Zimbabwe is intensifying efforts to confront Tuberculosis (TB) stigma and discrimination after new data revealed that thousands of cases went undetected last year, undermining national targets to eliminate the disease.
Health officials say stigma, which is deeply entrenched both in communities and within healthcare systems, is a major barrier to diagnosis and treatment, with serious consequences for public health.
This is why the government, through the Ministry of Health and ChildCare with the National AIDS Council (NAC) is rolling out a National TB Stigma Reduction Plan to reduce discrimination.
Speaking during a district sensitisation programme in Bulawayo last Thursday, officials warned that despite TB being preventable and curable, Zimbabwe continues to record significant infections and deaths annually.
Latest figures show that in 2025, an estimated 35 000 people had TB in Zimbabwe, but only 22 000 were detected and put on treatment, leaving about 13 000 cases “missing” and untreated.
At the same time, between 1 500 and 2 000 people die from TB every year.
Read CITE investigation that exposed the issue: https://cite.org.zw/bulawayos-silent-crisis-patients-defaulting-on-hiv-and-tb-treatment/
“These are people who are out there in the community, not on treatment, and potentially transmitting TB to others,” said Community TB Care Officer in the Ministry of Health and Child Care, Dr Kwenziweyinkosi Ndlovu.
“For us to defeat TB, there are two main things we must do, find all the cases and treat them all. If we don’t, the disease will continue to spread.”
Zimbabwe’s TB burden remains significant, with an incidence rate of about 203 cases per 100 000 people.
“WHO uses mathematical modelling, based on population size and disease burden, to estimate TB cases in each country. For Zimbabwe, the estimated number of people with TB in 2025 was 35 000. Of these, about 22 000 were detected, with 13 000 missing,” Dr Ndlovu said.
The country also faces a high rate of TB and HIV co-infection, with 49 percent of TB patients also living with HIV.
However, officials say the fight against TB is undermined by stigma, which discourages people from seeking testing or adhering to treatment.
Dr Ndlovu said a recent stigma assessment revealed that 40.9 percent of people experience TB-related stigma at community level, including within health facilities themselves.
“That is what shocked us the most. Even in our own health institutions, health workers are contributing to stigma,” he said.
Officials explained that stigma leads people to hide symptoms such as persistent coughing, night sweats, and weight loss, key indicators of TB, rather than seeking medical help.
“Once someone is stigmatised, they won’t come forward,” Dr Ndlovu said.
“Even those already on treatment may stop taking medication or try to hide it, which compromises their recovery.”
TB treatment typically lasts six months and requires strict adherence, often under a directly observed treatment (DOT) system where a health worker or family member makes sure patients take their medication.
“TB is preventable and curable but as long as stigma persists, people will continue to suffer in silence and the disease will continue to spread,” Dr Ndlovu said.
Experts say stigma not only delays diagnosis but also disrupts treatment, increasing the risk of drug-resistant TB and further transmission.
Professor Jephias Matunhu, a consultant involved in developing the National TB Stigma Reduction Plan, said TB remains one of the top 10 causes of death globally and continues to pose a major public health challenge in Zimbabwe.
“This plan is grounded in evidence that stigma, discrimination, violence, and inequality increase vulnerability to TB and create barriers to accessing healthcare,” he said.
The plan aims to scale up human rights-based interventions, reduce stigma and discrimination, and strengthen gender-sensitive responses to TB.
It targets vulnerable groups including women and girls in rural areas, people living in poor conditions, miners, prisoners, migrants, healthcare workers, and people living with HIV.
Prof Matunhu said addressing stigma requires a multi-sectoral approach involving communities, lawmakers, healthcare workers, and civil society.
Among its key strategies are community mobilisation, legal literacy campaigns, training for healthcare workers and law enforcement, and strengthening legal support systems for affected individuals.
The plan also seeks to address gender inequality and gender-based violence, which can further limit access to TB services.
“Arresting stigma requires community involvement and collaboration across sectors,” Prof Matunhu said.
City health officials also highlighted a worrying trend in testing behaviour, noting that many people are more willing to test for HIV than for TB, despite the diseases often being linked.
“HIV and TB are often called the ‘terrible twins,’ but we must correct the misconception that everyone with TB is HIV positive,” Dr Ndlovu said afterwards.
“HIV increases vulnerability to TB, but TB can affect anyone, especially those with weakened immune systems due to poor nutrition, diabetes, or other conditions.”
Zimbabwe has made progress in expanding TB diagnostic capacity, with 188 GeneXpert machines, 21 Truenat machines, and 71 digital X-ray machines deployed across the country.
New technologies, including artificial intelligence-assisted diagnosis, are also being introduced to improve detection rates.
Community health workers remain central to these efforts, contributing significantly to case finding and treatment support.
In 2025, they helped identify over 2 300 TB cases through community screening initiatives.
“About 85 percent of patients on TB treatment are supported at home,” Dr Ndlovu said. “Community health workers and family members play a critical role in adherence.”
Despite these gains, the programme faces serious challenges, including a funding gap of around 60 percent, shortages of healthcare workers and periodic stock-outs of essential medicines.
“Without adequate funding, even the best plans cannot be fully implemented,” Dr Ndlovu said.
It’s always been said that as a country, we are good at planning but in terms of implementation, things are not done. Some have joked that the condition is implementitis.”
Legal experts also explained the importance of protecting the rights of TB patients.
National AIDS Council legal officer, Fanuel Ncube said patients have the right to privacy, access to healthcare, and protection from discrimination.
“It is outright illegal for health professionals to disclose a patient’s health status without consent,” he said.
“Empowering individuals begins with helping them understand their rights and recognise when those rights are violated.”
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