A Special Note for the Region of the Americas
We must keep in mind that stigma is a social determinant of health and illness. Not only stigma can lead to delay in seeking diagnosis and in adhering to treatment, but it also impairs the availability of material and socioeconomic resources (such as sanitation, housing, work, education), as well as the social relationships that support the livelihoods of persons affected by leprosy.
Lack of material resources and substantive equality, as well as of community acceptance and support, play a major role in health inequities. Harmful stereotypes and stigma usually impact the overall living conditions of affected persons, producing multiple and negative outcomes regarding their social and physical well-being.
At least 90% of the new cases of leprosy officially reported on the American continent annually are from Brazil. However, countries were successful in eliminating leprosy as a public health problem. It means that the region can become a sort of landmark laboratory for assessing which public strategies work both in high-endemic and low-endemic countries, also regarding the elimination of stigma and discrimination.
There are not many reports of discriminatory laws in force in the Americas, but there are several reports of institutionalized discrimination at the administration of the State, such as in educational, health or social security services. Structural stigmatization is still ongoing, and misconceptions about leprosy are quite common.
Multisectoral policies are key to address the social roots of leprosy and discrimination, as well as the participation of persons affected by leprosy in the monitoring of human rights violations, enforcement of rights, awareness raising activities and counseling services.