Breaking the Silence on Hepatitis
Viral hepatitis has been dubbed a "silent epidemic." As many as two-thirds of those infected with either hepatitis B or C are ignorant of their status, only realizing it when their infection flares into cirrhosis or liver cancer. There is very limited public awareness of the disease. And then there is the silence of stigma, the unwillingness to talk about infections associated with sexual activity and drug use, even though the majority of hepatitis B infections occur during childbirth and until 1992 hepatitis C could be contracted through blood transfusions.
A comprehensive, national approach to viral hepatitis prevention and treatment should be undertaken to break through the silence and stigma, says a recent report by the Institute of Medicine. The disease affects up to 5.3 million Americans -- and one out of every 12 people worldwide -- and accounts for nearly half the liver transplants performed in the United States.
Effective treatments are available for the majority with chronic hepatitis B or C. Vaccination can prevent hepatitis B infection, but health care and social service providers' knowledge about hepatitis B and C is generally poor, and many fail to follow guidelines for screening patients and providing care and services. Moreover, these services are fragmented among providers and organizations, leading to missed opportunities. A more coordinated approach includes improved identification of infected individuals and medical management of those with chronic infection. The onus is not just on traditional health care venues; organizations that provide services to at-risk populations, including prisons, Asian-American outreach groups, HIV and STD clinics, and shelter-based programs, have key roles to play, too.
Steps also need to be taken to eliminate the stigma associated with viral hepatitis. Negative attitudes about hepatitis B in Asian cultures where the disease is endemic may contribute to immigrants' reluctance to seek testing. In China, for example, people who test positive face job and social discrimination. In addition, negative perceptions about illicit-drug users, who are at greatest risk for hepatitis C, can affect the care they receive or their willingness to seek treatment.
The report recommends a public awareness initiative along the lines of the effort that succeeded in increasing recognition of HIV/AIDS and reducing its stigma. Educational programs and materials about viral hepatitis should be developed and made available to all health professionals and social service providers. -- Christine Stencel
Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Committee on the Prevention and Control of Viral Hepatitis Infections, Board on Population Health and Public Health Practice, Institute of Medicine (2010, 252 pp.; ISBN 0-309-14628-3; available from the National Academies Press, tel. 1-800-624-6242; $39.00 plus $5.00 shipping for single copies).
The committee was chaired by R. Palmer Beasley, professor of epidemiology and disease control, University of Texas School of Public Health, Houston. The study was funded by the U.S. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services' Office of Minority Health, U.S. Department of Veterans Affairs, and the National Viral Hepatitis Roundtable.