Tackling stigma in health care
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Health care is the most common setting that people with viral hepatitis experience stigma. It is essential to recognise how stigma occurs across the health sector so we as health professionals can work towards reducing it.
Stigma in Australian health care
Half of Australians have admitted they would act negatively towards someone based on their hepatitis status. While this number is lower for health professionals, there is still room for improvement.
Research into the attitudes of Australian healthcare workers by the UNSW Centre for Social Research in Health found:
- 20% would act negatively towards someone based on their hepatitis B or hepatitis C status.
- 56% would act negatively towards people who inject drugs (PWID).
- 69% have witnessed another health worker behaviour negatively towards someone who injects drugs.
What is stigma, and why is it an issue?
Stigma is when a person, group or community are treated negatively based on a real or perceived characteristic. This could include someone’s hepatitis status, race, gender, plus many others.
Stigma occurs more often when people perceive certain behaviours to be acts of moral failure, such as injecting drug use or unprotected sex.
These attitudes can also lead to self-stigmatisation, where a person adopts these negative views about who they are. This is harmful to a person’s mental and physical health, emotional well-being, self-esteem and connection with the community and health care.
Stigma and hepatitis
Lack of knowledge about risk factors and transmission is a common cause of hepatitis-related stigma.
Due to past experiences, people living with hepatitis often expect to be treated negatively. This expectation impacts how they approach and act in a health setting. It can be a major barrier for people even accessing health services and receiving the care they need.
Australia’s National Blood Borne Virus strategies identify stigma as an important area for action within key priority populations. Without addressing stigma, we cannot hope to eliminate hepatitis and improve quality of life in our communities.
What does stigma look like in health care?
Examples of stigma in a health care setting include:
- A lack of willingness to work with clients
- Breaches of confidentiality, e.g. disclosing a client’s hepatitis status to other staff
- Excessive infection control procedures, e.g. wearing multiple pairs of gloves
- Refusing requests for testing
- Refusing access to treatment
- Rushed release from care
- Not offering treatment based on assumptions about a patient’s ability to correctly follow treatment instructions
What is the flow-on effect?
When patients are exposed to stigma within health care, this can result in:
- Reduced hepatitis testing
- Reduced treatment uptake and adherence
- Less engagement with health providers
- Reluctance to disclose symptoms or hepatitis status
- Increased risk of transmission
- Increased healthcare costs
How do we overcome stigma?
What can we do as health professionals to improve?
- Educate health providers to increase confidence to test, treat and manage hepatitis
- Create roles in the workforce for those with lived experience. Peers offer support and understanding that others cannot, which improves willingness to engage with health care.
- Offer opportunities for staff and community to connect with lived experience. Engaging with and listening to those lived experiences reduces negative attitudes that drive stigma.
- Advocate for improvements in laws, policies and constitutions to address structural stigma. Without this, the health sector will continue to disadvantage people’s access to safe and appropriate health care.
- Empower people through education, support groups, and counselling to reduce misinformation about viral hepatitis and the negative impact of self-stigmatisation.
These interventions help build a supportive and non-judgmental health care environment that improves client engagement and individual health outcomes, leading to population health benefits.
Further information on stigma in health care
Explore some of the fantastic sessions available on stigma by the Centre for Social Research in Health
Language is powerful, and can inform both positive and negative attitudes in society. The Power of Words guide by the Alcohol and Drug Foundation is a great resource that can broaden your understanding of positive language.
Broady, T. R., Brener, L., Hopwood, M., Cama, E., & Treloar, C. (2020). Stigma Indicators Monitoring Project: Summary Report. Phase Two. Sydney: UNSW Centre for Social Research in Health. http://doi. org/10.26190/5ebca29f38662
Broady, T. R., Brener, L., Vuong, T., Cama, E., & Treloar, C. (2021). Online interventions to reduce stigma towards population groups affected by blood borne viruses in Australia. The International journal on drug policy, 29(103292). https://doi.org/10.1016/j.drugpo.2021.103292