RACIAL DIFFERENCES IN HEPATITIS В AND HEPATITIS С
Vulnerable subpopulations with high rates or risks of hepatitis-B virus (HBV) and hepatitis-C virus (HCV) infection may warrant focal points for public health efforts to reduce or eliminate the transmission of these diseases. Although four million persons in the United States—or 1.8% of the population—are thought to be infected with HCV, the estimated U.S. rates for non-Hispanic African Americans are as high as Э.2%. For HBV, the estimated rates for the United States are approximately 5%, whereas the rates for non-Hispanic African Americans are as high as 12%. Recently, persons with severe mental illness (SMI), including veter ans, were specifically defined as another high-risk subpopulation for both HBV and HCV infection, with rates of 20% and 23%, respectively. SMI criteria include the presence of a major mental illness, chronicity, and pervasive impairment of function. SMI diagnoses include schizophrenia, bipolar disorder, depression, and, for veterans, PTSD because of its severe and disabling effect in this population.
Military veterans, particularly those accessing the Department of Veterans Affairs (VA) health services, represent a significant proportion of the homeless and deinstitutionalized mentally ill. High rates of these infections have been reported in veteran cohorts: as many as 30% of homeless, impoverished veterans are HBV-infected, and 10-35% of veterans using VA health services are HCV-infect-ed. Combat and medical work have been described as risk factors for HCV in veterans. Among veterans with HCV infection, high rates of SMI have been reported. Collectively, these individuals constitute an overlapping subpopulation at high risk for both HBV and HCV infection. cialis super active online
The extent to which race/ethnicity factors contribute to the heightened risk is not known. The risks for minorities may be underestimated, because these infections are under-recognized among persons belonging to disenfranchised risk groups (i.e., homeless or deinstitutionalized persons) of which minorities are disproportionately represented. Furthermore, veterans with SMI are often unaware of their hepatitis infections, which raises concerns about the risk of continued transmission. Race/ethnicity may be linked to several social contextual factors (e.g., poverty, homelessness) that place members at greater risk for exposure to and subsequent development of HBV and HCV Thus, it is crucial to characterize this high-risk population further and to understand if there is a role of race/ethnicity in the risks of these infections.
In this study, we examine racial differences in the constellation of risk behaviors associated with HBV and HCV infection among veterans with SMI. Specifically, we address two questions: 1) Does the prevalence of HBV and HCV risk behaviors differ by race in a sample of veterans with SMI? and 2) Do racial differences in risk behaviors (e.g., combat exposure, injection drug use [IDU], sharing needles, and unprotected sex for drugs) account for any observed racial differences in seroprevalence for HBV and HCV? Viagra Super Active