Stigmatization and discrimination of patients with chronic hepatitis C

Gender disparity and stigma experience of patients with chronic hepatitis B virus infection: A prospective cross-sectional study from a hospital in Nigeria

Backgound

Hepatitis B virus (HBV) infected persons often suffer stigma. Stigma can come from the society or be self-induced. This study assessed the gender differences and stigma experience of patients with HBV.

Methods

Prospective cross-sectional design with a qualitative element using a pretested interviewer administered questionnaire and an in-depth oral interview of HBV infected patients. Quantitative data obtained were entered into SPSS version 20 and analyzed using simple descriptive and inferential statistics, while content analysis was used for the qualitative data.

Results

Total of 242 respondents answered the quantitative questionnaire. There were 142(58.7%) males and 100 (41.3%) females; age range was 18-72 years with mean (SD) of 35.4(10.7) years. Overall stigma rate was 23.1%. Stigma resulted from a positive HBsAg test, and the experience was unaffected by other markers of HBV infection. Stigma was higher in the domain of disease transmission for both single and married respondents and was particularly higher among males than females. Stigma among females affected pre-marital engagements and also caused marital disharmony among married respondents. In-depth oral interview of 23 HBV infected respondents revealed that many exhibited self-stigma, had wrong knowledge of HBV infection modes, complications, and interpretation of HBV internet information which aggravated stigma reactions.

Conclusions

Stigma of HBV is high and majorly in the domain of disease transmission. It is higher in males than females. Enlightenment campaign targeting singles and married couples and HBV infection modes is advocated.

Beyond clinical outcomes: the social and healthcare system implications of hepatitis C treatment

Background

Hepatitis C virus (HCV) infections in people who inject drugs (PWID) can now be treated and cured. However, the impact that HCV treatment has on drug-user health, practices and wellbeing is not known. The aim of this research was to understand the non-clinical impact that HCV treatment has in PWID and their reasons for accessing and completing treatment.

Methods

Participants aged 25–67 years who had injected opioids or stimulants (currently or in the past) and had completed direct-acting antiviral treatment were recruited from seven European countries. Participants completed a 30-min online survey administered face-to-face between September 2018 and April 2019. The questionnaire responses were used to assess the mental and physical impact of having completed treatment.

Results

Of the 124 participants who completed the survey questionnaire, 75% were male, 69% were over 45 years old and 65% were using opioids and/or stimulants at the start of HCV treatment. Participants reported improvements in the following areas after completing HCV treatment: outlook for the future (79%); self-esteem (73%); ability to plan for the future (69%); belief in their abilities (68%); confidence (67%); empowerment (62%); energy levels (59%); and ability to look after themselves (58%). The most common reasons for starting HCV treatment were: becoming aware of treatments that were well tolerated (77%) and effective (75%); and understanding the potentially severe consequences of HCV (75%).

Conclusions

The benefits of HCV treatment go beyond clinical outcomes and are linked to improved drug-user health and wellbeing. Sharing information about well-tolerated and effective HCV treatments, and raising awareness about the potentially severe consequences of untreated HCV are likely to increase the number of PWID who are motivated to access and complete HCV treatment in future.

[Chronic hepatitis B and C as stigma: Is the problem relevant for Russian society?]

Chronic hepatitis B and C (CHB and CHC) are a serious medical and social problem of the world community.

AIM

to study the problem of stigmatization and attitudes to patients with CHB and CHC among adolescents and adults.

MATERIALS AND METHODS

An anonymous survey was conducted in 120 residents of the Kirov region. Of these, 94 adults (aged 18 to 76 years; average age 39.3±11.5 years) of different specialties except medical (group 1) and 26 adolescents aged 16-17 years (average age 16.5±0.5 years), high school students (group 2). The original questionnaire included 16 questions divided into 3 blocks. Block 1 contained questions about the socio - demographic status of the Respondent, block 2 and block 3 included questions on the epidemiology of HCV and HBV infection and on the treatment of patients with CHC and CHB respectively.

RESULTS

In the course of work the majority of respondents (50-65.4%) from both groups revealed a negative attitude towards patients with CHB and CHC (to a lesser extent pronounced against close relatives and friends of CHC patients), manifested by a desire to exclude casual contact and refusal to live in the same room with the patient CHB/CHC, no desire of sharing your child/brother in the same kindergarten group patients with CHB/CHC child. Fear of Contracting HBV/HCV infection has been linked to poor knowledge of the factors and pathways of transmission of these diseases. In a few cases, adolescents and adults showed an extreme degree of destructive attitude, which was expressed in the adoption of discriminatory measures against this category of patients - dismissal from work and expulsion from school/University.

CONCLUSION

The results indicate that there is a problem of stigmatization of patients with CHB and CHC in society, both in children and adults, which requires systematic work on health education.

Contextualizing Canada's hepatitis C virus epidemic

In 2016, Canada signed on to the World Health Organization (WHO) 2030 hepatitis C virus (HCV) disease elimination targets. Most of Canada's HCV disease burden is among five disproportionately affected population groups: 1) Baby boomers, who are at increased risk of dying from decompensated cirrhosis and hepatocellular carcinoma and for whom one-time screening should be recommended to identify those undiagnosed; 2) People who inject drugs (PWID), whose mortality risks include HCV infection, HCV acquisition risks and co-morbid conditions. While HCV infection in PWID can be effectively cured with direct-acting antivirals, premature deaths from acquisition risks, now exacerbated by Canada's opioid crisis, will need to be addressed to achieve the full benefits of curative treatment. PWID require syndemic-based solutions (harm reduction, addictions and mental health support, and management of co-infections, including HIV); 3) Indigenous populations who will require wellness-based health promotion, prevention, care and treatment designed by Indigenous people to address their underlying health disparities; 4) Immigrants who will require culturally designed and linguistically appropriate services to enhance screening and engagement into care; and (5) For those incarcerated because of drug-related crimes, decriminalization and better access to harm reduction could help reduce the impact of HCV infections and premature mortality. A comprehensive prevention, care and treatment framework is needed for Canada's vulnerable populations, including those co-infected with HIV, if we are to achieve the WHO HCV elimination targets by 2030. The aim of this review is to describe the HCV epidemic in the Canadian context.