventive therapy. Study sites are Broward County, Florida, and Leogane, Haiti. The methodology has been tested and refined in a broad range of geographic settings and illness problems, including tuberculosis. The research team brings ample qualifications to implement the proposed study, including preliminary studies of stigma and TB among Haitians in South Florida that led to the development of a culturally competent Haitian community clinic. The project has strong support from the Florida Bureau of Tuberculosis Control and Immigrant Health, the Broward County Health Department, Haitian Physicians Abroad and St. Croix Hospital in Haiti. Parallel cultural epidemiologic studies of illness-related stigma are being planned for several other countries. This will provide an opportunity to integrate the Haitian study with a larger, multi-country collaboration. However, this application is designed as a stand-alone project with independent research aims.

Agency
National Institute of Health (NIH)
Institute
Fogarty International Center (FIC)
Type
Research Project (R01)
Project #
3R01TW006320-02S1
Application #
6953519
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Michels, Kathleen M
Project Start
2003-06-01
Project End
2006-05-31
Budget Start
2004-06-01
Budget End
2005-05-31
Support Year
2
Fiscal Year
2004
Total Cost
$45,000
Indirect Cost
Name
University of South Florida
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
069687242
City
Tampa
State
FL
Country
United States
Zip Code
33612
Coreil, Jeannine; Lauzardo, Michael; Heurtelou, Maude (2012) Anticipated tuberculosis stigma among health professionals and Haitian patients in South Florida. J Health Care Poor Underserved 23:636-50
Coreil, Jeannine; Mayard, Gladys; Simpson, Kelly M et al. (2010) Structural forces and the production of TB-related stigma among Haitians in two contexts. Soc Sci Med 71:1409-17
Coreil, Jeannine; Lauzardo, Michael; Clayton, Heather (2010) Stigma and Therapy Completion for Latent Tuberculosis among Haitian-origin Patients. Fla Public Health Rev 7:32-38