Gender and the associations between HIV and TB-related stigma and mental health outcomes among people with Tuberculosis in Botswana

Tuberculosis and HIV are highly stigmatized, and co-infection can result in intersectional stigma worsening mental health outcomes (depression and anxiety). Meanwhile, stigma may be experienced differently by gender. The study aimed to examine the associations between TB and HIV-related stigma and mental health outcomes, and to assess whether gender moderates these relationships among people newly diagnosed with TB in Botswana. Participants were recruited from 12 health centers in Gaborone. Depression, anxiety, TB-related Stigma and HIV-related Stigma were assessed using PHQ-9, the ZUNG Self-Rating Anxiety Scale, the Van-Rie TB-related Stigma Scale and an HIV-related Stigma Scale, respectively. Association between mental health outcomes and TB or HIV-related stigma was examined using linear regression. Moderation analysis was done by using interaction terms. Among 180 participants with TB, 64 (35.6%) were women and 99 (55.0%) had HIV. The association between depression and stigma (TB-related stigma from patient perspective, TB-related stigma from community perspective, HIV-related stigma) did not reach statistical significance after adjusting for confounders ({beta} = 0.12, p = 0.065; {beta} = 0.03, p = 0.7; {beta} = 0.07, p = 0.4, respectively). Similarly, the regression models for anxiety and stigma (TB-related stigma from patient perspective, TB-related community perspectives, HIV-related stigma) also showed no evidence of association in the final models ({beta} = 0.04, p = 0.7; {beta} = -0.11, p = 0.4; {beta} = 0.24, p = 0.14, respectively). Food insecurity showed a positive association with mental health outcomes whereas male gender was associated with lower depression and anxiety. There was no evidence of gender moderation for the association between mental health outcomes and the various stigma types. We recommend that TB programs should be strengthened to address food insecurity as well as other financial and material needs of people with TB and or HIV.