Immigrants from Asia are three to 12 times more likely to get hepatitis B than their Canadian-born counterparts, says a new public education campaign launched by S.U.C.C.E.S.S., an immigrant-serving organization in British Columbia.
Dr. Eric Yoshida, professor of medicine at the University of British Columbia and head of the division of gastroenterology at the Vancouver General Hospital, explains that the high prevalence of the hepatitis B virus (HBV) among newcomers can be attributed to mother-to-child transmissions at birth or early childhood in countries where infection rates are high, and where vaccination is uncommon.
Infection rates are also impacted by the lack of systematic testing and treatment for new immigrants arriving to the country, as well as high costs of medications, lack of awareness, and difficulty accessing medical care.
“I know many HBV carriers who ignore the infection because they can’t find a stable doctor or a doctor who speaks their language,” says T.H., who migrated to Canada from Taiwan when he was 12 years old and is an HBV carrier.
Another difficulty he recognizes is that the resources available are mostly provided in English, or are too technical.
Urgent need for education
Aiming to reduce the barriers that newcomers may face when accessing these resources, S.U.C.C.E.S.S. carried out the Let’s Talk About B: Hepatitis B (HBV) Public Education Program.
“We recognized the urgent need for the program after conducting 1,000 surveys among different groups, through which we discovered that most people don’t know much about hepatitis B,” explains Queenie Choo, CEO of S.U.C.C.E.S.S.
Financed by a grant of the provincial government, S.U.C.C.E.S.S conducted 68 educational workshops and participated in 105 community and outreach events to raise awareness about the risks, prevention, diagnosis, treatment options, and self-management tools of hepatitis B among the general public and Asian immigrants in particular.
It reached almost 30,000 individuals of all ages among Chinese, Korean, Filipino and South Asian communities in Vancouver and the Lower Mainland.
“Every community is unique and each one requires different information. The resources available need to adapt to each population so that people are more likely to engage with them,” says Alan Huang, S.U.C.C.E.S.S. HBV program manager.
“For this reason, the materials we created were culturally appropriate,” he adds. The workshops were given by facilitators who spoke the language of the communities they focused on, were provided in places where these populations usually congregate, and addressed cultural beliefs that could prevent people from getting involved.
HBV is diagnosed through a simple blood test that can be performed for free at family doctors’ offices and walk-in clinics.
Huang also says that they focused on Asian populations because they tend to have a higher risk of getting hepatitis B. There are approximately 60,000 to 100,000 chronic carriers in B.C. Near 70 per cent of them are immigrants, and among those, over 85 per cent are of Asian descent.
Dr. Yoshida explains that while several factors increase immigrants’ risks of getting infected, HBV is also prevalent in other regions of the world. T. H. considers that educational programs such as Let’s Talk About B “can raise awareness and help people understand that HBV is not just an immigrant disease, but something we should all be aware of and encourage people around us to get tested.”
According to a S.U.C.C.E.S.S. press release, around 75 per cent of the participants discussed HBV with their primary care providers and/or got screened. The organization continues engaging community-based organizations and public health officials to promote and deliver health campaigns among other populations across Canada in the future.
Hepatitis B (HBV) is a type of liver disease caused by a virus. Billie Potkonjak, director of health promotion and patient services of the Canadian Liver Foundation, explains that one of the main risks of HBV is that if it is not diagnosed and treated on time, it can increase patients’ chances of developing liver cancer and other chronic conditions, such as cirrhosis.
However, HBV is a “silent killer,” according to Choo. Dr. Jessica Chan, family physician and chair of the Hepatitis Medical Advisory Committee for S.U.C.C.E.S.S., says that the condition is likely to go undiagnosed because symptoms do not appear immediately.
HBV is diagnosed through a simple blood test that can be performed for free at family doctors’ offices and walk-in clinics. Nevertheless, as Dr. Chan points out, unless people specifically tell their doctor that they want to be tested, physicians will assume that somebody else has already performed the screening.
Fear of deportation is present among immigrants, but Canada does not deport people because of the disease.
Hence, Potkonjak highlights that “it is extremely important to talk to your doctor, so that they can diagnose the disease if you have it, and prescribe appropriate medication to stop the virus from destroying your liver.”
Stigma can prevent people from seeking appropriate care. “HBV is somewhat of an unknown disease in Canada. It is not a topic I like to discuss openly, in fear of being rejected,” says T.H.
One of the myths around HBV is related to its transmission. Dr. Chan explains that although hepatitis B can also be transmitted by blood or body fluids, the majority of people worldwide get infected during childhood or infancy.
Dr. Yoshida adds that it cannot be transmitted through food, coughing, or casual contact. “It is not contracted because you had lunch with somebody or sat on a crowded bus.”
The difference between hepatitis A, B, and C may also be unknown to the general public.
Fear of deportation is present among immigrants, but Canada does not deport people because of the disease, and individuals should not be discriminated based on health status in the country, explains Dr. Yoshida.
A person who migrated from Hong Kong and has lived with HBV for 35 years recommends people to engage with projects such as the Let’s Talk About B Program and the Living with Liver Disease Program offered in different provinces by the Canadian Liver Foundation.
“It is important to stay positive and get in charge of your own health,” he says. “Don’t be afraid of talking to your doctor, getting tested, and receiving treatment if you need it. There is nothing to be ashamed of, and this can save your life.”