Hep C and Outreach to Hispanics

It’s a Hispanic Thing
Hep outreach & research are needed for a vulnerable community
by Larry Buhl

[dropcap]I[/dropcap]n a presentation at a National Hispanic Medical Association (NHMA) meeting in February, Dr. Julio Gutierrez, an assistant professor of medicine at the University of Texas Health Science Center in San Antonio starts with a paradox of Hispanic health. Contrary to popular belief, Hispanic Americans are twenty-four percent less likely to die of all major causes than whites, according to the CDC, and are much less likely to die of chronic lower respiratory diseases (-137 percent), suicide (-160 percent) and heart disease (-34 percent). But they are much likelier to die of chronic liver disease and cirrhosis (+40 percent) than whites.

And within the baby boomer cohort Hispanics are six times more likely to be infected with the hepatitis C virus (HCV).

Gutierrez goes on to shatter some myths about why Hispanics might be especially disadvantaged with liver disease. It is not, he says, due to high alcohol use, language barriers, or poverty rates.

The truth is, many Hispanics start off with a genetic disadvantage: fatty liver, or, in medical terms, a high likelihood of having non-alcoholic fatty liver disease (NFLD). A 2008 Dallas Heart Study showed that forty-five percent of Hispanics have “fatty liver” compared to thirty-three percent in whites and twenty-four percent in African Americans.

Gutierrez concludes that the combination of HCV plus fatty liver in Latinos explains some of the increased risk of death but fatty liver alone is probably a bigger problem.

What a propensity for NFLD means is that anything that affects the liver, whether it’s alcohol or hepatitis, is likely to affect a person of Hispanic origin faster and more severely than it would a member of another group.

There are additional challenges, Gutierrez says, that disadvantage Hispanics and can lead to worse health outcomes. Only five percent of gastroenterologists in the U.S. are Hispanic. And Hispanics are more likely to be uninsured, even in the era of Obamacare, than Americans in every other racial category.

The insurance disparity is especially troubling to Mariah Johnson, a senior manager on the hepatitis and policy and legislative affairs teams at the National Alliance of State and Territorial AIDS Directors (NASTAD).

“What we need is a stronger political will at the federal and state level to dedicate resources to communities most vulnerable (to hepatitis),” she tells A&U. “That includes Hispanics and American Indians.”

But dedicating resources is one challenge. Determining which resources to dedicate in which ways is a bit trickier, according to Dr. Elena Rios, president and CEO of the National Hispanic Medical Association.

“Hispanics trust medical professionals and have a high respect for them,” Rios tells A&U. “But making sure that they actually go to the doctor for routine screenings, that’s more challenging.”

Rios and Johnson agree that there should be a massive education and outreach campaign aimed at Hispanics in the U.S. But they admit that the messages and media need to be tailored to meet Hispanics where they are.

“We need to talk to leaders in the communities,” Rios says, suggesting that top-down institutional messages are less likely to be effective than a grassroots campaign to inform Hispanics about liver health and the importance of testing.

And to overcome some preconceived notions about hepatitis, Johnson adds. She tells A&U that there are no hard statistics on it, but rather anecdotal evidence that Hispanics, more than other groups, think of hepatitis, especially HCV, as something that people only get from having unsafe sex or from using IV drugs.

IV drug use is a major risk factor for HCV infection, but it’s not the only way a person can get it. Other risk factors include age (baby boomers more likely to be infected) and having a medical procedure before widespread testing of the blood supply began in 1992.
All of these factors, and the tendency for people with HCV to have no symptoms for decades—while the virus is doing its damage—mean that the Hispanic community in the U.S. is, according to Rios, “sitting on a time bomb.”

Gutierrez in his presentation suggested a novel approach to education and outreach for Hispanics, or, more specifically, a telenovela approach. He says NHMA has a goal of writing PSAs targeting Latinos to run during the popular TV “Hispanic soap operas,” telenovelas. PSAs and other media vehicles could share a narrative of health risks for Hispanics/Latinos.

He adds that a “test and treat” protocol for HCV must be incorporated in clinics and health care settings that serve Hispanics and that genetic testing—the PNPLA3 gene is associated with a high risk of fatty liver disease—should be affordable, accessible and routine. And Gutierrez wants more Hispanics to be included in clinical trials, and even for more Hispanic researchers to lead those trials.

Larry Buhl is a journalist, radio producer, screenwriter, and novelist living in Los Angeles.