Social Isolation, Social Exclusion and Access to Resources: Mapping the Gendered Impact of TB-related Stigma Among TB Patients in Eastern Cape Province, South Africa.

Background: Stigma and isolation among people living with tuberculosis (PLWTB) is well documented. Poorly understood are the gendered pathways by which TB-related stigma results in isolation or impacts access to resources during one's illness-to-health journey. Methods: We interviewed PLWTB receiving treatment at government clinics in Buffalo City Metro, South Africa. Semi-structured guides explored: TB symptom experiences; access-to-care; treatment motivation; key supporters; and access to mental and tangible resources (MTRs) during illness. Open coding was done inductively, with MTR domains informed by the Network-Individual-Resource Model. Findings were analyzed through a cyclic iterative and deductive process using social isolation and exclusion as interpretive lenses. Memos and pathway mapping examined gendered differences in stigma, isolation, and access to networked MTRs. Results: One-hundred forty-two PLWTB (Men = 93; Women = 61) were interviewed. PLWTB described pervasive TB stigma and isolation. Women described self-isolating in response to enacted and anticipated stigma. Men described active exclusion by friends and family. Women's maintenance of familial ties facilitated access to MTRs while ill. Men's systematic exclusion reduced their agency to access resources. Men and women described regaining of physical strength and recovery of social networks, but also the sustained post-treatment stigma impact. Conclusions: We identified gendered pathways through which TB stigma and isolation affect access to MTRs. For women, stigma led to social isolation, but familial networks maintained access to MTRs, fostering resilience. Men experienced social exclusion, reduced agency to access MTRs, and increased vulnerability during illness. Findings can guide gender-responsive interventions to reduce the impact of TB stigma on health outcomes.