SETTING: Little is known of the social and cultural issues influencing the uptake of and attitudes to tuberculosis (TB) care by people of African extraction living in the UK. OBJECTIVE: To describe the perceptions and experiences of African patients with TB in London, focusing on issues relating to diagnosis, treatment adherence and stigma. DESIGN: Qualitative study using in-depth interviews. RESULTS: Misinterpretation of early symptoms led to delays in seeking health care. Although half of the respondents reported denial of the diagnosis, they reported good treatment adherence, noting the role of TB specialist nurses in promoting adherence. Respondents felt stigmatised by the diagnosis, although actual experiences of stigma were rare. Experience of TB in a known person mitigated stigma. Human immunodeficiency virus (HIV) disease was perceived to have worsened TB stigma, and most patients offered HIV testing initially declined, fearing stigmatisation and poor illness outcomes if positive. CONCLUSIONS: Awareness of TB can be improved among migrants at high risk of developing the disease and among health professionals. Counselling around HIV testing for TB patients must take their beliefs into account if a high uptake of testing is to be achieved.