“I was worried to be discriminated against,” shares our anonymous community member, who recently completed treatment for TB. “Even if people find out now that I’m TB-free, I worry they will still be distant towards me because they might think I still have it.” In Ketchikan, Alaska, amidst the challenges of weather and isolation, a community member faced a health diagnosis that brought not just medical concerns but cultural ones too. Tuberculosis (TB), a disease surrounded by misconception and stigma, became an unexpected part of their journey.
Tuberculosis remains the number one infectious disease globally, with 10.8 million people becoming sick with TB in 2023 alone (WHO, 2024). The World Health Organization estimates that one-quarter of the world’s population has latent or active TB. These numbers are staggering, and stigma often acts as a barrier to individuals accessing TB care and support services. Within the United States, TB disproportionately affects Asian American communities, with Filipinos having TB rates approximately 30 times higher than U.S.-born white persons, according to CDC data. In 2022, Asian Americans accounted for 36% of all TB cases in the US despite representing only about 6% of the population (CDC, 2023).
The interviewee chose to keep their diagnosis private, sharing it with healthcare providers and one trusted community health liaison. “I didn’t even tell my close friends or family,” they explained. “I just don’t want them to worry about me. I’m worried they might think I’m disgusting.”
The Treatment Journey
One of the biggest misconceptions about tuberculosis is the difference between active TB and latent TB (sometimes called “sleeping TB”). When someone tests positive on a TB skin test or IGRA blood test but isn’t feeling ill, they typically have latent TB, which means they cannot transmit the disease to others and it’s not currently making them sick. In our interviewee’s case, they were diagnosed early. The treatment process itself is rigorous but effective, which included taking nine tablets once a week for three months – a regimen known as directly observed therapy short-course (DOTS). They received a congratulatory letter from Public Health upon completion, confirming they were TB-free. “Through God’s help, I didn’t have any side effects,” they share. “My doctor tested me early, and that’s how we found out. My health providers made sure to check in with me every week.” Jennifer Bergen, Alaska State Public Health Nurse IV, explains: “Early detection is critical. Many people have latent TB infection without symptoms and never develop active TB disease. Treatment prevents progression to active disease and stops transmission. It’s important to catch latent TB while it’s still inactive and treat it before it makes you sick.”
The Role of Community Support
Czarina, KWC’s Community Health Liaison, was able to gain the interviewee’s trust. Czarina represents a new generation of healthcare advocates breaking down cultural barriers and learning how to incorporate the shared Filipino heritage to build trust and respect.”You didn’t sign anything with the hospital to keep my diagnosis private, and yet you didn’t disclose my case to anyone,” they told Czarina. “You respect my privacy so much.” Public Health services also went above and beyond: “Public Health made it easy for me to get my medication by meeting me at the closest coffee shop. I have one story with my nurse at public health—it was Sunday, and I had to take my medication, but I was out of it and at work. My nurse came to my job on her day off just to give me my medication. She knew I wanted to be discreet, so she put it in a gift bag. That’s how caring they are.”
Moving Forward: A Community Approach
Breaking the stigma around TB requires both individual courage and community support. It’s important to understand that TB is a bacterium that does not discriminate based on ethnicity, race, gender, or age. Anyone can be infected with TB if they encounter someone with active TB, and often, you will never know where you were exposed. “You could have been exposed on an airplane or at the grocery store—you will never know,” explains Public Health Nurse Bergen. “While some individuals have higher risk for encountering TB, such as those with frequent international travel, living in congregate settings, or serving in health care, it’s important to remember tuberculosis is common and can affect everyone.”
Research shows that cultural competence in healthcare delivery significantly improves treatment outcomes for TB patients. A 2023 study in the Journal of Immigrant and Minority Health found that culturally tailored TB education programs increased treatment completion rates by nearly 30% among Asian American populations. Dr. Florence Roan M.D, an infectious disease specialist at the University of Washington emphasizes: “We need to recognize that TB is not just a medical condition—it carries social and cultural dimensions that affect how people seek care and adhere to treatment.”
A Message of Hope
Our interviewee leaves us with an important message: “Public health is willing to help you as much as they can. They are such good people to the community, and they are also such a help if you are financially struggling.” Despite fear and stigma, we are reminded that there is support through public health services, translation assistance, and compassionate healthcare providers. “My doctor never treated me like I was sick,” they recall. “He didn’t wear gloves or a mask. When he comes into the clinic room, he makes sure to ask ‘how are you?’ I would even start to talk to him about my personal life and problems.” TB is treatable and curable. With early detection, proper treatment, and community support, we can overcome both the disease and the stigma surrounding it.
Breaking Down Barriers to Care
Here are several factors made accessing care challenging for our interviewee:
Transportation barriers: “I had a hard time financially at first and with transportation because it depends on the weather. If it’s windy, I’m scared I might fall outside walking.”
Medication access: Concerns about privacy made pharmacy visits stressful due the possibility that someone may identify the medication being distributed. “At Walmart, I didn’t trust some employees there. Some of my Filipino friends might start talking about me.”
Cultural stigma: Some Filipinos have a way of making one feel unapproachable / inadequate and that feeling is even stronger when they may have heard you were sick with something highly contagious. “Even if you’re not saying anything, what I’m thinking is that you’re thinking I’m still sick. Our people are cautious, and I understand, so I decided to be distant instead.
Local Resources and Support
If you or someone you know needs TB testing or treatment, confidential services are available:
Alaska Public Health Centers: Offer free or low-cost TB testing and treatment. Visit http://dhss.alaska.gov/dph/Nursing/ for locations. The Ketchikan Public Health Center is not connected with immigration decisions—they reach out only to ensure individuals are connected to resources they need.
TB Free Alaska Program: Provides resources and support for TB patients. Call 1-907-269-8000 or email tb@alaska.gov.
Financial Assistance: Programs like Love in Action can help with food supplies during treatment. PeaceHealth Medical Center offers “the Bridge Program” to help with financial burdens. Public Health staff can help navigate this program to reduce costs for office visits, lab work, and X-rays.
Ketchikan Kapamilya: Offers cultural support, Tagalog Translation services, and connection. Visit ketchikankapamilya.org or text 907.821.4818.
Follow-up Care: At the end of TB treatment, you’ll receive TB treatment completion records that should be kept for proof of treatment. Public Health will also maintain these records if needed in the future.
Sources
Centers for Disease Control and Prevention. (2023). Tuberculosis — United States, 2022. MMWR, 72(12), 313–318.
Journal of Immigrant and Minority Health. (2023). Cultural competence in tuberculosis care: Improving outcomes among Asian American populations, 25(2), 457-469.
World Health Organization. (2024). Global Tuberculosis Report 2024. Geneva: WHO. Retrieved from https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024/tb-disease-burden/1-1-tb-incidence
Alaska Department of Health and Social Services. (2024). Tuberculosis in Alaska: Annual Report 2023.
WORLD TB DAY 2025 Information & Resources: www.who.int/campaigns/world-tb-day/2025
Maraming Salamat to Rafael Bitanga, Malasakit Matters Feature Writer
