Background
Methods
Results
Participants
United States (n = 15a ) | Germany (n = 12b) | Italy (n = 12) | China (n = 12) | Japan (n = 12) | Total (N = 63) | |
---|---|---|---|---|---|---|
Sex, n (%) | ||||||
Female | 8 (53) | 7 (58) | 8 (67) | 7 (58) | 9 (75) | 39 (62) |
Male | 7 (47) | 5 (42) | 4 (33) | 5 (42) | 3 (25) | 24 (38) |
Mean age, yearsc | 36 | 48.8 | 53.4 | 38 | 58.1 | 48.8 |
Median age (range), yearsc | 49.5 (36–58) | 52 (31–65) | 58.5 (29–71) | 38 (25–57) | 59.5 (44–70) | 50.0 (25–71) |
Ethnicity, n (%) | ||||||
Asian | 5 (36) | 1 (8) | 0 | 12 (100) | 12 (100) | 30 (48) |
Black/African American | 1 (7) | 0 | 0 | 0 | 0 | 1 (2) |
Caucasian/White | 6 (43) | 10 (83) | 12 (100) | 0 | 0 | 28 (44) |
Hispanic | 2 (14) | 0 | 0 | 0 | 0 | 2 (3) |
Other | 0 | 1 (8) | 0 | 0 | 0 | 1 (2) |
Living status, n (%) | ||||||
Living with partner/spouse | 4 (29) | 3 (25) | 2 (17) | 9 (75) | 4 (33) | 22 (35) |
Living with partner and children | 5 (36) | 1 (8) | 5 (42) | 0 | 5 (42) | 16 (25) |
Living with children | 1 (7) | 1 (8) | 2 (17) | 0 | 0 | 4 (6) |
Living with family | 1 (7) | 0 | 1 (8) | 1 (8) | 1 (8) | 4 (6) |
Living alone | 3 (21) | 7 (58) | 2 (17) | 1 (8) | 1 (8) | 14 (22) |
Living with parents | 0 | 0 | 0 | 1 (8) | 0 | 1 (2) |
Other | 0 | 0 | 0 | 0 | 1 (8) | 1 (2) |
Highest education level, n (%) | ||||||
Junior high school | 0 | 0 | 0 | 0 | 2 (17) | 2 (3) |
High school | 1 (7) | 0 | 1 (8) | 4 (33) | 1 (8) | 7 (11) |
Technical college | 0 | 0 | 0 | 0 | 4 (33) | 4 (6) |
Apprenticeship | 0 | 2 (17) | 0 | 0 | 0 | 2 (3) |
Vocational training | 0 | 5 (42) | 0 | 8 (67)d | 0 | 13 (21) |
College or associate’s degree | 6 (40) | 1 (8) | 7 (58) | 0 | 22 (35) | |
University | 0 | 4 (33) | 1 (8) | 5 (42) | 18 (29) | |
Bachelor’s degree | 2 (13) | 0 | 1 (8) | 0 | 11 (17) | |
Graduate or postgraduate degree | 6 (40) | 0 | 2 (17) | 0 | 0 | 8 (13) |
Employment status, n (%)e | ||||||
Employed full-time | 12 (80) | 5 (45) | 2 (17) | 9 (75) | 6 (50) | 34 (55) |
Employed part-time | 2 (13) | 3 (27) | 0 | 0 | 3 (25) | 8 (13) |
Unemployed | 1 (7) | 1 (9) | 2 (17) | 3 (25) | 1 (8) | 8 (13) |
Retired | 0 | 1 (9) | 3 (25) | 0 | 2 (17) | 6 (10) |
Other | 0 | 1 (9) | 4 (33) | 0 | 0 | 5 (8) |
Mean time since diagnosis, yearsf | 10.7 | 10.5 | 11.7 | 10.6 | 19.7 | 12.5 |
Genotype, n (%) | ||||||
Genotype A | 4 (27) | 10 (83) | 0 | 0 | 0 | 14 (22) |
Genotype B | 2 (13) | 0 | 0 | 0 | 1 (8) | 3 (5) |
Genotype C | 1 (7) | 1 (8) | 0 | 0 | 3 (25) | 5 (8) |
Genotype D | 1 (7) | 1 (8) | 1 (8) | 0 | 0 | 3 (5) |
Unknown/NR | 7 (47) | 0 | 11 (92) | 12 (100) | 8 (67) | 38 (60) |
Treatment naïve, n (%) | 2 (13) | 4 (33) | 3 (25) | 0 | 1 (8) | 10 (16) |
Current treatment, n (%) | ||||||
NRTI | 6 (40) | 8 (67) | 4 (33) | 8 (67) | 4 (33) | 30 (48) |
Tenofovir | 2 (13) | 6 (50) | NR | 2 (17) | NR | 10 (16) |
Entecavir | 4 (27) | 2 (17) | NR | 6 (50) | NR | 12 (19) |
Azathioprine | 0 | 0 | 2 (17) | 0 | 0 | 2 (3) |
Unknown | 0 | 0 | 0 | 0 | 2 (17) | 2 (3) |
Prednisone | 0 | 0 | 1 (8) | 0 | 0 | 1 (2) |
Ursodiol | 0 | 0 | 2 (17) | 0 | 0 | 2 (3) |
Furosemide | 0 | 0 | 1 (8) | 0 | 0 | 1 (2) |
Interferon | 2 (13) | 1 (8) | 0 | 3 (25) | 2 (17) | 8 (13) |
Lamivudine | 1 (7) | 0 | 2 (17) | 1 (8) | 1 (8) | 5 (8) |
Tenofovir alafenamide | 1 (7) | 0 | 0 | 0 | 0 | 1 (2) |
Adefovir dipivoxil | 0 | 0 | 0 | 2 (17) | 0 | 2 (3) |
Thymopolypeptides | 0 | 0 | 0 | 1 (8) | 0 | 1 (2) |
Traditional Chinese medicine | N/A | N/A | N/A | 6 (50) | 1 (8) | 7 (11) |
Unknown | 2 (13) | 0 | 0 | 1 (8) | 1 (8) | 4 (6) |
Not currently on treatment | 2 (13) | 0 | 0 | 0 | 5 (42) | 7 (11) |
Time since treatment initiation, n (%) | ||||||
3–24 months | 7 (47) | 6 (50) | 7 (58) | 5 (42) | 1 (8) | 26 (41) |
> 24 months | 3 (20) | 2 (17) | 2 (17) | 8 (67) | 5 (42) | 20 (32) |
Unknown | 1 (7) | 0 | 0 | 0 | 0 | 1 (2) |
Comorbidities, n (%) | ||||||
None | 8 (53) | 6 (50) | 5 (42) | 8 (67) | 7 (58) | 34 (54) |
Depression | 3 (20)g | 0 h | 0 h | 0 | 1 (8) | 4 (6) |
Anxiety | 2 (13) | 0 | 1 (8) | 0 | 0 | 3 (5) |
High blood pressure | 1 (7) | 4 (33) | 2 (17) | 0 | 1 (8) | 8 (13) |
Heart disease | 0 | 3 (25) | 1 (8) | 0 | 0 | 4 (6) |
Congestive heart failure | 0 | 2 (17) | 1 (8) | 0 | 0 | 3 (5) |
Diabetes | 0 | 2 (17) | 4 (33) | 0 | 2 (17) | 8 (13) |
Stroke | 0 | 0 | 1 (8) | 0 | 0 | 1 (2) |
Asthma/respiratory disease | 0 | 1 (8) | 4 (33) | 0 | 0 | 5 (8) |
COPD | 0 | 1 (8) | 3 (25) | 0 | 0 | 4 (6) |
Thyroid disease | 0 | 0 | 6 (50) | 1 (8) | 0 | 7 (11) |
Arthritis/osteoarthritis | 0 | 0 | 3 (25) | 0 | 1 (8) | 4 (6) |
Cancer | 0 | 0 | 1 (8) | 0 | 2 (17) | 3 (5) |
Other | 1 (7) | 2 (17) | 0 | 3 (25) | 2 (17) | 8 (13) |
Impact of living with CHB
Concept | Selected supporting quotes |
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Emotional impacts | |
Anxiety/fear Reasons for feeling fearful included: • Transmission to family and friends • Disease progression, including liver function and cirrhosis • Treatment efficacy • Impact on work • Impact on relationships/fear of rejection | • “The biggest concern is its transmission, as the disease is contagious.” (CN-09) • “Socially, I do think about being very cautious not to possibly spread this to my kids or anything when I’m using utensils around the house…” (US-14) • “I worry a lot about my liver. That it gets damaged…I’m quite young and I worry how many years I can live with it…I’m afraid of dying early.” (DE-09) • “I’m also worried about my condition getting worse. Because this disease is incurable currently, I just hope it isn’t getting worse.” (CN-10) • “I am afraid for my permanent job, how bad the illness is, whether I will get well again, whether the pills will help.” (DE-02) • “It’s like if…I had a time bomb in my pocket. I know I have it, but it’s unpredictable, so I do not know what could happen to me in the future or how it could affect my family, my children, my marriage.” (IT-11) • “ …some companies now do not require employees to take medical examination for hepatitis B, these companies may still require them to do so privately. If they are found to have hepatitis B, they may be fired…” I: And are you worried? “Of course.” (CN-10) • “Yes, definitely, especially in relation to my love and sexual life. Beyond precautions, because I don’t want to get pregnant or similar, I almost avoid being touched because I’m scared to be contagious, so I find it difficult, very complicated.” (IT-04) • “My approach and self-confidence when it comes to forming relationships, may that be romantic, or friendship, or business related…I don’t know if it’s subconscious at this point because I’ve done a lot of work over the years to try to get peace with my condition. But sometimes it does show up in weird ways with my behavior where I’ll sort of sabotage myself before getting to a point where I have to take a risk or something like that just for fear of rejection, mostly I think.” (US-12) |
Shame/embarrassment about disclosing condition • Includes shame related to inability to donate blood | • “At the beginning I felt ashamed of telling people because I don’t really know when I got infected and how. And then I keep wondering about it. And people are asking.” (DE-09) • “For example, sometimes we see blood donation vehicles in the neighborhood and my friend asked when was the last time I donated blood? I did not know what to say.” (CN-02) |
Low self-esteem | • “My self-esteem I think is a little bit down.” (US-13) |
Need for secrecy/concealment | • “I never talk about my symptoms with my friends. So when I’m tired I blame other things for it.” I: So they don’t know about your illness? “No, definitely not.” (DE-11) • “Well, no one knows about it, only my office colleagues know about it. Only my family knows, but no one else. My partner doesn’t know. And that is it. It has always been something I didn’t want to share or talk about. You are very careful in certain situation but you don’t tell it. You can’t tell your friends, unless it is a real and close friend. You don’t talk about this topic, never.” (IT-01) • “In terms of social life, because basically I won’t share or discuss my disease with others, it’s a private thing. If you don’t tell, nobody knows that you have hepatitis B.” (CN-01) • “…it’s something that I’m not very comfortable with sharing with others.” (US-14) |
Feeling overwhelmed, difficulty accepting diagnosis, sadness/depression, anger, betrayal, denial, not feeling human/normal | • “I was lost when I got diagnosed. I was overwhelmed.” (CN-03) • “Sometimes it can be such an emotional burden. I don’t consider myself a normal person anymore.” (CN-02) • “[The] month that it happened and I was a very upset, disturbed, and bothered person. I was irritable. I was angry.” (US-11) • “I felt betrayed. I felt abused by this guy that I had dated.” (US-11) • “I think there was a bit of denial of the beginning.” (US-15) • “It’s affected me emotionally by making me not feel human, making me not feel like I can do everything I want to do. It makes me feel like a lost soul. It makes me feel like just like I got this burden on me that I just can’t get rid of, and no matter what I do, I can’t shake it. It makes me feel kind of useless at times.” (US-10) |
Lifestyle limitations | |
Reduced/no exercise | • “Well, my lifestyle has changed, for sure, since I feel tired more frequently, I had to give up on a lot of sports.” (IT-12) • “I can’t do any heavy house chores.” (CN-06) |
Dietary limitations and reduced/no alcohol intake | • “…The impact it has on living habits is that I need to pay more attention to my diet now.” (CN-04) • “When I went out with friends and everyone was drinking alcohol and I was not allowed to. And I felt as an outsider.” (DE-05) • “I have to avoid alcohol. I don’t mean to get drunk, but a glass of wine would be nice at dinner. Fatty foods as well. I was told off by all the specialists.” (IT-07) • “I never really drank much alcohol and now I won’t drink any because I always worry about the liver cirrhosis.” (US-03) |
Increased hospital visits, frequent treatment, different attitudes from medical staff | • “I have to go for blood tests more periodically than the average person.” (US-03) • “The impact on life is that I have to take medicines on time every day.” (CN-01) • “The medications must be taken on an empty stomach or two hours after mealtime. Therefore, I cannot have a nightlife. I like to take my medications at nine o’clock and finish my meal at seven o’clock. It affects my social life.” (CN-07) • “Yes, I always state it [hepatitis B status]; I had an appointment in the morning and once they saw on the form that I have hepatitis B, I was taken as the last patient.” (DE-07) |
Unable to share utensils | • “For example, if I have drunk from a glass or a bottle, I make sure that nobody else drinks from it.” (DE-01) • “I try not to eat the hot pot communally and share their dishes with others. I usually eat on individual dishes and don’t share plates and utensils.” (JP-12) • “I would use independent tableware, and my dishes were also placed on a separate plate. I use a toilet by myself. My clothes or towels, including my cups, toothbrush, are all kept separately. I wanted to do it myself because there is a child at home. I am very worried that it will be transmitted to my child.” (CN-11) • “Some of my relatives, middle-aged and elderly women, are generally mean-minded. When I went to their house for dinner, they will prepare a set of cutleries for me, and then said that they are prepared for me. After I used them up, they throw away those cutleries.” (CN-09) |
Impact on work • Taking time off work • Increased fatigue impacts performance • Some jobs not/no longer possible | • “I get tired more easily. Fatigue is always there, so it has influenced my performance.” (IT-01) • “…right after my diagnosis. I did not go to work for half a year. Treatments took some time. Also because my numbers were too high so I couldn’t go back to work.” (CN-06) • “I have to see a doctor every other month or once every three months. I have to have lab tests all the time. I have to be on medication all the time, every day, so those all kind of affect my work…” (US-05) • “I found it hard to focus at work.” (US-12) |
Social life impacts | |
Isolation, reduced social interaction, reduced social life • Includes inability to stay up late due to fatigue | • “I think that’s always been the toughest part of it, is the emotional aspect of feeling so isolated.” (US-15) • “When I went out with friends and everyone was drinking alcohol and I was not allowed to. And I felt as an outsider.” (DE-05) • “It has affected my social life. For example, at the gatherings with my fellow students. Things can be especially difficult if there is food or drinking involved. It depends on the situation, but I generally try to avoid attending…” (CN-02) • “I can’t…stay up late. I have to stick to a routine to keep the disease under control.” (CN-06) • “I lost many ‘friends.’” (IT-02) |
Social commitments/family relationships | • “When I have something planned, then suddenly I can’t do it anymore.” (DE-02) • “And they [relatives] may tell their children not to play with me…And tell the children not to get close to me…” I: How did you feel when you heard that? “I wanted to leave. I’d better to be alone.” (CN-09) • “He [father] just decided to label me as someone who is become a little bit of an outsider from his perspective, right, not a full member of the family, not full son. So these things running through my mind all the time.” (US-02) • “If you have like family or relatives or friends, and if you were trying to get close to their children, you feel like you don’t want to make the parents feel bad that you might some way give the virus to their kid, so that kind of puts us in a stigma that we shouldn’t be getting too close to other people’s children.” (US-05) |
Meeting new people/difficulty maintaining friendships | • “First, I withdrew a bit, that was of course a restriction, and then regarding food and eating. As to partner choice, at some point you like to consider having a new partner and I blocked completely at first. For the first three or four years there was nothing. You don’t want to transmit anything to the new partner, do you? So, I let it all develop slowly and when I then explained this, there was not really a lot of understanding.” (DE-04) • “Well, there’s always that rejection from certain people sometimes. I have talked to someone and I kind of lost a few friendships because of this, because I thought I was just being open. I guess the misinformation, how you get it, sometimes people don’t understand and they think that by just shaking your hand or just by maybe sharing or drinking from the same glass of water they’ll get it. So there are people that have just walked away from my life because of that.” (US-13) |
Difficulties with intimacy and sexual relationships/dating | • “In a partnership it is difficult to explain this to the other person. You don’t say that in the beginning. If the woman can’t handle it, she may never want to see me again. It’s not always easy.” (DE-06) • “I have less sex.” (CN-06) • “Yes. My relationships do suffer because of it [hepatitis B].” (CN-07) • “Socially it’s affected me in a way that I’m not dating. Before I was open to dating and I was putting myself out there and I was on a dating site. I’m not doing that because I still don’t feel that I am as comfortable as I want to be.” (US-11) |
Impact of CHB-related social stigma
Concept | Participants’ comments |
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Understanding of stigma | |
Participants’ definitions of “stigma” | • “…a preconceived myth or judgment that people identify with it.” (US-11) • “…it’s being put in a certain category that’s not looked at in a positive light.” (US-14) • “Prejudices. You get pigeonholed.” (DE-03) • “Stigma is something where a person is labeled, judged by others and where the person is also somewhat excluded.” (DE-08) • “It means to ‘label’ something.” (IT-07) • “…you feel uncomfortable and ashamed to see people because someone is judging and commenting on you.” (CN-12) • “[People] may feel that others are isolating them in various ways because the disease is a contagious disease.” (CN-01) |
Impacts of stigma | |
Experienced judgment/prejudice | • “People who I don’t know so well. People I only greet on the street. And suddenly they keep their distance. Or warn others.” (DE-10) • “I felt I was being judged, as if catching hepatitis was my fault because I did something, I felt as if I was someone’s ‘plague spreader.’” (IT-03) • “When someone thinks about sexually transmitted diseases, they always see you as if you were the dirtiest, weirdest person in the world…” (IT-04) • “I have felt badly because other people judge me without knowing the reason why I have contracted hepatitis B.” (IT-02) • “The doctor said, ‘You are a hepatitis B carrier! You could cause hospital infections!’” (JP-02) |
Experienced relationship problems (negative experiences with partners or family and friends) | • “Well, there’s always that rejection from certain people sometimes. I have talked to someone and I kind of lost a few friendships because of this, because I thought I was just being open.” (US-13) • “I had a date. And there was a point when I had to tell him and it was over very quickly because he judged me and stigmatized me. He thought I was ill and contagious. He completely cut off contact with me.” (DE-09) • “People know to keep a distance away from you. They avoid you no matter what. I have fewer friends now.” (CN-06) |
Experienced lack of awareness/understanding from others | • “People in [the US] generally don’t really know even the difference between the different types. And the most common one talked about here is hepatitis C, which is commonly associated with IV drug use, unsafe sex practices, other unsafe behaviors, which in turn cause a lot of people to judge other people based on those preconceived notions.” (US-12) • “It’s not contagious through talking, or food. But people, obviously they don’t quite understand.” (US-06) • “I had to explain what it is first. When I have a partner, I have to explain.” (DE-03) • “No matter what type of the hepatitis is, people are scared of it, they are scared of being infected. Many people actually don’t know exactly the transmission mode of hepatitis, so they’re so scared of it. They will keep away from you if they know you have it.” (CN-01) • “Many people have misunderstandings about hepatitis B, so they will definitely have certain precaution or discrimination.” (CN-04) |
Avoidance by others | • “He went as far as not wanting to sit at the same dining table with me…I noticed some weird behavior on my dad’s part.” (US-02) • “People who were good friends before are avoiding me now. They would never tell me that they are avoiding me but they don’t have time for me anymore. We don’t meet anymore.” (DE-10) • “I noticed that everyone held back a bit, and me too, of course and so we were not so close any longer.” (DE-04) |
Negative experiences at work | • “…everyone [in the work team] held back a bit, and me too, of course and so we were not so close any longer.” (DE-04) • “During the physical exam, I found out there was another coworker who had the same disease. When I found out that we had the same hepatitis B condition, I started to see him differently. When I read his report, I could only imagine what other people would have thought when they read mine. I turned in my resignation after that and left the job. So, I think job hunting has been a very challenging thing.” (CN-02) |
Exclusion | • “Prior to disclosing [my hepatitis B status], the person I was talking with was very excited to have me and was ready to accept me into their [college martial arts] program. But then once I revealed my status, I got a follow-up email several days later saying that there was just not going to be a spot.” (US-06) • “I invited friends for a BBQ but they didn’t have time but later I heard that they did a BBQ themselves but without me [I felt like] an outsider. Hurt. And then I don’t want to go there the next time because I feel unwanted.” (DE-10) • “People shut the door on you only because you had hepatitis B.” (CN-05) |
Others not wanting to share food/drink or utensils, self-restriction around sharing meals | • “But I do feel, I remember one time that I went to a park and I meet somebody, it’s a girl, and we chat awhile…and she’s a little bit hungry and I offer her an apple. But she was really happy, and when…there was a phone call, in that conversation I must’ve mentioned my hep B with my family. And she overheard it and she stopped eating that apple.” (US-06) • “Some of my relatives, middle-aged and elderly women, are generally mean-minded. When I went to their house for dinner, they will prepare a set of cutleries for me, and then said that they are prepared for me. After I used them up, they throw away those cutleries.” (CN-09) |
Denied opportunities | • “I was trying to register classes in the college as a registered nurse major, and I tried really hard. And before you get enrolled, you need to provide them the proof of vaccination. And because I just noticed before the registration that I am a carrier, I tried to explain to them because I’m pretty healthy and I don’t have any symptoms…and they show me the instructions on where I can get treatment. And then I get treated, then I get to the vaccinations, but I can show them the proof of vaccination, and they won’t do that. So that’s really bothering, at one point, for me. It changed my career, actually. I really want to be a nurse, but I couldn’t because of this.” (US-06) • “I did pass multiple interviews and got to the last test. But I was failed because of the medical examination…Since then I only looking for jobs at those companies which don’t require the medical examination.” (CN-10) |
Negative experiences at a clinic/hospital | • “Then the doctor might have seen my patient record and knew that I have hepatitis B. I accidentally touched some things, and I didn’t sit on the operating table as required by him. Then there was a nurse. She said, ‘You have hepatitis B, you don’t sit around, don’t transmit it to others.’ At that time, I felt very ashamed. She was so brutally candid and talked to me like that, I was shocked.” (CN-11) |
Reduced social activities | • “…my usual social activities have been greatly reduced. Now I usually try to avoid going out to eat with others. I don’t want to join such activities.” (CN-09) |
Impact of CHB-related self-stigma
Concept | Participants’ comments |
---|---|
Understanding of self-stigma | |
Participants’ definitions of “self-stigma” | • “Self-stigma is like, a classification that one has put upon himself. It’s not necessarily dictated by society, it’s internal and it’s how you feel about yourself. And a lot of times it’s probably a false perception, self-stigma. I mean, you may think everyone thinks I have the cooties and actually that could be in your mind, no one is judging you.” (US-14) • “It’s the stigma that we place on ourselves. It’s the thoughts and the feelings and the emotions that we have related to something, a title or a feeling.” (US-09) • “If I have a negative association about myself.” (DE-06) • “Perhaps it’s what happened to myself when I stigmatized myself, meaning, I self-blamed, I [pause] self-punished, that’s what I mean.” (IT-05) • “I feel ashamed about myself and avoid getting close to others because of my disease.” (CN-10) • “It means you are embarrassed because of your illness. It feels that you are less than other people.” (CN-02) |
Impact of self-stigma | |
Secrecy/concealment of diagnosis from all but trusted family or friends | • “…the reason I say it’s made me slightly self-conscious because it’s something that I’m not very comfortable with sharing with others and right there lets me know that it’s something I’m not proud of because of that reluctance to want to tell others that I have it. And, so, right there lets me know there’s an eternal internal reluctance or stigma that I have also placed on myself and not just society has placed it on me.” (US-14) • “Yeah, I wouldn’t want to tell anybody because I feel like people will treat me different and treat me like I’m a walking virus that’s contagious, that will hurt them. I can’t handle that.“ (US-11) • “I only talk about it to very few friends and I often withdrew from them.” (DE-01) • “My colleagues don’t know, my neighbors don’t know. I was embarrassed.” (DE-09) • “In daily life, there is no need to tell about my disease to distant relatives or friends you don’t normally interact with. I don’t want to give my wife’s relatives any worries, so I feel that I don’t have to tell them. However, if I was hospitalized for a long period of time, I wonder if I would have to tell them about the disease. It makes me anxious by telling people about my disease.” (JP-07) |
Devaluation, self-blame, inferiority, worthlessness, shame, guilt | • “I think of that myself as not as good as other people…” (US-05) • “I judge myself. Because of my free life. I blamed myself.” (DE-09) • “Yes, feeling inferior, ‘dirty.’” (DE-04) • “I thought I was different than others.” (DE-05) • “I feel inferior to other people. I have ruined my life for not being careful. I blamed myself for it.” (IT-02) • “I feel I’m not good enough compared to other people…” (CN-02) • “I feel like a burden to my family. I’m rubbish, just like dust.” (CN-011) |
Not taking opportunities | • “I’ve avoided some professions knowing that I wouldn’t want to deal with anyone knowing, such as like the medical field…And I think I remember in my early twenties reading that one story, it could have been just one in a thousand, but it definitely discouraged me from pursuing nurse practitioning, which is what I wanted to do for quite a while…” (US-12) • “I deliberately avoided these companies that require a medical examination.” (CN-10) |
Withdrawal, social isolation, marginalization, alienation | • “I was depressed and withdrew into myself, and hardly went outside, only to work, stayed at home, only saw my very closest friends, one or two people or my mother. But otherwise I kept very much to myself.” (DE-04) • “At the beginning I couldn’t even imagine to kiss someone or get closer to someone. I withdrew and I was afraid. I didn’t want to infect other people.” (DE-09) • “I try to avoid social situations even if somebody ask me to hang out at night. And if I don’t want to let others know my hepatitis B, it’s just like, I just haven’t been completely honest with others, I’m hiding something from them.” (CN-10) • “When I have a choice of hanging out with my fellow students, I’d much rather be alone…” (CN-02) • “People who aren’t familiar with the disease like to avoid me.” (CN-07) |