Despite comprising only 4.8% of the total US population (Figure),1 Asian Americans account for more than half of the 1.4 to 2 million chronic hepatitis B (CHB) infections.2 The disproportionate rate of infections among this demographic is attributed to a variety of factors but, collectively, they represent a pressing public health concern within this population.

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Figure. States with large clusters of Asian Americans.
Based on reference 1.

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Sang Tran, MD

Sang Tran, MD, runs a private internal medicine practice in Fairfax, Virginia, caring for a primarily Vietnamese patient population. Dr. Tran has worked to lower the incidence of CHB infections among Asian Americans for the past 18 years, but he still sees lack of access to screening as his greatest obstacle. “Sometimes we don’t have the opportunity to help people because they still don’t have insurance. Also, many Asians don’t go to the doctor for an annual physical exam; they only go when they are sick,” he said.

But CHB is often asymptomatic, thus complicating Dr. Tran’s ability to make a diagnosis until considerable liver damage has occurred.

Son Nguyen, MD, a gastroenterology fellow at Tulane University in New Orleans, Louisiana, shares Dr. Tran’s frustration. “This is a disease that needs management, and yet I continue to see these people and what is the recurrent theme—the first time they’ve heard of hepatitis B virus (HBV) is when they are told they have cancer … [or] when they are told they’re cirrhotic and throwing up blood,” said Dr. Nguyen, whose patient population is mainly composed of Asian Americans with low socioeconomic status and limited English proficiency who have never heard of HBV (Table).1

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Son Nguyen, MD

To break down these barriers to care, Dr. Nguyen holds free HBV screenings within his New Orleans community. Last year, he successfully screened about 1,000 individuals. But his greatest challenge during these community screenings continues to be misconceptions about the relationship between symptoms and disease status. “It’s a stigma that ‘I feel great, I’m asymptomatic, so why would I have a disease that you describe [as being] so bad?’ So [clinicians] have to get over that hump and explain that CHB is asymptomatic,” said Dr. Nguyen.

Cultural practices also may dissuade patients from presenting to care. In fact, the use of herbs is still very popular among Asians due in part to television commercials that promote these natural remedies. “All patients can tell you is that it will make your liver feel fresh, and I ask them ‘what does that mean?’ I don’t even know what it means when my liver feels fresh, but that’s the advertisement that they get,” said Dr. Nguyen.

“Some patients, if they come from a very traditional Vietnamese family, may not believe in Western medicine or may believe that it does more harm to the body than natural herbs,” said Dr. Tran. As a result, he created a unique method to educate Vietnamese patients about CHB and its modes of transmission. “I do my own simple, straightforward CD and DVD [in Vietnamese] to provide instructions for the patient because it saves me a lot of time. And patients study it and come back with more questions.”

Table. Language Barriers
Ethnicity Percentage of Total Asian-American Population Proportion with Limited English Proficiency
Chinese 22.8% 41.5%
Filipino 17.4% 18.5%
Korean 9.7% 41.3%
Vietnamese 10.6% 50.5%
Based on reference 1.

Dr. Tran also tries to engage family members in the therapeutic alliance, explaining the concept of diseases and transmissibility to both patients and their relatives. “Most people try to keep [their CHB status] secret; they’re afraid and don’t want people to know … so we have to explain exactly how the virus spreads to other people.”

Ultimately, increasing awareness about CHB infection and improving patients’ quality of life creates a domino effect. “No advertisement is better than word of mouth. If you make a difference in one person’s life, then they’re going to tell others,” explained Dr. Nguyen.

References

  1. Asian & Pacific Islander American Health Forum. Demographic and socioeconomic profiles of Asian Americans, Native Hawaiians, and Pacific Islanders in the United States. http://www.apiahf.org/​sites/​default/​files/​Demographic_Socioeconomic_Profiles_AANHPI.pdf. Accessed March 19, 2013.
  2. Cohen C, Holmberg SD, McMahon BJ, et al. Is chronic hepatitis B being undertreated in the US? J Viral Hepat. 2010;18(6):377-383.

Multilingual Educational Materials

  • http://asianamericanhealth.nlm.nih.gov
    The National Library of Medicine offers a resource for users to select their language and then locate the information by disease state.
  • http://hepbsmart.com
    This educational website, sponsored by Gilead Sciences, Inc., can be browsed in 14 different languages. It provides disease awareness and resources for patients, along with printable brochures in several languages.
  • http://www.hepb.org
    Users can print useful information on living with and understanding HBV in Chinese, Korean, and Vietnamese languages.
  • http://liver.stanford.edu
    As part of the Jade Ribbon Campaign, the Asian Liver Center at Stanford University allows health care professionals to order free educational brochures in a variety of Asian languages.
  • http://www.hepbmoms.org
    Users can order educational brochures, read current news articles about HBV, or download their HBV fact sheet in 11 different languages, including Vietnamese, Thai, Korean, and Chinese.