Father Damien's coming elevation to sainthood in October is renewing efforts to eliminate the centuries-old stigma attached to Hansen's disease, also known as leprosy.

The illness still occurs — though rarely — in the United States and continues to be a public health concern in several developing nations.

On average, 20 new cases of Hansen's disease are diagnosed in the Islands annually. Hawai'i has one of the highest per capita rates of Hansen's disease nationally, though other states, including Texas and California, see more cases.

"I think people don't realize it's still out there," said Lori Ching, program manager for the state Hansen's Disease Community Program.

Most new Hawai'i patients are immigrants from Asia and the Pacific, and are diagnosed thanks to screening programs that also look for other illnesses.

Worldwide, more than 200,000 new cases of Hansen's disease were diagnosed in 2008.

Advocates for patients say Damien's canonization is helping spotlight the ongoing push to eradicate Hansen's disease, whose cure was found in the 1940s. The lessons of Damien and Kalaupapa from more than a century ago are also resonating with people worldwide who have the disease and say its stigma is still so strong that they are often afraid to publicly discuss their illness.

Valerie Monson, secretary and coordinator for Ka 'Ohana o Kalaupapa, a nonprofit that advocates for Hansen's disease patients in Kalaupapa and works to preserve the history of the settlement, said many are using Damien's story as a human rights story to help end the stigma associated with Hansen's disease.

"Leprosy is one of the few diseases where human rights are stripped of people" because of discrimination, said Monson, who has also written extensively about Kalaupapa. "The world is now looking at (the history of) Kalaupapa for leadership. And people are standing up. They're speaking out I think like never before."

ANCIENT AFFLICTION

Recorded cases of Hansen's disease date back more than 3,000 years — and its stigma, advocates say, is just as old. Much of the stigma is related to the disfigurement that patients in advanced stages of the disease can experience. There are also plenty of myths about the disease and how it spreads, advocates for patients say. Hansen's disease is difficult to transmit and much of the population is naturally immune.

Because of the stigma to patients, some prefer not to use the word "leprosy," though the term is used by the U.S. Centers for Disease Control and Prevention and the World Health Organization.

Hansen's disease was first detected in the Islands in the mid-1800s, and was likely brought here by immigrants. Fearing an epidemic, the Hawaiian Kingdom in 1865 established Kalaupapa as a settlement and required those diagnosed with the disease to go there.

At one time, nearly 9,000 people were quarantined in Kalaupapa. Hawai'i's quarantine restrictions on Hansen's disease patients were lifted in 1969.

Today, 19 patients still live in Kalaupapa by choice.

The Rev. Damien de Veuster arrived at the Moloka'i settlement in 1873, at age 33, to minister to the patients when no one else would. During his 16 years on Moloka'i, Damien worked to create a community for patients as a way to give them dignity and a source of pride.

He died in 1889 from Hansen's disease.

Damien will be elevated to sainthood Oct. 11 in Rome. The Congregation of the Sacred Hearts priest is already known worldwide for his service to those who were isolated in Kalaupapa, and hundreds of Hansen's patients from around the world are expected to attend his canonization.

Anwei Law, international coordinator for a Hansen's disease advocacy group called the International Association for Integration, Dignity and Economy Advancement, said people with Hansen's disease from all over the world "have a great reverence" for Father Damien.

"Anybody diagnosed with this disease feels this legacy of thousands of years of misunderstanding," she said. In Kalaupapa, she said, "these were people coming together under unimaginable circumstances, but they were good people and they created a community and that community has inspired the world. Just knowing that tells you something about Father Damien."

Hansen's disease, which is one of the least contagious infectious diseases, is caused by a slow-growing bacterium that mainly affects the skin, nerves and mucous membranes. In advanced stages, the disease causes disfiguring sores and disability from nerve damage.

The disease is cured with a multi-drug antibiotic therapy, mostly on an outpatient basis.

FEW NEW U.S. CASES

There were about 70 new cases of Hansen's disease nationwide in 2008, compared with about 100 the previous year, according to the CDC.

In the Islands, there are about 225 people on the outpatient registry for Hansen's disease. Most have been cured, but are being monitored annually for recurrence.

Since 1993, there have been 291 new cases of Hansen's disease diagnosed in Hawai'i.

Health Department officials said most people diagnosed with the disease are immigrants from countries where Hansen's disease is more prevalent, including the Federated States of Micronesia, American Samoa and Vietnam.

So far this year, there have been 15 new cases, though not all are confirmed.

Few of those diagnosed with the disease are from Hawai'i. One Hawai'i resident was diagnosed in 2007, however, and two in 2005.

In the mid-1990s, the state Health Department began screening incoming immigrants for Hansen's disease, after a cluster of about 12 people were diagnosed with the disease in Kona. The patients were all migrants, and most came from a single family.

Since then, health officials have been working to increase awareness of Hansen's disease with health fairs and screenings at churches and clinics. People can also request to be screened in their homes, because of the stigma involved with the disease. More recently, the Health Department has offered screenings at homeless shelters and housing projects.

Ching, of the Hansen's Disease Community Program, said some Hansen's disease cases are caught through immigration screenings. But that system is not fool-proof, since not everyone who comes into the country is required to go through those tests, including arrivals from the Federated States of Micronesia. Helping those people, Ching said, requires continued community outreach efforts and education.

The screenings and any treatment for Hansen's disease is free in Hawai'i.

Hansen's disease is considered rare in most developed countries and is close to being all but eliminated in some nations where it used to be widely seen. Also, the number of cases worldwide is on the decline. In 2001, some 763,000 people were diagnosed with the disease — about 500,000 more than the total diagnosed last year.

Countries with the highest number of cases include Brazil, India and Indonesia.

Law, of the IDEA advocacy group, which has branches in 22 countries, said the statistics are still distressing given that Hansen's disease is easily curable.

"There are still a lot of people getting this disease around the world today," she said.

She added: "Of course, the problem is the stigma. There's a different kind of bar with leprosy. It needs to be raised."