Discrimination against hepatitis B carriers in China.
ABSTRACT In China, an estimated 130 million people carry the hepatitis B virus (HBV). Chinese HBV carriers frequently encounter dis crim ination in aspects of their lives—at school, in em ploy ment, in relationships, and within families. For example, many employers and universities refuse to accept anyone with a positive HBV test, and some kindergartens refuse to admit children who are carriers.
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ABSTRACT: Psychosocial issues and health-related quality of life (HRQOL) are important components of care in patients diagnosed with chronic hepatitis B (CHBV). In this review, we searched Medline, ISI Web of Knowledge, Google Scholar and the American Association for the Study of Liver Diseases (AASLD) website (until January 2012) using relevant terms and we categorized the retrieved content into three areas: HRQOL, mental health, and psychosocial issues such as stigma and coping. Increasing severity of CHBV leads to a decline in HRQOL. Cirrhosis worsens HRQOL, whereas treatment and psycho-education improves it. Frequency of mood disorders seems to be increased in patients with CHBV, although not all studies have shown this trend. Some factors such as alcohol consumption and low social support negatively impact patients' mental health. Those with CHBV generally have better HRQOL and mental health than their hepatitis C (HCV) counterparts. Patients with psychiatric disorders, particularly those with prolonged institutionalization, have a generally higher risk of acquiring CHBV infection compared to the general population. Robust studies regarding the stigma in patients with CHBV are lacking, although some studies have suggested a higher degree of perceived stigma in these patients. HRQOL and mental health are significantly affected in CHBV patients, particularly in those with more severe forms of the disease. There are few studies that addressed the effects of intervention in CHBV patients with psychosocial problems. Other subjects necessitating additional research include stigma, coping mechanisms, and other less common, yet important psychosomatic disorders.Archives of Iranian medicine 02/2013; 16(2):114-22. · 1.22 Impact Factor
www.thelancet.com Vol 378 September 17, 2011 1059
Discrimination against hepatitis B carriers in China
In China, an estimated 130 million people carry the
hepatitis B virus (HBV).1,2 Chinese HBV carriers frequently
encounter dis crim ination in aspects of their lives—at
school, in em ploy ment, in relationships, and within fam-
ilies. For example, many employers and universities refuse
to accept anyone with a positive HBV test, and some
kindergartens refuse to admit children who are carriers.3
Fear and prejudice against HBV carriers in mainland
China stems from ignorance about HBV and mis under-
standing of how it is transmitted. Many people incorrectly
believe that they can be infected through every day
contact with HBV carriers, or by eating with them.
Some Chinese pharmaceutical companies and hos-
pitals have exploited the prevalence of hepatitis B to
peddle alleged cures and remedies. Their advertisements
exag gerate the contagious nature of the disease and
claim that a large proportion of HBV carriers later
have cirrhosis or hepatocellular carcinoma. As a result,
misleading information has become widespread
throughout China. Past events, government policies, and
the mass media have together created deep prejudice
towards HBV carriers.
One manifestation is that illegal testing of blood for HBV
is required by most employers in China.4 A 2008 survey of
multinational and joint-venture companies by the Beijing-
based group Yirenping5 found that although 56% of
respondents said that they did not explicitly refuse to hire
people with HBV, some continued to require job applicants
to have tests for the virus. After an incident in which
an HBV carrier killed an employer6 and other individual
rights movements against employment discrimination,7
the Chinese Government has taken steps to eradicate
discrimination against HBV carriers in employment and
education since 2007.8
In February, 2010, China’s Ministries of Health,
Education, and Human Resources and Social Security
jointly banned HBV check-ups for school enrolment and
employment.9 Institutions and organisations that break
this rule will be punished; medical staff who disclose
details of HBV carriers will be warned, forced to stop
their medical practice, or their physician’s certifi cate
could be revoked.
However, regulations and enforcement are two diff erent
things. Without enforcement and strict penalties for
transgressors, China’s laws and regulations have been
ineff ective. Government policies are met with local
government counter-measures and so well-intentioned
policies do not work at grass-roots level. Many job
applicants are still asked to provide HBV test results, but
now have to sign a voluntary agreement to an HBV test.10
Public education is key to the elimination of the fear and
misunderstanding that leads to discrimination against
HBV carriers. Accuracy is needed at every stage of the
process from medical research through to communication
to the public. The public-service function assumed by the
health department of the government is crucial. Since
China is far from being a civil society, its health department
should take the lead in education and outreach initiatives.
Only large-scale dissemination of scientifi c knowledge
about hepatitis B can eliminate the ingrained fear that
leads to discrimination. We also call on the media to report
more promotional programmes, communicate accurate
scientifi c information about HBV, and pay attention to
vulnerable groups of carriers. The government has a key
role in public health and edu cation—we hope for success
in the future.
Tian Yang, *Meng-chao Wu
Eastern Hepatobiliary Surgery Hospital, Second Military Medical
University, Shanghai 200438, China
We declare that we have no confl icts of interest.
1 Liu J, Fan D. Hepatitis B in China. Lancet 2007; 369: 1582–83.
2 Custer B, Sullivan SD, Hazlet TK, Iloeje U, Veenstra DL, Kowdley KV. Global
epidemiology of hepatitis B virus. J Clin Gastroenterol 2004;
38 (suppl 3): S158–68.
3 Bejing Yirenping Center. Plea to halt bias on hepatitis suff erers. March 13,
2009. http://www.yirenping.org/english/suff erers.htm (accessed June 17,
4 China Daily. Hep B carriers allowed to join public service. Jan 21, 2005.
htm (accessed June 17, 2011).
5 China Central Television. Health Ministry to cancel hepatitis B tests for
employment and school enrollment. Dec 30, 2009. http://english.cctv.com/
program/chinatoday/20091230/101108.shtml (accessed June 17, 2011).
6 Ni C-C. Hepatitis B cause for discrimination in China. Jan 13, 2004. http://
hepatitis13 (accessed June 17, 2011).
7 China Radio International. I’m a hepatitis B carrier: will you give me a hug?
Jan 6, 2009. http://www.china.org.cn/environment/health_green_
living/2009-01/06/content_17064313.htm (accessed June 17, 2011).
8 Xinhua News Agency. China to make rules to protect privacy of hepatitis B
carriers. July 14, 2007. http://www.china.org.cn/health/2007-07/14/
content_1217086.htm (accessed June 17, 2011).
9 The People’s Daily. China’s health ministry stresses ban of hepatitis B tests.
March 27, 2010. http://english.peopledaily.com.cn/ 90001/90782/90880/
6932467.html (accessed June 17, 2011).
10 China Daily. Discrimination against hepatitis B carriers rising—survey.
March 5, 2009. http://www.chinadaily.com.cn/china/2009-03/05/
content_7542374.htm (accessed June 17, 2011).