Hep B Blog

2017 Commemoration of National African Immigrant and Refugee HIV & Hepatitis Awareness (NAIRHHA) Day

On Wednesday, September 13th, the Multicultural AIDS Coalition – Africans For Improved Access (AFIA) program, Hepatitis B Foundation, and Coalition Against Hepatitis for People of African Origin (CHIPO) commemorated NAIRHHA Day by hosting a webinar discussing “Barriers and Strategies to Addressing HIV and Hepatitis B among African Immigrants: A NAIRHHA Day Webinar.” More than 100 people participated in the webinar. The majority represented government agencies and community-based organizations. This year is particularly exciting because lead organizers also submitted a request to HIV.gov (formerly AIDS.gov) to officially recognize NAIRHHA Day on Sept. 9th as a federal HIV awareness day for African immigrants and refugees in the U.S.

As discussed during the commemorating webinar, there is growing data related to the disproportionate impact of hepatitis B, as well as HIV on African immigrants in the US. African immigrants are underdiagnosed due to lower screening rates and present at a later stage of the disease compared to the general US population. Stigma is seen as the major barrier. In addition, the lack of knowledge about transmission, disease prognosis and treatment are widespread, reducing the likelihood that individuals will seek out testing and treatment services.

NAIRHHA Day was launched in 2014 in an effort to address these issues. It is a joint venture organized by the Multicultural AIDS Coalition – Africans For Improved Access (AFIA) program, Hepatitis B Foundation, and Coalition Against Hepatitis for People of African Origin (CHIPO). As explained by Chioma Nnaji, Director at the Multicultural AIDS Coalition – Africans For Improved Access (AFIA) program, “Several of the current awareness days are inclusive of African immigrant communities, but do not comprehensively address their unique social factors, cultural diversity as well as divergent histories and experiences in the US.”

In addition to providing an overview on HIV and HBV epidemiological data, the webinar highlighted findings from two national initiatives. A recent project lead by The Hepatitis B Foundation and Coalition Against Hepatitis for People of African Origin (CHIPO) was funded by the Centers for Disease Control and Prevention (CDC) to better understand the individual, interpersonal, community, and society‐level barriers and facilitators associated with HBV screening, vaccination and linkage to care among African immigrant communities in the US. This project established a 14-member African Immigrant Advisory Board representing non‐profit leaders, community health educators, academics/researchers, government partners, clinicians across 8 states. Through focus groups, interviews and in-person meetings, the Advisory Board documented cultural and religious beliefs, and the complexity of the US healthcare system as major barriers to hepatitis B testing and linkage to care. The Advisory Board also identified approaches to help overcome these barriers, such as working with trusted community leaders, using storytelling, and finding ways to incorporate Western medicine into traditional medicine practices. Next steps will include working with coalition members around the U.S. to develop specific hepatitis education and screening projects that incorporate these strategies.

The webinar also highlighted the Tulumbe! Project. Tulumbe is a Luganda word (language spoken in Uganda) that means, “Let us engage.” The Tulumbe! Project is funded by the Pipeline to Proposals Award under Patient Centered Outcome Research Institute (PCORI) to engage diverse stakeholders in defining areas of need and priorities in HIV services for African immigrants, and identify research topics important to the African immigrant community, African immigrants living with HIV, providers and other stakeholders. Pipeline to Proposals Award funds three tiers of awards that help individuals or groups build community partnerships, develop research capacity, and hone a comparative effectiveness research question that could become the basis of a research funding proposal to submit to PCORI or other health research funders. For more info: https://www.pcori.org/research-results/2017/tulumbe-project-tier-ii

Overall, NAIRHHA Day provides a means for organizations, providers, communities, families, and individuals to:

  • Raise awareness about HIV/AIDS and viral Hepatitis to eliminate stigma
  • Learn about ways to protect against HIV, viral Hepatitis and other related diseases
  • Take control by encouraging screenings and treatment, including viral Hepatitis vaccination
  • Advocate for policies and practices that promote healthy African immigrant communities, families, and individuals

Recognizing September 9th as National African Immigrant & Refugee HIV/AIDS and Hepatitis Awareness Day (NAIRHHA Day) is an important step to addressing issues of HIV and viral hepatitis in the African immigrant community in a culturally and linguistically appropriate way. We are asking you to speak out and support federally recognizing NAIRHHA Day on Sept. 9th by contacting:

  • your local health departments
  • local and national HIV and hepatitis organizations
  • the HIV.gov Team at @HIVGov

Facebook: https://www.facebook.com/NAIRHHA

Twitter: @NAIRHHADay

Who’s at Risk for Hepatitis B? Learning the Hep B Basics

 

Are you or someone you know at risk for hepatitis B? You might be more at risk than you think, and since hepatitis B is vaccine preventable, it makes sense to get tested and vaccinated for HBV.  Hepatitis B is the number one cause of liver cancer worldwide. The survival statistics for liver cancer are particularly grim, with a relative 16,6% 5-year survival rate.  The hepatitis B vaccine also protects against hepatitis delta, the most severe form of viral hepatitis.

It is important to note that everyone is susceptible to hepatitis B. It does not discriminate.  It infects, babies, children, teens, adults and seniors. It has no racial or religious bias, though it is certainly more prevalent among certain ethnic groups –mainly because it is endemic to the homelands of these communities. For example, if you look at the prevalence map for hepatitis B, you will see that in most of the world, hepatitis B is at an intermediate, (2-7%) or high HBsAg prevalence (>8%) level.  Looking at the numbers, 2 billion people in the world, that’s 1 out of 3 people, have been infected with HBV and 257 million are chronically infected. That represents three-quarters of our world. Even if you aren’t living in these parts of the world, you may be traveling to some of these areas for work or pleasure, or perhaps your parents and other family members were born in HBV endemic areas.  Since there are often no symptoms for HBV, and screening and vaccination may be lacking in some populations, HBV is transmitted from one generation to the next, with many completely unaware of their HBV status – until it’s too late.

People at risk for hepatitis B include the following: (not noted in a particular order)

  • Health care providers and emergency responders due to the nature of their work and potential for exposure.
  • Sexually active heterosexuals (more than 1 partner in the past six months)
  • Men who have sex with men (MSM)
  • Individuals diagnosed with a sexually transmitted disease (STD)
  • Illicit drug users (injecting, inhaling, snorting, pill popping)
  • Sex contacts or close household members of an infected person (remember, you may not know who is or is not infected)
  • Children adopted from countries where hepatitis B is common (Asia, Africa, South America, Pacific Islands, Eastern Europe, and the Middle East) and their adopted families
  • Individuals emigrating from countries where hepatitis B is common (see above)
  • Individuals born to parents who have emigrated from countries where hepatitis B is common (see above)
  • ALL pregnant women – because infants are so vulnerable to HBV (90% of infected infants will remain chronically infected, and HBV is very effectively transmitted from infected mother to baby.)
  • Recipients of a blood transfusion before 1992
  • Recipients of unscreened blood and blood products – sadly an issue in many parts of the world.
  • Recipients of medical or dental services where strict infection control practices are not followed – sadly another issue in parts of the world.
  • Kidney dialysis patients and those in early renal failure
  • Inmates of a correctional facility
  • Staff and clients of institutions for the developmentally disabled
  • Individuals with tattoos and body piercings performed in a parlor that does not strictly adhere to infection control practices – it may be up to you to ensure proper infection control practices are followed.
  • People living with diabetes are at risk if diabetes-care equipment such as syringes or insulin pens are inadvertently shared.

The good news is that hepatitis B is a vaccine preventable disease. There is a safe and effective, 3-shot HBV vaccine series that can protect you and your loved ones from possible infection with HBV.  The earlier you are vaccinated, the better. In the US, a birth dose of the vaccine is recommended for all infants, since these little ones are most vulnerable to hepatitis. (90% of infected infants will live with HBV for life). HBV vaccination doesn’t give you a free-pass from other infectious diseases such as HCV or HIV, both without vaccines, so strict infection control practices should still be followed. However, HBV is a tenacious virus that survives outside the body for a week and is 50-100 times more infectious than HIV  3-5 times more infectious than HCV.  Plus the HBV vaccine is actually an anti-cancer vaccine, so why not get vaccinated?

Hepatitis B isn’t casually transmitted, but in the right scenario, it is effectively transmitted. You may think that situation may never come about for you, or for your loved ones –especially your little ones who are so vulnerable to HBV. Some people travel to exotic lands with unsafe blood supplies and poor infection control practices, and sometimes they get sick, or require emergency dental or medical services, so they may be put at risk. Most people have had a lapse in judgment – sometimes it’s a one-time thing, sometimes it lasts for years, but the net-net is that it’s unusual to find someone who has not engaged in some sort of high-risk activity, whether intentionally or unintentionally. If you are properly vaccinated to protect against hepatitis B, you can cross that concern off your list.

B sure. Get screened. if you do not have HBV, get vaccinated and be hepatitis B free. If you discover you have HBV, talk to your doctor and have him refer you to a liver specialist who can better evaluate your hepatitis B status and your liver health.

Diagnosed with Hepatitis B? Preventing Transmission to Others. Learning the HBV Basics Transmission – Part III

How can you prevent future transmission? Now that you are aware of your infection, it’s easier than you think.  In a perfect world, everyone would be vaccinated against HBV and be protected, but of course this is sometimes not the case. Always encourage HBV vaccination when possible now that you understand the importance of this safe and effective 3-shot series. However, the vaccine does take time to complete, so in the interim, some general precautions will keep you and everyone you know safe.

Always maintain a barrier between blood and infected body fluids and any open cuts, mucous membranes (eyes, nose or mouth), or orifices of someone else. Keep cuts, bug bites – anything that bleeds or oozes – covered with a bandage. Also, remember to carry a spare bandage.  These are some simple prevention methods.

Do not consider unprotected sex unless you are sure your partner has had all 3 shots of the HBV vaccine series. And remember to consider the risks of other infectious diseases that are transmitted sexually if you are not in a monogamous relationship.  Multiple sex partners and non-monogamous relationships expose you to the potential of more health risks and even the possibility of a co-infection.  Co-infections are when someone has more than one serious chronic condition (like HBV and HCV , HBV and HIV or HBV and HDV).  Co-infections are complicated health conditions that you want to avoid. Therefore, practice safe sex by using a latex or polyurethane condom if you have multiple partners.

General precautions include carefully handling of your own blood, tending to your own blood spills when possible, and properly disposing of feminine hygiene products. Properly dispose of blood stained materials in tightly closed plastic bags. If someone else must tend to your bleeding wound or clean up your blood spill, be sure they wear gloves, or maintain a barrier, and wash their hands thoroughly with soap and water.  Many germs and virus (like HBV) can be effectively killed when cleaned using a diluted bleach solution of 1 part bleach to 9 parts water.  Ideally this solution should be made when needed as the shelf life is limited.  Everyone should use these basic precautions – with or without a known HBV infection.  Make this part of your daily life.

And what about your personal items?  Well it’s best if they are kept personal and out of common areas unless everyone is vaccinated. This includes things like razors, nail clippers, files, toothbrushes and other personal items where microscopic droplets of blood are possible.  This is good practice for everyone in the house. After all, you may not be the only one with an infection. Simple changes in daily habits keep everyone safe.

If those at risk in your life are not already vaccinated or have not recovered from a past infection, then they need to start the series immediately. This includes sexual partners and close house hold contacts and  family members. The HBV vaccine is a safe and effective 3-shot series.  Timing may be of concern or a sense of urgency, so just get it started. The regular schedule is completed within six months. Tack on an extra month and ask their doctor to test surface antibody (anti-HBs) titers 1-2 months following the last shot of the series to ensure that adequate immunity has been generated by the vaccine.  This is not standard routine but will help insure those at higher risk that they are protected. In the interim, remember to practice safe sex with your partner using latex or polyurethane condoms.

The timing of the antibody titre should be 4-8 weeks following the last shot of the series. If titers are above 10 then there is protection for life.  If someone has been previously vaccinated a titer test may show that their titers have waned and dipped below the desired reading. There is no reason to panic, as a booster shot can be administered and then a repeated titer test one month later will ensure adequate immunity. Once you know you have generated adequate titers, there is no need for concern of transmission.

When recovering from an acute infection, if your follow up blood test results read: HBsAg negative, HBcAb positive and HBsAb positive then you have resolved your HBV infection and are no longer infectious to others and you are no longer at risk for infection by the HBV virus again.

However if your follow up blood tests show that you are chronically infected or your infection status is not clear, you will want to take the precautionary steps to prevent transmitting your HBV infection to others. You will also need to talk to your doctor to be sure you have the appropriate blood work to determine your HBV status and whether or not you are chronically infected.

Please be sure to talk to your doctor if you are unsure, and don’t forget to get copies of those labs. Check out  transmission part I and part II if you are looking for a little more transmission information.