title: Social stigmatization and hepatitis C virus infection.
abstract: OBJECTIVE
  Our aim was to assess stigmatization by evaluating the impact of hepatitis C virus (HCV) on social interactions, feelings of rejection, internalized shame, and financial insecurity, and behavior.
  
  
  BACKGROUND
  HCV patients suffer from slowly progressive disease. Although much research has improved the long-term prognosis of chronic HCV, quality of life may be affected by perceived social stigmatization.
  
  
  METHODS
  In a cross-sectional study, HCV patients without cirrhosis or significant comorbidities were recruited from the University of North Carolina viral hepatitis clinic. Subjects completed a questionnaire administered by a trained interviewer that assessed changes in sexual behavior, personal hygiene habits, social function, and interactions. Additionally, subjects completed validated, standardized questionnaires, the Health Status Questionnaire, and the SCL-90-R. Frequencies were calculated for the prevalence of stigmatization and altered social interaction. Correlations between education and behavior changes were assessed. A series of multivariate analyses controlling for age, sex, and education were performed to assess the association between HCV acquisition risk and stigmatization.
  
  
  RESULTS
  One hundred seventy-five of 217 potential subjects (81%) participated in the survey. The average age was 45.2+/-7.7 years. Fifty-five percent were men and 53% were single. Twenty-nine percent had some college education. Risk factors for HCV acquisition included transfusion (21%) and injection drug use (29%), whereas 32% had an unknown mode of infection. Among common activities, 47% were less likely to share drinking glasses, 14% were less likely to prepare food, and one-third of subjects were less likely to share a towel. Thirty-five percent of respondents reported changes in their sexual practices. Decreased frequency of kissing and sexual intercourse was reported in 20% and 27% of individuals, respectively. Almost half of the single subjects reported increased use of condoms compared with only 20% among married couples. The majority of subjects perceived financial insecurity, internalized shame, and social rejection. Only 39% reported health impairment. Education level did not influence behavior change.
  
  
  CONCLUSIONS
  The majority of HCV subjects alter common behaviors and report financial insecurity, internalized shame, and social rejection, regardless of the method of HCV acquisition or socioeconomic status. These findings indicate that all HCV individuals be counseled and encouraged to participate in educational programs at the time of diagnosis to reduce unnecessary behavioral changes and stigmatization perceptions to improve quality of life.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, NC, USA. szacks@med.unc.edu
authors.forename: Steven
authors.initials: S
authors.lastname: Zacks
authors.forename: Kimberly
authors.initials: K
authors.lastname: Beavers
authors.forename: Dickens
authors.initials: D
authors.lastname: Theodore
authors.forename: Karen
authors.initials: K
authors.lastname: Dougherty
authors.forename: Betty
authors.initials: B
authors.lastname: Batey
authors.forename: Jeremy
authors.initials: J
authors.lastname: Shumaker
authors.forename: Joseph
authors.initials: J
authors.lastname: Galanko
authors.forename: Roshan
authors.initials: R
authors.lastname: Shrestha
authors.forename: Michael W
authors.initials: MW
authors.lastname: Fried
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D019698:Hepatitis C, Chronic / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D011287:Prejudice; D011788:Quality of Life / Q000523:psychology*; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires