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Social Stigmatization and Hepatitis C Virus Infection

Zacks, Steven MD, MPH; Beavers, Kimberly MD, MPH; Theodore, Dickens MD, MPH; Dougherty, Karen MSN, ANP; Batey, Betty PA-C; Shumaker, Jeremy BA; Galanko, Joseph PhD; Shrestha, Roshan MD; Fried, Michael W. MD

Journal of Clinical Gastroenterology: March 2006 - Volume 40 - Issue 3 - p 220-224
Liver, Pancreas, and Biliary Tract: Clinical Research

Goal Our aim was to assess stigmatization by evaluating the impact of hepatitis C virus (HCV) on social interactions, feelings of rejection, internalized shame, and financial insecurity, and behavior.

Background HCV patients suffer from slowly progressive disease. Although much research has improved the long-term prognosis of chronic HCV, quality of life may be affected by perceived social stigmatization.

Study In a cross-sectional study, HCV patients without cirrhosis or significant comorbidities were recruited from the University of North Carolina viral hepatitis clinic. Subjects completed a questionnaire administered by a trained interviewer that assessed changes in sexual behavior, personal hygiene habits, social function, and interactions. Additionally, subjects completed validated, standardized questionnaires, the Health Status Questionnaire, and the SCL-90-R. Frequencies were calculated for the prevalence of stigmatization and altered social interaction. Correlations between education and behavior changes were assessed. A series of multivariate analyses controlling for age, sex, and education were performed to assess the association between HCV acquisition risk and stigmatization.

Results One hundred seventy-five of 217 potential subjects (81%) participated in the survey. The average age was 45.2±7.7 years. Fifty-five percent were men and 53% were single. Twenty-nine percent had some college education. Risk factors for HCV acquisition included transfusion (21%) and injection drug use (29%), whereas 32% had an unknown mode of infection. Among common activities, 47% were less likely to share drinking glasses, 14% were less likely to prepare food, and one-third of subjects were less likely to share a towel. Thirty-five percent of respondents reported changes in their sexual practices. Decreased frequency of kissing and sexual intercourse was reported in 20% and 27% of individuals, respectively. Almost half of the single subjects reported increased use of condoms compared with only 20% among married couples. The majority of subjects perceived financial insecurity, internalized shame, and social rejection. Only 39% reported health impairment. Education level did not influence behavior change.

Conclusion The majority of HCV subjects alter common behaviors and report financial insecurity, internalized shame, and social rejection, regardless of the method of HCV acquisition or socioeconomic status. These findings indicate that all HCV individuals be counseled and encouraged to participate in educational programs at the time of diagnosis to reduce unnecessary behavioral changes and stigmatization perceptions to improve quality of life.

*Division of Gastroenterology and Hepatology, Department of Medicine

Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill

Supported in part by a grant from the Center for Gastrointestinal Biology and Disease P30 DK34987 (Kimberly Beavers, PI). Steven Zacks is supported in part by K23 DK064762-02. Michael Fried is supported in part by RR 00046, K24 DK066144-01, and RO1 HL064817-04.

Reprints: Steven Zacks, MD, MPH, 8009 Burnett-Womack Bldg, CB 7584, Chapel Hill, NC 27599-7584 (e-mail:

Received for publication July 6, 2005; accepted September 1, 2005

Copyright © 2006 Wolters Kluwer Health, Inc. All rights reserved.