title: A comparison of stigma among patients with leprosy in rural Tanzania and urban United States: a role for public health in dermatology.
abstract: BACKGROUND
  Leprosy is a chronic infection of the skin and peripheral nerves caused by the bacterium Mycobacterium leprae, which causes peripheral insensitivity and disfigurements of the skin, limbs, and digits. Social stigma is a common consequence of leprosy and may differ according to level of physical disfigurement and geographic location. The objective of this study was to assess social stigma encountered by patients with leprosy in clinical settings located in rural Tanzania and urban USA and to compare the social stigma reported in these regions.
  
  
  METHODS
  A total of 56 respondents were recruited from one leprosy inpatient facility in Shirati, Tanzania (n = 28), and one outpatient clinic in Los Angeles, USA (n = 28). Cross-sectional data were obtained from face-to-face interviews, which were conducted with respondents at each clinic location. Measures of perceived stigma were assessed in family relationship, vocational, social interaction, and interpersonal contexts.
  
  
  RESULTS
  Patients in Tanzania, as compared with those in the USA, reported significantly higher levels of stigma in family relationship and vocational contexts. Tanzanian patients also reported higher levels of stigma in social interaction and self-esteem contexts, but these differences were marginally significant and may reflect the small sample size.
  
  
  CONCLUSIONS
  Leprosy-related social stigma is a major problem in regions of both developed and developing countries; however, patients with leprosy in developing countries reported higher levels of stigma in four social contexts. A public health role in dermatology is discussed as an agent of early diagnosis, control, and education in order to reduce social stigma and promote social rehabilitation.
authors: Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. nroosta@usc.edu
authors: Neda
authors: N
authors: Roosta
authors: David S
authors: DS
authors: Black
authors: Thomas H
authors: TH
authors: Rea
mesh_terms: D000328:Adult; D000368:Aged; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003880:Dermatology; D004651:Employment; D005195:Family Relations; D005260:Female; D006266:Health Education; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D007918:Leprosy / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology*; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D011634:Public Health; D012649:Self Concept; D057545:Social Stigma; D013636:Tanzania