This paper reports results from a multicenter study of gender differences i
n the stigma associated with onchocercal skin disease (OSD) in five African
sites: Cameroon, Ghana, Nigeria (Awka and Ibadan) and Uganda. The studies
used a common protocol to compare affected and unaffected respondents, that
is, men and women with onchodermatitis in highly endemic areas and respond
ents from communities with low endemicity or no onchocerciasis. The methods
were both quantitative and qualitative, allowing for the comparison of sti
gma scores and people's verbal descriptions of their experiences and attitu
des. Questions to the unaffected were asked after providing them with photo
graphs and short descriptions (vignettes) depicting typical cases. We found
that stigma was expressed more openly by the unaffected, who perceived OSD
as something foreign or removed from themselves, whereas the affected tend
ed to deny that they experienced stigma as a result of the condition. Gende
r differences in stigma scores were not significantly different for men and
women, but qualitative data revealed that stigma was experienced different
ly by men and women, and that men and women were affected by it in distinct
ive ways. Men were more concerned about the impact of the disease on sexual
performance and economic prospects, whereas women expressed more concern a
bout physical appearance and life chances, especially marriage. Similar tre
nds were found in the different sites in the responses of affected and unaf
fected respondents, and differences between them, despite geographical and
cultural variations. (C) 2000 Elsevier Science Ltd. All rights reserved.