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Spotlight Series on Hepatitis C

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Hepatitis C in Canadian Immigrants and Newcomers: Why Are Hepatitis C Rates Higher in These Populations?

February 6, 2017

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Individual-Level Barriers

Socio-economic barriers

Canadian newcomers and recent immigrants have high rates of unemployment and are over-represented in precarious and vulnerable employment.29 This can affect their ability to access care,30,31 including hepatitis C testing and care.

Provincial health plans do not cover the cost of prescription drugs and with higher levels of unemployment and precarious jobs many people do not have extended health benefits like drug plans.32 The risk of losing their wages, which are extremely important for their survival, means that Canadian immigrants, and particularly newcomers, use the healthcare system infrequently or only when they are too sick to work because of the lack of paid sick days.33 Immigrants' ability to access care is also compromised by a number of other complex socio-economic factors like precarious employment, lack of transportation and child care.

Linguistic and cultural barriers

There are a number of linguistic and cultural barriers to medical care for immigrants and newcomers. Immigrants and newcomers may hesitate to engage with the system due to language barriers and cultural unfamiliarity.34 Immigrants and newcomers mostly settle in areas that are largely inhabited by their community.35,36 This may facilitate access to ethno-specific services; however, it can result in a huge pressure on the few ethno-specific physicians and services available in those neighbourhoods.34 Those who cannot be accommodated by these service providers either do not access services at all or have to travel long distances to see a healthcare provider who is familiar with their culture or understands their language.

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Stigma

In some immigrant communities, there is a strong stigma attached to blood-borne diseases, including hepatitis C. Stigma is primarily linked with the fear of contagion, which results from a lack of understanding about hepatitis C transmission. Stigma can reduce the likelihood of accessing testing and care.37 People might also hesitate to share all of their risk factors for hepatitis C22 with a provider due to stigma. This can affect their access to appropriate screening for hepatitis C.

Stigma can also be related to one's immigration status, which can have a direct bearing on one's ability to access care. People who are medically uninsured due to their immigration status, like undocumented persons or refugees whose appeals have been rejected, find it difficult to get the care they need37 not only because of the associated stigma but also fear of being reported to the authorities.


What Can Frontline Services Do to Improve Newcomers' Access to Hepatitis C Testing and Diagnosis?

Changing Canadian demographics and the high prevalence of hepatitis C in immigrants and newcomers requires frontline workers and service providers to shift their understanding of hepatitis C. Here are some practical ideas.

Frontline service providers can:

  • Offer or refer immigrants and newcomers from hepatitis C endemic countries to screening. The CCHIR tool can help determine if screening is appropriate.
  • Learn more about hepatitis C in Canadian immigrants and newcomers and access both service provider and client resources from CATIE's website. A number of culturally tailored multilingual client resources are available here for clients to get information on hepatitis C in their own languages.
  • Know more about local settlement services, newcomer health services, translation and interpretation services and link up their clients with them.
  • Work in partnerships with public health, settlement and newcomers services, and immigrant health organizations to create culturally safe services. 
  • Be sensitive to the presence of stigma related to hepatitis C in many newcomer communities.


Resources

Clinical Guidelines Checklist for New Immigrants and Refugees (Canadian Collaboration for Immigrants and Newcomers) -- an eLearning knowledge translation tool designed for primary care practitioners to help integrate the Canadian Immigrant Health Guidelines into practice

Hepatitis C and Immigrants and Newcomers (CATIE) -- hepatitis C resources for service providers working with immigrants and newcomers from countries where hepatitis C virus is endemic.

Fozia Tanveer is CATIE's Knowledge Broker, Immigrant and Newcomer Hepatitis C Community Health Programming. She has been working with CATIE's Hepatitis C Ethnocultural Education and Outreach Program since 2011 and has a Master's of Development Studies from the School of Oriental and African Studies, University of London.

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Related Stories

Researchers Call for Easing Restrictions on Access to Hepatitis C Treatment in Canada
What Is the Prevalence of Hepatitis C Among HIV-Positive Gay, Bi, Two-Spirit and Other Men Who Have Sex With Men?



This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication Prevention in Focus: Spotlight on Programming and Research. Visit CATIE's Web site to find out more about their activities, publications and services.

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