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Commentary: Asian Americans and HBV
My Perspective as an Asian American Healthcare Professional Living With Chronic Hepatitis B

Released: April 27, 2023

Jennifer Wild
Jennifer Wild, MS, BSN, RN, OCN
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Key Takeaways
  • As a healthcare professional living with chronic HBV infection, I use my story to reduce HBV-related stigma and encourage HBV screening and treatment for my patients.
  • Healthcare professionals can make a positive impact by asking all of their patients who were born in HBV-endemic areas to consider HBV screening.

My Story
I was born in South Korea in the 1980s and adopted by American parents, and I moved to the United States when I was 3 months old. It wasn’t until 22 years later—when I was completing the occupational health requirements for my very first job as a registered nurse—that I learned I am a chronic carrier of hepatitis B virus (HBV). At the time, I was shocked and felt sorry for myself. Now, I am living with HBV and receiving treatment for it, and I don’t think about it most days. 

Barriers to HBV Diagnosis
The main barrier that I encountered on the path to my HBV diagnosis was a sense of false security from the very healthcare professionals (HCPs) who were meant to be looking out for me. I have been privileged to have health insurance coverage since the day I arrived in the United States, and I completed the 3-vaccine HBV immunization series before my first birthday. Upon matriculating into nursing school, my HBV antibody titer failed to prove immunity, so I again received the 3-vaccine series. The subsequent titer also was negative, and the medical professionals in my life—my family physician, my student health clinic, and my school of nursing—all told me that I was simply “resistant” to the HBV.

It was the occupational health physician at my first hospital employer who asked me, “Have you ever been tested for the actual hepatitis B virus?” A week later, I finally had my diagnosis when I tested positive.

Self-education
I began to educate myself about HBV, learning about the endemic rates of HBV infection in Asian countries and the higher risk of chronic HBV infection due to perinatal transmission to infants. I established care with a hepatologist, and when my liver function tests later began to rise, I joined a clinical trial for what is now a standard of care oral antiviral treatment. I now live and practice in California, where one third of my patients are Asian, and I have dedicated my career to the care of patients with liver cancers. I sometimes wonder how many of my biological family members may have died of liver cancer, but I do not seek to find out. 

Caring for Patients With HBV and Liver Cancer
Many of my patients receive their HBV diagnosis the same day they receive their advanced-stage liver cancer diagnosis. They are predominantly Asian, and many are young, in their 30s to 50s. They tell me that liver cancer runs in their families, but when I ask about HBV, they say they do not know of anyone else in their family with it.

The barrier for many of my patients is HBV awareness and screening, the latter of which is a challenge for the un- or underinsured—and awareness often is stymied by stigma.

Even when patients share their HBV status with their family members, the family members are sometimes still reluctant to be tested. “I feel fine—I am not sick” is a phrase I am commonly told. If they are tested and are found to have HBV, they then are reluctant to seek treatment. “I don’t take prescription medications; they are expensive,” they say. Unfortunately, discussing the risk of liver cancer associated with untreated HBV can be interpreted as fearmongering and can damage the patient care relationship. A patient my own age once asked me, “If HBV is such a big deal, wouldn’t I have heard of it before?” 

Increasing HBV Awareness
I will continue to wish for a K-pop star‒led public awareness campaign, but until that happens, the best solutions that are within our day-to-day work are promoting HBV screening and fostering trust in the medical profession. Healthcare costs and lack of health insurance can be tremendous barriers to HBV screening and treatment, but those relate to systemic issues that are not within the power of an individual HCP to quickly address for the patient being seen tomorrow morning. I encourage my HCP colleagues to get involved in their state-level discussions toward improving access to healthcare and health equity. 

The individual HCP can make a positive impact by asking all patients who were born in HBV-endemic areas to consider HBV screening. Many people don’t realize that they are from an HBV-endemic region or that they are at high risk for having HBV. Free HBV screening is often available through local departments of public health and can be useful if HBV screening is cost prohibitive for the patient.

Reducing HBV-Related Stigma
Perhaps of most importance, we can reduce HBV-related stigma by building greater trust between patient communities and HCPs. We must educate ourselves about HBV risk factors, HBV-endemic areas, which tests to order, and the most affordable treatment options so that we can confidently and accurately present this information to our patients. We can humbly grow our cultural sensitivity toward Asian American patients and their families. And we can admit when we aren’t sure about something but that we will find out the answer.

I have sometimes shared my story with my patients and/or their families when I am discussing the importance of getting tested for HBV. When they see that I am not trying to sell them a medication, that I am not afraid of HBV-related stigma, and that I am just trying to speak honestly with unnie or oppa, that is when we overcome these barriers together. 

Your Thoughts?
What strategies do you use to overcome barriers to HBV screening and treatment in your Asian American patients? Join the conversation by posting a comment below.