@article{183,
  keywords = {Anthropology, Bible, Brazil, Female, Humans, leprosy, Leptospirosis, Leukemia, Male, Metaphor, Prejudice, Semantics, Social Adjustment, Stereotyping},
  author = {Nations MK and Lira GV and Catrib AMF},
  title = {Stigma, deforming metaphors and patients' moral experience of multibacillary leprosy in Sobral, Ceará State, Brazil.},
  abstract = {<p>In response to the call for a new Science of Stigma, this anthropological study investigates the moral experience of patients diagnosed with severe multibacillary leprosy. From 2003 to 2006, fieldwork was conducted in the so-called 'United-States-of-Sobral', in Ceará State, Northeast Brazil. Sobral is highly endemic for leprosy, despite intensified eradication efforts and a 30% increase in primary care coverage since 1999. Of 329 active leprosy cases at two public clinics, 279 multibacillary patients were identified and six information-rich cases selected for in-depth ethnographic analysis, utilizing illness narratives, key-informant interviews, home visits, participant-observation of clinical consultations and semi-structured interviews with physicians. A 'contextualized semantic interpretation' revealed four leprosy metaphors: a repulsive rat's disease, a racist skin rash, a biblical curse and lethal leukemia. Far from value-free pathology, the disease is imbued with moral significance. Patients' multivocalic illness constructions contest physicians' disease discourse. 'Skin Spot Day' discriminates more than educates. Patients' 'non-compliance' with effective multi-drug therapy is due to demoralizing stigma more than a rejection of care. 'Social leprosy' in Northeast Brazil deforms patients' moral reputations and personal dignity.</p>},
  year = {2009},
  journal = {Cadernos de saude publica},
  volume = {25},
  pages = {1215-24},
  month = {2009 Jun},
  issn = {1678-4464},
  url = {http://www.scielo.br/pdf/csp/v25n6/04.pdf},
  doi = {10.1590/s0102-311x2009000600004},
  language = {eng},
}