Stigma: A Barrier Created by Limited Access to Care and Health Education on Hepatitis C (HCV) Testing and Treatment within the Puerto Rican Population

Significance: Hepatitis C (HCV) is a long-term illness that progresses gradually and has become increasingly common among People Who Inject Drugs (PWIDs) in Puerto Rico. Barriers such as inadequate access to healthcare and limited health education contribute to widespread stigma against both HCV and the PWID community.

Purpose: This review aims to explore the existing evidence on how stigma related to Hepatitis C negatively influences testing and treatment among PWIDs in Puerto Rico. It also emphasizes the urgent need for federal support and funding to implement prevention and treatment initiatives targeting this stigma.

Methodology and scope: This systematic review did not involve any participants. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework guided the literature review process. A total of 285 articles were initially identified through a targeted keyword search, including terms like "Puerto Ricans," "Chronic Hepatitis," "Hepatitis C," "HCV stigma," and related topics. After removing 11 duplicates and excluding 274 articles based on various criteria such as geographic relevance, study population, and language only 7 articles met the inclusion criteria for review.

Key findings: Stigmatization related to HCV significantly affects PWIDs’ willingness to undergo testing and pursue treatment, thereby impacting timely diagnosis and healthcare outcomes in Puerto Rico. The literature suggests that stigma acts as a critical barrier, deterring individuals from accessing essential medical services.

Results: Out of 285 initial sources, a rigorous screening process led to the selection of 7 articles suitable for review. Reasons for exclusion included non-U.S. based studies, incarcerated populations, lack of relevance, unavailability of full texts, and studies involving minors.

Conclusion: This review highlights a pressing public health issue: persistent stigma surrounding HCV and drug use among PWIDs, coupled with limited healthcare access and health literacy, continues to hinder effective intervention in Puerto Rico. According to data presented by Watson (2022), approximately 95% of those diagnosed with HCV report having faced stigma at some point in their lives. To curb the spread of HCV and mitigate stigma, it is vital for the U.S. government to allocate resources for public education, expand access to testing and treatment, and support community-level programs. Collaborative efforts among policymakers, medical professionals, and local organizations are essential to improve healthcare infrastructure and deliver equitable care to vulnerable populations.