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About Hepatitis B, HBV, Hepatitis B Prevention

Happy Pride Month – HIV/HBV Co-Infection

 

June is Pride Month in the United States! This month we celebrate the LGBTQ+ community in honor of the 1969 Stonewall Uprising in Manhattan. This blog post will discuss HIV/HBV coinfection in LGBTQ+ individuals and how to prevent both viruses.

HIV/HBV Co-Infection

Human Immunodeficiency Virus or HIV disproportionately affects LGBTQ+ individuals, mostly gay and bisexual men. In the United States, approximately 69% of the 37,968 new HIV cases were among gay and bisexual men in 2018. HIV can also impact lesbian women, although the infection rate among this community is lower. There is also very limited current data out about lesbian and bisexual women and the burden of HIV. However, HIV can be transmitted between women who have sex with women through sex toys and injection drug use. The CDC reports 1 million people have identified as transgender in the United States, and 2% of those individuals are affected by HIV.

Approximately 5-20% of the HIV-infected population worldwide is also living with hepatitis B. These rates vary among different regions and at-risk populations based on modes of transmission. This figure may approach 20% in Southeast Asia, and 5% in North America and Western Europe. In the U.S., Western Europe, and Australia, the prevalence of chronic hepatitis B was reported to be 5%-14% among HIV-positive individuals.

Since both HIV and the hepatitis B virus share similar transmission routes, it is not surprising that there is a high frequency of coinfection. Sexual activity and/or injection drug use are the most common routes of transmission of the hepatitis B virus among those also infected with HIV.

Prevention

You can easily prevent hepatitis B with a safe and effective vaccine. The vaccine comes in either 2 or 3 doses, given over a span of 6 months. Learn more about the vaccine dose schedule here!

If you are not vaccinated for hepatitis B, ask your doctor or primary care provider for the vaccination! Check out this list of LGBTQ+ friendly providers.

If you are unsure of your hepatitis B status, ask your doctor or primary care provider to become tested! The hepatitis B test is super simple – it only requires one blood sample. Your doctor should order the “hepatitis B panel” which includes different tests. Read more hepatitis B testing here!

You can lower your risk of acquiring HIV by using PrEP (pre-exposure prophylaxis). PrEP is a daily medication you can take to prevent HIV. Just make sure you are tested for hepatitis B before starting PrEP. Read more about PrEP here!

 

Author: Evangeline Wang

Contact Information: info@hepb.org

HBV, Living with Hepatitis B

Hep B & HIV CoInfection: Get Tested Today!

Each year, World AIDS Day is held on December 1st to raise awareness about HIV and AIDS.  HIV/AIDS still remains a large problem, with nearly 40 million people living with the infection. Hepatitis B (HBV) remains a large issue as well, with 292 million people living with the chronic infection. Despite the inadequate amount of resources or attention that hepatitis B receives, it is important to talk about it whenever we discuss HIV/AIDS.  Why? Any individual already living with hepatitis B or HIV can also contract the other infection. This is called a coinfection, and it can have serious consequences if not addressed. Let’s look at HIV/HBV coinfection by the numbers: 

  • Globally, 10% of those living with HIV are also living hepatitis B 

    Courtesy of New England Journal of Medicine’s article titled: HIV–HBV Coinfection — A Global Challenge
  • Coinfection rates can be as high as 25% in countries where both infections are common
  • Up to 50% of injection drug users have an HBV/HIV coinfection 
  • Chronic hepatitis B progression can be up to 5 times faster in coinfected individuals compared to those living with just hepatitis B 

HIV vs Hep B: What’s the Difference? 

Hepatitis B is a viral infection of the liver that can increase one’s chances of liver disease and liver cancer.  HIV is a virus that attacks the immune system and kills the cells that are needed to fight off disease and infection. Though they are two different viruses, they can be spread in similar fashions: direct contact with infected blood, via sexual transmission, injection drug use, and through mother to child transmission during childbirth. Hepatitis B is primarily spread through mother-to-child transmission, HIV is most commonly spread by unprotected sex. Among those living with a coinfection, sexual transmission and injection drug use are the most common modes of transmission. Because of the similar transmission routes, it is recommended that people living with HIV be tested for hepatitis B and hepatitis C and those living with hepatitis B should be tested for HIV. 

Hepatitis B may be up to 100 times more infectious than HIV, but it also has a highly effective vaccine! Family members and sexual partners of people living with hepatitis B who have not been infected can protect themselves in just 2 or 3 doses. HIV does not have a vaccine, but people can take precautions to prevent transmission –  like not sharing sharp personal items – such as razors, needles, or toothbrushes – and practicing safe sex (use a condom), or through HIV pre-exposure prophylaxis (PRep). Those precautions can also prevent the spread of hepatitis B. While HIV and hepatitis B do not have cures, they both have highly effective treatments. You can learn more about HIV and hepatitis B treatments by clicking the links. 

HIV/HBV Coinfection 

If you are living with hepatitis B, it is important to get tested for HIV as well. Coinfections are very serious, and can sometimes complicate treatment. Worldwide, HIV/HBV coinfection has become an increased priority because research has shown that conditions associated with hepatitis B and C are now among the leading causes of hospital admission and death in people living with HIV. 

Left untreated and unmanaged, HIV/HBV coinfections can cause rapid progression of liver disease and liver damage, leading to serious complications at younger ages. There is also a higher risk of liver damage from anti-retroviral therapy (HIV treatment) in individuals living with hepatitis B than in those living with just HIV. Though some HIV treatments may also help treat hepatitis B, treatment options can vary based upon the person and the progression of the infections, so it is very important to discuss your options with your healthcare provider. Those living with hepatitis B, HIV, or HIV/HBV coinfection should always be closely monitored by a knowledgeable doctor.

Living with a coinfection can be scary, but with proper management and care, you can lead a healthy life! Check out this video from Jason –  one of our #justB storytellers – on successfully living with an HIV/HBV coinfection, and how he has learned to overcome challenges.  

Hepatitis B Advocacy, United States

The History of National African Immigrant and Refugee HIV & Hepatitis Awareness Day 2019

 

Each year in September, the Hepatitis B Foundation recognizes National African Immigrant and Refugee HIV and Hepatitis Awareness Day (NAIRHHA). Founded by advocates in Massachusetts, Washington D.C., and New York, NAIRHHA Day has been observed annually on September 9th by healthcare professionals, awareness campaigns, and other organizations since 2014. Although not yet nationally recognized, the multicultural AIDS Coalition (MAC) and the Coalition Against Hepatitis B for People of African Origin (CHIPO) are working to establish NAIRHHA day as its own federally designated awareness day. As explained by Chioma Nnaji, Director at the Multicultural AIDS Coalition’s Africans For Improved Access (AFIA) program, there is a great need to establish NAIRHHA day as its own day.  “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.”

Why NAIRHHA Day? 

People born outside of the U.S. often face different health challenges than those born in the country and face various barriers to accessing important healthcare services. African immigrants (AI) are disproportionately burdened by HIV and viral hepatitis. Advocates for NAIRHHA Day recognized the need to address these health issues in the community and thought that a combined awareness day would be the most effective way to reach the largest number of people impacted. 

Hepatitis B presents a significant public health burden for many African countries, and subsequent immigrant populations living in the United States. Although data is limited on hepatitis B infection among African immigrant (AI) and refugee communities in the U.S., studies have shown infection rates are high – between 5 and 18%1,2,3,4,5. One community study in Minnesota even found AIs accounting for 30% of chronic hepatitis B infections 6. AI communities are also known to be disproportionately affected by HIV/AIDS, with diagnosis rates six times higher than the general U.S. population7. Despite this alarming disparity, HIV and hepatitis B awareness, prioritization, and funding has remained limited for this population.

Two of the largest barriers to testing for HIV and viral hepatitis among African immigrants are lack of awareness and stigma. Cultural and religious values shape the way people view illness, and there can be fears around testing and diagnosis of illness, and moral implications for why someone may feel they are at risk. While stigma about HIV/AIDS and hepatitis B often come from within one’s own community and culture, it is primarily driven by lack of awareness. Oftentimes, awareness is low in an individual’s home country because of limited hepatitis education, resources, and healthcare infrastructure.  When they arrive in the U.S., awareness remains low for similar reasons. Community health workers and physicians are vital stakeholders to raise community awareness in a culturally sensitive way to help identify current infections and prevent future ones through vaccination.

Recognizing NAIRHHA Day is important in order to address the numerous barriers to prevention and treatment that African immigrants face. It was also founded to acknowledge the cultural and ethnic differences that influence how African-born individuals interact with their medical community and the concept of illness. The specific goals of the day of recognition include:  

  • Raising awareness about HIV/AIDS and viral hepatitis to eliminate stigma;
  • Learning about ways to protect against HIV, viral hepatitis and other related diseases;
  • Taking control by encouraging screenings and treatment, including viral hepatitis vaccination;
  • Advocating for policies and practices that promote healthy African immigrant communities, families, and individuals. 

What has been done so far? 

The path to federal recognition has been a slow process, but progress has been made! Check out the timeline below for a brief overview of what has been accomplished since the day was created: 

2014:

    • Inaugural city-wide events in Houston, Texas; Boston, Massachusetts; Washington D.C.; Maryland; Seattle, Washington; New York; Ohio and Philadelphia.
    • A national petition was created and 40% of the petitioners are from or live in Massachusetts; 60% of signers are from 33 other states across the US

2015:

2016:

    • Senator Elizabeth Warren gave a proclamation in Massachusetts
    • Created an informational blog post for the National Viral Hepatitis Roundtable 
    • Joined the African immigrant Hepatitis/HIV Twitter chat (#AIHHchat)

2017:

    • Hosted a national webinar focused on barriers and strategies  addressing HIV and hepatitis B among African immigrants
    • Official request to HIV.gov to officially recognize NAIRHHA Day

2018:

    • Hosted an online panel discussion addressing HIV and HBV stigma among African immigrant 
    • New social media campaign
    • National Webinar with HBF and CHIPO focused on stigma

September marks the unofficial beginning of National African Immigrant Heritage Month (NAIHM) – state and federal officials in over thirty states recognize September as NAIHM despite it not being federally declared –  which is why NAIRHHA Day is held on September 9th. Federal recognition would significantly boost awareness within the community and allow for the creation of much-needed resources like culturally sensitive education tools. It would also help to disseminate the important health messages on a larger, national scale. 

This year, the Hepatitis B Foundation and CHIPO are excited to be sponsoring four community events with partners throughout the U.S. to commemorate NAIRHHA day and promote hepatitis B and HIV education and testing in AI communities.

For more information about NAIRHHA Day: 

  • Follow NAIRHHA Day on Twitter @NAIRHHA
  • Check out our blog posts on NAIRHHA Day
  • Visit the CHIPO website and click here for downloadable badges and infographics
  • Contact Chioma, Director of the Multicultural AIDS Coalition, at cnnaji@mac-boston.org to get involved in advocacy for NAIRHHA Day

References:

  1. Kowdley KV, Wang CC, Welch S, Roberts H, Brosgart CL. (2012). Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology, 56(2), 422-433. And Painter. 2011. The increasing burden of imported chronic hepatitis B—United States, 1974-2008. PLoS ONE 6(12): e27717.
  2. Chandrasekar, E., Song, S., Johnson, M., Harris, A. M., Kaufman, G. I., Freedman, D., et al. (2016). A novel strategy to increase identification of African-born people with chronic hepatitis B virus infection in the Chicago metropolitan area, 2012-2014. Preventing Chronic Disease, 13, E118.
  3.  Edberg, M., Cleary, S., & Vyas, A. (2011). A trajectory model for understanding and assessing health disparities in Immigrant/Refugee communities. Journal of Immigrant and Minority Health, 13(3), 576-584.
  4.  Kowdley, K. V., Wang, C. C., Welch, S., Roberts, H., & Brosgart, C. L. (2012). Prevalence of chronic hepatitis B among foreign‐born persons living in the united states by country of origin. Hepatology, 56(2), 422-433.
  5.  Ugwu, C., Varkey, P., Bagniewski, S., & Lesnick, T. (2008). Sero-epidemiology of hepatitis B among new refugees to Minnesota. Journal of Immigrant and Minority Health, 10(5), 469-474.
  6.  Kim WR, Benson JT, Therneau TM, Torgerson HA, Yawn BP, Melton LJ 3d. Changing epidemiology of hepatitis B in a U.S. community. Hepatology 2004;39(3):811–6.
  7.  Blanas, D. A., Nichols, K., Bekele, M., Lugg, A., Kerani, R. P., & Horowitz, C. R. (2013). HIV/AIDS among African-born residents in the United States. Journal of immigrant and minority health, 15(4), 718–724.

Hepatitis B Advocacy, Hepatitis B Prevention

Facing the Threat of Hepatitis B Following Sexual Coercion or Assault

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Image courtesy of tuelekza at FreeDigitalPhotos.net.
Image courtesy of tuelekza at FreeDigitalPhotos.net.

By Christine Kukka

Around the world, the most common way hepatitis B is spread is through sex — and sometimes it’s not consensual.

In the United States, sexual transmission of hepatitis B accounts for nearly two-thirds of acute or new cases in adults. According to a U.S. Centers for Disease Control and Prevention (CDC) report, about one in five women and one in 71 men reported experiencing rape at some point in their lives. And abusers rarely use condoms.

One of the hardest things to talk about is the relationship between how hepatitis B is spread and sexual assault or coercion – defined as anytime a woman, man or child is forced to submit to sex either through rape or assault, or with a partner who refuses to use a condom.

About one in 20 women and men (5.6% and 5.3% respectively) experienced sexual violence, such as sexual coercion or unwanted sexual contact in the 12 months prior to the CDC’s survey; and 13 percent of women and 6 percent of men reported they had experienced sexual coercion at some time in their lives. Among women, most abusers were intimate partners, family members or acquaintances. Among males, most perpetrators were acquaintances.

Research suggests these figures under-estimates the true prevalence of sexual violence around the world, which endangers public health on many levels. There is the mental trauma victims experience and there is the spread of sexually-transmitted infections, such as hepatitis B and HIV.

Hepatitis B is 50- to 100-times more infectious than HIV and can be passed through the exchange of body fluids, such as semen, vaginal fluids and blood. The CDC recommends the following steps to protect against hepatitis B following sexual assault.

When the perpetrator has hepatitis B (is positive for the hepatitis B surface antigen-HBsAg):

  • If the victim has never been vaccinated, he or she should receive the hepatitis B vaccine series and also receive a dose of HBIG (hepatitis B antibodies).
  • If the victim has been vaccinated in the past, he or she should immediately get a hepatitis B vaccine dose (called a booster dose.)

When the perpetrator’s hepatitis B status is not known:

  • If the victim has not been immunized against hepatitis B, he or she should received the hepatitis B vaccine series.
  • If the victim has already been vaccinated against hepatitis B, no treatment is needed.

In South Africa, for example, women’s inability to control their lives sexually is fueling the HIV epidemic. One study that followed 1,500 pregnant women who were in married or stable relationships found an astonishing HIV infection rate of 38 percent. Many reported having been abused physically and sexually in the recent past, which helps explain why AIDS is now the biggest killer of young women in southern Africa.

Image courtesy of Sira Anamwong at FreeDigitalPhotos.net
Image courtesy of Sira Anamwong at FreeDigitalPhotos.net

Sexual assault is not always accompanied by physical violence. A woman may not have the power to require her partner to use a condom without risking physical or verbal abuse, or a person may not tell his or her sexual partner that they have hepatitis B. Coercion can be silent, and fueled by ignorance and low self-esteem.

Here is an email that the Hepatitis B Foundation recently received that illustrates this: “My boyfriend is hepatitis B and C positive, as he was a drug addict. We had unprotected sex often over two to three months. I want to ask, is there any chance of myself being infected?”

Sadly, this woman is at very high risk of infection, especially from hepatitis B. What stopped her from insisting he wear a condom or walking away from a relationship with a man who had little concern for her health and welfare?

Poverty, a lack of choices, resources and education, and a host of other factors stop victims from walking away from their abusers every day around the world.

To protect the health of people around the world, we need to fight in any way we can to stop sexual violence, protect women’s reproductive health, and enable everyone to control their lives.

In southern Africa, researchers have come up with a vaginal ring that contains anti-HIV drugs and discreetly protects a woman from HIV infection, without requiring her to negotiate condom use with an abuser inside or outside her marriage.

But this treats a symptom, not the disease of sexual violence that spreads trauma, fear and diseases such as hepatitis B. However we can, whenever we can, we must work to make a difference.

Hepatitis B Prevention

Love Safely This Valentine’s Day

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Please be sure to love safely this Valentine’s Day.  Are you living with HBV or hoping to avoid living with HBV? HBV is a vaccine preventable disease that is effectively transmitted sexually. If you are not infected with HBV, why not get vaccinated and protect yourself for life? The HBV vaccine is a safe and effective, 3 shot series. If you think you might be in a high risk group for HBV, talk to your doctor about first being screened for HBV before being vaccinated.

If you already have HBV, the vaccine won’t protect you. You need to talk to your doctor about your HBV status and whether or not you would benefit from treatment at this time (Not everyone needs treatment, but you need blood work interpreted by an HBV knowledgeable doctor to be sure).

Show the love by protecting yourself and your sexual partners by wearing a condom. They protect the mouth, vagina or rectum from infected semen if used consistently and correctly.  Keep in mind that the riskiest sexual activity is unprotected receptive anal intercourse. This is because the lining of the rectum is very thin and more likely to bleed leading to the possibility of infection with blood borne pathogens like HBV, HCV and HIV, along with other sexually transmitted diseases. Receptive vaginal intercourse is the next highest risk. Although the lining of the vagina is stronger than the rectum, inflammation, infection, or microscopic scrapes make the vagina vulnerable to unprotected intercourse. The likelihood of blood borne pathogen transmission with oral sex is least risky, but that is because the risk of blood contact is much lower. However, any kind of intimate sharing of bodily fluids presents some degree of risk of transmitting blood borne pathogens like HBV, HCV and HIV, and may effectively transmit other sexually transmitted diseases.

It’s important if you’re living with HBV, not living with HBV, or not quite sure of your infectious disease status. If you are living with HBV, properly wearing a condom keeps you safe from becoming co-infected with another infectious disease. No one wants a co-infection.  It complicated and dangerous for your health.  If you do not have HBV, then avoid getting an infection by you or your partner wearing a condom. HBV is vaccine preventable, but HCV, HIV and other STDs are not vaccine preventable. Considering the health and safety of yourself and your sexual partners is paramount. You may not know what they have, and they may not know what you have. Why take the risk? Love safely, get vaccinated against HBV, and wear a condom consistently and correctly. “Share affection, not infection”.

Hepatitis B Prevention

Considering the Transmission of HBV Through Tattooing or Piercing

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This month’s Clinical Infectious Diseases evaluated the transmission of HCV through tattooing and piercing. It is important to note that HBV is also of great concern when considering a tattoo or piercing. Unless you are vaccinated against hepatitis B, you are at risk for HBV if you are tattooed or pierced under unsterile conditions. The net-net is if you have a tattoo or piercing in a professional parlor – one that follows infection control practices and uses single-use items whenever possible and sterilizes re-used equipment using ultrasonic cleaning and sterilization with an autoclave , there does not appear to be an increased risk, though additional study is warranted. However, tattoos or piercings in prisons, or other settings that are not performed under sterile conditions are a serious danger.

The process of tattooing entails repeated injections of tiny drops of ink. That’s thousands of tiny needle sticks per minute, and a very effective transmission route for blood borne pathogens like HBV, HCV and HIV. This does not mean getting a tattoo will expose you to infectious disease, but if you choose a tattoo parlor that is not well regulated and safely follows all infection control practices, then you greatly increase your risk of infection.

Here’s the problem with tattoo parlors in the United States. They are not carefully or consistently regulated. There are no federal regulations. For the most part they are state regulated, with each state having its own rules and regulations.  Regulated states require that tattoo parlors have permits, and be inspected. Who inspects the parlor? – Sometimes it’s the State Department of Health, and sometimes it’s the local health department, so the inspections vary. There are some states with local regulations within the state, and even a few states with NO regulations. That is worrisome and dangerous. What are the rules and regulations for your state on this unofficial list? (Please read the site disclaimer) Do the research on the rules in regulations in your state, or city before looking for a tattoo parlor.

What does this mean if you’re considering a tattoo? Your tattoo is a personal decision that will live with you for the rest of your life. You don’t want to contract an infectious disease that may also live with you for the rest of your life and potentially threatens your life.  Shop for a clean, parlor that treats each tattoo like a mini, out-patient procedure – with all infection control practices followed. You want a tattoo parlor that uses single-use needles, ink, ink cups, and gloves. You want to see these tools come out of their sterile packaging –right in front of your eyes. You want a tattoo parlor with a functioning, inspected autoclave so that re-usable tools such as tattoo machines and needle bars can be properly sterilized. You want a tattoo parlor that is clean and an artist that washes his hands and wears gloves. If the shop is dirty, keep looking.  Speak up and ask the artist questions about his shop and his infection control practices. Don’t forget to ask to see the autoclave. If anything makes you wary about the visit, look else-where.

 

Baruch S. Blumberg Institute