Recently, the internationally renowned medical journal The Lancet published a review by academician Wu Mengchao entitled “Hepatitis B Discrimination in China”. Academician Wu Mengchao called on the whole society to pay attention to the hepatitis B community, popularize general knowledge about hepatitis B, eliminate hepatitis B discrimination, and create a fair and harmonious social environment. In order to help people eliminate discrimination against hepatitis B virus infected people, we invited Professor Miao Xiaohui, Vice President of Changzheng Hospital of Second Military Medical University, to analyze related issues. 1. Ask the government: Why is it difficult to eliminate hepatitis B discrimination in China even though the government has introduced relevant “anti-discrimination” policies? The incidents of employment discrimination against people with chronic hepatitis B virus in China have been reported in the press and the Internet for many times, and many experts from the Chinese Medical Association’s Infectious Diseases Branch and Hepatology Branch have appealed to the government, which has drawn the attention of the relevant departments of the country, and in order to effectively intervene in the problem of employment discrimination, the relevant departments of the country have promulgated several documents with legal effect: In January 2005, the Ministry of Personnel and the Ministry of Health launched the “Medical Examination for Civil Servants”. Ministry of Health launched the General Standards for Medical Examination for Civil Servants (for Trial Implementation), which officially abolished the restriction on hepatitis B virus carriers. In 2007, the Ministry of Labor and Social Security and the Ministry of Health jointly issued the Opinions on Safeguarding the Employment Rights of Hepatitis B Surface Antigen Carriers, followed by a number of other regulatory documents issued by different departments aimed at eliminating discrimination. In February 2010, the Ministry of Human Resources and Social Security, the Ministry of Education and the Ministry of Health of the People’s Republic of China jointly promulgated the Notice on Further Standardization of Medical Examination Programs for School Entrance and Employment to Safeguard the Rights of Hepatitis B Surface Antigen Carriers in School Entrance and Employment. At this point, the legal framework against discrimination in employment has become very clear and well-developed. “It should be said that the introduction of these regulations and documents is necessary at this stage in China, and is a boon to many hepatitis B virus surface antigen carriers and chronic hepatitis B patients. The issue of discrimination against a particular disease is not essentially a legal issue, not to mention that any legal constraints may be broken in various forms, and the rights of people infected with the hepatitis B virus will still be violated within a certain range. For example, citing China’s Guidelines for the Prevention and Treatment of Chronic Hepatitis B, the nation is told that chronic hepatitis B is a less contagious infectious disease and that the hepatitis B virus must be transmitted through the blood route, so that contact with hepatitis B patients at work or in daily life is safe. This inference of causality is scientifically based and undoubtedly correct, but this expression creates a public illusion because this simple description of scientific facts cannot have a sufficient impact on the elimination of discrimination. This is an important reason why hepatitis B discrimination is still difficult to eliminate in China, even though the government has introduced relevant “anti-discrimination” policies. Therefore, anti-discrimination should not be promoted and oriented only by the degree of infectiousness of the hepatitis B virus or the ease of the transmission route, but also by the moral and ethical level to distinguish right from wrong. This is the only way to establish an unshakable foundation for creating social harmony between the “sick and the non-sick”. The ban on medical tests may be a misfortune for patients. In addition, it is worth noting that the ban on tests related to anti-hepatitis B discrimination, while bringing good news to many hepatitis B virus surface antigen carriers and chronic hepatitis B patients, may also bring negative effects. In recent years, there has been a hotly debated topic on the issue of anti-hepatitis B discrimination, and that is the possibility that the elimination of laboratory tests related to hepatitis B virus infection, including marriage tests, could have serious adverse consequences, namely that people infected with hepatitis B virus could not be detected in a timely manner! In China, even in developed cities, the proportion of people who take spontaneous annual medical checkups is very small, and people in less developed areas will only go to the hospital for checkups when they are sick, and a large number of patients with slow hepatitis B will only be discovered at a very serious stage, even to the point of cirrhosis or liver cancer, and the result of delayed diagnosis is inevitably delayed treatment. The inaugural medical checkup or mandatory premarital checkup, on the other hand, has the potential to make up for the shortcomings caused by not doing routine health checkups, and may detect hepatitis B virus-infected patients at different stages of the disease in time and get timely and correct treatment. So, in this sense, limiting or eliminating the medical checkup program may again be a misfortune for hepatitis B patients! This also requires a call against discrimination, while introducing various anti-discrimination regulations, there must also be supporting measures, the importance of such supporting is not at all less than anti-discrimination itself, and can even rise to the height of a strong country. 2. Ask the medical profession: Is China still a “hepatitis B power”? As we all know, China is the country with the highest incidence of chronic hepatitis B and the largest number of patients, and has been self-deprecatingly called the “hepatitis B power”, accordingly, China’s “hepatitis B discrimination” problem has become the world’s largest. Those who do not have hepatitis B are often “not concerned about it”, but once they find out that one of their close contacts has hepatitis B, they panic. Fear of hepatitis B and discrimination against hepatitis B have caused lovers to break up or wives to be separated from each other, which is common enough in China to make people numb; for those who have hepatitis B, self-pity, reckless diagnosis and treatment, fear of the future, avoidance of reality, and concealment of the disease are also common. The moral and ethical problems caused by this ignorance seem to be excused. In fact, China is trying to remove itself as a major hepatitis B country. Therefore, the public must be informed and familiarized with hepatitis B through various means as soon as possible, and hepatitis B must be properly diagnosed and treated. (1) The 10% hepatitis B virus carrier rate has become history. In fact, with the joint efforts of medical scientists from all walks of life, the momentum of the epidemic of slow hepatitis B in China has been effectively curbed. Here are a few figures. According to the results of a survey conducted in 2006, the carrier rate of hepatitis B surface antigen among children aged 1 to 4 years old in China was only 0.96%; among children aged 5 to 14 years old, the rate was 2.42%; among people aged 15 to 59 years old, the carrier rate of hepatitis B surface antigen was 8.57%, and the carrier rate for the whole population was 7.18%. How to understand these 4 percentages? In 1992 there was a corresponding set of data showing that the carriage rate for all 4 populations was around 10%! 1.3 billion Chinese, a one percentage point drop would reduce the number of infected people by 13 million! This result is due in large part to the effective vaccination of newborns after birth and the administration of high-value hepatitis B immunoglobulin, as well as to the fact that the “stockpile” of hepatitis B infections has been greatly reduced after hepatitis B patients have received effective antiviral treatment, thus further reducing the risk of transmission from one population to another. There is also every reason to believe that the rate of hepatitis B virus infection has declined further since 2006. (2) Breakthroughs in hepatitis B treatment have been achieved. In the past 10 years or so, due to the introduction of effective interferon and nucleoside anti-hepatitis B virus drugs, a breakthrough in the treatment of chronic hepatitis B has been achieved, and the resulting decline in the incidence of serious liver diseases associated with chronic hepatitis B, such as cirrhosis, liver cancer and severe hepatitis, has been remarkable. As long as the replication of the hepatitis B virus in the body is effectively suppressed over time, then hepatitis B can be controlled over time or stabilized over time, and even severe liver disease can be reversed. Unfortunately, these exciting messages have not yet been delivered to all people, which has become another important factor in long-term hepatitis B discrimination and interference with harmony. 3. Ask patients: Self-improvement and self-confidence, do you have these new insights? Hepatitis B discrimination is like a three-foot freeze that needs time and temperature to melt, and all parties should actively participate and work on it. The author takes the platform of Popular Medicine to give some advice or suggestions to people infected with hepatitis B virus. First of all, patients should be self-empowered, no need to feel inferior, do not “dwarf” themselves in the heart. People infected with hepatitis B virus do not constitute a group that endangers human beings, society and families at all, and chronic hepatitis B is just an ordinary common disease. Secondly, slow hepatitis B is not only treatable but also curable, patients must actively accept the new treatment concept, as long as possible, must actively fight and accept antiviral treatment, must not believe in false advertising, take the so-called prescription or modern therapy, that not only spend a lot of money, worse is to harm the liver, harm the body, delay the cure. Patients must also accept the concept of long-term treatment with drugs, cooperate with doctors, choose the right drugs for them, and regularly monitor various indicators during treatment. Many patients with hepatitis B do not understand or even resist taking long-term antiviral drugs. Ask: If they are unfortunate enough to have chronic diseases such as hypertension or diabetes, will they refuse lifelong treatment? The answer is obviously no, so why is the idea of long-term antiviral treatment for hepatitis B unacceptable? Thirdly, there should be a new understanding of the so-called “hepatitis – cirrhosis – liver cancer” trilogy. In fact, the reason is very simple, as long as in the middle of any of these three disease states to interrupt, then do not have to sing the end of the sad song? Long-term antiviral therapy can do this, cirrhosis can be reversed, and liver cancer can be prevented and treated. Fourth, for family-transmitted chronic hepatitis B patients, patients must not blame the previous generation on the one hand, but also be concerned that one of them may also be a de facto chronic hepatitis B patient; on the other hand, they must also be responsible for the next generation and take appropriate blocking measures to the maximum extent possible under the proper guidance of their doctors to avoid their children being infected or contaminated. Fortunately, interruption of transmission is no longer a myth, but a fact. The hepatitis B vaccination of newborns and the injection of high-priced hepatitis B immunoglobulin, which were discussed earlier, are one of the effective means of interruption. It is also important for couples with hepatitis B to take drug interruption before or during pregnancy, except that there are still certain risks, but by taking drug interruption under the guidance of a doctor, it is possible to both prevent intrauterine transmission of the hepatitis B virus and reduce the risk of damage to the mother and child. The “hepatitis B community” is not conducive to “mental health” With the increasing abundance and convenience of electronic networks, many online communication platforms belonging to the hepatitis B community are increasing and “flourishing”, but. The author does not recommend that we develop too much personality in this area, we learn hepatitis B-related knowledge and exchange their respective treatment experience in a website is certainly possible, but must not deliberately hold into a group. Otherwise, the establishment of such circles and the formation of groups is not only detrimental to the harmony of society as a whole, but over time will produce a sense of self-isolation in the patient’s psyche, and will intentionally or unintentionally put themselves in “that category”, which is the opposite of what is going on. In fact, hepatitis B patients never belong to an alternative. 4. Ask the public: Can you jump over the hurdle of “fear”? I would like to tell non-hepatitis B virus-infected people some facts through some examples or almost jokes, or give them some inspiration, so that they can be expected to treat hepatitis B patients fairly from their hearts. It’s not easy for adults to get hepatitis B. I often use the phrase “it’s not easy for adults to get hepatitis B” to reassure my patients and their families in the clinic, and I even demonstrate this by holding up my teacup or taking my cell phone aside and telling my patients that I take my teacup with me when I leave the clinic and put my cell phone directly into my pocket to show that at least I never worry about I was never worried about being infected by a hepatitis B patient. I have had several patients or family members say to me, “If you are a hepatologist, you must have a great way to prevent hepatitis B. Think about it, is that possible? If so, why don’t I sell my intellectual property to save everyone from hepatitis B and make myself rich at the same time? Many young couples are looking forward to having a child, but the wife or husband is worried that the virus in their body will be transmitted to each other, so the couple has not had sex for a long time or has been having sex with a condom. Previous studies have found that couples in which one partner is hepatitis B, the other partner is less likely to have hepatitis B than the average person, and often their blood surface antibodies to the hepatitis B virus are positive (a protective antibody), in fact, most of them are infected with the virus and produce antibodies after special close contact between the couple, and have no worries, already ” The “condom” on the “condom”, why suffer from infection? In addition, we have been attacking the Chinese habit of sharing meals, but in the short term it seems impossible to change this habit. It is hard to imagine a Chinese family sitting around the table, each sharing their own plate. I believe that meal sharing would destroy the unique Chinese harmony at the table that has been in place for thousands of years, and unless there is a member of the family with a digestive tract infection, family meal sharing is unnecessary. It is not advisable to copy the Western model of eating to prevent hepatitis B, because eating together is definitely not a way to contract the hepatitis B virus. On several occasions, I have asked people at my table at a dinner table: What do you think about the possibility that one of the dozen or so of us is a hepatitis B surface antigen carrier or even infected with the hepatitis B virus? After saying that, everyone seemed to have no idea and continued to drink and eat, with very few people using public chopsticks. To a certain extent, this reflects that people are not very afraid of the abstract and invisible hepatitis B virus, but they just can’t jump over the “fear barrier” when they come into contact with specific and definite hepatitis B patients. What I am trying to illustrate through these examples is that, firstly, the transmission of hepatitis B virus between adults in daily life is not an easy task and is not a cause for concern. Second, many of the concerns and worries are due to misconceptions, so it is necessary to learn and understand the correct knowledge of disease prevention. Third, the effective way to control hepatitis B transmission is mother-to-child or father-to-child interruption; effective treatment of the presently ill to reduce the number of infected groups; and rejection of dangerous lifestyles rather than work and normal life away from infected people. Fourth, the disease can sometimes be avoided, and sometimes it is difficult to avoid, and if you do not have this disease, you may also have another disease, and there is only a difference between the severity of the disease and the effectiveness of the treatment, and there is no difference between the disease or the “nobility” of the patient. In short, chronic hepatitis B is a common disease, chronic hepatitis B patients are a class of ordinary non-healthy people. It makes no sense to discriminate against hepatitis B and hepatitis B patients. Therefore, we must understand hepatitis B correctly and trust each other in order to build a harmonious and fair social environment.