Addressing Gender Inequalities in Tuberculosis: A Conversation with Dr. Zolelwa Sifumba

While tuberculosis affects more men than women globally, it can have severe consequences for women, particularly during pregnancy and the reproductive years. A vast majority of deaths from TB occur in countries where gender inequalities are also prevalent. TB has an outsized impact on vulnerable groups – including those with other diseases like HIV/AIDS – but as an airborne disease it can strike anyone, anywhere.  

Dr. Zolelwa Sifumba, a doctor in Cape Town, South Africa, and one of the Global Fund’s Faces of the Fight, recently spoke to Friends about her unique journey overcoming TB, the various challenges she faced and how the global health community can do more to combat TB as a widespread threat to women worldwide. 

Q:  Can you talk about how you contracted TB? What was the recovery like for you?  

A: I contracted TB during my clinical rotation in the ward of GF Jooste Hospital in Cape Town. After discovering a lump on my neck, I decided to see my doctor who did a biopsy. When my results came back, I received a call and was diagnosed with multi-drug resistant TB. The most challenging part of my journey to becoming TB free was my treatment, which lasted 18 months. Going through treatment was very challenging. I had to take 21 pills a day and receive injections. I suffered from various side effects such as nausea, vomiting, diarrhea and joint pain. While this experience was challenging, I am grateful for the many TB survivors who supported and encouraged me along the way. This experience taught me how to use my voice as an advocate. 

Q: Generally, women with TB face stigma and discrimination. Is that something you experienced or have witnessed? If so, can you elaborate?

A: The most significant stigma associated with tuberculosis is [the idea] that everyone who has it is infected with HIV/AIDS. For example, many people assumed that I was HIV positive because of my MDR-TB diagnosis, but that was not the case as I contracted MDR-TB through occupational exposure. Some other challenges I encountered were being isolated from my friends, family, and confusion about whether or not I would continue to pursue my medical career. 

Q: Do you see men and women being treated differently in the way TB is diagnosed and treated? If so, what steps can health providers or global health institutions like The Global Fund take to address gender inequalities in TB diagnosis and treatment delivery?

A: I think global health institutions can do a better job of addressing the attitudes that female workers have towards women seeking treatment and care for tuberculosis. For example, I felt like there were times that I had had to hide my TB diagnosis to ensure that I felt comfortable seeking care.  I believe that these intuitions can do a better job of educating the community and healthcare workers by dispelling the myths that exist around TB. People must realize that TB is not a dirty disease, and anyone can contract it from just breathing, but it can be treated and cured. 

Q: What was it like going from being the doctor treating others to a patient with a life-threatening disease? 

A: I was still a medical student when I contracted MDR-TB. However, it was quite the adjustment going from a medical student to a patient. To be honest, I never thought that I would contract TB, but my diagnosis with MDR-TB made me more a humble and patient person. It also forced me to remember that I am a human being. It gave me insight into how the patients I saw were feeling, and the difficulties they experienced in navigating TB treatment and care. I also use my experience as a TB survivor to encourage TB patients and remind them that they will be able to get through this challenging time. Although I no longer have MDR-TB, I am still afraid that I may get TB again. Because of this fear, I am in the process of deciding if I will continue to work in clinical medicine. 

QGiven your experience, what do you want people to know about TB? 

AThe one thing I would want people to know about TB is that anyone can get it. We all breathe and are at risk. No one is invincible.

Portions of this interview have been edited for length and clarity.