Abstract In the context of high HIV prevalence, tuberculosis is proving hard to control, becoming an increasingly prevalent disease and forcing a more integrated public health approach to the dual epidemics. Yet this integrated approach often overlooks the implications of how intertwined TB and HIV have become in the social reality of people living in high HIV prevalence settings. In this context, TB, the most common and serious of HIV's opportunistic infections in Sub‐Saharan Africa, has become progressively more stigmatised, and this paper argues, a new disease stigma has unfolded—namely TB‐HIV stigma. Rooted partly in judgement, blame and shame; fears of TB transmission; and public health practice and policy, TB‐HIV stigma has serious implications for TB outcomes and for management of HIV. The paper demonstrates the strength of the association between TB and HIV in urban and rural Zambia, how visible signs of TB become a trigger for TB‐HIV stigma, and explores three key causes of this stigma that could be addressed by integrated TB‐HIV services. Copyright © 2006 John Wiley & Sons, Ltd.