User:Bryn17/sandbox

I plan to edit the Leprosy Stigma article. I think the clarity can be fixed by rewording the introduction paragraph. I also plan to contribute more to the section on Hawaii, add a background about stigma in general including the definition and history, and means by which stigma is perpetuated and prevented. Several section edits are shown below:

Leprosy stigma is a type of social stigma, a strong negative feeling towards a person with leprosy or Hansen's disease relating to their moral status in society. It is also called leprosy-related stigma, leprostigma, and stigma of leprosy. Since ancient times Hansen's disease instilled the practice of fear and avoidance in my society because of the physical disfigurement it caused and lack of understanding the cause of the disfigurement. While many societies stigmatized Hansen's disease, the degree of stigmatization varies depending on the society's cultural value. Due to the historical trauma the word "leprosy" invokes, the disease is now called Hansen's disease, named after the person who discovered mycobacterium leprae, the bacteria agent causing Hansen's disease. Although Hansen's disease is considered only mildly contagious and there is a pharmacological cure, people who suffered from Hansen's disease describe the pain from stigma as far more worse than the physical manifestations.

Definition of Stigma
The word “stigma” originated from the Greeks who used it to “refer to bodily signs designed to expose something unusual and bad about the moral status” of a person. These bodily signs can thought of as the lesions causing physical deformities in a person's skin in the context of leprosy.

American sociologist Erving Goffman defines "stigma" as an attribute that is deeply discrediting; a stigmatized individual is one who is not accepted and not accorded the respect and regard of his peers, who is disqualified from full social acceptance. It is associated with 1) physical deformities, such as facial plaques, facial palsy, claw hand deformity or footdrop; 2) blemishes of character, such as are associated with alcoholism, drug addition, or leprosarium; or 3) race, nation, social class, sexuality and religion that are thought of as second-class by another group. Stigma itself is constructed based on “historical processes, cross-cultural differences, and structural inequalities,” which determine social norms.

United States
Hawaii

In 1865, the Kalaupapa settlement was founded on the island of Molokai, a geographically isolated peninsula bordered high mountains ("the pali") on one side a rough sea waters and coral reef on the other, served as a prison for those with inflicted by Hansen's disease on the Hawaiian Islands. By 1865 the rising numbers of Hansen's disease patients could no longer be ignored, the “Act to Prevent the Spread of Leprosy of the nation of Hawaii” was passed which criminalized leprosy and sentenced victims to permanent exile. The quarantine of lepers was based on the new assumption of leprosy being a highly contagious disease. Stigmatization of leprosy began as “a relatively unknown disease [changed] into a socially and morally threatening phenomenon”. Those with severe cases were sent to Kalawao, an isolated settlement on the island of Molokai. Later a second and larger settlement was developed at Kalaupapa. This settlement had a peak population of about 1100 shortly after the turn of the twentieth century; in total about 8500 persons were quarantined here over the decades until 1965. Both settlements are in Kalawao County.

After quarantine ended in 1960, those persons living at Kalaupapa who chose to do so could remain for the rest of their lives. The entire county is now within what is known as the Kalaupapa Leprosy Settlement and National Historical Park, which preserves both the major structures of the settlements and the associated environment of the area.

For the Native Hawaiians, who constituted most of the Hansen’s disease patients, this was devastating. Culturally, they believed their self-identity was intrinsically tied to their land. To relocate them to Kalaupapa as exiles was just the same as stripping them of their identity. The stigma of Hansen’s disease also led to no medical services between 1865-1873 on Kalaupapa. No doctors were sent there because they were afraid of becoming infected. Only kokua, family members, and Father Damien tended to the victims of Hansen’s disease on Molokai. Kalaupapa was an innovative approach to a solution for leprosy by Westerners, which became a model for controlling disease worldwide: it was the first time ostracized and shunned people were torn from families and transported to a remote prison island.

Myobacterium leprae was most likely brought to the island by Westerners, despite accusations of the Chinese plantation workers.In 1886, Molokai Leprosy Hospital reported that missionaries recognized leprosy as early as 1823 prior to any Chinese immigration. A physician also recognized similar symptoms in 1840, which was still before Chinese laborers came to Hawaii. The Chinese were able to recognize the disease because they had seen it in China, but they were not the ones to bring it to the island. It was most likely a Westerner, since the Hawaiians did not recognize the disease and there was no documentation of Hansen’s disease among the Hawaiian prior to the arrival of Westerners. In addition, between 1866-1885, of the 3076 patients, 2997 were Native Hawaiian, 57 European, and 22 Chinese.

Factors contributing to leprosy stigma
 Biblical References 

In The Book of Leviticus, Leviticus 13 states "But if the bright spot is white on the skin of his body, and it does not appear to be deeper than the skin, and the hair on it has not turned white, then the priest shall isolate him who has the infection for seven days.”

General public's misconceptions
The general public still has misconceptions about leprosy, with persistent beliefs that it is highly contagious. In the twenty-first century, agencies such as The Leprosy Mission campaign to end these misconceptions and work to educate people about leprosy, its causes, and how it is transmitted. They want people with the disease to be identified so they can be treated and limit the physical damage, as well as control contagion. In the twenty-first century, effective, free treatment of dapsone, rifampicin, and clofazimine was available through WHO. However, in many parts of the world, lay people still believe the disease to be incurable. The multi-drug therapy provided free to countries where the disease is endemic provides a reliable cure for leprosy.

The misconception also stems from the discontinuity between science and government policy. Although the medical community has agreed for decades that Hansen’s disease is only mildly contagious, it still remains on the list of “communicable diseases of public health significance” for health-related grounds of inadmissibility on the US Citizenship and Immigration Services website, even though HIV was removed in 2010. As of 2018, Hansen’s disease is still listed as a “communicable disease of public significance,” and therefore, screened for as part of the immigration medical exam.

The Press
On the May 7, 2007 Lou Dobb's Tonight program, Madeleline Cosman, a scholar and lawyer--not physician, falsely stated “there have been 7000 cases in the past 3 years.” In a later interview with 60 Minutes, Dobbs was questioned about the 7000 cases in 3 years figure but said, “If we reported it, it’s a fact.” On the contrary, The National Hansen’s Disease Programme represented this number in 30 years—not 3 years. Although Dobbs admitted the mistake in a later New York Times article, the ramifications of the false statement persisted.

The United Nations
Since 1995, WHO has supported the eradication of Hansen’s disease through the administration of free multi-drug treatment worldwide and the promotion of education of Hansen’s disease to erase stigma towards Hansen’s. Although the goal for the complete eradication of leprosy in 2020 seems infeasible for “zero patients” due to the long period of M. leprae dormancy, the WHO has shifted towards a “Final Push” Strategy focusing on early detection to reduce disabilities. Moreover, most patients do not die from leprosy but from other diseases and complication—not the bacteria infection itself. In addition, people may survive for many years but still have leprosy or survive with disabilities.