• Encourage notification of household and sexual contacts of infected people to be tested for HBV and HCV and encourage hepatitis B vaccination of close contacts.

General Public Awareness and Education

Lack of knowledge about HBV and HCV transmission contributes to the stigma of infection and is a barrier to testing, prevention, and care. Public HIV-awareness campaigns led to reduced stigma and discrimination toward patients with HIV infection (Brown et al., 2003). As in the case of HIV/AIDS, increasing general public knowledge about hepatitis B and hepatitis C can be expected to reduce discrimination toward infected people, reduce transmission, and increase early diagnosis and treatment that ultimately save lives.

Broader community education should include print and multimedia educational materials about viral hepatitis for the public, large employers, and health insurers. It should work to mobilize and facilitate a grassroots movement among community stakeholders, including health-care providers, employers, mainstream and ethnic media, community-based organizations, and students. Large employers, such as multinational corporations, are potentially important partners in hepatitis prevention and control in that they provide health benefits to about two-thirds of Americans who have health insurance and are commonly employers of foreign-born people from HBV-endemic countries both in the United States and overseas.

The lack of knowledge and awareness about hepatitis B and hepatitis C in the general population suggests that integration of viral-hepatitis and liver-health education into existing health-education curricula in schools will help to eliminate the stigma of those chronically infected and improve prevention of viral hepatitis. There is evidence that adolescents are unaware of hepatitis B and hepatitis C risks and how to prevent becoming infected (Moore-Caldwell et al., 1997; Slonim et al., 2005). Many schools already require health education on HIV, which has transmission routes similar to those of hepatitis B and hepatitis C (CDC, 2008b). Several school-based programs have been demonstrated to reduce HIV risk in students and could serve as models for viral hepatitis education initiatives (Gaydos et al., 2008; Kennedy et al., 2000).

Community-Based Outreach to Foreign-Born

Immigrants from HBV-endemic countries make up the largest population of people who have chronic hepatitis B in the United States, and it is essential that they receive culturally and linguistically tailored information

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