Hepatitis B: Is It A Barrier For Employment And Marriage In Ghana?

Permit me to start with Wutah's love song -“Love goes where love is and I can't deny it if you love me come and join me and let us sing a song” it will therefore be disheartening if we allow preventable and treatable disease or sickness to separate lovers and also become hindrance for employment.

Hepatitis B is a potentially life-threatening liver infection disease caused by the hepatitis B virus. It is a major global health problem. It can cause chronic liver disease and chronic infection and put people at high risk of death from cirrhosis of the liver and liver cancer.

More than 240 million people have chronic (long-term) liver infections. More than

780, 000 people die every year due to the acute or chronic consequences of hepatitis B.

A vaccine against hepatitis B has been available since 1982. Hepatitis B vaccine is 95% effective in preventing infection and its chronic consequences, and was the first vaccine against a major human cancer.

Hepatitis B virus can cause an acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. Hepatitis B prevalence is highest in sub-Saharan Africa and East Asia. Most people in these regions become infected with the hepatitis B virus during childhood and between 5–10% of the adult population is chronically infected.

In highly endemic areas, HBV is most commonly spread from mother to child at birth, or from person to person in early childhood.

Perinatal or early childhood transmission may also account for more than one third of chronic infections in areas of low endemicity, although in those settings, sexual transmission and the use of contaminated needles, especially among injecting drug users, are the major routes of infection.

The hepatitis B virus can survive outside the body for at least 7 days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine.

The hepatitis B virus is not spread by contaminated food or water, and cannot be spread casually in the workplace. Hepatitis B is NOT spread through casual contact, hugging, coughing, sneezing, or eating food prepared by someone who is infected. You do not have to worry about these things even before your family members are protected by the vaccine. So, even while your family members or sexual partners and completing the vaccine series, you do not have to worry about transmitting the virus through casual contact.

Most people do not experience any symptoms during the acute infection phase. However, some people have acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

In some people, the hepatitis B virus can also cause a chronic liver infection that can later develop into cirrhosis of the liver or liver cancer.

More than 90% of healthy adults who are infected with the hepatitis B virus will recover and be completely rid of the virus within 6 months.

It is not possible, on clinical grounds, to differentiate hepatitis B from hepatitis caused by other viral agents and, hence, laboratory confirmation of the diagnosis is essential. A number of blood tests are available to diagnose and monitor people with hepatitis B. They can be used to distinguish acute and chronic infections.

Laboratory diagnosis of hepatitis B infection focuses on the detection of the hepatitis B surface antigen HBsAg.

There is no specific treatment for acute hepatitis B. Care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.

Some people with chronic hepatitis B can be treated with drugs, including interferon and antiviral agents. Treatment can slow the progression of cirrhosis, reduce incidence of HCC and improve long term survival. Treatment, however, is not readily accessible in many resource-constrained settings.

Many organizations in Ghana don't want to employ someone who is Hepatitis B surface antigen positive. Those organizations do not have work place policies which outline these policies. Medical test for employment and marriage is not about hepatitis B alone but it complies a lot of tests and single out hepatitis B test alone to disqualify the person which is not fare. Transmission of hepatitis B occurs when blood from someone with the virus enters the bloodstream of another person. The virus is not passed on through general day to day contact between people. Because of this, there is negligible risk in the workplace – except for certain sectors such as skin penetration services (tattooing, body piercing) and certain medical fields (those specifically involving 'exposure prone procedures').

Most of the organizations in Ghana have their hospitals where applicants go for medical test and when the applicants test positive for hepatitis B surface antigen then the Medical doctor declare the person not fit for employment. Instead of doing further test like Liver Function test, viral load and hepatitis B profile they not but they will go ahead to declare the person not fit for employment. In some cases the viral load (DNA) will be high but the liver is healthy, the medical doctor cannot use higher viral load (DNA) copies to declare the person not fit for employment because when the person is on treatment, the person can reduce the viral load (DNA) copies drastically to not detected.

Some of the health professionals in Ghana look at business aspect of their professional than the interest of the patients. In some cases the Medical doctor will declare the medically fit for employment but in their report they will state that the person is Hepatitis B positive. Healthcare professionals they are responsible for clearing patients for employment.

The Human Resource Manager who does the recruitment does not have acknowledged about the Hepatitis B so basic on the medical report they will not employ the person. Hepatitis B surface antigen positivity alone has become a basis for discrimination, work restriction and subsequent disqualification from employment in Ghana. Each year many potential workers are denied employment solely because of misconceptions about the risk of hepatitis B (HBV) transmission, lack of knowledge about the natural history of this disease and the risk of developing complications while at work .Many HBV-positive workers are denied employment because of the misconceptions and lack of knowledge about the disease.

Hepatitis B is not spread through the usual workplace activities. The job of most workers does not confer a risk for transmission of Hepatitis B. However, there are certain occupations which pose a higher risk of transmission of Hepatitis B because it involves exposure to potentially contaminated blood. These would include occupations in the health care setting and other workers whose occupation involves the potential for exchange of blood. Many job applicants who are Hepatitis B surface antigen (HBsAg) positive are declared unfit for work without appropriate medical evaluation and counseling.

These individuals are otherwise healthy and can be gain-fully employed. Because the workplace is part of the larger community of fighting the Hepatitis B epidemic, strategies need to be implemented to reduce the risk of transmission of Hepatitis B in the workplace and eliminate discrimination against Hepatitis B positive workers.

Health wise it is manageable and treatable. Socially, the hepatitis B virus is not spread by contaminated food or water, and cannot be spread casually in the workplace. Hepatitis B is NOT spread through casual contact, hugging, coughing, sneezing, or eating food prepared by someone who is infected. Legally, the laws of the land frown on it.

The Labour act 2003, section 59 (1) an employer shall not employ a young person on any work unless a medial practitioner has certified that the young person is in good health and is medically fit for the work. (2) Where a person fails to comply with subsection (1) the person shall be ordered by the Minister to have the medical examination conducted. What is the Labour commission of Ghana doing? Is there any law to punish those organizations?

Dr Jamias in Philippines said “Hepatitis B positive workers should not be treated differently. It unfair when people with diabetes or hypertension get to be hired when they have higher risk of fainting or getting a heart attack at the workplace”

The Theobald Hepatitis B Foundation and Hepatitis Coalition of Ghana strongly voiced out this concern on how employers hire workers for their company or organization by restricting those who are inflicted with HBV.

In marriages, many counselors do not have basic knowledge in hepatitis be it the cause prevention, treatment and management. They do not agree to marriage on the basis that one of the partners is hepatitis B positive. The status of an individual should not deter him or her from getting married, since proper care and support are required from friends and family to help curb the stigma associated to it.

Many people become fearful of getting married or telling their partners. Some people also think that they many lose their partner if they tell them so they will not tell them. It is advisable to inform your partner before getting married rather than if him/her getting to know later which can bring a divorce. If your partner is worthy of your love he/she will deal with your health issues.

As part of my work, I have encountered several young talented beautiful and very handsome individuals living with hepatitis B and are happy married. This is because they have received proper education about the disease condition in such as causes, prevention, treatment and management.

In the case where only one partner is infected, the other can complete his or her vaccination so as to become fully immune. But in cases where both partners are infected, they can receive proper education on the disease condition and proper treatments outlined for them. During pregnancies, the mother is tested to see if she has the infection so that the baby can receive the HBIG vaccination at birth, prior to breastfeeding. In this way, the baby cannot be infected.

The way forward
A positive Hepatitis B surface antigen result should not be a basis to discriminate, restrict, or disqualify a job applicant from being gainfully employed. A Hepatitis B positive applicant should not be declared unfit to work and denied employment without appropriate medical evaluation and counseling.

Hepatitis B screening in the pre-employment setting should NOT be made mandatory. Screening for hepatitis B should be performed only if applying for occupations known to be at high risk for transmission of hepatitis B in the workplace. No screening is recommended for low risk occupations.

Prospective marriage couples should be educated during counseling about the causes, prevention, treatment and management of Hepatitis B and other STIs.

Employers should not prevent someone from getting a promotion or dismiss them because they have hepatitis. Employers also have a legal duty to provide employees with any special facilities or services they need to help them do the job, as long as it won't cause the employer 'unjustifiable hardship'.

Employers should neither isolate nor discriminate workers who are Hepatitis B virus (HBV) positive.

Article 1 of the 'LAW ON PROTECTION AGAINST DISCRIMINATION' says that; This Law shall regulate the protection against all forms of discrimination and shall contribute to its prevention.

Article 2 also clarifies the purpose of the law; The purpose of this Law is to ensure for every person the right to:

1. Quality before the law;
2. Equality of treatment and of opportunities for participation in the public life;

3. Effective protection against discrimination.
Therefore employers must also ensure that for applicants with a disability; only attributes relating to the essential duties of the job form part of the medical.

It's closer than you think. Know it and Confront it!

From: Theobald Owusu-Ansah

President, Theobald Hepatitis B Foundation

President, Hepatitis Coalition of Ghana

Email: [email protected]/ [email protected]

Tel: +233-247-093893/ +233-268-269214

Web: www.theobaldhepb.org

WhatsApp: +233-247-093893