| BackgroundHepatitis B virus (HBV) infection remains a challenging health issue all over the world.In China,HBV infection is one of the most serious and prevalent infectious diseases and there are millions of hepatitis B patients and HBV carriers in China.In fact,hepatitis B patients and HBV carriers suffer not only physical injury and economic burden of hepatitis B, but also experience discrimination against them when applying for jobs or educational opportunities or when getting on with other people in everyday life.The widely existed discrimination against hepatitis B makes hepatitis B patients and HBV carriers feel severe psychological stress and cannot live a normal life. In order to avoid being labeled ’hepatitis B patient’ or ’carrier’ by more people, some of them usually attempt to hide their infection status and refuse regular screening, treatment and seeking advices from doctors.It will influence both the individuals’ health and the overall control of hepatitis B in China.Thus,it is of great significance to reduce and eliminate discrimination against hepatitis B in China.ObjectivesThis study aims at analyzing the present situation of discrimination against hepatitis B patients and HBV carriers through the questionnaire survey, and indirectly understanding hepatitis B patients’ and HBV carriers’ psychological pressure caused by hepatitis B discrimination in everyday life.We also aim at quantitatively analyzing the influencing factors of hepatitis B discrimination in rural China. We hope that the study can give some policy recommendations to reduce and eliminate hepatitis B discrimination.MethodsThe data of this study came from the program-"To what extent do user fees affect hepatitis B vaccine coverage rates in China",which was funded by the National Research Council of Norway.Our study is one of the parts of the program. The program was carried out in 2011-2012.The study participants were from 42 villages across seven provinces with notable regional, economic, and epidemiological diversity:Beijing, Heilongjiang, Shandong, Hebei, Jiangsu Hainan and Ningxia. We used a self-designed interview questionnaire and surveyed 36677 participants.Descriptive statistical analysis,single factor statistical inference,multiple factor statistical inference were used to explore the present situation and influencing factors of discrimination against hepatits B patients and HBV carriers in rural China.Main ResultsHBV-related discrimination in rural China was very serious. Of all the participants,47.57%、56.79%、49.85% were unwilling to accept gifts from hepatitis B patients or HBV carriers, have dinner with them, or hug and shake hands with them,respectively.68.34% of the participants were unwilling to agree their children to play with children whose parent carried HBV, and 81.65% were unwilling to agree their children to marry hepatitis B patients or carriers.According to their HBV-related discrimination index scores, the participants were divided into three groups.19.09% of the participants were in the without/mild discrimination group(discrimination index score≤3); 23.40% were in the medium discrimination group(3<discrimination index score≤6); 57.51% were in the severe discrimination group(discrimination index score>6).For the severe discrimination outcome(without/mild discrimination group as basis outcome),the results of the multiple multinomial logistic regression showed that nearly all estimated coefficients and RRR were statistically significant, except for household income. "Fear of being infected with HBV" was the most important influencing factor associated with HBV-related discrimination. The RRR of "fear of being infected with HBV" was 11.727 relative to the reference group "no fear of being infected"(P=0.000). Increasing knowledge about false HBV transmission routes greatly reduced the probability of severe HBV-related discrimination. Compared with the low-level knowledge about false HBV transmission group, the medium-level knowledge group had fewer probability of severe HBV-related discrimination (RRR=0.503, P=0.000).The high-level knowledge group was aslo statistically significant compared with the low-knowledge group (RRR=0.372, P=0.000)."Received vaccination" was related to reduced HBV-related discrimination (RRR=0.793,P=0.018).Females showed more severe discrimination against hepatitis B patients and HBV carriers (RRR=1.239, P=0.006).Compared with the 18-28 years group, participants aged 38-48,48-58, and 58+ years showed more severe discrimination with increasing RRR (1.488,1.734, and 2.369, respectively).Participants with higher education tended to have less severe discrimination compared with those with less education (RRR=0.672, P=0.001).Compared with farmers，civil servants, village doctors, and teachers were less likely to exhibit severe HBV-related discrimination (RRR=0.672, P=0.001)Conclusions and SuggestionsHBV-related discrimination in rural China is very common and serious.Something must be done to eliminate it. Several factors are associated to various degrees, with this discrimination. Fear of HBV infection is the main factor associated with HBV-related discrimination, not lack of related knowledge, although this to a lesser degree was also a factor. Compared with people who don’t have fear, people who fear from getting infected with HBV show more discrimination More misunderstanding of false HBV transmission routes lead to more discrimination. Receiving HBV vaccination is associated with less discrimination. In addition, older adults and those with less education are more likely to exhibit severe discrimination.Most of the village doctors show severe discrimination against hepatitis B patients and carriers.This study puts forward the following suggestions:(1) The government departments of health should take some measures to reduce and finally eliminate discrimination against hepatitis B patients and HBV carriers in rural China. (2) Elimination of hepatitis B-related discrimination starts from eliminating the fear of getting infected with hepatitis B virus. (3) Policy makers should develop large-scale dissemination of knowledge about hepatits B and HBV, especially knowledge about false HBV transmission routes. (4) Dissemination of HB-related knowledge and elimination of hepatitis B-related discrimination must start with training village doctors. (5) Pay more attention to the key populations such as old people and rural residents with limited education. (6) Policy makers should take some measures to strengthen adult HBV immunization programs. |
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