Representations and disease experience of hepatitis B by Sub-Saharan patients in Ivory Coast and France

Objective: Hepatitis B, a major public health problem in Africa and among Sub-Saharan populations living in France, remains poorly characterized and insufficiently managed. Two social sciences studies in Abidjan (Cote d'Ivoire) and Ile-de-France investigated representations of hepatitis B and attitudes towards medical care among chronic hepatitis B carriers. Comparison of the two studies raises the question of the role of different settings of access to care in the relationship towards disease and medical care. Methods: In Abidjan, the study was conducted with 14 patients at the University Hospital and the blood donor monitoring medical centre (Centre medical de suivi des donneurs de sang). In Ile-de-France, it was conducted among 33 chronic carriers in two hospital departments. The method was qualitative, using semi-structured interviews and consultation observations. Results: The comparison showed similarities and differences. Similarities exclusively concerned representations of hepatitis B, ignorance of the disease, and the negatively-charged association with HIV, linked in particular to the lack of collective mobilization on issues relating to hepatitis B in Africa and France. Differences concerned patients' attitudes towards medical follow-up and screening of close relatives, which are determined by the radically different funding conditions between the two sites. Given the lack of universal health insurance in Ivory Coast, patients with chronic hepatitis B experience difficulties of access to medical care. Conclusion: These studies emphasize the need for awareness campaigns on hepatitis B and information about conditions of management of chronic hepatitis B carriers in Sub-Saharan Africa.