Designing programmes to address stigma in leprosy: issues and challenges

Leprosy stigma is still prevalent in both endemic and non-endemic countries, and is a major factor leading to delay in patients seeking treatment. This paper reviews studies on factors influencing stigma in leprosy and the effectiveness of programmes targeting it. Most research showed that high level of knowledge of the curability and non-infectiousness of leprosy was not correlated with more positive attitudes and acceptance of leprosy patients. The mixed effects of interventions ranging from worsening stigma, to no change or slight change in positive attitudes suggest that stigmatising attitudes are difficult to change. There is a need for more integrated psychosocial, cultural and behavioral studies to identify important independent predictors of stigma. More rigorous study designs are needed to evaluate intervention programmes targeting stigma to provide evidence on what approaches work and what do not work.