Impact of Stigma on People Living with Chronic Hepatitis B

Abstract

Background

People with chronic infectious diseases such as hepatitis B can face stigma, which can influence everyday life as well as willingness to engage with medical professionals or disclose disease status. A systematic literature review was performed to characterize the level and type of stigma experienced by people infected with hepatitis B virus (HBV) as well as to identify instruments used to measure it.

Methods

A literature review was performed using the PubMed, Embase and Cochrane Library databases to identify studies describing HBV-related stigma. For inclusion, articles were required to be published in full-text form, in English and report quantitative or qualitative data on HBV-related stigma that could be extracted.

Results

A total of 23 (17 quantitative and 6 qualitative) articles examined HBV-related stigma. The scope of the review was global but nearly all identified studies were conducted in countries in the WHO Southeast Asia or Western Pacific regions or within immigrant communities in North America. Several quantitative studies utilized tools specifically designed to assess aspects of stigma. Qualitative studies were primarily conducted via patient interviews. Internalized and social stigma were common among people living with chronic HBV . Some people also perceived structural/institutional stigma, with up to 20% believing that they may be denied healthcare and up to 30% stating they may experience workplace discrimination due to HBV.

Conclusion

HBV-related stigma is common, particularly in some countries in Southeast Asia and the Western Pacific region and among Asian immigrant communities, but is poorly characterized in non-Asian populations. Initiatives are needed to document and combat stigma (particularly in settings/jurisdictions where it is poorly described) as well as its clinical and socioeconomic consequences.

Keywords:

• hepatitis B
• stigma
• discrimination

Abbreviations

HBeAg, hepatitis B envelope antigen; HBV, hepatitis B virus; HCP, healthcare professional; HCV, hepatitis C virus; HIV, human immunodeficiency virus; IDU, intravenous drug user; MeSH, medical subject heading; MSM, men who have sex with men; STI, sexually transmitted infection; WHO, World Health Organization.

Acknowledgments

The abstract of this paper and summary findings were presented at the European Association for the Study of the Liver (EASL) International Liver Congress in April 2018. The abstract for the poster was published in the Journal of Hepatology 2018; 68 (Suppl 1) pS185.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

KB, KC, US and EC are current employees of Janssen, which provided funding for this manuscript. JSP, WV and RP are current or former employees of Ossian Health Economics and Communications, which has received consulting fees from Janssen Pharmaceutica NV.

Additional information

Funding

This study was supported by funding from Janssen Pharmaceutica NV.