The finding:
This qualitative study of 36 focus groups and 70 individual interviews with people with sickle cell disease (SCD) and stakeholders in caregiver roles in three African countries found that SCD-related stigma exists across socio-ecological levels (individual, interpersonal, organizational, community, public policy). Identified contributors to SCD-related stigma included self-blame, discrimination based on medical complications of SCD, and cultural beliefs that associate SCD with supernatural elements such as witchcraft. Primary manifestations of stigma included social discrimination (e.g., employers reluctant to hire individuals with SCD), explicit bias even among healthcare workers, pity, and social isolation (e.g., “othered” by peers in school). Proposed strategies to mitigate stigma fell into four categories: increasing SCD advocacy to improve awareness, stakeholder education to positively influence community perception, counselling for patients on the psychosocial impacts of SCD, and better clinical management of SCD to improve outcomes.

Strength and weaknesses:
This article highlights the lived experience of individuals with SCD in Cameroon, Ghana, and Tanzania and provides a lens through which to appreciate the widespread impact that cultural context has on the perception of medical illnesses. However, demographic information was not consistently obtained for all participants, which makes it difficult to assess demographic impact in this sample.

Relevance:
Patients with sickle cell disease often encounter stigma across socio-ecological contexts on a global scale, not just in more racially heterogenous countries such as the United States. Not only should we be mindful of the ways in which self-perception and cultural dynamics may impact our patients with SCD, we as C-L psychiatrists should also be aware of the stigma and bias within the healthcare settings in which we practice and the potential impact on care delivery.