Individual identities and stigma inequalities: insights from the experience of people affected by podoconiosis in Rwanda.

Introduction: Podoconiosis is a Skin Neglected Tropical Disease (SNTD) that affects impoverished individuals in tropical regions. While there is a substantial understanding of the stigma associated with podoconiosis, little is known about the podoconiosis-related stigma experience based on individual identities, such as gender, class, age, location and physical ability. Due to the power differentials associated with these identities, individuals experience health problems differently, resulting in health disparities. This paper aims to discuss the inequalities related to podoconiosis stigma due to individual identities, informing policies and practices to reduce podoconiosis stigma-related disparities.

Methods: This paper draws on a qualitative research approach to explore how individual identities shape the experience of podoconiosis stigma among affected people. Qualitative methods, including participant observation, interviews, focus group discussions, and key informant interviews with persons affected, family members, community health workers, and representatives, were employed. Data were thematically analysed.

Results: Our findings reveal the complex nature of podoconiosis stigma-related inequality rooted in individual identities. We identified three main themes: (1) the importance of cultural norms and traditions in shaping social positioning, (2) Uneven stigma experience, and (3) the importance of one's social positioning in coping with stigma due to podoconiosis. Certain stigmatised individuals or groups face higher levels of stigma than others. Affected individuals are often associated with culturally defined identities. Those with oppressive identities experience significantly more stigma compared to those with positive identities, because of cultural interpretations linked to class, ability, gender, and age. Poor married women and men, young girls, and disabled individuals with podoconiosis encounter greater stigma than their peers.

Conclusion: This paper illuminates that the podoconiosis stigma inequalities are shaped by individuals' identities related to gender, age, economic status, and bodily ability. Individuals with oppressive identities endure more stigma than others., and this differential stigma experience enhances the understanding of how disparities in stigma associated with podoconiosis or other SNTDs underpin health inequities. Such insights suggest integrating interventions to reduce podoconiosis stigma with others, such as gender equality education, economic empowerment programs, fostering positive identities and social inclusion, thus reducing disparities.