Complex situations for people living with hepatitis B

Is there anyone my patient with hepatitis B must tell about their diagnosis?

In almost every instance, a person living with hepatitis B has no legal obligation to share their diagnosis and may choose not to due to the risk of stigma and discrimination. This includes in the workforce, in medical settings and with friends and family.

There are some rare instances in which a person living with hepatitis B is required to disclose this, including when they are:

a healthcare worker engaging in exposure prone procedures (EPPs) – see further information here.
donating blood or blood products
applying to work for the Australian Defence Force
applying for insurance or superannuation.

Quick Links

Who do you have to tell? | PDF | Hepatitis Australia

Know your rights | PDF | LiverWELL

What considerations are there for healthcare workers living with hepatitis B?

For most healthcare workers living with hepatitis B there are no special considerations. As for any healthcare worker, universal precautions and regular hand hygiene should be observed.

If your patients are healthcare workers living with hepatitis B and need to provide evidence of hepatitis B vaccination, you can support them by providing a letter that states they are not susceptible or at risk.

Healthcare workers performing exposure prone procedures (EPPs) are required to ensure they are under appropriate medical care and meet the criteria set out in these guidelines before performing EPPs. This is part of APHRA’s registration guidelines.

There are guidelines for viral load and testing (which is not covered by Medicare):

Viral load must be under 200 IU/mL.
Workers must be retested every 6 months if on treatment and every 3 months if not.

Quick Links

Australian National Guidelines for the Management of Healthcare Workers Living with Blood Borne Viruses and Healthcare Workers who Perform Exposure Prone Procedures EPPs | PDF | Communicable Diseases Network Australia

What do I do if my patient is not eligible for Medicare?

If your patient is an international student, they must have health insurance. However, this doesn’t always cover the cost of consultation. Patients should check with their insurer to find out what is covered. If they present to a public hospital for testing and care, they are likely to incur a cost.

If your patient is a refugee or and asylum seeker, they can go to one of the services that provide health care for refugees and asylum seekers in Victoria. Although these are free services, eligibility may be assessed. For example, the service may assess Medicare eligibility and whether or not the person is applying for protection.

The list below is not complete and there may be other local health services you can refer to.

In Victoria all people seeking asylum who are ineligible for Medicare can access full medical care in public hospitals for free, including outpatient appointments.

For further information on accessing medications and pathology seek advice from an experienced provider. If accessing the PBS is not possible for antiviral treatment, up to 3 months of medication can be imported from overseas. Generic tenofovir and entecavir can be acquired at a reasonable cost.

Quick Links

Recent arrivals, asylum seekers and family support services | Website | Better Health Channel

Hospital access for people seeking asylum | Website | Victorian Government Department of Health

Infectious diseases | Website | Victorian Refugee Health Network

How can I support my patient with their visa/migration process?

Providing a reassuring medical report in a migration case is very important and can contribute to a favourable outcome for your patient.

Recent updates to departmental policy mean that in very few circumstances will a visa applicant living with chronic hepatitis B be denied a permanent visa because they do not meet the health requirement set by the Department of Home Affairs. However, it is important to understand the threshold of expected healthcare costs as an applicant living with chronic hepatitis B may fail to meet the health requirement for a permanent visa if the Medical Officer of the Commonwealth assesses that the provision of health care or community services received in Australia would result in a significant cost to the Australian community or would prejudice the access of Australian citizens or permanent residents to these services.

People living with hepatitis B who have migrated to Australia may have completed a health undertaking. This is an agreement migrants make with the Australian Government about meeting their healthcare requirements. Under this health undertaking, migrants must contact Bupa (Australia’s migration medical services provider) on arrival and attend an appointment with a state or territory health clinic. Further information can be found here.

Quick Links

Hepatitis B and Immigration | PDF | ASHM

Health undertaking | Website | Australian Government Department of Home Affairs

Why is it important to be aware of how to care for people in various situations

“I was suspended from my nursing job when the hospital found out I had hepatitis B, and my baby was kicked out of daycare until the hospital figured out what to do with me – a really painful time for us all”. – Community member with lived experience of hepatitis B

“For 30 years I held this huge secret inside me and if I ever did tell someone I had HBV I would end up crying because of the pent-up anxiety. I only ‘came out’ publicly after retirement and felt so much relief. I regretted having lived with this secret for such a long time.” – Community member with lived experience of hepatitis B

Stigma and discrimination is often experienced by people living with hepatitis B and can be complex and profound, shaping relationships, employment, access to healthcare and wellbeing. Hepatitis B related stigma and discrimination can be related to overlapping stigma in relation to racial or ethnic background among other considerations.

There is significant evidence that stigma is encountered in healthcare settings by people living with bloodborne viruses including hepatitis B. This can include experiences of delayed care, reluctance to disclose symptoms and impact the therapeutic relationships required for quality care.