Gender and the stigma of onchocercal skin disease in Africa

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.