I am honoured to speak on viral hepatitis from the perspectives of patients in Ghana. Viral hepatitis is a silent and under-estimated public health problem worldwide, and which is particularly endemic in the Sub-Saharan Africa and Ghana. Hepatitis B is a preventable disease.

Thousands of Ghanaians live with viral hepatitis. About a third of Ghanaians living with viral hepatitis are unaware of their status and are not receiving care and treatment for the condition. Raising awareness about hepatitis is crucial to effectively fight stigmas, stem the tide of new infections, and ensure treatment reaches those who need it. On World Hepatitis Day, we join others across Ghana and around the world in promoting strategies that will help save lives and prevent the spread of viral hepatitis.

“Hepatitis” means inflammation of the liver. It refers to a group of viral infections that affect the liver. There are five main hepatitis viruses, referred to as types A, B, C, D, and E. The most common types are the A, B, and C.

Ladies and Gentlemen, nearly one out of every three people in the world (approximately 2 billion people) has been infected by the hepatitis B virus (HBV), and one in twelve (more than 520 million people) live with chronic HBV or/and hepatitis C (HCV) infection. In Ghana, hepatitis is the leading infectious cause of death, claiming the lives of thousands of Ghanaians each year. While we have come thus far in containing the spread of the virus, much more work is still needed to be done in treating and managing the disease.

Viral hepatitis affects Ghanaians of all backgrounds, but certain groups are at a greater risk than others. Before blood was screened for viral hepatitis many who received blood transfusion were infected, infants born to mothers infected with the viral hepatitis, and persons with multiple sex partners or indulge in certain behaviours such as injection of drugs, tattooing and tribal marks have a higher risk of infection.

Carriers of viral hepatitis in Ghana face many social and economic challenges. Ladies and Gentlemen, the social impact of hepatitis on carriers are numerous but because time is not on my side, I will focus on but a few:

Social effects on patients

Sexual Activity: Many viral hepatitis patients in Ghana are fearful of engaging in sexual activities once they are diagnosed with the virus. They are concerned about passing the virus onto their partners, and as a result, many marriages are not consummated and relationships are broken. But research shows that sexual activity can benefit one’s immune system. Sexual activity triggers the release of endorphin, which helps create a more positive attitude. It also helps one to forget about his/her problems. Thus, sexual activity can go a long way to enhance the healing process and creating an environment for a better functioning of one’s immune system. Carriers of the viral hepatitis living with one long-term sexual partner do not need change their sexual habits and practices. However, those with more than one sexual partner should practice safe sex by using condom.

Stigmatization: There is a societal stigma about hepatitis. Infected people are alienated by society. Individuals may also be isolated within their families, hidden away from visitors or made to eat alone. Many carriers are refused access to educational facilities and there is as a result a high prevalence of school dropout and illiteracy. They are looked down upon for contacting the virus, as it is generally to be associated with sexual promiscuity. Because society ignores their plight some carriers choose to revenge on society by spreading the virus through indiscriminate sexual activities.

Difficulties in accessing medical care: Many health centres in Ghana are not well equipped to handle viral hepatitis cases and the technical know-how of some medical doctors and other healthcare professionals in treating the condition is limited. As a result, many patients do not get diagnosed and do not get referred to receive appropriate medical attention that they may need.

Low self-esteem: Many carriers of the virus suffer a great loss of self-esteem once diagnosed. Because of the lack of knowledge about the disease, many away even from close relatives, withdraw from society and can no longer participate in public activities. Low self-esteem can bring depression, which can lead one to commit suicide. Many people living with the chronic viral hepatitis in Ghana become depressed as a result blaming themselves. They find it very difficult to tell their partners or family members because getting infected by the viral hepatitis is usually associated with indulging in sexual activities.

Beliefs: Some people see the viral hepatitis as a curse. There is a traditional belief that viral hepatitis is a spiritual disease. It is also believed that viral hepatitis is hereditary so if one’s parents are infected, it is automatically thought that children will also be infected. Most patients also believe that viral hepatitis is not treatable.

Stress: Carriers of the virus are always stressed up because of the factors I just numerated earlier. Stress can suppress the immune system, which may cause patients to be more vulnerable to other diseases. The stress may be compounded by the fact that one may never know how, when, or where the infection occurred since most people are not diagnosed until well after the initial infection. Asking questions and trying to understand as much as one can about Hepatitis B can also go a long way toward reducing one’s stress level. Without knowledge you run the risk of having your decision controlled by fear and misinformation.

Breastfeeding: Breastfeeding mothers are always fearful of transmitting the virus to their newborn babies. Some mothers will not breastfeeding their babies at all, which is dangerous because the breast milk is good for the baby to grow well. It is always advisable to inform one’s nurse when one is going for antenatal care, the nurse will give your baby a shot called H-BIG and a shot of hepatitis B vaccine within 12 hours after birth. After the baby has been vaccinated on delivery, it is alright to breastfeed the baby. The viral hepatitis is not transmitted through breast milk! It is important to take good care of your nipple areas to prevent cracking and bleeding.

Marriage: Many people are fearful of getting married or telling their partners of their status. Some people also think that they may lose their partners if they tell them so they will not tell. Is advisable to inform your partner before getting married, if he/she gets to know of it? Yes, it is always a good idea to let your partner know of one’s status before marrying so that the would-be partner can get vaccinated

Life Span: There is no life span for hepatitis patients, you can live as many years as God wants you to live when you treat it and monitor it well. Many patients are fearful of death so those who call always want to know the number of years they have on earth or to know the time they will die. “Say no to ignorance.”

Ladies and Gentlemen, I will now focus on the economic impact of hepatitis on individuals, families and the national economic development and growth.

Economic effects on patients

Household Income: The incomes of carriers of the viral hepatitis may also be affected because carriers may not be able to work at their full capacity and/or even holding down permanent job.

Basic Needs: Most carriers have to constantly cut their spending on basic necessities of life .The most likely expenses to be cut are clothing, electricity, food, shelter and other services. The cost of medical treatment means that most of their already reduced income is spent on medical care.

Termination of Employment: People living with chronic viral hepatitis have to visit the hospital regularly, which costs their employers thousands of cedis in medical bills and time away from the workplace. As a result, employments of many carriers are employments of many carriers are often terminated.
The Way Forward

Counseling:
• Counseling should be an integral part of any medical model when treating carriers of viral hepatitis.
• A holistic approach should be adopted by medical doctors and allied healthcare professionals in treating carriers so that their psychological needs can be recognized.
• Adequate support should be given when one is diagnosis or the first time, as patients do experience great stresses due to fear of the disease and of rejection and social stigma that are associated with the disease.

Confidentiality: Confidentiality is as important for viral hepatitis patients as it is for all other patients. All healthcare professionals should treat the cases of their patients with the strictest confidentiality, particularly with regards to:
- Medical records
- Staff confidentiality
- Partner/family notification and disclosure

Screening facilities: Screening facilities should be provided at all local health centres, district polyclinics, and regional government hospitals (e.g. all pregnant women should be tested).

Prevention tools: Precaution should be exercised regarding injection safety, blood safety and immunization of all new born as well as vaccination of all healthcare professionals.

Continuing care: Ensuring that those already infected with the virus have timely access to care, and effective and affordable treatments to delay development of the disease and prevent disability and eventual death.

Disease surveillance: Strengthening disease surveillance, such as establishing national database to monitor spread of the virus in order to establish patterns of progression would be a step in the right direction.

National awareness: Increasing national awareness of viral hepatitis through the commemoration of a World Hepatitis Day on 28 of July every year, as Member States agreed to do at the 63rd World Health Assembly in Geneva on 21 May, 2010.

Ladies and Gentlemen, we must make sure that this "silent epidemic" does not go unnoticed by health professionals or by communities across our country. Our goal is to reduce the number of new infections, increase status awareness among people living with virus, and eliminate the transmission of viral hepatitis from mothers to their children.

The first step toward achieving these goals is to raise public awareness of this life-threatening disease. We must work to reduce the social stigma of the virus, and to ensure that testing, information, counseling, and treatment are available to all who need it. The hard work and dedication of healthcare professionals, researchers, and advocates will help bring us closer to these goals. On this day, we renew our support for those living with the viral hepatitis, and for their families, friends, and communities who are working to create a brighter, healthier future for all!
For counsel and advice on treatment and management, Contact us. Support our work to spread the word but not the virus.

Theobald Owusu-Ansah
President, Theobald Hepatitis B Foundation
President, Hepatitis Coalition of Ghana
Regional Board Member for Africa, World Hepatitis Alliance, UK
Board Member, National Association of Hepatitis C Taskforce, USA
Email: theobald2003@yahoo.com/ president@theobaldhepb.org
Web: www.theobaldhepb.org . Tel: +233 (24) 709-3893 / +233-26-8269214