Stigma and Its Determinants Among Individuals With Hepatitis C Virus Infection

Blood sample with sexually transmitted diseases: HIV, HBV, HCV, Syphilis
A team of investigators from the University of Pennsylvania Perelman School of Medicine evaluated factors associated with stigma related to a history of hepatitis C virus infection.

A cross-sectional study among individuals with a history of hepatitis C virus (HCV) infection found that most experienced stigma associated with a diagnosis of HCV. The researchersfound similar stigma scores between HCV-monoinfected and HIV/HCV-coinfected individuals but differing determinants associated with these infections, according to the results of a study published in the Journal of Viral Hepatitis.

To investigate stigma as a barrier to HCV treatment and elimination, a cross-sectional study of 270 patients with a history of HCV infection receiving treatment at an outpatient clinic in Philadelphia was conducted from July 2018 to May 2019. Stigma was evaluated using the validated HCV Stigma Scale, which was adapted from the Berger HIV Stigma Scale.

The investigators found that 95.5% of participants reported experiencing HCV-related stigma, and that mean stigma scores did not differ significantly between HCV-monoinfected and HIV/HCV-coinfected participants (P=.574). Significant interactions between HIV status and multiple determinants were observed and prompted analysis stratified by HIV status. Previous HCV treatment without cure, female gender, Hispanic/Latino ethnicity, and some college education were significantly associated with higher HCV-stigma scores among HCV/HIV-coinfected individuals. An annual income ranging from $10,000 to $40,000 was associated with significantly lower stigma scores. No significant associations were observed among HCV monoinfected patients.

Study limitations included the fact that only English speakers could participate due to the HCV Stigma Scale not being available in other languages. Therefore, the study results lack generalizability to non-English-speaking patients or those not engaged in healthcare. The models used were also unlikely to fully capture the complexity of how the identified factors intersect on patients’ experiences of disease-related stigma. To address these limitations, the study investigators suggest further qualitative research that complements these models. Social desirability bias can also not be excluded due to the self-reporting on determinants of stigma despite efforts to minimize this with anonymous computerized questionnaires. In addition, due to the cross-sectional nature of the study, causal relationships cannot be determined nor can changes in perceptions of HCV-related stigma over time or across stage of care. Therefore, longitudinal research is needed to better understand changes in stigma as patients progress through treatment.

According to the investigators, this work does “demonstrate that most HCV-infected patients experience some degree of disease-related stigma.” The determinants of this stigma are multifaceted and differ by HIV status. The investigators believe that the findings could have implications on the development of targeted interventions to reduce the harms of stigma and combat the HCV, HIV, and opioid syndemic.


Saine ME, Szymczak JE, Moore TM, et al. Determinants of stigma among patients with hepatitis C virus (HCV) infection [published online June 5, 2020]. J Viral Hepat. doi:10.1111/jvh.13343