A woman with leprosy is in double jeopardy.

The double jeopardy associated with female leprosy patients is the central theme underpinning this essay. It constitutes a combination of biological factors unique to women and culturally defined bias, resulting in more stigmatization and isolation for women. Having examined the female immunological response and biological roles, the essay continues by focusing on the gender-culture perspective of leprosy. It draws upon an historical analysis of the experiences of Indian and African women to illustrate the ways in which gender roles impact upon health education and the utilization of health care services. Concluding comments suggest strategies that might improve female leprosy patient status, and views towards future research.

Os efeitos da hanseníase em homens e mulheres: um estudo de gênero / The effects of leprosy on men and women: a gender study

Detectou-se diferentes experiências de viver a hanseníase no contexto familiar e individual de uma populaçäo constituída por 202 hansenianos (132 homens e 70 mulheres), inscritos no programa de controle e tratamento dos serviços de saúde de Ribeiräo Preto. Duas etapas para coletas de informaçöes foram realizadas. Na primeira, os hansenianos responderam a um questionário com perguntas estruturadas; na segunda, foram ouvidos relatos de situaçöes vividas no cotidiano de dez homens e mulheres. Os dados revelaram que a doença mobilizou representaçöes diferentes entre os homens e mulheres nos diferentes grupos sociais. A hanseníase representou um desequilíbrio entre os gêneros, acentuando as desigualdades já existentes no campo sócio-cultural e criando novos problemas responsáveis pelos prejuízos bio-psico-sociais e econômicos, além dos estigmas que pesam sobre os indivíduos. Tais resultados devem reorientar os programas de controle e tratamento, visando à recuperaçäo social dos hansenianos, e também servir de paradigma a novas investigaçöes.

Incorporating gender in the anthropology of infectious diseases.

The paper focuses on key issues in research and control of infectious diseases and demonstrates the utility of combining a gender perspective with anthropological investigation both for understanding disease and for designing and evaluating interventions for its control. Based on a definition of gender as opposed to sex, it illustrates, with the help of a gender framework for tropical diseases, how this concept is applied. It argues that gender-sensitive research is essential to the understanding of the nature of the disease, its prevalence, distribution, determinants and consequences. Examples are taken from anthropological studies on infectious diseases, including research on urinary schistosomiasis, malaria, leprosy, leishmaniasis and onchocerciasis. How gender-sensitive qualitative research can guide the design and evaluation of appropriate interventions for the prevention and control of infectious diseases is also discussed.

Sex differences in the absorption of dapsone after intramuscular injection.

A trial was performed with a long-acting dapsone (DDS) injection, consisting of an aqueous suspension of dapsone crystals, in doses of 900 mg and 1200 mg. Forty-one Ethiopian leprosy patients, 13 women and 28 men, participated in the study. There appeared to be a large discrepancy in the serum concentration curves of dapsone between men and women. Following injection of 900 mg dapsone in men, a peak of 2.28 +/- 1.06 micrograms/ml (mean +/- S.D.) was observed in the first week. After two weeks the serum concentrations had fallen to 0.42 +/- 0.29 micrograms/ml, and after four weeks they fell to 0.11 +/- 0.09 micrograms/ml. Following injection in women, the curves were smooth with a peak in the first week of only 1.04 +/- 0.40 micrograms/ml, while the serum concentrations after four weeks were still 0.42 +/- 0.23 micrograms/ml. The differences between the mean curves of men and women were statistically significant (p less than 0.001). The 1200 mg dapsone injections were only given to men. The explanation of the sex difference in intramuscular absorption can probably be found in the differences in the thickness of gluteal fat in men and women. In these Ethiopian leprosy patients, the non-protein-bound fraction of dapsone comprised 17 +/- 4%. In saliva, 19.5 +/- 7.0% of the dapsone level in serum was found. Methemoglobin levels were raised but did not reach levels of clinical importance. No other significant side effects were observed.

Association between lepromatous leprosy and Australia antigen

Australia antigen is more common in patients with lepromatous leprosy than in patients with tuberculoid leprosy or in non-leprosy controls. In the combined populations, the frequency is, in general, higher in males than females, and in younger people than in older people. Australia antigen has now been found to be associated with lepromatous leprosy, leukaemia, and hepatitis, and to cluster in families. It is sugegsted that indivuduals with Australia antigen have an inadequate immune response and are especially susceptible to various illness, including lepromatous leprosy.