Comparative Study of Stigma and Discrimination in Vaccinated and Non-Vaccinated COVID-19 Survivors in Bangladesh

doi:10.21203/rs.3.rs-4809209/v1

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Research Article

Comparative Study of Stigma and Discrimination in Vaccinated and Non-Vaccinated COVID-19 Survivors in Bangladesh

https://doi.org/10.21203/rs.3.rs-4809209/v1

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Historically, pandemics have often resulted in stigma and discrimination against people affected. Despite some studies outlining the stigmatized experiences of COVID-19 survivors in Bangladesh, there is a notable lack of comparative research into the lived experiences of survivors across different pandemic phases. This study is intended to fill this gap by thoroughly investigating the stigmatized experiences of both vaccinated and non-vaccinated COVID-19 survivors in Bangladesh. Using a qualitative comparative case study approach, we interviewed 22 COVID-19 survivors (13 non-vaccinated and 9 vaccinated) in Bangladesh during two pandemic periods (July 26–August 12, 2020, and October 10, 2022–April 10, 2023). Recruitment was made by adopting a convenient sampling technique through social media platforms and personal networks. Due to the pandemic, interviews were conducted primarily via telephone and online, such as Zoom. All interviews were then thoroughly transcribed and subjected to an in-depth thematic analysis. The findings highlight crucial factors that contribute to stigma and discrimination against COVID-19 survivors, including fear of death, infection, disease control measures (such as lockdown, public announcements, and placing red flags on victims' houses), and personal experiences with COVID-19 testing. Notably, non-vaccinated participants reported a variety of experiences associated with COVID-19 stigma and discrimination that differed from those of their vaccinated peers. The study also found that social support and normalized perceptions of COVID-19 played important roles in reducing stigma and discrimination against survivors. As a result, this study is significant for healthcare workers and policymakers in Bangladesh in developing effective pandemic management and control strategies.

COVID-19

qualitative research

comparative case study

stigma and discrimination

combating stigma

Bangladesh

The coronavirus (COVID-19) has sparked widespread public health concerns due to its high contagiousness and ability to mutate, as well as its complex method of transmission and resistance to environmental changes [1, 2]. One of the major impacts of COVID-19 on public health is the perceived stigma experienced by infected individuals and their family members. From a sociological perspective, social stigma is the act of identifying and labeling a social group with negative attributes, leading to social discrimination and exclusion [3–5]. During a pandemic, "stigma" refers to the process of categorizing, labeling, discriminating, and treating someone differently from others due to an alleged association with a specific disease [6]. Stigma could deteriorate the affected individuals' and groups' emotional, mental, and physical well-being [7]. People with stigmatized infectious diseases may face rejection from partners, family, and friends, lose their jobs, and receive poor health services, leading to alienation, depression, or anxiety [8–10]. Prior research has demonstrated that individuals with infectious diseases such as HIV and SARS often experience stigma and discrimination in the form of devaluation, stereotyping, isolation, prejudice, and aggressive attitudes. Similarly, the COVID-19 pandemic has led to fear, anxiety, and heightened stress levels, contributing to societal stigma and discrimination against those affected by COVID-19, as well as their family members, close friends, and healthcare providers. [11].

The first case of COVID-19 in Bangladesh was reported on March 8, 2020, and the first recorded fatality occurred on March 18, 2020 [12]. Following this, the Bangladesh government implemented several measures to curb the spread of the virus. These measures included a nationwide stay-at-home order, commonly referred to as a lockdown, which was enforced from March 16, 2020, until May 30, 2020 [13]. Educational institutions remained closed from March 16, 2020, until September 11, 2021, to minimize in-person interactions [14]. In addition, the use of isolation and quarantine measures was strongly recommended to effectively manage the transmission of the disease. The restrictions on movement and physical contact imposed by the government have caused fear, anxiety, and stress among the general population, leading to stigmatization [14, 15]. Since the start of the pandemic, misinformation, fear, and panic have been widespread across the country [16]. Individuals with limited understanding of the virus have faced anxiety, discrimination, and stigma [17]. During the early stages of the pandemic in Bangladesh (2020–2021), there were numerous instances of discrimination and stigma against individuals infected with COVID-19. These included cases of infected patients being abandoned by their families, symptomatic individuals being left by their children, denial of religious rites for the deceased, social isolation of affected individuals and their families, harassment, forced eviction, and other distressing incidents. Additionally, there were reports of locals obstructing the establishment of a proposed COVID-19 hospital, protesting lockdown measures, and refusing to allow the burial of COVID-19-infected individuals in local cemeteries [18, 19]. However, at the beginning of 2023, such scenarios seemed to have changed considerably. The global mass vaccination drive has had a profound impact on reducing the rates of COVID-19 infections and fatalities. According to a study by Watson et al. (2022), it is estimated that vaccination efforts have averted 14.4 million deaths, resulting in a 79% decrease in global fatalities from COVID-19 between December 8, 2020, and December 8, 2021 [20]. Furthermore, a recent study in the US indicated that the efficacy of COVID-19 vaccination was 36.9% for individuals who received two doses before infection and 68.7% for those who received three doses prior to contracting COVID-19 [21]. In Bangladesh, the vaccination rate for corona (any dose) had reached 88.39% by April 6, 2023 [22]. The implementation of a mass vaccination program, along with essential measures such as awareness campaigns, quarantine and lockdown enforcement, isolation of infected individuals, observance of social distancing, and mask-wearing has significantly slowed the spread of the virus in recent years. Consequently, the public's fear of the disease has decreased. As a result, instances of discrimination and stigma against COVID-19 patients are no longer frequently reported on news platforms and social media. Therefore, individuals who experienced COVID-19 during the early stages of the pandemic faced more challenges than those who contracted the virus more recently [22]. The stigma and discrimination experienced by early COVID-19 survivors have been well-documented in various global contexts [23–26]. However, there is a noticeable gap in research focusing on the experiences of vaccinated survivors.

Stigma can cause negative health outcomes for infected individuals and the general population, making it a serious public health concern. Stigmatized individuals often conceal their disease status [27], refrain from seeking medical care, and demonstrate non-adherence to treatment protocols to avoid discrimination [28, 29]. Research has indicated that individuals infected with HIV often experience discomfort when disclosing their status, because of perceived social stigma [30, 31]. Individuals with COVID-19 symptoms were reported similarly to hide their symptoms when accessing healthcare services and avoid testing. Such practices may act against healthcare policies, help ongoing transmission of the virus, and disrupt the efforts to manage any pandemic outbreak [27]. Combating stigma is therefore important to reduce transmission of the virus as well as non-disclosure of disease status. Considering the impact of social stigma, this research seeks to investigate the stigma experienced by both non-vaccinated and vaccinated COVID-19 survivors in Bangladesh. The aim is to inform the development of effective health policies for managing pandemic outbreaks. Furthermore, by comparing the experiences of stigma and discrimination between non-vaccinated and vaccinated survivors, we can gain insights into the factors that contribute to stigma and identify the necessary policies for combating stigma during a pandemic. The study aims to offer a comprehensive understanding of the process of stigmatization by comparing the experiences of non-vaccinated and vaccinated survivors at various phases of the pandemic. The findings will provide valuable insights for health experts and policymakers to develop more effective public health policies from the perspective of COVID-19 survivors.

Study Design and Participants

We conducted a qualitative study using a comparative case study design to investigate the experience of stigma and discrimination faced by non-vaccinated and vaccinated COVID-19 survivors in Bangladesh. This study design provides an in-depth understanding of how experiences of COVID-19-related stigma and discrimination have changed across non-vaccinated and vaccinated survivors over various phases of the pandemic. We employed a convenient sampling technique to access COVID-19 survivors due to several constraints during the pandemic, such as lockdown restrictions, fear of transmission, and a limited number of available and accessible participants to be included in the study. The respondents for this study were selected from diverse socioeconomic backgrounds, including healthcare providers, government officials, businessmen, private job holders, journalists, students, housewives, unemployed, and retired senior citizens. We also ensured that respondents from diverse geographical regions of Bangladesh were included. The inclusion criteria were different for non-vaccinated and vaccinated respondents. The inclusion criteria for non-vaccinated respondents were: 1) individuals identified as COVID-19 positive after clinical testing, 2) they were not vaccinated when infected with Coronavirus, and 3) stayed in quarantine for at least two weeks at home or in hospital. Vaccinated respondents were selected based on criteria such as 1) individuals infected with coronavirus after receiving at least two doses of vaccines, and 2) they stayed at least a two-week isolation period at home or in the hospital. Both groups of respondents willingly participated in the study. We interviewed 22 respondents altogether (13 non-vaccinated and 9 vaccinated COVID-19 survivors). The sample size was determined when data saturation was reached, and similar themes emerged.

Interview outline

We aim to understand how COVID-19 survivors perceive their personal experience of contracting COVID-19 disease in the context of stigmatization and discrimination. Hence, we employed an in-depth interview approach. This method allows participants to narrate and describe their experiences with greater detail as they have lived through COVID-19 disease-related experiences and vulnerabilities. An interview checklist was prepared based on the published literature and reviewed through several meetings with the research team (TA, SA, Mw, MAI). The interview guideline includes the following broad sections with key points to understand the experiences of COVID-19-related stigma and discriminations: (1) Participants' perspective and understanding of COVID-19 2) Participants' experiences of earlier symptoms, testing procedures, and vaccination. (3) Law enforcement agency’s initiatives (lockdown, putting red flags, etc.) and social vulnerabilities. 4) Experience of quarantine and isolation. 5) Experiences of stigma and discrimination: social, economic, and mental. 6) Respondents' feedback on the support they needed and suggestions to minimize stigma and discrimination. We employed the same interview guidelines for both non-vaccinated and vaccinated survivors to understand their lived quarantine experiences, stigmatization, and vulnerabilities.

Data Collection

We adopted a qualitative approach using in-depth interviewing to elicit relevant information from the respondents. The data collection happened in two different phases of the pandemic. In the first phase, we interviewed 13 non-vaccinated participants between July 26 and August 12, 2020, during the first wave of the pandemic in Bangladesh. In the second phase, we interviewed 9 vaccinated participants between October 10, 2022, and April 10, 2023. The reason we collected data in two time periods was to compare the experiences of COVID-19-related stigma and discriminations faced by non-vaccinated and vaccinated COVID-19 survivors. When we collected data from the non-vaccinated participants in the earlier phase of the pandemic, the fear of the pandemic was severe among the population, lockdowns and quarantines were strictly followed, and vaccines were not adequate and available for all populations in Bangladesh. However, during the second phase, fear of the pandemic decreased among the population; lockdown measures were not strictly enforced, and most individuals received at least one dose of the coronavirus vaccine. In both phases, we identified the respondents through several means, such as a social media campaign and using personal networks. The interviews were conducted via telephone and Zoom meetings based on ethical accountability for not contributing to the spread of the virus. Using personal networks and social media campaigns, initially, we scheduled 15 non-vaccinated respondents but stopped after 13 interviews since data saturation was achieved thereafter, making further interviews unnecessary. During the second phase, we encountered challenges in recruiting vaccinated participants as many people were less interested in taking part in COVID-19-related research. This may be attributed to decreased concerns about the virus and the return to normal life following an extended period of lockdown. After running several social media campaigns and leveraging personal networks, we successfully interviewed 9 vaccinated respondents who willingly took part in the study.

The researchers provided the participants with an overview of the study's context and purpose and obtained their verbal consent to take part. Additionally, most participants were emailed a consent form and interview guide. Upon agreeing to be interviewed, participants had the option to schedule telephone or Zoom interviews at their convenience. The interviews, conducted in Bangla by four contributing authors (TR, SA, MB, MAI), ranged from 20 to 65 minutes in duration. All interviews were audio recorded with the participants' informed consent using an electronic device.

Data Analysis

We conducted a thematic analysis of the data gained from 22 in-depth interviews with non-vaccinated and vaccinated COVID-19 survivors in Bangladesh. First, we transcribed the audio recordings into English. Each team member read the transcripts multiple times to become familiar with the contents and note initial impressions and recurring themes. Based on multiple readings of transcripts, we developed a preliminary coding framework using Microsoft Excel 365, which contains all the important themes and sub-themes generated and refined through several team discussions with the team members. When generating themes, we focused on patterns, similarities, and differences in stigma experiences between vaccinated and non-vaccinated individuals. To ensure consistency, we coded each transcript by at least two team members, resolving discrepancies through consensus. The research findings were organized into major themes and sub-themes (refer to Table 2) and were accompanied by verbatim excerpts. Including verbatim excerpts ensured that the respondents' perspectives were accurately represented in this research article. In cases where the researchers encountered challenges in interpreting the statements, further clarification was sought from the respondents in follow-up meetings to validate the findings. Any conflicting opinions on the findings were discussed and resolved with the guidance of a qualitative research expert.

Characteristics of the participants

The study included participants who had tested positive for COVID-19 through clinical testing. Of the participants, 64% (14) were male and 36% (8) were female, with an average age of 30 years. The objective of this study is to examine the stigmas and discrimination faced by COVID-19 survivors in Bangladesh. To achieve this, respondents from diverse socio-economic backgrounds were included, rather than focusing on any specific social group. As a result, the study encompasses individuals from various backgrounds, including healthcare workers, government officials, private sector employees, students, business professionals, homemakers, and senior citizens. In order to enhance the overall inclusivity of the research findings, deliberate efforts were made to ensure representation from both rural (54.54%) and urban (45.46%) areas. Approximately 46% of the respondents were frontline workers, such as healthcare professionals, police officers, magistrates, bankers, and journalists. This group faced greater susceptibility to stigma and discrimination due to their professional roles during the pandemic. Additionally, 27% of the respondents were students who were particularly eager to participate in the study, aiming to highlight the challenges faced by educational institutions during COVID-19. All respondents underwent quarantine and isolation for a period of 14–31 days. Furthermore, 80% of the participants practiced home quarantine, while the remaining individuals were admitted to specialized hospitals dedicated to COVID-19 treatment. The duration of treatment varied from 11 to 32 days. The characteristics of the participants are delineated in Table 1.

Table-1: Characteristics of the respondents (N = 22)

Characteristics of the respondents

N (%) of the participants

Age group: (21–73) year

Non-vaccinated: (22–73) year

Vaccinated: (21–32) year

30 yr

30.77 yr

27.78 year.

Sex:

Male

Female

64%

36%

Occupation:

Frontline workers

Students

Faculty

Private job holders

Businessman

Housewife

Senior citizen

46%

27%

13.63%

4.55%

9.09%

4.55%

Area of residence

Urban

Rural

45.46%

54.54%

Isolation status

< less than 18

>= equal or more than 18

54.54%

45.46%

Vaccination Status

Yes

41.01%

59.09%

After collecting the participants' responses, we conducted a theme analysis to examine the stigmatization and discrimination experienced by individuals who had survived COVID-19, regardless of their vaccination status. Thus, this study identified three major themes (factors that contribute to stigmatization and discrimination, experiences of stigma and discrimination, strategies to combat stigma and discussion) as well as eleven subthemes (fear of death, fear of infection, government's immediate measures, negative attitudes from neighbor’s and colleagues, social disconnectedness and ostracization, social support and connectivity, vaccination, controlling media news, etc.). A full explanation of the participant's response is provided below, taking into consideration the participant's vaccination status:

Theme I: Contributing factors to stigmatization and discrimination

During the COVID-19 pandemic, the stigmatization and discrimination of both vaccinated and non-vaccinated individuals were significantly influenced by the widespread fear of infection and death, which was exacerbated by intense media coverage and strict government measures such as lockdowns and red-flagging homes. In addition, the social stigma associated with COVID-19 testing and disclosing a positive status exacerbated social vulnerability. Important findings are described under the following sub-themes:

Fear of death

The majority of the non-vaccinated respondents stated that they became afraid when they were identified as COVID-19 positive. They started to believe that they were very close to death as they got infected with this disease The repeated and widespread news on television and social media, according to the respondents, has exacerbated death fear among the people, including those infected with the coronavirus. As a result, some non-vaccinated respondents said they decided to refrain from using social media to keep themselves calm and stress-free during their quarantine period. COVID-19-infected and symptomatic individuals and their family members experienced avoidance and negligence because of this death fear among the general population.

Contrary to this, a small number of vaccinated individuals felt fearful of death when faced with a COVID-19 infection. The majority of them remained positive about their prospects for recovery and were not worried about mortality. The vaccinated respondents expressed confidence in their ability to recover due to their immunization. In addition, print and social media focused less on the news related to COVID-19 deaths and infection rates during the later phases of the pandemic and many COVID-19 survivors started sharing their stories of recovery on different social media platforms, which helped to decrease the death phobia among the public.

Fear of infection

Both non-vaccinated and vaccinated participants in the study expressed anxiety and concern about potentially spreading the virus to their loved ones, despite their own confidence in their ability to recover. Many also reported feeling guilty about the possibility of infecting their family and friends. To minimize the risk of transmission, the majority of participants chose to maintain strict isolation from their relatives, even though this took a toll on their mental well-being. The fear of spreading the virus caused feelings of alienation and isolation among both vaccinated and unvaccinated individuals. Respondents shared that the fear of transmitting the virus through social interaction caused panic among their family members, often resulting in the infected person being isolated and feeling alienated. One vaccinated respondent shared,

"Ever since I contracted the Corona infection, my father has been distancing himself from me. While my mother always made sure I had everything I needed and was constantly there for me emotionally, my father kept physical distance. It was painful for me, but I made an effort to accept it casually." (R16, Student, Vaccinated).

Government’s immediate measures: lockdown, miking, and putting red flags

In the early stages of the pandemic, publicly identifying as a coronavirus patient worsened the stigmatization experienced by infected individuals and their families. A majority of non-vaccinated respondents in this expressed that disclosing their status as Corona patients left them feeling vulnerable and stigmatized, leading to strict lockdown measures for themselves and their family members in line with the government's initial COVID-19 policies. Additionally, a government health initiative involving miking and displaying a red flag on the houses of coronavirus-positive patients caused widespread panic. As a result, individuals showing COVID-19 symptoms were hesitant to seek clinical testing and share their test results with others. One respondent summarized their concern as follows:

"I panicked as I provided the police all of my information. If police officers came to my neighborhood and placed a lockdown on my home, everyone would recognize me as the first Corona patient in my neighborhood and be afraid of me. This was quite distressing for me. " (R1, Student, Non-vaccinated).

The measures implemented to control the spread of Coronavirus, such as lockdown, miking, and raising a red flag outside the victim's home, created heightened anxiety and stress among Coronavirus patients and their families. A number of non-vaccinated participants expressed their dissatisfaction with the impact of these measures on their family members. In addition, it was mentioned that disclosing the identities of Coronavirus patients and subjecting them to tests placed them in a socially vulnerable situation. Therefore, despite experiencing coronavirus symptoms, some non-vaccinated chose to keep their symptoms concealed and chose not to be tested.

Vaccinated respondents, on the other hand, did not experience measures such as lockdown, miking, and putting red flags on patients' houses. Hence, they did not experience a similar social process of stigmas to non-vaccinated participants. Moreover, they did not experience any difficulties in exposing corona-positive status to others, demonstrating a cooperative and accepted social circumstance for corona-infected patients. However, two respondents mentioned that they feared disclosing their situation to people. After receiving a lot of negative and harsh remarks from relatives and colleagues, one person realized that they should not disclose their positive coronavirus status to others. Another respondent mentioned that their family was hesitant to disclose news of their infection to neighbors and relatives due to fear of stigma and discrimination.

COVID-19 testing exacerbates the process of stigma

According to both vaccinated and non-vaccinated respondents, the process of enduring clinical testing for COVID-19 has resulted in an increase in stigmatization. They stated that they were subjected to stigmatization and exclusion from their colleagues and acquaintances after testing positive for coronavirus. This led them to recognize that coronavirus testing may have exposed them to social vulnerability.

" I realized that it would be best if I avoided taking tests and remained negative. I have previously spent three or four months at home. I could stay at home for another 14 days without testing. This would allow me to lead a normal life”. (R5, Magistrate, Non-Vaccinated).

Other responders, on the other hand, stressed the significance of coronavirus testing in terms of exerting control over the virus's transmission. Although they did not exhibit any physical symptoms of COVID-19, they were nonetheless subjected to testing in order to prevent the spread of the virus to others and to assure their own safety.

Theme II: Experiences of stigma and discrimination

COVID-19 survivors experienced significant stigma and discrimination during their quarantine/isolation, including neglect and harassment from neighbors and colleagues, social ostracization, and disconnectedness. Such experiences are elaborated in the following sub-themes:

Labeling and blaming

During the early stages of the pandemic, non-vaccinated individuals and their family members encountered various instances of neglect, harassment, and hostility from their neighbors. The majority of non-vaccinated individuals reported receiving reduced social support and cooperation from their neighbors. Even after recovering and returning to regular activities, they were met with disdainful looks and frequent negative comments from residents. One individual reported that he and his family faced severe mistreatment from local villagers, including the placement of thorns in front of their door and surrounding their homes with barbed wire to prevent them from leaving. Furthermore, the respondents mentioned that their neighbors did not express concern about the health of the affected individuals as a common courtesy. Instead, many of them exhibited a distressing attitude towards those infected with COVID-19. As one respondent described:

"After my Corona infection, relatives and neighbors started to treat us like enemies. Even my sister, who came and kept food in front of my house and then left, did not visit us. I always had good relations with my neighbors, but during my hard times, they treated us horribly. Truly, we experienced the fear of death on earth before death." (R7, Businessman, Non-Vaccinated)

According to the non-vaccinated participants, many of their neighbors labeled Corona patients as criminals or sinners who had contracted the disease due to impiety, criminal activity, or disobedience to God. Some patients even began to believe that they were being punished by God for their sins. They faced harsh reactions from their neighbors, who blamed the patients for spreading the disease in their community and endangering everyone's lives. One participant described his experience as follows:

“I had an upsetting experience where some neighbors blamed us for bringing a disease to our area. They shouted at me, asking why we had come here and didn't return to our village. I replied patiently, telling them this is my home and I have the right to stay here. Despite this, they continued to accuse us of bringing the disease to the neighborhood. I tried to explain logically, but they wouldn't stop blaming us” (R2, student, Non-vaccinated).

In the earlier phase, non-vaccinated COVID-19 patients faced significant negligence, prejudice, and stigmas. However, in the later phases of the pandemic, vaccinated patients did not experience these challenges. Instead, they reported that their neighbors were helpful and cooperative during their recovery. They received encouraging remarks and a positive outlook from their neighbors, which greatly contributed to their healing process.

Social disconnectedness and ostracization

During the initial phase, non-vaccinated COVID-19 patients and their family members experienced social disconnection and ostracism from their close relatives and neighbors. The local administration's implementation of various lockdown measures, including marking the homes of affected individuals with a red flag, inadvertently made them more susceptible. For example, one individual shared that after testing positive for COVID-19, his neighbors and even his sister cut off all contact with him. The fear of infection and stigma was so strong that people avoided visiting the pond at the home of an infected individual, where they had been bathing for years. Another respondent mentioned that her children were refused access to the local playground due to her infection. Furthermore, family members of infected individuals were barred from attending mosque prayers, and some faced resistance from relatives and neighbors when organizing funerals for the deceased. One respondent shared experiences of his father’s funeral, who died due to COVID-19.

"When my father passed away, none of our neighbors visited our home. We couldn't find anyone to help carry the casket. Only a few relatives stepped forward to assist us, and we completed the funeral quickly."(R7, Non-vaccinated).

Vaccinated patients, on the other hand, did not report experiencing the same issues as non-vaccinated participants. According to the respondents, vaccination boosts people's confidence, leading them to believe that COVID-19 would not cause significant harm to infected patients. As a result, they did not maintain the same distance and disconnected from COVID-19 patients.

Non-co-operation from colleagues

Many non-vaccinated patients reported unfriendly behavior and a lack of cooperation from their colleagues. Additionally, their colleagues sometimes attempted to avoid them in professional settings. One participant, whose entire family contracted COVID-19, experienced severe mistreatment from their employer.

"When my brother and I tested positive for the virus, the district health officer called us. He was shouting and blaming my brother for the entire incident. He kept saying to my brother, "You have brought this disease to this area." His words greatly upset my brother. The unexpected phone call also surprised me. He behaved in a very insensitive manner. In such a situation, he should have shown sympathy towards my brother's family instead of blaming him for everything."(R3, student, non-vaccinated).

Only one vaccinated respondent out of nine reported experiencing non-cooperation and unfriendly treatment from his colleagues. This individual had been infected with COVID-19 multiple times and faced difficulties in his office throughout the pandemic. On each occasion, he found that his colleagues did not welcome him, eventually leading to his decision to leave his job. However, all other vaccinated respondents received good behavior and support from their friends and colleagues.

Table-2: Themes and Sub-themes

Themes	Sub-Themes
Factors contributing to stigmatization and discrimination	Fear of death
	Fear of infection
	Government’s immediate measures: lockdown, miking, and putting red flags
	COVID-19 testing exacerbates the process of stigma
Experiences of stigma and discrimination	Labeling and blaming
	Social disconnectedness and ostracization
	Non-cooperation from colleagues and close ones
Strategies to combat stigma and discrimination	Social support and connectivity
	Considering corona as a treatable disease
	Access to testing and vaccination efforts
	Monitoring news media

Theme III: Strategies to combat stigma and discrimination

This section offers effective strategies to combat stigma and discrimination associated with COVID-19 developed from participants’ feedback. Important insights are described under the following sub-themes:

Social support and connectivity

Both vaccinated and non-vaccinated individuals reported receiving substantial social support from their family members, relatives, and friends, which significantly contributed to their recovery. Non-vaccinated COVID-19 survivors highlighted the immense support and encouragement they received from their loved ones during their isolation, including regular meal preparations, obtaining essential items, and maintaining communication. This support played a significant role in their survival during this challenging period. Additionally, married couples emphasized the unwavering support they received from their spouses, which helped them maintain mental resilience during those trying times.

For most COVID-19 survivors in this study, social support and consistent communication were essential for their mental well-being. Even in quarantine, they stayed connected with family, friends, colleagues, and acquaintances. This network and communication played a critical role in dispelling stigmatization and discriminatory attitudes towards COVID-19 patients. In times of a pandemic when physical contact is limited, emotional support through communication becomes invaluable. A medical professional said:

"At that time, the most important thing was that we talked a lot. I belonged to a large and well-connected family. Despite being in isolation, we stayed connected with each other. My relatives and friends constantly cared for us and asked if we needed anything. They were also great sources of support and courage."(R13, Vaccinated, Doctor).

Considering corona as a treatable disease

One significant distinction between vaccinated and non-vaccinated participants, which also influenced their recovery, was their perception of COVID-19. During the initial phase of the pandemic, Corona was seen as a lethal disease. However, this perception shifted in the later stages. Specifically, after the government launched a mass vaccination campaign, the fear of death decreased among the public, and they began to acknowledge that coronavirus is a treatable illness that can be managed with proper health precautions and vaccination. Consequently, vaccinated respondents in this study reported experiencing less fear, anxiety, and stigma compared to non-vaccinated respondents. Vaccinated individuals noted that their neighbors were more supportive and empathetic because they understood that coronavirus could be managed with medication. They also observed increased support and understanding from their neighbors, relatives, and colleagues as they recognized that medication could effectively manage the coronavirus. According to one of the vaccinated respondents,

"Being a COVID-19 positive patient was not uncommon when I contracted the virus. I experienced only mild fever and cough. People were not as panicked as they used to be."(R20, Teacher, Vaccinated).

Access to testing and vaccination efforts

Participants who contracted COVID-19 during the early stages of the pandemic encountered various challenges related to coronavirus testing. These challenges included inadequate testing facilities, inaccurate test results, crowded medical environments, and non-compliance with health regulations. Their main concern was access to sufficient testing facilities. Many individuals expressed that equal access to COVID-19 testing would help normalize the situation and foster people's trust in the healthcare system. This, in turn, would reduce the stigma associated with the disease. Vaccinated individuals believed that widespread vaccination campaigns played a crucial role in instilling confidence in people's recovery from the infection. Furthermore, the global implementation of vaccination programs has effectively lowered the death rates, which has significantly reduced public concerns about COVID-19.

Monitoring news media

During a pandemic, both vaccinated and non-vaccinated individuals concur that it is vital to closely monitor the news media. The frequent reports of COVID-19 infection and mortality rates have caused significant concern and stress among patients and their families, to the extent that many non-vaccinated participants have refrained from using social media. Furthermore, several misleading news reports and instances of mistreatment and neglect by COVID-19 patients have contributed to public fear and exacerbated the stigmatization process. Thus, it is recommended to combat fake and alarming news and to actively monitor the news media during a pandemic.

According to one vaccinated respondent,

"Authorities should monitor news media and content to control panicked situations. Furthermore, people should be informed by publishing data and information about any disease, as awareness can better control COVID-19." (R16, Faculty, Vaccinated).

This research delved into the stigma and discrimination faced by both non-vaccinated and vaccinated COVID-19 survivors in Bangladesh. Our data was gathered from two groups of individuals during two phases of the pandemic: non-vaccinated survivors following the initial outbreak, and vaccinated survivors in the most recent phase of the pandemic in Bangladesh. By examining the experiences of these two participant groups, we identified three broad themes and eleven sub-themes. We conducted a comparative analysis of the stigma and discrimination related to COVID-19 experienced by non-vaccinated and vaccinated survivors. While numerous studies have examined the manifestations of stigma in healthcare and medical settings [32–37], this study is focused on the implications of stigma in social settings.

By comparing non-vaccinated and vaccinated individuals who tested positive for COVID-19, we identified significant factors that could help reduce stigma and promote the mental wellbeing of patients through policies aimed at enhancing social and community support. The present study has identified new sources of stigma arising during the COVID-19 pandemic, including the fear of death, infection, coronavirus testing, and government measures such as lockdowns, miking, and placing red flags in infected individuals' houses. Building on previous academic work, this study confirmed that the fear of death and infection were significant factors contributing to social stigma against individuals with COVID-19 [17]. However, non-vaccinated and vaccinated individuals experienced these factors differently. Due to the extensive coverage of COVID-19-related deaths on social media and television, as well as the highly contagious nature of the virus, non-vaccinated individuals experienced higher levels of fear, anxiety, avoidance, and stigma compared to vaccinated individuals. Similar research has shown that COVID-19-related deaths can intensify fear, panic, and anxiety in individuals [7, 23, 38], leading to the stigmatization of COVID-19 patients [39]. Various healthcare providers in both rural and urban areas of Bangladesh have also faced stigma due to concerns about the risk of death and transmission during the COVID-19 pandemic [40]. Enforcing lockdown measures and red flags at the homes of patients and disclosing patients’ identities through miking led to increased stigma, as reported by non-vaccinated participants in this study. While these measures were crucial in controlling the spread of the virus, they also contributed to negative perceptions and profanity of the affected individuals and their families within the community. Despite the effectiveness of these efforts, members of the public and those experiencing COVID-19 symptoms became hesitant to disclose their illness and avoided seeking testing. Findings from a separate study conducted in Bangladesh reflect similar conclusions, showing that individuals who were infected with COVID-19 tended to conceal their symptoms and avoid social distancing and testing to evade social exclusion stemming from measures such as lockdown and miking [17].

This study also uncovered that revealing a patient's identity through coronavirus testing led to the stigmatization of both COVID-19 patients and their families during the pandemic. Participants reported experiencing social exclusion and stigmatization after testing positive for COVID-19, which led them to be reluctant to undergo testing. Another study conducted in the US found that testing positive for COVID-19 was one of the two most significant factors associated with experiencing stigma [18]. Other studies have also documented that symptomatic individuals avoid getting tested for COVID-19 due to the anticipated stigmas and negative perceptions [17, 7].

This research documented the various types of stigma and discrimination experienced by individuals who have survived COVID-19. These included receiving negative comments, encountering denial, experiencing rude behaviors from neighbors, and facing non-cooperation and avoidance from colleagues. Additionally, survivors also experienced social disconnection, ostracization, labeling, and blame from others. These discriminatory behaviors had significant distressing effects on the mental and physical well-being of the patients. Several studies on COVID-19 have already detailed the different forms of stigma experienced by patients in Bangladesh and worldwide [17, 7, 27, 41]. The study sought to compare the levels of stigma experienced by vaccinated and non-vaccinated individuals. The results revealed that vaccinated participants encountered notably less stigma and social avoidance from their relatives, neighbors, and colleagues compared to non-vaccinated respondents. Participants attributed this difference to the widespread COVID-19 vaccination efforts. Unlike individuals in the early stages of the pandemic who were unsure about proper medical treatment and immunization, vaccinated individuals expressed confidence in their immunity and believed it contributed to a quicker recovery. These findings indicate that vaccination played a pivotal role in boosting people's confidence in their ability to recover from coronavirus. While similar results have not been documented in other studies, previous research has investigated the association between complete vaccination, and less severe cases of COVID-19 with early hospital discharge [42]. Apart from the findings of this study, we did not come across any literature that illustrates the correlation between rising vaccination rates and the reduction of COVID-19-related stigma. Hence, future research should delve deeper into this aspect.

Our study presents recommendations for minimizing stigma and discrimination based on participant feedback. This valuable insight can guide health policymakers and the government in formulating effective policies to combat stigma and discrimination during pandemics. Our research highlights the importance of social support and connectivity for the mental well-being of COVID-19 patients. Given the need to avoid physical contact during a pandemic, virtual communication can play a crucial role in keeping patients connected with their friends and relatives. Both vaccinated and non-vaccinated patients stressed the significance of social connections in helping them remain stress-free and confident in navigating this challenging situation. The study also revealed the distressing effects of isolation from family members on patients. In our study, vaccinated survivors reported experiencing lower levels of stress, anxiety, and stigma compared to non-vaccinated survivors. This was attributed to the support, cooperation, and emotional connection with their family members, friends, and neighbors. Additionally, a separate study on frontline workers in Bangladesh also advocates for social and organizational support as a coping strategy [23]. Previous research conducted in other social settings has also highlighted the benefits of social support and connectivity in aiding the recovery from infectious diseases [43, 44]. The availability of proper medical treatment for COVID-19 has significantly helped people overcome fear, anxiety, and stigma associated with infected patients. The widespread vaccination campaign by the government has been instrumental in diminishing fear and stigma. It is crucial for authorities to ensure that coronavirus testing and immunization are easily accessible and efficiently administered to prevent people from being apprehensive about seeking medical care. Furthermore, this study, along with previous research, emphasizes the importance of monitoring news media and curbing the dissemination of fake news and rumors to stop the spread of infectious diseases [13]. Multiple studies on COVID-19 have made it obvious that the lack of accurate information, misinformation, and rumors can contribute to the stigmatization of COVID-19 patients [45, 38].

Strength and limitations

There were a few limitations to this comparative qualitative case study. The small number of participants in this study limits its generalizability. There may have been a bias in the selection of participants who willingly consented to be interviewed. In the initial stages, COVID-19 survivors who were non-vaccinated were willing to share their experiences. However, as the pandemic progressed, it became difficult to find an equal number of vaccinated cases for a fair comparison. In addition, conducting face-to-face interviews with participants to gain a comprehensive understanding of their perspectives was not possible due to pandemic restrictions. Furthermore, this study does not focus on a particular social group. The qualitative findings from this study, which aim to address stigma and discrimination against COVID-19 survivors in Bangladesh, may not be applicable to other contexts. Despite these limitations, this study makes a significant contribution to the field of public health and comparative qualitative research. Prior to this study, the authors did not come across any qualitative comparative case study that investigated the unique experiences of COVID-19 survivors who were vaccinated and those who were not, specifically focusing on their quarantine periods during the pandemic. Thus, this study could serve as a guide for future researchers to conduct more qualitative comparative case studies in other contexts, aiming to gain insights into the experiences of both vaccinated and non-vaccinated COVID-19 survivors. Furthermore, future studies can expand on this research to explore the various factors and manifestations of COVID-19 related stigma and discrimination in Bangladesh, as well as evaluate the effectiveness of any interventions aimed at reducing such stigma and discrimination.

Effective public health policy should consider how and why both vaccinated and non-vaccinated COVID-19 survivors suffer various forms of stigma and discrimination in different social settings. This is particularly important to know during a pandemic because stigmatized individuals may face dire conditions while receiving medical treatment and care, which can deteriorate their mental and physical health. This comparative qualitative case study bridges this gap by exploring the underlying process of stigma and discrimination for both vaccinated and non-vaccinated COVID-19 survivors in Bangladesh. Results showed that several initiatives (e.g., lockdown, shut down, miking, strict isolation, and quarantine measures) were taken by the government during the initial phase of the pandemic to reduce the spread of the Coronavirus, which caused fear and anxiety amongst the survivors and triggered the stigmatization process. Therefore, healthcare practitioners and policymakers should consider socio-psychological circumstances before implementing such measures. Although such measures are successful in other contexts, in Bangladesh, these measures had negative repercussions (e.g., fear and anxiety among the general people, avoidance of stigmatized individuals and their family members, etc.) for the well-being of COVID-19 patients. Therefore, reducing anxiety and fear would be a requirement for a robust public health strategy.

Additionally, this research further revealed that vaccination, social support, and connectivity were very crucial aspects for both vaccinated and non-vaccinated survivors in reducing the stigmatization process. The study also revealed that because of the mass vaccination program, normalized perceptions about coronavirus, and media exposure, vaccinated individuals think they experienced less stigma and discrimination than non-vaccinated individuals. Future researchers should conduct more quantitative comparative research on COVID-19 survivors to understand the effectiveness of the mass vaccination programs and the social support and connectivity in reducing stigma and discrimination in Bangladesh. This current study is significant for healthcare workers and policymakers in Bangladesh in developing effective pandemic management and control strategies. Furthermore, by understanding the socio-psychological intricacies of stigmatization for both vaccinated and non-vaccinated COVID-19 survivors, this study provides substantial insights into developing policies, actions, and awareness programs to minimize future pandemic-related stigma and discrimination for the vulnerable population.

Ethics approval and consent to participate

This research has made every effort to adhere to and address ethical considerations. Before initiating data collection, study approval was obtained from the corresponding author’s affiliated institution. All experimental protocols were approved (Code: 3631108- FY 2020–2021) by the Research Cell of Bangabandhu Sheikh Mujibur Rahman Science and Technology University. While the institutions did not have an ethical review board, we adhered to the ethical principles established for human participants under the Helsinki Declaration (as revised in 2013) throughout the research. As a result, we ensured that the identities and privacy of the study participants were protected throughout the entire data-obtaining collection procedure. In addition, verbal and written informed consent was obtained from all the participants before the interview. Meanwhile, all study participants were permitted to withdraw from the research at any point without facing any negative consequences. To protect the participants' privacy and safety, their responses were encoded with unique numbers, and their actual names were replaced with fictitious ones. Additionally, we utilized a password-protected Google Drive storage system restricted to the researchers to secure data storage.

Consent for Publication

Not applicable

Competing Interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Funding

No funding.

Author Contribution

TR conceived and designed the study. TR, SA, MB, and MAI conducted data collection, analysis, and interpretation. TR and SA initially drafted the article and subsequently collaborated on revisions. The final version of the paper was reviewed and approved by all authors, with the corresponding author serving as the guarantor.

Acknowledgement

The authors would like to thank Dr. Jalal Uddin for his critical and constant feedback on our paper. Besides, the authors would like to pay gratitude to all the informants who shared their experiences with us.

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

MacKenzie JS, Smith DW. COVID-19: A novel zoonotic disease caused by a coronavirus from China: What we know and do not. Microbiol Australia. 2020;41(1):45–50. https://doi.org/10.1071/MA20013.
Mohsin M, Mahmud S, Uddin Mian A, Hasan P, Muyeed A, Taif Ali M, Faysal Ahmed F, Islam A, Maliha Rahman M, Islam M, Rahaman Khan MH, Rahman S, M. Side effects of COVID-19 vaccines and perceptions about COVID-19 and its vaccines in Bangladesh: A Cross-sectional Study. Vaccine. X; 2022. p. 12. https://doi.org/10.1016/j.jvacx.2022.100207.
Goffman E. ). Stigma; notes on the management of spoiled identity. Englewood Cliffs, N.J.: Prentice-Hall; 1963.
Phelan JC, Link BG, Dovidio JF. Stigma and prejudice: One animal or two? Soc Sci Med. 2008;67(3):358–67. https://doi.org/10.1016/j.socscimed.2008.03.022.
Potter E. &. (2008). NIH Public Access. Bone, 23(1), 1–7. https://doi.org/10.1177/0190272512459968. Stigma.
UNICEF S. COVID-19 & stigma: How to prevent and address social stigma in your community | UNICEF Sudan. Unicef. :text=Use only credible%2C official sources; 2020. pp. 1–6. https://www.unicef.org/sudan/covid-19-stigma-how-prevent-and-address-social-stigma-your-community#:~. even if it seems accurate.
Chew CC, Lim XJ, Chang CT, et al. Experiences of social stigma among patients tested positive for COVID-19 and their family members: a qualitative study. BMC Public Health. 2021;21:1623. https://doi.org/10.1186/s12889-021-11679-8.
Lee L-Y, Tung H-H, Chen S-C, Fu CH. Perceived stigma and depression in initially diagnosed pulmonary tuberculosis patients. J Clin Nurs. 2017;26(23–24):4813–21. https://doi.org/10.1111/jocn.13837.
Oduenyi C, Ugwa E, Zimako Ojukwu JO-A. An exploratory study of stigma and discrimination among people living with HIV/ AIDS in Abuja municipal area council, Nigeria. Afr J Reprod Health. 2019;23(1):88–99. https://doi.org/1 0.29063/ajrh2019/v23i1.9.
Kane JC, Elafros MA, Murray SM, et al. A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries. BMC Med. 2019;17. https://doi.org/10.1186/s12916-019-1250-8.
Turner-Musa J, Ajayi O, Kemp L. (2020). Examining social determinants of health, stigma, and covid-19 disparities. In Healthcare (Switzerland) (Vol. 8, Issue 2). https://doi.org/10.3390/healthcare8020168
Haque SE, Rahman M. Association between temperature, humidity, and COVID-19 outbreaks in Bangladesh. Environ Sci Policy. 2020;114:253–5. https://doi.org/10.1016/j.envsci.2020.08.012.
Akanda AA, Ahmed R. How successful Bangladesh is in controlling the coronavirus pandemic? Bull Natl Res Cent. 2020;44:196. https://doi.org/10.1186/s42269-020-00451-4.
Akhter S, Kumkum FA, Bashar F, Rahman A. Exploring the lived experiences of pregnant women and community health care providers during the COVID-19 pandemic in Bangladesh through a phenomenological analysis. BMC Pregnancy Childbirth. 2021;21(1). https://doi.org/10.1186/s12884-021-04284-5.
Roberton T, Carter ED, Chou VB, Stegmuller AR, Jackson BD, Tam Y, Sawadogo-Lewis T, Walker N. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modeling study. Lancet Global Health. 2020;8(7):e901–8. https://doi.org/10.1016/S2214-109X(20)30229-1.
Hossain MB, Alam MZ, Islam MS, Sultan S, Faysal MM, Rima S, Hossain MA, Mahmood MM, Kashfi SS, Mamun A, Al, Monia HT, Shoma SS. COVID-19 public stigma in the context of government-based structural stigma: A cross-sectional online survey of adults in Bangladesh. Stigma Health. 2021;6(2):123–33. https://doi.org/10.1037/sah0000305.
Miah MS, Mamun MR, Hasan SMM, Sarker MGF, Miah MS, Khan MGU, Kabir A, Haque MA, Chowdhury NMRA. COVID-19 transmission flows through the stigmatization process in Bangladesh: A qualitative study. Lifestyle Med. 2022;3(1):1–7. https://doi.org/10.1002/lim2.52.
Bulbul Siddiqi and Nur Newaz Khan. (2023). Social Stigma and Suffering: Perceptions, Practices and Impacts around COVID-19 in Bangladesh, South Asia Multidisciplinary Academic Journal [Online], 29 | 2022, Online since 27 October 2022, connection on 19 February 2023. URL: http://journals.openedition.org/samaj/8253; https://doi.org/10.4000/samaj.8253
Kibria MG, Islam T, Islam MT, Kabir R, Ahmed S, Sultana P. Stigma and its associated factors among patients with COVID-19 in Dhaka City: evidence from a cross-sectional investigation. PeerJ. 2022;10:e14092. 10.7717/peerj.14092. PMID: 36221262; PMCID: PMC9548314.
Watson OJ, Barnsley G, Toor J, Hogan AB, Winskill P, Ghani AC. (2022). Global impact of the first year of COVID-19 vaccination: a mathematical modelling study. Lancet Infect Dis. 2022;22(9):1293–1302. 10.1016/S1473-3099(22)00320-6
Marra AR, Kobayashi T, Callado GY, et al. The effectiveness of COVID-19 vaccine in the prevention of post-COVID conditions: a systematic literature review and meta-analysis of the latest research. Antimicrob Steward Healthc Epidemiol. 2023. 10.1017/ash.2023.447.
Nazmunnahar AB, Haque MA, Tanbir M, Roknuzzaman ASM, Sarker R, Rabiul Islam M. COVID-19 vaccination success in Bangladesh: Key strategies were prompt response, early drives for vaccines, and effective awareness campaigns. Health Sci Rep. 2023;17(5):e1281. 10.1002/hsr2.1281.
Arefin S, Rashid T, Bhattacharjee M, Habib MD, Islam MA, Rahaman MA. (2022). The whole sky has broken down on me. I might die alone: A qualitative study on the experiences of COVID-19 positive frontline workers in Bangladesh. Frontiers in Sociology, p. 7. https://doi.org/10.3389/fsoc.2022.1054921
Mahbubur Rahman M, Sadequr Rahman M, Mahbubur Rahman M, Yasmin F. (2021). Barriers to providing basic education among Rohingya Children in Kutupalong Rohingya unregistered camp View Project Women empowerment and NGOs in Bangladesh View Project Social Stigma, Prejudice, and Discrimination: A Study on the COVID-19 Patients and Hom. In Barishal University Journal of Social Sciences (Vol. 2, Issue 1). https://www.researchgate.net/publication/359483419
Missel M, Bernild C, Christensen SW, Dagyaran I, Berg SK. It is Not Just a virus! Lived Experiences of People Diagnosed with COVID-19 Infection in Denmark. Qual Health Res. 2021;31(5):822–34. https://doi.org/10.1177/1049732321990360.
Sahoo S, Mehra A, Suri V, Malhotra P, Yaddanapudi LN, Puri D, G., Grover S. Lived experiences of the Corona survivors (patients admitted in COVID wards): A narrative real-life documented summaries of internalized guilt, shame, stigma, anger. Asian J Psychiatry. 2020;53. https://doi.org/10.1016/j.ajp.2020.102187.
Barrett R, Brown P. Stigma in the time of influenza: social and institutional responses to pandemic emergencies. J Infect Dis. 2008;197(Suppl):S34–7. https://doi.org/10.1086/524986.
Scott N, Crane M, Lafontaine M, Seale H, Currow D. Stigma as a barrier to diagnosis of lung cancer: patient and general practitioner perspectives. Prim Health Care Res Dev. 2015;16(06):618–22. https://doi.org/10.1017/S1463423 615000043.
Stangl AL, Earnshaw VA, Logie CH, et al. The health stigma and discrimination framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med. 2019;17:18–23.
Sorsdahl KR, Mall S, Stein DJ, Joska JA. The prevalence and predictors of stigma amongst people living with HIV/AIDS in the Western Province. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2011;23(6):680–5. https://doi.org/10.1080/09540121.2010.525621.
Syed IA, Syed Sulaiman SA, Hassali MA, Thiruchelvum K, Lee CKC. A qualitative insight of HIV/AIDS patients’ perspective on disease and disclosure. Health Expect. 2015;18(6):2841–52. https://doi.org/10.1111/hex.12268.
Yang CC, Tsai J-Y, Pan S. Discrimination and well-being among Asians/Asian Americans during COVID-19: The role of social media. Cyberpsychology Behav Social Netw. 2020;23(12):865–70. https://doi.org/10.1089/cyber.2020.0394.
Briciu V, Topan A, Calin M, Dobrota R, Leucuta D-C, Lupse M. Comparison of COVID-19 Severity in Vaccinated and Unvaccinated Patients during the Delta and Omicron Wave of the Pandemic in a Romanian Tertiary Infectious Diseases Hospital. Healthcare. 2023;11:373. https://doi.org/10.3390/healthcare11030373.
Tsukuda M, Kayano T, Ito Y. Experiences of COVID-19-Related Stigma: A Qualitative Study on Nurses Caring for Patients with COVID-19. J Nurs Res. 2022;30(6):e241. 10.1097/jnr.0000000000000528.
Badrfam R, Qorbani M, Zandifar A. Status of stigma on the health care workers related to COVID-19 at the first wave of the pandemic in Iran: A qualitative study. Front Psychiatry. 2022;13:1045683. 10.3389/fpsyt.2022.1045683.
Abdulqadir J, Nashwan. Mehmet Korkmaz & Ilknur Aydın Avci (2022) Stigma against health care providers caring for COVID-19 patients in Turkey, Cogent Public Health, 9:1, 2110191, 10.1080/27707571.2022.2110191
Chanpa NB, Kotecha I, Kumar P, Tiwari DS, Vasavada DA, Bhatt RB. Stigma and discrimination among doctors toward health-care staff working at COVID-19 sites. Arch Ment Health. 2020;21:77–82.
Meltzer GY, Chang VW, Lieff SA, Grivel MM, Yang LH, Des Jarlais DC. Behavioral Correlates of COVID-19 Worry: Stigma, Knowledge, and News Source. Int J Environ Res Public Health. 2021;18(21):11436. 10.3390/ijerph182111436.
Abuhammad S, Alzoubi H, K., Khabour O. Fear of COVID-19 and stigmatization towards infected people among Jordanian people. Int J Clin Pract. 2021;75(4). https://doi.org/10.1111/ijcp.13899.
Tune SNBK, Islam BZ, Islam MR, Tasnim Z, Ahmed SM. (2022). Exploring the knowledge, attitudes, practices and lived experiences of frontline health workers in the times of COVID-19: a qualitative study from Bangladesh. BMJ Open. 11;12(1), 10.1136/bmjopen-2021-051893
Mistry SK, Ali ARMM, Yadav UN, Huda MN, Rahman MM, Saha M, Rahman MA, Lim D, Ghimire S. Stigma toward people with COVID-19 among Bangladeshi older adults. Front Public Health. 2022;10:982095. 10.3389/fpubh.2022.982095.
Ruiz-Giardin JM, Rivilla M, Mesa N, Morales A, Rivas L, Izquierdo A, Escribá A, San Martín JV, Bernal-Bello D, Madroñal E, et al. Comparative Study of Vaccinated and Unvaccinated Hospitalised Patients: A Retrospective Population Study of 500 Hospitalised Patients with SARS-CoV-2 Infection in a Spanish Population of 220,000 Inhabitants. Viruses. 2022;14:2284. https://doi.org/10.3390/v14102284.
Uddin MK, Islam MN, Ahmed O. COVID-19 Concern and Stress in Bangladesh: Perceived Social Support as a Predictor or Protector. Trends Psychol. 2022. https://doi.org/10.1007/s43076-022-00158-7.
Awang MM, Kutty FM, Ahmad AR. Perceived social support and well-being: First-year student experience in university. Int Educ Stud. 2014;7(13):261–70. https://doi.org/10.5539/ies.v7n13p261.
Islam MS, Sarkar T, Khan SH, Kamal AHM, Murshid Hasan SM, Kabir A, Yeasmin D, Islam MA, Chowdhury KIA, Anwar KS, Chughtai AA, Seale H. COVID-19-Related infodemic and its impact on public health: A global social media analysis. Am J Trop Med Hyg. 2020;103(4):1621–9. https://doi.org/10.4269/ajtmh.20-0812.

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Comparative Study of Stigma and Discrimination in Vaccinated and Non-Vaccinated COVID-19 Survivors in Bangladesh

Status:

Version 1

Abstract

Introduction

Materials and Methods

Study Design and Participants

Interview outline

Data Collection

Data Analysis

Results

Characteristics of the participants

Theme I: Contributing factors to stigmatization and discrimination

Fear of death

Fear of infection

Government’s immediate measures: lockdown, miking, and putting red flags

COVID-19 testing exacerbates the process of stigma

Theme II: Experiences of stigma and discrimination

Labeling and blaming

Social disconnectedness and ostracization

Non-co-operation from colleagues

Theme III: Strategies to combat stigma and discrimination

Social support and connectivity

Considering corona as a treatable disease

Access to testing and vaccination efforts

Monitoring news media

Discussion

Strength and limitations

Conclusion

Declarations

Funding

Author Contribution

Acknowledgement

Data Availability

References

Additional Declarations

Status:

Version 1