From Jharkhand to Tamil Nadu, healthcare providers are adopting a new approach that fights the stigma associated with the disease.
Published on June 17, 2026 | 7:00 am ⚊ Updated on June 17, 2026 | 7:00 am
India has one of the highest burdens of tuberculosis.
summary: A positive TB diagnosis is received with horror in India. Now, public health professionals are approaching testing with the goal of not only contracting the disease, but also avoiding the stigma associated with it.
India remains the TB capital of the world, according to the World Health Organization.
During my fieldwork to understand how TB stigma shapes care-seeking behavior and the measures being adopted to address it, I repeatedly encountered an interesting shift in the way TB screening is organized.
In conversations with frontline health workers in Jharkhand, a senior TB supervisor described how her team stopped advertising independent TB screening campaigns because, as she put it, “the moment TB is announced, people don’t come.” She explained that the fear of being associated with a stigmatized disease made people hesitate to even provide a sputum sample.
Instead, the team is now integrating TB screening into public health screening camps, inviting people to have their blood pressure or blood sugar levels checked. These are services that are actively sought by community members, and carry no social stigma. Once people arrive and participate in the health consultation routine, health workers gently ask about symptoms such as persistent cough, night sweats or unexplained weight loss and, if indicated, suggest a TB screening test.
What was particularly striking was that this adaptation was not unique to one place. Nearly 2,000 kilometers south, at a primary health center in Thogaipadi, Tamil Nadu state, a mid-level health care provider described much the same approach. “When we go directly to people for TB screening, they are hesitant. They worry about what the neighbors will think. But when the mobile clinic comes in to do NCD screening – and we integrate TB screening into that – the stigma is simply not there. The sputum sample comes easily.”
The similarity between these narratives, which emerged independently from very different social and geographical settings, suggests that frontline workers were responding intuitively to the social costs associated with open association with TB. What I observed was not an attempt to hide the purpose of TB testing from people. People knew when they were being screened for the disease, but there was a reshaping of the social context in which screening for TB was done.
When the stigma becomes stronger than the disease
India accounts for more than a quarter of the global burden of TB, both in terms of cases and deaths. However, for every person who presents with a diagnosis, another person turns away because they cannot bear the social consequences of being seen seeking TB care. Decades of associating the disease with poverty, the risk of transmission, and social shame have turned the diagnosis of TB into something to be hidden rather than treated.
Across India, countless stories illustrate the persistent stigma surrounding TB. A positive diagnosis has quietly ended marriages, cost people their livelihoods, and created invisible barriers between people with TB and their families and communities. This fear of discrimination leads to delays in seeking care, diagnosis and treatment, allowing transmission to continue unchecked.
India has invested significantly in strengthening its TB response, expanding access to rapid diagnostics such as GeneXpert devices and scaling up the National TB Elimination Program through multi-stakeholder initiatives such as the TB Mukt Panchayat, the 100 Days TB Campaign, and the Corporate TB Pledge, which encourages companies to create TB-aware, stigma-free workplaces and support employees affected by the disease. These efforts support TB case detection and enhance service delivery. However, stigma remains deeply entrenched, quietly undermining the progress the health system has made and limiting the impact of these investments.
Integrated screening approach for tuberculosis
Integrating TB and NCD screening is not just a workaround. It reflects a clinical reality that has long been underutilized as a strategy.
Diabetes, among India’s fastest-growing health crises, makes a person two to three times more likely to develop active TB. TB, in turn, disrupts blood sugar control, making it more difficult to manage both conditions simultaneously. Similar links exist with high blood pressure, tobacco use, and poor nutrition. These are not parallel epidemics. They are overlapping burdens carried by the same people, housed in the same facilities, and living in the same households.
The World Health Organization has long called for a two-way screening approach in recognition of these interactions. India’s National Tuberculosis Elimination Program has moved in this direction: individuals diagnosed with HIV, diabetes, or some other condition should be screened for TB, and people with TB should be screened for diabetes. This framework is now being encouraged in the workflow of ASHAs, ANMs and mid-level health providers. Studies in low- and middle-income countries, including India, have found that the proportion of people with TB identified through diabetes screening is significantly high, higher than what could be detected through passive case detection alone. But implementation was uneven between states and provinces. Health workers describe competing program requirements, insufficient time during noncommunicable disease clinics to complete TB symptom checklists, and documentation systems that treat the two conditions as two separate administrative universes.
Queue without shame
The communities most affected by TB—remote Adivasi villages, urban slums, and migrant settlements—are precisely the communities most likely to avoid a TB screening campaign. The social cost of appearing there is very high.
The NCD screening camp changes the whole calculus. It brings something people desperately want: a blood pressure reading, a blood sugar test, a moment of attention from the health system that is not fraught with shame. In this queue, people who would have remained invisible to the health system for months, silently coughing, silently losing weight, begin to appear. Taken out of an isolated, self-contained camp, with its separate signs, advertisements, and visual markers, TB screening loses its ability to flag people as different or suspect. Instead of classifying someone as potentially having TB, it becomes a regular component of routine health screening, allowing individuals to engage with the health system without fear of social judgement.
Promote a two-way approach
The insight from Jharkhand and Tamil Nadu points to something that India’s TB elimination strategy must now take seriously. It is necessary to ensure effective implementation of the two-way approach to TB screening. Stigma is not a communication problem that can be solved through better awareness campaigns. It is a structural problem, and it requires structural solutions.
Integrating tuberculosis screening into health screenings for noncommunicable diseases is one such solution. It quietly removes the conditions under which TB stigma operates. When TB screening is routine, unremarkable, and integrated into the normal rhythm of health screening, it ceases to be a marker. When the disease ceases to be a sign of shame, people will seek TB care without fear.
This shift in thinking – from parallel programs to a single integrated workflow for healthcare workers – may be the most important implementation lesson that India’s health system has yet to fully absorb.
(Edited by R. Rajesh Kumar.)
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