Perceptions of Hepatitis B among African Immigrants in New York City: An Opportunity to Increase Awareness and Avoid Stigma

Abstract

Purpose: Hepatitis B virus (HBV) is highly endemic in sub-Saharan Africa, and a recent dramatic increase in immigration to the U.S. from this region highlights the importance of screening and linkage to care in this community. As part of a larger screening program at our institution, this pilot study examines barriers and facilitators of viral hepatitis screening and linkage to care programs among African foreign-born persons living in New York City. Methods: We used community-based participatory qualitative research methods to identify major themes of African participants' knowledge, attitudes and behaviors towards HBV. Through respondentdriven sampling, we recruited 39 participants and conducted 4 focus groups between October, 2011 and October, 2012 to assess modifiers of screening behavior. Results: Participants' median age was 39 years, 79% were uninsured, 82% were unemployed, and 70% had moved to the U.S. within the past 10 years. Five major themes emerged as barriers, and two emerged as facilitators of screening and linkage to care. Barriers to HBV screening included a general lack of knowledge, the virus' long latency period, fatalism, fear of cost associated with seeking care, and concerns over the confidentiality of results. In contrast, knowledge of the opportunity for prevention through a vaccine, and the availability of treatment emerged as important cognitive facilitators of screening and linkage to care. From these themes, an over-riding narrative emerged that participants perceived the general low level of knowledge as an important opportunity for framing the discourse around HBV in their community, so as to increase awareness but avoid generating stigma against imputed immoral behavior associated with transmission. Conclusion: This guiding narrative and the behavior modifiers identified in this study have important implications for improving the ongoing viral hepatitis screening and linkage to care programs being conducted in this high-prevalence and difficult-to-reach African foreign-born group.