# Stigma associated with leprosy among patients, contacts, and the general population in an endemic region of Brazil

## TL;DR

This study explores stigma related to leprosy in Brazil, finding that social and cultural factors contribute to discrimination among patients and the general population.

## Contribution

The study quantifies leprosy-related stigma across patients, contacts, and the general population in Brazil and identifies demographic factors influencing stigma.

## Key findings

- Feelings of shame and social avoidance are central to leprosy stigma across groups.
- Higher stigma scores are associated with female sex, higher education, and religious practice.
- Contacts and the general population perceive more stigma than patients.

## Abstract

Leprosy is associated with social exclusion and discrimination. Historical records of compulsory isolation, severe clinical manifestations, and fear of contagion have contributed to the perpetuation of prejudice and discriminatory attitudes. In Brazil, the psychosocial impact of leprosy among patients, contacts, and the general population remains poorly understood.

To assess the stigma associated with leprosy and to identify factors influencing its impact among patients, contacts, and the General Population (GP).

A cross-sectional study was conducted, including three groups (patients, contacts, and GPs) from the metropolitan region of Manaus – AM (Brazil). Demographic and clinical data were collected, and stigma was evaluated using the Explanatory Model Interview Catalogue-Affected People (EMIC-AP) for patients and the EMIC-Community Stigma Scale (EMIC-CSS) for contacts and GPs. The impact of different aspects was assessed within each group, and clinicodemographic factors associated with higher stigma were explored.

A total of 214 patients, 104 contacts, and 393 GPs were evaluated. The EMIC-AP mean (SD) score among patients was 16 (9), whereas the EMIC-CSS scores were 15 (7) for contacts and 12 (6) for the GP group. Network analysis revealed that feelings of shame, negative self-opinion, and social avoidance were central elements of stigma across groups. Female sex among patients (β = -2.9; p = 0.03), higher education among contacts (β = 3.2; p = 0.03); and younger age and religious practice among the GPs (β = -1.3 and 1.3; p < 0.05) were associated with higher stigma scores. After standardization, contacts and GP exhibited greater stigma perception than patients (θ = 0.02 and -0.06 vs. -0.26; p < 0.05).

Non-randomized sample from a single center.

Leprosy-related stigma persists across patients, contacts, and GPs, reflecting deep-rooted social and cultural misconceptions. Beyond medical cure, achieving the “Zero Leprosy” goals demands integrated actions that promote education, community engagement, and psychosocial support to reduce prejudice and promote social inclusion.