More than a virus: A study of hepatitis B related stigma and trust in healthcare providers among Chinese immigrants living in Australia

Abstract

China is described as having an intermediate prevalence of chronic hepatitis B. Chinese immigrants bear a disproportionate burden of hepatitis B virus (HBV) infection in Australia but have poor healthcare access. Laws were enacted which discriminated against people living with HBV (PLHBV) in mainland China from the 1990s. Although these were repealed in 2005, the experience of PLHBV from mainland China has been shaped by this institutional discrimination. Despite the increased attention to the barriers to healthcare for PLHBV, particularly among Chinese immigrants in Western countries, little is known about barriers to HBV healthcare in the Australian context. This study, conducted in Sydney and Melbourne, uses both qualitative and quantitative approaches and is positioned in social constructivism theory. It aims to examine the Chinese community’s knowledge and perceptions about HBV, their attitudes towards PLHBV, the lived experience of PLHBV, and their experiences of HBV-related stigma in the community and healthcare encounters. A total of 396 participants from the Chinese community completed either a paper or online survey, and 16 Chinese immigrants living with HBV participated in semi-structured in-depth interviews either by phone or face-to-face. Quantitative data analysis included analysis of variance (ANOVA) and multiple linear regression models. Qualitative data analysis was guided by reflexive thematic analysis, using the Health Stigma and Discrimination Framework and the concept of trust in healthcare. Survey findings indicate that participants’ knowledge about HBV prevention, transmission and treatment was in the low-to-middle range, and there was a moderate level of HBV-related stigma among participants. Participant accounts in the interviews show that HBV-related stigma was mostly driven by a lack of HBV knowledge and fear of infection. Stigmas related to sociocultural factors interacted with HBV-related stigma. This study highlights the significance of trust in healthcare encounters, suggesting that trust in medical professionals affects a host of health-related behaviours and health outcomes among patients. Based on these findings, a comprehensive approach to address barriers to HBV healthcare is proposed that highlights a need for a culturally sensitive response and a joint effort between HBV education, medical professionals, and health policy makers.