The Jakarta Post
As hepatitis is seen as a highly transmittable infection, patients living with it face social stigma that can lead to discrimination. (Shutterstock/File)
The Hepatitis Care Community (KPH) has found that many companies conduct hepatitis screenings during personnel recruitment and promotion processes as employers believe that the infection increases corporate medical costs because of its potential to develop into a chronic ailment. They also believe the infection makes employees unproductive.
“Within a year, we received around 10 complaints about discrimination in the workplace,” KPH founder Marzurita said in a discussion held by Forum Ngobras, a forum concerned about health issues, in Jakarta in late September.
Marzurita said that the KPH had also received a report on a senior high school in Bogor, West Java that required its students to test negative for HIV/AIDS and hepatitis. The situation has raised questions over whether hepatitis is easily transmitted.
Rino A. Gani, the chairman of the Health Ministry’s hepatitis experts commission, said hepatitis C can only be transmitted through exposure to infected blood.
“So, it’s not as easily [transmitted] as people think,” he said.
In what is medically termed as a continuous infection, the illness can become chronic if a patient’s immune system fails to overcome the infection completely. Therefore, it causes permanent damage or cirrhosis, with the liver shrinking and hardening, resulting in liver failure or liver cancer.
Based on Population Basic Health Research in 2013, hepatitis B patients in Indonesia constituted 7.2 percent of the population, while hepatitis C patients comprised 1 percent.
“In total, about 8.2 percent, or 22 million people, in Indonesia were infected by this disease,” Rino said.
Rino said that even though Indonesia had no valid data on the number of cases of cirrhosis, according to global research, 30 to 40 percent of hepatitis cases develop into cirrhosis.
“But cirrhosis can set in after 20 to 30 years. Its means that, as long as there is no continuous inflammation, then the patients can be fit for work,” the internist said.
The hepatitis examination commonly conducted by companies on their employees is called the HbSAg test, which refers to the protein marker for the hepatitis B virus within the body. Laboratory tests typically show reactive or non-reactive results. If reactive, the body tests positive for hepatitis. However, the reactive result does not mean the person is unfit for work because, as Rino explained. The virus could be dormant or inactive despite the HbSAg presence.
Kasyunil Kamal from the Indonesian Occupational Medicine Association (PERDOKI) said that corporate requirements for a hepatitis examination was a form of discrimination and violation of regulations. Based on a 1997 Director General of Industrial Relations and Manpower Control circular on the termination of hepatitis B tests in personnel health examinations, such tests can only be requested for certain types of work, such as within the medical and food processing fields.
Kasyunil said it was not acceptable for companies to affect their employees’ careers solely based on medical test results that indicate the company would face increased corporate medical costs.
“We now have the healthcare insurance [BPJS] system covering medical costs for employees. What companies should do is inform employees about health maintenance and disease prevention, which should be prioritized instead of discriminating the patients,” he said.
Rino also underlined that not all types of hepatitis should be treated and that some only needed to be monitored periodically, depending on the level of damage of the liver. Although there is no treatment that can eliminate hepatitis B, employees suffering from the disease can get drugs that prevent the liver from deteriorating. The drug needs to be consumed over a long period of time or even for a lifetime.
“But it’s not just hepatitis B that requires life-long treatment — hypertension and diabetes also do. The drugs [for hepatitis B] aren’t expensive, about Rp 700,000 (US$51)per month. They are covered by the BPJS, so it shouldn’t be a problem,” he said.
For hepatitis C, there are currently direct acting antiviral (DAA) drugs that can eliminate the virus with a success rate of up to 98 percent.
With advancements in medications and improvements in public health insurance, Rino said there was no reason for employers to be afraid of hepatitis and that patients should no longer be discriminated against.