In Canada, one in three people affected by hepatitis C was born outside of the country. Hepatitis C prevalence among Canadian immigrants and newcomers is double the overall Canadian prevalence. Research also shows that immigrants and newcomers experience worse health outcomes from viral hepatitis and liver cancer when compared to the Canadian-born population, including higher rates of hepatocellular carcinoma and mortality rates from viral hepatitis and liver cancer that are two to four times higher. Talking to Canadian immigrants about hepatitis C becomes very important given the fact that they are a population at risk of disease.
How transmission occurs
Over the past four decades, a large majority of immigrants who come to Canada are from regions of the world with high or intermediate hepatitis C prevalence; countries like China, India, Pakistan and the Philippines.
Globally, most hepatitis C infections occur in medical settings from the use of unsterilized equipment, unsafe injections or the transfusion of unscreened blood and blood products. Infection control practices also differ from country to country, with most immigrants acquiring hepatitis C in their countries of origin before moving to Canada. Hepatitis C can also be transmitted through cultural or traditional medical practices that are common in certain countries, such as shaving tools at community barber shops, wet cupping or acupuncture where needles are re-used.
The barriers in accessing care
After arriving in Canada, immigrants face many barriers in accessing care and it can take a long time before they are diagnosed with hepatitis C, and even longer to be linked to treatment and care. Some studies
indicates that on average it takes up to 10 years for an immigrant to be diagnosed with hepatitis C and another five years to be linked to care. Some factors that impact people’s ability to access healthcare include their immigration status, poverty, precarious employment, lack of access to information, transportation issues and limited childcare.
Immigrants and newcomers are less likely to acquire hepatitis C through injection drug use. But because in Canada the virus is more commonly transmitted through injection drug use, some Canadian healthcare providers may not think to offer testing to people who do not inject drugs, including immigrants who may have had a different kind of exposure.
Another barrier is the lack of testing programs for immigrants within their communities. Testing needs to be easy to access and embedded within the community to improve uptake.
Cooking up a campaign
As Canada’s source for HIV and hepatitis C information, CATIE tackles some of these challenges by delivering hepatitis C education and outreach to immigrants and newcomers in Ontario – and the service providers who work with them – funded by the Ontario Ministry of Health. We train and employ educators from and for the largest immigrant communities in Ontario, and we publish culturally relevant hepatitis C information in 13 languages.
But in the context of the COVID-19 pandemic, one-on-one education work has become even more difficult. To overcome the logistical challenge of reaching people during lockdown, we developed a series of videos intended to spark dialogue within immigrant families and with their service providers – CATIE Kitchen: Talking about Hepatitis C.
This campaign raises awareness about hepatitis C prevalence and risk, and the need for testing and linkage to treatment and care. Featuring real discussions with real family members preparing traditional meals, the video explores how hepatitis C is an immigrant health issue and how important it is to talk to your loved ones about testing and treatment.
How to better engage immigrants and newcomers
Fortunately, highly effective treatments are now available, curing 95% of people with hepatitis C in eight to 12 weeks. For most people, the costs are covered through territorial, provincial or federal insurance plans, and for others, through employer-provided insurance plans.
Talking about hepatitis C with newcomers and immigrants is the first step to improving their health. If you are a service provider, CATIE’s website has a large collection of resources to support your work. Resources written for immigrants and newcomers are available in print, video and online, much of it available in languages spoken by large immigrant communities in Canada.
Whether it is in the kitchen or in the clinic, there’s never a bad time to start talking about hepatitis C.
Fozia Tanveer is CATIE’s manager of immigrant and newcomer hepatitis C community health programming. She has been working with CATIE since 2011 and has a master’s degree in development studies from the School of Oriental and African Studies, University of London.