Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
Harm Reduct J. 2023 Aug 26;20(1):116. doi: 10.1186/s12954-023-00844-4.
Experiences of stigma and discrimination can act as a significant barrier to testing, monitoring, and treatment for hepatitis B virus (HBV). Aboriginal and Torres Strait Islander Australians are a population disproportionately impacted by HBV and yet limited research has explored HBV-related stigma in these communities. To begin preliminary explorations of HBV-related stigma among Aboriginal and Torres Strait Islander people, we interviewed health workers about their perceptions regarding HBV infection and HBV-related stigma.
Participants were recruited from staff involved in the Deadly Liver Mob (DLM) program which is a health promotion program that offers incentives for Aboriginal and Torres Strait Islander clients to be educated on viral hepatitis, recruit and educate peers, and receive screening and treatment for blood-borne viruses (BBVs) and sexually transmissible infections (STIs), and vaccination. Semi-structured interviews were conducted with 11 Aboriginal and Torres Strait Islander and non-Aboriginal or Torres Strait Islander health workers who have been involved in the development, implementation, and/or management of the DLM program within participating services in New South Wales, Australia.
Findings suggest that stigma is a barrier to accessing mainstream health care among Aboriginal and Torres Strait Islander clients, with stigma being complex and multi-layered. Aboriginal and Torres Strait Islander people contend with multiple and intersecting layers of stigma and discrimination in their lives, and thus HBV is just one dimension of those experiences. Health workers perceived that stigma is fuelled by multiple factors, including poor HBV health literacy within the health workforce broadly and among Aboriginal and Torres Strait Islander clients, shame about social practices associated with viral hepatitis, and fear of unknown transmission risks and health outcomes. The DLM program was viewed as helping to resist and reject stigma, improve health literacy among both health workers and clients, and build trust and confidence in mainstream health services.
Health promotion programs have the potential to reduce stigma by acting as a 'one stop shop' for BBVs and STIs through one-on-one support, yarning, and promotion of the HBV vaccine, monitoring for chronic HBV, and treatment (where required).
污名和歧视的经历可能成为乙型肝炎病毒 (HBV) 检测、监测和治疗的重大障碍。澳大利亚原住民和托雷斯海峡岛民受到 HBV 的影响不成比例，但对这些社区中与 HBV 相关的污名知之甚少。为了初步探索原住民和托雷斯海峡岛民中与 HBV 相关的污名，我们采访了卫生工作者，了解他们对 HBV 感染和 HBV 相关污名的看法。
参与者是从参与致命肝脏行动 (DLM) 计划的工作人员中招募的，该计划是一项健康促进计划，为原住民和托雷斯海峡岛民客户提供教育病毒性肝炎、招募和教育同伴、接受血液传播病毒 (BBV) 和性传播感染 (STI) 筛查和治疗以及疫苗接种的奖励。对 11 名参与澳大利亚新南威尔士州参与服务的 DLM 计划的开发、实施和/或管理的原住民和托雷斯海峡岛民和非原住民或托雷斯海峡岛民卫生工作者进行了半结构化访谈。
研究结果表明，污名是原住民和托雷斯海峡岛民客户获得主流医疗保健的障碍，污名复杂且多层次。原住民和托雷斯海峡岛民在生活中面临着多种相互交织的污名和歧视，因此 HBV 只是这些经历的一个方面。卫生工作者认为，污名是由多种因素造成的，包括整个卫生劳动力和原住民和托雷斯海峡岛民客户中普遍存在的 HBV 健康素养低、对与病毒性肝炎相关的社会习俗的羞耻感以及对未知传播风险和健康结果的恐惧。DLM 计划被认为有助于抵制和拒绝污名，提高卫生工作者和客户的健康素养，并建立对主流卫生服务的信任和信心。
健康促进计划通过一对一支持、交谈和推广乙型肝炎疫苗、监测慢性 HBV 以及（如有需要）治疗，可以作为 BBV 和 STI 的“一站式服务”，从而有可能减少污名。
