02224nas a2200349   4500000000100000008004100001260001300042653001700055653001000072653001100082653001100093653001100104653001200115653001800127653001300145653000900158653001300167653001400180653001400194653002200208653001700230100001500247700001200262700001500274245012200289856004600411300001200457490000700469050001700476520136700493022001401860       2009                            d  c2009 Jun10aAnthropology10aBible10aBrazil10aFemale10aHumans10aleprosy10aLeptospirosis10aLeukemia10aMale10aMetaphor10aPrejudice10aSemantics10aSocial Adjustment10aStereotyping1 aNations MK1 aLira GV1 aCatrib AMF00aStigma, deforming metaphors and patients' moral experience of multibacillary leprosy in Sobral, Ceará State, Brazil.  uhttp://www.scielo.br/pdf/csp/v25n6/04.pdf  a1215-240 v25  aNATIONS 20093 a<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>  a1678-4464