Impact of socio-economic development, contact and peer counselling on stigma against persons affected by leprosy in Cirebon, Indonesia – a randomised controlled trial

ObjectivesPeople affected by leprosy are often stigmatised, but stigma is rarelyquantified and the effectiveness of interventions is often not evaluated. The SARIProject aimed to test and evaluate three interventions: counselling (involving peercounsellors), socio-economic development (SED) and contact between communitymembers and affected people.ResultsThis study used a controlled trial design in which pairs of the stigma-reduction interventions were randomly allocated to sub-districts in Cirebon District,Indonesia. The study sample consisted of one cohort of people affected by leprosy (on treatment or treated) and two independent samples of community members. The latter were selected through purposive sampling. Three scales (e.g. SARI Stigma Scale,Participation scale) were applied among leprosy-affected people and two scales(e.g. Social Distance Scale) were used among community members pre- and post-intervention. Among affected people (n=237), significant differences in reduction of stigma and participation restrictions were found in all intervention areas and an improvement in quality of life in some intervention areas. Social distance and social stigma significantly reduced among community members (n=213 and 375) in the two intervention areas where the contact intervention was implemented. Two of the five instruments indicated changes in the control area, but the changes in the intervention areas were much larger.ConclusionThe SARI Project has demonstrated that a measurable reduction inleprosy-related stigma can be achieved, both at community level and among peopleaffected by leprosy, using reproducible interventions that can be adapted to differentsettings and target groups.