The Long Walk: Women with Tuberculosis in Enugu South Speak Up Against the Cost of Stigma

By Precious Nwonu

By admin , in Ignite Inside stories , at December 7, 2025

Sandra (not her real name) still recalls the shock that came with her tuberculosis diagnosis. When she turned 25 years, she had to come to terms with her unexpected health status. She was told she has tuberculosis. “It was hard initially”, she recalls. “In this country, when you’re diagnosed with TB, it’s like a death sentence more like having HIV. It’s really disturbing,” she said, her voice heavy with emotion. “But after some counselling from the health team, I discovered it’s curable. It’s not a do-or-die affair. Once you’re taking your medication and you’re constant with your drugs, you will recover in no time. It was hard at the initial stage for me, accepting my TB status.”

Sandra said she had mistaken the symptoms for an ordinary cough at first. “At first, I thought it was a normal cough, so I was taking antibiotics, but after two days it came back. It became persistent, so I had to go to the health facility to run a test to know what was wrong. That was where I was diagnosed with TB, and I was given TB drugs to start treatment,” she explained.

She recalled that life changed almost immediately after her diagnosis, especially her relationship with friends. “When people discovered, most especially my friends, that I had TB, I was treated poorly by them. Most of them kept their distance from me. With their action, it became clear to me they were not really my friends. They were there to benefit from what I was offering them but left me when I was battling with TB at the initial stage,” she said sadly. “Apart from my friends, people around me avoided me because they were scared they would contract the disease if they interacted with me. When they wanted to talk to me, they stayed at a distance.”

The experience, Sandra said, was painful but also eye-opening. “I really felt pained by their actions, and this has really taught me not to stigmatise people because of their TB status. I used to be like that until it happened to me, and now I’ve learnt my lesson,” she admitted.

Sandra takes her monthly medication at the Enugu State Medical Centre (ENMC), about 20.5 kilometres — a 37-minute ride — from her home in Akegbe-Ugwu, Nkanu West. “Yes, the distance from my place to the medical centre is far. I spend over one thousand naira on transport and also the time I have to spend going there,” she said. “The day I plan to visit the health centre to take my drugs, I don’t plan to do any other thing that day because of the time it takes. But I feel safe getting care that’s a bit distant from the community where I reside.”

She also described some of the physical side effects she experienced while on treatment. “Other challenges I was facing were that, while taking the drugs, I would sometimes feel dizzy or have headaches. When I complained to the DOT officer, they told me the drugs were reactive and doing their work hence the changes in my body system. They said if I continued taking them, it would stop, and truly, it stopped about two to three months after I started,” she recounted.

Sandra believes fighting stigma against female TB patients requires both support and awareness. “Women need to be constantly reminded that having TB is not a death sentence. It’s very important for them to complete their dosage. Also, more awareness needs to be done in the public to let people know about the disease and that it’s not proper to stigmatise those who have it,” she advised.

Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. According to the World Health Organization (WHO), it “most often affects the lungs” but can also impact other parts of the body. In Nigeria, the National Tuberculosis and Leprosy Control Programme (NTBLCP) was established to coordinate efforts against TB (alongside leprosy) and thereby reduce the burden of disease in the country.

The causes of TB lie in infection with the Mycobacterium tuberculosis bacterium. Per WHO, TB is “spread through the air when people with TB cough, sneeze or spit.” When someone inhales even a few of these airborne germs, they can become infected. Not everyone who is infected becomes sick: some people carry the bacteria in a latent state (they are not ill and cannot spread it), while others develop active disease when the bacteria multiply and overcome the body’s defences. Transmission of TB requires respiratory exposure in most cases. According to the U.S. Centers for Disease Control and Prevention summary, TB germs “can get into the air when a person with active TB disease of the lungs or throat coughs, speaks, or sings.” Because of this, “close and prolonged contact” with a person with untreated active lung TB increases the risk of catching TB.

According to a report by the Global Fund to Fight AIDS, Tuberculosis and Malaria, Nigeria is one of the top ten countries in the world with the highest number of tuberculosis (TB) cases, recording over 200,000 new infections each year. Treatment coverage has improved from about 24 percent in 2019 to around 40 percent in 2021, and ongoing efforts supported by the Global Fund aim to further expand TB diagnosis and patient enrollment for treatment.

Stigma around TB affects everyone, but it often hits women harder. In many communities, women are expected to look after their families and keep the home healthy. When a woman is diagnosed with TB, people may see her as “unclean” or as someone who has failed in her role. Some even wrongly believe she also has HIV because the two diseases are often linked in people’s minds. This kind of thinking makes women feel ashamed and afraid to speak up or seek help. Because of this fear, many women delay going to the hospital when they start coughing or feeling weak. They hide their symptoms so that neighbours or relatives won’t suspect anything or they travel a distance to treat themselves to avoid the gossip in their community. Health experts say this delay makes the illness worse and also puts others at risk of infection.

The NTBLCP reports that stigma remains one of the biggest reasons people refuse to get tested or complete their treatment. Stigma also brings social and emotional pain. Some women are avoided by friends and neighbours after their diagnosis. Others are abandoned by their partners or lose their jobs. This rejection can lead to sadness, loneliness, and even depression. Women who depend on others financially may struggle to pay for transport to health centres or to take care of their children while on treatment. Because of the shame and fear of being recognised at the clinic, some women stop taking their medication or travel far away for treatment.

The NTBLCP and the Nigeria Centre for Disease Control (NCDC) say fighting this stigma is just as important as giving medicine. They call for more awareness in communities to let people know that TB is curable, and having it should never be a reason to discriminate against anyone.

To understand how stigma affects women with tuberculosis across different societies, several studies have explored the issue from various perspectives. A study titled “Stigmatization and Discrimination of Female Tuberculosis Patients in Kyrgyzstan – A Phenomenological Study,” published in the International Journal for Equity in Health (Vol. 24, 185, July 2025), reveals that the discrimination and stigmatization female TB patients face, mostly from in-laws, are rooted in the patriarchal and conservative attitudes of Kyrgyz society, which negatively affect their mental health.

Similarly, in another study titled “Stigma among Tuberculosis Patients and Associated Factors in Urban Slum Populations in Uganda,” published in the International Journal for Africa Health Sciences (December 2021), it was revealed that stigma toward TB was high in the urban population of Uganda. The study found that stigma was mainly associated with knowing someone who had died of TB, perceiving TB symptoms as similar to HIV/AIDS, and having previous TB treatment.

In India, the study “Wounds Beyond Treatment! Women with TB Face Social Rejection,” conducted by King George’s Medical University (KGMU) and published in the Journal of Associations of Chest Physicians, highlighted the deep social stigma faced by women with TB in Lucknow. The research, which examined 960 new female TB cases under the National Tuberculosis Elimination Programme (NTEP), found that 10% of marriages involving female TB patients ended in divorce—particularly among younger women—while 40% of unmarried women were denied marriage after diagnosis. It also showed that 25% of women felt isolated in their own homes, 18% were rejected by their husbands or in-laws, and 10% ultimately faced divorce, revealing the intense social rejection and emotional suffering women with TB endure.

Looking beyond TB, a related study on women’s health stigma titled “The Stigma of Reproductive Health Services Utilization by Unmarried Women,” published in March 2016 in the National Library of Medicine Journal, revealed that society often links reproductive health issues with sexual activity. This association creates stigma and limits unmarried women’s access to reproductive health and welfare.

Far from Home: Why Women in Enugu South Travel Miles to Hide Their TB Fears

Margret, a widow and petty trader, began experiencing serious leg pain that made it difficult for her to walk or carry out her daily activities. Her children had to assist her at home. At first, she thought she had been poisoned and started taking medication for poison, but the pain persisted. A neighbour whose brother worked in a hospital advised her to visit the facility for proper diagnosis. It was there she was diagnosed with tuberculosis.

Margret, who pleaded for anonymity, said she was given supplements to take alongside her TB drugs but could not afford them. “I was told the supplement would help me recover faster, but I can’t afford it,” she said, her voice laced with desperation.

Like Sandra, Margret travels a distance for her treatment. She visits the Eastern Nigeria Medical Center (ENMC) in Enugu monthly for her drugs. “The distance is far, and transportation is a challenge. Sometimes I have to borrow money to come here,” she said.

Ebube, a trader in her early forties, travels 25.2 kilometres to the Eastern Nigeria Medical Center (ENMC) for treatment. “People around me where I live knew I had TB. They saw the pain I went through before my diagnosis, but they didn’t avoid me. Instead, they showed love, care, and concern,” she said, grateful for the support.

Ebube believes more awareness is needed to reduce stigma around TB. “I think more awareness should be created so that people will know about the disease and not be scared of those who have it,” she said.

Dr. Odo Chidebere, Programme Manager for TB, Leprosy, and Buruli Ulcer Control Programme, Enugu State Ministry of Health, explained that TB cases are rising in Enugu, and the disease is highly communicable. “The burden of TB is high not only in Enugu but across Nigeria as a whole,” she said.

Justina Odoh, TB Focal Person for Enugu South LGA, emphasized the need for awareness and education. “We keep going out to create awareness and conduct case searches in communities, churches, markets, etc., to let people know about this disease,” she said.

The stories of Sandra, Margret, and Ebube highlight the urgent need for support and understanding. TB is not a death sentence; it is a curable disease. However, stigma, fear, and lack of access to care perpetuate the cycle of suffering.

As Dr. Odo notes, “Stigmatization is really a challenge because people feel that just talking with someone with TB will infect them… It’s a fight — we create awareness so that people will know it’s not by hugging, talking, kissing, or shaking someone infected.”

The time for change is now. We must break the silence surrounding TB, challenge stigma, and support women like Sandra, Margret, and Ebube. Together, we can create a world where TB is no longer a source of shame, but a reminder of our shared humanity and resilience.