Leprosy as a multilayered biosocial phenomenon: The comparison of institutional responses and illness narratives of an endemic disease in Brazil and an imported disease in Portugal.

This paper questions the relation between human health and society from the case study of leprosy. To discuss the cultural and social mediator factors of both the experience of leprosy and outcomes of medical practices, it examines the biomedical twist in the dialectic between citizenship and public good that aimed to turn leprosy into a disease like any other, with the advent of multidrug therapy during the 1980s. Such analysis is based on a multisited ethnography, developed between 2008 and 2013 in two divergent contexts from the global South and North: Brazil, which remains the country in the world with the highest relative cases of leprosy, and Portugal, in which leprosy has become an imported disease. The main results of this research point to the limits of a pharmaceuticalized governmentality of leprosy and to heterogeneous medicalization's processes, which evince the determinacy of historical intersections between the State and civil society, as well as the corollaries of the former in medical care. This paper concludes with an analysis of the partition between biomedical cure and the healing of leprosy, which unveils the intermediation of institutional and extrainstitutional factors in access to health and in the cure of leprosy. It is finally argued that such intermediation requires a public health approach that might resocialize leprosy through a paradigmatic shift toward intersectoral and participatory operational strategies.