By Robin Lord Smith | Richmond Times-Dispatch | February 10, 2022

As Virginians continue to adapt to the ongoing COVID-19 pandemic, another serious public health threat, viral hepatitis, is impacting the commonwealth’s most vulnerable populations. Historically marginalized communities including people of color, people who are incarcerated and people who use drugs have faced inequities in access to treatment, testing and education.

These barriers often are due to preconceived or uninformed notions of what it means to live with viral hepatitis, both by those who have an infection and by the broader population. To achieve viral hepatitis elimination, we must eliminate the stigma against people living with it.

Viral hepatitis is a serious public health threat that can cause liver cancer, cirrhosis or scarring of the liver, and even death. More than 5 million Americans are living with hepatitis; an estimated 39,900 Virginians are living with hepatitis C, and approximately 2,000 hepatitis B cases are reported to the state health department each year.

While vaccination, testing and treatment exist and serve as tools to fight the epidemic, incidence rates of hepatitis B and C are increasing, adult vaccination rates against hepatitis B remain low and treatment rates for hepatitis C are declining.

Virginia has taken recent strides to eliminate viral hepatitis by 2030, a goal set by the World Health Organization for the United States. Beginning in January 2022, Virginia Medicaid removed prior authorization requirements for hepatitis C treatments, expanding access to a vital tool in combating the virus within vulnerable populations.

This is especially important given the recent spike in drug overdoses in the commonwealth, as hepatitis C is tied to the ongoing opioid use epidemic. Virginia received a “B” grade from Hep ElimiNATION for its ability to eradicate viral hepatitis by 2030. The project grades jurisdictions based on their current policy landscapes and strategies addressing the viral hepatitis epidemic.

What is not measurable, however, is the impact stigma has on people living with hepatitis. They might internalize a sense of shame — many feel they don’t deserve treatment. They also might face external stigmas that bring into question their morals or values, sometimes coming from friends and family who do not understand what it means to have viral hepatitis.

Because the lack of safe equipment for intravenous drug use is a leading cause of hepatitis B and C, disclosing one’s condition could draw unwanted attention to issues such as drug use, which carries its own stigma. Misconceptions of how hepatitis spreads also can lead to stigma. Many wrongly believe hepatitis B and C can spread via sharing food or physically touching an infected person.

Studies have shown that stigma against those living with hepatitis not only can influence everyday life; it also affects people’s willingness to engage with medical professionals, disclose their disease status or seek out treatment options.

Meanwhile, the hepatitis B and C epidemics — and their statistical growth rates among communities of color, people who inject drugs, immigrants, people who are incarcerated and others — are symptoms of larger systems of stigma and health inequity.

Take for example this statistic: Asian Americans and Pacific Islanders make up less than 5% of the total U.S. population, but account for more than 50% of Americans living with chronic hepatitis B.

Or this one: Though an estimated 80% of new hepatitis C infections occur among people who inject drugs, this population often is denied access to treatment for no other reason besides their drug use.

Pair disease-associated stigma with stigmas marginalized communities otherwise face, and one can more clearly see the impacts of biases on both a person’s ability to adequately manage their disease, and efforts to stem the tide of viral hepatitis more broadly.

Virginia can take three manageable yet effective steps to counter the rise in viral hepatitis, while rooting out associated stigmas. First, the commonwealth must expand harm reduction services, particularly for people who use drugs and people who are incarcerated.

Second, Virginia’s leaders can commit to a fully funded, comprehensive hepatitis elimination plan. Hep ElimiNATION recommends the commonwealth convene a group of multidisciplinary stakeholders to develop this plan, which will guide efforts to improve viral hepatitis strategies and outcomes.

Finally, Virginia health care providers should commit to implementing universal screening guidelines for hepatitis C, in line with national Centers for Disease Control and Prevention guidance. A one-time hepatitis C test for all adults and all people during pregnancy will help mainstream testing and end the stigma associated with it.

If we remove all other barriers, we still cannot eliminate hepatitis without eliminating stigma. Until we decide that people living with hepatitis should be treated with dignity and respect, regardless of how they live their lives, we will fail to deliver humane health care.

Robin Lord Smith is community engagement coordinator of the National Viral Hepatitis Roundtable and co-founder of the Virginia Hepatitis Coalition. She lives in Floyd County.