The stigmata and discrimination experienced, in southern India, by cases of lymphatic filariasis A. KRISHNA KUMARI * , K. T. HARICHANDRAKUMAR { , K. KRISHNAMOORTHY * and L. K. DAS * * Vector Control Research Centre (Indian Council of Medical Research), Indira Nagar, Pondicherry, 605 006, India { Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Dhanwantiri Nagar, Pondicherry, 605 006, India Received 21 May 2010, Revised 25 June 2010, Accepted 28 June 2010 Between November 2006 and November 2009, the stigmata and discrimination experienced by 201 cases of lymphatic filariasis (LF) living in three areas of the southern Indian state of Tamil Nadu (the Pondicherry urban agglomeration and two, endemic, rural villages in Villupuram district) were investigated in interviews. The narratives of nine of the interviewees are reported here in detail, to bring to light the various domains of life in which LF cases are stigmatized and discriminated against. Lymphatic filariasis can, and often does, adversely affect each case’s livelihood, marital prospects, and social and marital life and can also diminish the marital prospects of a case’s children. The deformity caused by the disease and the incapacitation resulting from the often-frequent attacks of adenolymphangitis appeared to be the main reasons for the stigmatization and discrimination. Although morbidity control is one of the ‘twin pillars’ of the Global Programme for Elimination of Filariasis, the stigmata and discrimination associated with such morbidity also need to be addressed. Human lymphatic filariasis (LF), a major vector-borne disease and public-health pro- blem in many developing countries (Pani and Srividya, 1995; Dunyo et al., 1996), has been ranked as the second leading cause of long- term chronic disability world-wide (WHO, 1995). The clinical manifestations of this infectious disfiguring disease are generally irreversible (www.cdc.gov/ncidod/EID/vol10 no11/04-0624_07.htm). In its most obvious manifestations, LF causes enlargement of entire legs and/or arms, the genitals, the vulva and/or the breasts (WHO, 2000). Although not fatal, the disease can cause tremendous physical suffering (Gyapong et al., 1996) and cases are also often stigmatized. The asso- ciated stigmata — typically social processes, experienced or anticipated, characterised by exclusion, rejection, blame and/or devalua- tion — may be perceived, enacted or inter- nalized (Weiss et al., 2006). Perceived or felt stigmata include the individual’s perceptions and fears of what would happen if their status became known. Enacted or experienced stigmata include denial of rights (healthcare, employment, housing etc), exclusion by family and community, loss of respect or social status, and verbal and physical abuse. Internalized stigmata (‘self-stigmata’) consist of negative self-image, self-isolation, with- drawal, and feelings of shame, guilt and uncleanliness (Anon., 2004) In recent years, the concept of stigma has attracted increased attention from health professionals, mainly because stig- mata contribute to the burden of illness and influence the effectiveness of case finding and treatment (Weiss et al., 2006; Person et al., 2009). A health-related Reprint requests to: A. Krishna Kumari. E-mail: krishnaunni@gmail.com. Annals of Tropical Medicine & Parasitology, Vol. 104, No. 5, 421–426 (2010) # W. S. Maney & Son Ltd 2010 DOI: 10.1179/136485910X12786389891128