Hepatitis B discrimination in everyday life by rural migrant workers in Beijing

Abstract

Background: In China, the hepatitis B virus (HBV) is a particularly challenging public health issue, with an estimated 90 million chronic hepatitis B carriers accounting for almost 7% of the population. Healthrelated discrimination can serve as a barrier to prevention and care for infectious diseases, such as HBV, degrade the HBV sufferers' quality of life and limit HBV patients' employment opportunities. While rural migrants account for up to 40% of the total urban population in the developed cities in China, there has been no study of the discrimination behavior of rural migrant workers toward HBV carriers.Objective: This study evaluates the discrimination behavior of rural migrant workers toward HBV carriers and patients and proposes public policy recommendations to address discrimination and stigma.Methods: The sample comprised 903 rural adults, aged over 18 years old, who migrated to Beijing. Using a face-to-face interview, we surveyed rural migrants' demographic characteristics, knowledge of HBV and discrimination against HBV carriers. Descriptive statistics were used to characterize the study population, HBV stigma and knowledge of HBV. Three discrimination levels (no-mild, medium and severe discrimination) were modeled using multiple logistic regression.Results: Rural migrants to Beijing had a mean age of 36 years, were overwhelmingly married (91.58%), mostly with a junior high school or lower education (78.05%) and mainly engaged as temporary workers (42.52%) or self-employed (33.78%). Only 30.56% reported that they had been vaccinated against HBV. On the 0-10 discrimination scale, rural migrants rated 6.24, with only 4.54% displaying no sign of HBV-related discrimination. The high discrimination score occurred alongside a low mean knowledge of HBV (7.61 on the 1-22 ranking of HBV knowledge). Multiple logistic regression results suggest an inverse relationship between discrimination levels and HBV knowledge, especially knowledge about treatment and transmission routes. The "fear of being infected with HBV" and being HBV vaccinated was positively associated with HBV-related discrimination. Unemployed rural migrants were more likely to exhibit severe HBV-related discrimination than other occupational groups. Personal attributes, such as gender, age, marital status and education level were not associated with the level of discrimination.Conclusions: Knowledge of HBV, its transmission and treatment, and the fear of HBV infection were key features in understanding HBV discrimination by rural migrant workers. To reduce discrimination, HBV public health education campaigns need to focus on both knowledge about HBV and the fear of HBV infection. Such campaigns should target rural migrant subgroups, such as unemployed rural migrant workers.

Factors for self‐management activities among rural patients with chronic hepatitis B: A cross‐sectional study

“…In this study, rural patients with CHB reported receiving or perceiving low support from their social networks. A possible explanation may be that discrimination against patients with CHB has long existed in China for CHB is infectious and can hardly be cured (Leng et al, ). Stigma with CHB infection can significantly disrupt patients' social relationships and increase isolation (Valizadeh, Zamanzadeh, Bayani, & Zabihi, ), which may affect patients getting enough support to cope with CHB.…”

“…CHB infection increases the risk of developing severe liver diseases, such as cirrhosis, hepatic decompensation and hepatocellular carcinoma (Tang, Covert, Wilson, & Kottilil, ). Approximately 300,000 people die from CHB‐related diseases every year in China (Leng et al, ). Patients with CHB have suffered psychosocial issues and declined quality of life (Modabbernia, Ashrafi, Malekzadeh, & Poustchi, ).…”

Nonliver Comorbidities in Patients With Chronic Hepatitis B

“…For patients who had CHB but were unaware of their status, there was no statistically significant difference in having major depression . Although development of mental illness may be attributable, at least in part, to discrimination or fear of discrimination, this perception carries significant consequences for patients with CHB …”

“…26 Although development of mental illness may be attributable, at least in part, to discrimination or fear of discrimination, this perception carries significant consequences for patients with CHB. [27][28][29] aDverse eFFeCTs OF anTiviral THeraPY Currently, there is no cure for CHB, so the emphasis of management is on prevention through vaccination. In fact, since 1991, when the United States adopted childhood vaccination programs, there has been a 68% decrease in the prevalence of HBV infection.…”

The association between hepatitis B self‐awareness and depression: Exploring the modifying effects of socio‐economic factors

“…Given that hepatitis B can hardly be cured and can be transmitted in the population, discrimination against people with HBV has long existed in China, which may strongly affect patient's quality of life and mental status through certain psychosocial pathways . Disease‐related stigma and discrimination may cause negative social response .…”