Barriers to Hepatitis B Screening and Prevention for African Immigrant Populations in the United States: A Qualitative Study

Abstract

Chronic hepatitis B infection (HBV) disproportionately affects African Immigrant (AI) communities in the U.S., with a reported infection rate of 15%. HBV screening rates within these communities are low. This study sought to better understand the socio-cultural determinants associated with low HBV screening among AI communities and identify potential strategies to help inform the development of effective HBV education and screening interventions. Seventeen in-depth interviews were conducted with community health experts working in AI communities throughout the U.S. Interviews explored the potential impact of culture, perception of health, awareness of HBV, religious practices, current screening practice, provider relationship, and behaviors towards general prevention. Interview data were analyzed using thematic analysis. Religious preferences and cultural norms affect health care access, perceptions towards prevention, awareness of HBV, and contribute to myths and stigma within this population. Participants reported a lack of HBV knowledge and awareness and barriers to health care access including, cost, language, racism, understanding of Western Medicine, and usage of traditional medicine. This study elucidates the role of religious and cultural beliefs as barriers to HBV screening and care. Results can contribute to public health efforts to increase awareness, screening and vaccination efforts within AI communities.

The Lived Experience of Chronic Hepatitis B: A Broader View of Its Impacts and Why We Need a Cure

“…Thus, the messaging (and not only content) of education is important. For example, some have suggested the correction of misunderstandings about inaccurate HBV transmission routes plays a more important role in reducing discrimination than understanding of accurate HBV transmission routes [76,77]. To reduce HBV-related discrimination, policymakers should consider broad and multiple measures with a unified message to decrease the burden of stigma and discrimination, including increasing public education about HBV; promoting universal adult HBV immunization programs; and increasing screening and linkage-to-care programs in at-risk communities.…”

“…Some marginalised populations already tend to see the clinical services of the majority society as last resorts. For stigmatizing conditions such as CHB, many may prefer to avoid clinical services and see traditional or alternative health practitioners [54,76], who are not likely to be trained in the management of CHB and so are unable to prevent the HBV-associated disease progression.…”

Common Concerns, Barriers to Care, and the Lived Experience of Individuals with Hepatitis B: A Qualitative Study

“…10,28 Additionally, research shows that HBV-associated stigma had potentially negative impacts on mental health, wellbeing, employment, and relationships and is a major barrier to addressing HBV. 28,29 Queries from this study provide evidence to support this as well as wide-spread discrimination people with HBV experience when seeking education, employment, and residency in various countries which directly affects their careers, ability to immigrate, and their subsequent quality of life. It will be important moving forward to systematically de ne and document HBV-related discrimination, as it relates to employment, education, and immigration/residency, so that it can be understood and addressed.…”

“…In low income countries a health disparity associated with HBV is related to access to and cost of treatment. 10,16,29 HBV treatment has to be taken long-term, with the cost varying signi cantly across the world creating challenges in lifelong management of the disease. 7 Additionally, as new therapies currently in development move through clinical trial, it is important that accessibility be considered a top priority particularly within low-income countries where HBV is endemic.…”

Special Issue “Hepatitis B Virus Infection: From Diagnostics to Treatments”

“…HBV diagnosis and living with HBV. Although highly sensitive, specific, widely available, and inexpensive tests are now available to diagnose HBV infection, Freeland et al highlight some of the major hurdles that still prevent affected people from entering the health care system [1]. They focus on African immigrants to the United States and find (as with many other communities) that stigma and discrimination play a key role in preventing patient engagement in diagnosis and treatment.…”