Hepatitis B & C


Global context

The World Health Organisation endorses only four awareness days for health conditions – hepatitis is one of them, held annually on 28th July. The other three are TB, malaria, and AIDS.

This illustrates the level to which it is of global concern – 500 million people worldwide are infected with hepatitis B or C (or both).[1] The viruses affect the liver – ‘hepar’ means liver in Ancient Greek. Both can be fatal if left untreated, leading to liver cancer and cirrhosis. 57% of liver cirrhosis worldwide and 78% of primary liver cancer is caused by hepatitis B or C.[2]

It is known as the ‘silent epidemic’, as both viruses can be asymptomatic for decades, and only present when it can be too late for treatment. Globally, 1.5 million people die annually from hepatitis B or C;[3] this is more than twice the annual death rate from malaria.[4]

It is estimated that 1 in 3 people have been exposed to either or both viruses at some point in their lives.[5] Not all people who have been exposed to the virus will contract it; some people will contract and develop an acute infection, which usually lasts a few months, and can be cleared by the body’s immune system or through treatment. Rates differ for hepatitis B and C - about 20% of hepatitis C infections will clear naturally,[6] while for hepatitis B it depends much more on age. Only 5% of children who contract the infection clear naturally, whereas about 95% of adults who contract the infection clear it as the immune system is much more developed.[7] Some people go on to develop chronic infection of hepatitis B or C, where the virus lives in the body and causes damage over a number of years. This can then lead to other life-threatening diseases such as liver cancer and cirrhosis.

In Europe, hepatitis B or C affects 1 in 50 people.[8] Low levels of awareness and education are hindering testing and treatment for both viruses, which can be preventable and treatable. This is contributing to a vast global disease burden of hepatitis-associated diseases, which are usually end-stage and chronic, where drain on resources is very high and quality of life for patients is very low. Early diagnosis can combat this.


UK context

215,000 people in the UK are thought to be infected with chronic hepatitis C,[9] and 180,000 with chronic hepatitis B.[10] Every pregnant woman in the UK is now screened for hepatitis B.

Department of Health and NHS campaigns regarding both hepatitis B and C have focused on the White British population, and the common ways the viruses are contracted within this group – primarily, intravenous drug users, and men who have sex with men. The association with drugs, sex and alcohol means that the illnesses are stigmatised and very rarely talked about in other communities.

However, there is variation in common ways to contract the viruses across different groups of people.  As both viruses are transmitted through blood-to-blood contact or through bodily fluids, there are various ways they can be contracted.

Current resources, government campaigns and levels of practitioner knowledge do not reflect this variation, and therefore alienate and do not necessarily support other groups or communities.


Minority communities

Surprisingly for the severity and extent of the viruses, very little peer-reviewed research has been conducted on rates of hepatitis B and C amongst specific populations in the UK and worldwide; however, several studies[11] show that in East London, 5% of Pakistan-born people are infected; almost 4% of Somalia-born people are infected, and 2% of people born in Bangladesh are infected.

“These data [testing 4998 people of South Asian origin] indicate that nearly one in twenty people born in Pakistan and living in England has chronic viral hepatitis.”[12]

There is particular concern for the prevalence of infection amongst minority communities, as rates of testing are quite low, which suggests many are living with infection and are undiagnosed. This then could lead to unintentional transmissions to others, particularly as knowledge levels are so low regarding this, as well as prevention and better management. 


Common methods of transmission

The most common way to contract hepatitis B amongst the Pakistani community in the UK is through mother to child transmission (MTCT), where the mother already has hepatitis B and passes it to her child while giving birth. For hepatitis C it is through poor medical practices, most often back in the home country, and includes re-use of needles for injections, vaccinations and other blood-related medical procedures such as transfusions. Re-using razors for shving and haircutting is also a risk factor for transmitting hepatitis C. For the Muslim community, particular care must be taken around the head-shaving ceremony for babies (traditionally undertaken seven days after birth), circumcision, and preparation for Hajj and Umrah in terms of removal of body hair.


Specific issues relevant to the UK Pakistani population

Asymptomatic – Some people do experience symptoms of hepatitis B or C, which are similar for both viruses and include a general feeling of being rundown (easily mistaken by GPs), feeling depressed, a yellowing to the skin which indicates jaundice, fatigue, nausea, possibly poor concentration and aches and pains. Many people report a sense of feeling ‘not right’ without being able to pinpoint anything in particular. However, hepatitis B or C are often not accompanied by symptoms of illness. People may have been infected with the virus many years earlier, while receiving medical treatment or a haricut as a child in Pakistan. 

Language – The Pakistani community refer to hepatitis B as jirkaan (yellow = jaundice) and hepatitis C as kalajirkaan (black jaundice). Jaundice however is a separate illness and can indeed be developed by those who have hepatitis B or C (though not all patients who have jaundice have hepatitis B or C). 

Lack of GP knowledge with regards to hepatitis B and C transmission, and who is at risk – There remains a need to increase GP knowledge with regard to the increased risk of hepatitis B and C amongst different groups, and the differences - context - for this. This lack of knowledge is contributing to low levels of testing. From research focus groups and key informant interviews conducted as part of this project, it is clear that patients are being told on a regular basis that they are not at risk of hepatitis B or C, and being refused tests. Years of campaigns focused on intravenous drug has contributed to a narrowing of knowledge with regard to who else may be at risk, and why. 

Association with drugs, sex and alcohol creates stigma – The national campaigns that focus on drugs and unprotected sex have also unwittingly created stigma around both hepatitis B and C, despite the other ways in which it can be transferred. Amongst Muslim communities, the knowledge that does exist links both to extramarital sex, HIV/STIs, injecting drugs, and also drinking alcohol (generally people link liver to alcohol). All are associated with 'bad behaviour' and/or mistakes, meaning the illnesses can be hushed up and not talked about. This contributes to a lack of support for those who have the illness, and massive stigma towards them as people fear catching it. 

Low knowledge around transmission methods - The research groups showed that many people were unsure about how hepatitis B and C are passed on, with some thinking that the viruses could be passed on casually, that is, through e.g. touching, toilet seats, bad polluted air, contaminated food. This is not the case – both hepatitis B and C are transmitted through blood-to-blood contact, and hepatitis B can also be sexually transmitted.

‘Hep C is more serious than hep B’ - Hepatitis C is seen as more severe than hepatitis B, or as a more severe form of hepatitis B. They are in fact different illnesses; one is not a more severe form of the other. They both affect the liver and have similar symptoms, but causes and methods of transmission. Another misperception is that hepatitis A can develop into hepatitis B, and this can then develop into hepatitis C.

Barriers to testing – The research groups showed that people often took years to go and be tested, for many reasons – fearing not being able to look after family if they have the illness, not being able to find the time to be tested, too many hoops to jump through, poor communication with doctors or doctors being seen as being dismissive, treatment will make things worse, not wanting to be a social outcast, not wanting to be associated with the illness (occasionally it was seen as potentially damaging to marriage prospects), etc.

Urban/rural – Main populations at risk tend to be from urban areas, where there are more opportunities for transmission. This in part explains the lower rates of hepatitis B and C amongst the UK Bangladeshi population, as the vast majority originate in the rural region of Sylhet. The Pakistani population on the other hand originate from a broader range of urban areas.  

Age – First generation immigrants, who spent their childhood and early life in their home country before travelling to Britain, may well have at some point been exposed to the virus. British Pakistanis, Somalis and Bangladeshis, if they regularly travel back to their home country or even a one-off trip, could also potentially be at risk. As Census data show that up to 80% of the immigrant population in East London are under the age of 50, and that liver cirrhosis and cancer rarely present in people under 50, it is likely that the next few years will see a dramatic increase in the proportion of people presenting with end-stage liver disease due to chronic viral hepatitis.  


Action: for patients

Testing for hepatitis B or C is very simple – this is usually done by:

  • Blood test. This requires a small amount of blood being taken, either through a finger-prick test or more usually an injection in the arm, which is sent away for analysis. GPs and practice nurses can perform this test.
  • Saliva swab, for hepatitis C only. The infection itself is NOT present in saliva, but can indicate if the virus has ever been present in the body. A blood test will confirm this.

“Think about your visits home – if you ever visited the barber, or if you had to seek medical treatment and had to have an injection for anything. This might be a long time ago – 5 years, 10 years, 20 years, 30 years. If any of these things happened, get tested. If someone close to you or in your family has ever had hep B or C, get tested.”

Shabana Begum, Community Officer, The Hepatitis C Trust (former Hep C patient)


Action: for doctors

There is a free online course developed and accredited by the Royal College of General Practitioners (RCGP) for primary care practitioners on 'Hepatitis B and C Detection, Diagnosis and Management':



For hepatitis B, there is a vaccine which is approved by the WHO. Regular screenings for hepatitis B in the UK take place during antenatal checks, and babies who are at risk receive the vaccine within 24 hours after birth. People can receive the vaccination at any age.


As hepatitis B can also be transmitted during sex, using barrier methods of contraception such as condoms should prevent this (particularly if you don’t know if the other person has the virus or not. The only way to know is a test. See Action for patients, above).

Although there is no vaccine for hepatitis C, there are many ways in which transmission can be reduced or stopped.

  • Improved medical practices – using sterile and/or new equipment, including razors for shaving, haircutting; needles for injections and other blood-related medical procedures such as transfusions; body piercing equipment such as ear or nose piercing etc. Making sure that equipment is completely sterile and not been re-used is also important for circumcision and shaving babies’ heads in Muslim communities

Other preventative measures for both hepatitis B and C include:

  • Not sharing toothbrushes (in case of blood to blood transfer)
  • Never sharing needles or any equipment for injections (this includes anything medical, for tattoos or piercings, or drugs)



For hepatitis B, less severe cases usually clear the body within a few months, but this depends on the age of the person when the infection was contracted. Infection as a child is more serious than infection as an adult. More severe and chronic cases may involve antiviral medication and other things such as maintaining a good nutritional balance, but there is no specific treatment - it depends on the context of the individual.

For hepatitis C, there are a variety of treatments but currently the most common is antiviral medication. Courses of treatment vary depending on the genotype of the virus, severity of the virus (what stage it’s at), the individual, and what their priorities are in terms of dealing with the illness. It is possible to clear hepatitis C for good - be cured of it.


Please note: all content on this page focuses on primarily the UK Pakistani community and is based on current available information. Methods of transmission and advice may vary for other groups.


References and further reading

WHO Europe website, Hepatitis Data & Statistics

World Health Organisation (2013) Global policy report on the prevention and control of viral hepatitis

Public Health England (2013) Hepatitis C in the UK: 2013 Report

G Uddin et al (2009) ‘Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England: the prevalence cannot necessarily be predicted from the prevalence in the country of origin’ Journal of Viral Hepatitis, doi:10.1111/j.1365-2893.2009.01240.x

Health Protection Agency (2006) Migrant Health: A Baseline Report, Chapter 4: Hepatitis B pp59-65

Hep C Trust – information and resources relating to Hepatitis C

British Liver Trust – information on liver disease

British Liver Trust information on Hepatitis B

World Hepatitis Alliance – linking organisations and information globally

WHO Hepatitis B Factsheet

WHO Hepatitis C Factsheet


[1] WHO Europe website, Hepatitis Data & Statistics

[2] World Health Organisation (2013) Global policy report on the prevention and control of viral hepatitis p ii

[3] WHO Europe website, Hepatitis Data & Statistics

[4] World Health Organisation (2013) Global policy report on the prevention and control of viral hepatitis p1

[5] WHO Europe website, Hepatitis Data & Statistics

[6] Widely recognised statistics on disease progression, see e.g.

[7] see e.g. J Grebely et al (2014) 'The effects of female sex, viral genotype...' Hepatology 59:1 p109

[8] WHO Europe website, Hepatitis Data & Statistics

[9] Public Health England (2013) Hepatitis C in the UK: 2013 Report p8

[10] Health Protection Agency (2006) Migrant Health: A Baseline Report, Chapter 4: Hepatitis B p62

[11] see e.g. G Uddin et al (2009) ‘Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England…’ Journal of Viral Hepatitis

[12] G Uddin et al (2009) ‘Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England…’ Journal of Viral Hepatitis, p3

The latest news and comments around hepatitis B and C...

The project has been funded by: 

Barts Charity

The Charity works closely with Barts Health NHS Trust and associated healthcare institutions to develop innovative projects.


The project is also supported by:

The Blizard Institute (part of Barts & The London School of Medicine & Dentistry, Queen Mary University of London)


The Hepatitis C Trust

Based in London, the Trust was established in 1999 as a national charity dedicated to hepatitis C. They provide a wealth of excellent information on all aspects of hepatitis C, including the production of research and reports on a regular basis. They also have a confidential helpline and provide support to people with hepatitis C and their families.

Mental health


The rise of mental health issues in Muslim communities is a concern that is constantly raised in the course of our health work.

During our work in diabetes, cardio-vascular disease and perinatal mortality, nurses and doctors continually raised depression as a commonly occurring issue amongst their Muslim patients. There is a recognition that not enough is being done to tackle this in terms of education, for both patients and practitioners.

Any treatment is made more difficult by the fact that there is no direct translation for the word ‘depression’ in Urdu, Sylheti, Arabic and Somali, for instance. 

As such, as a ‘Western’ illness with ‘Western’ treatment, effective support can be complicated, drawn-out and challenging.

AT Medics, London's largest group of NHS GP practices, commissioned Maslaha to produce a resource focusing on mental health and depression. Through our research with doctors, nurses, patients and therapists, it became apparent that there was a lack of practical resources particularly amongst the Somali, Bangladeshi and Pakistani communities, coupled with a very strong sense of stigma. 

The stigma of ‘mental illness’ often means that those who don’t feel well fear being isolated and ostracised from their community, so don’t seek support.

For those who do seek support, there are often communication problems - linguistically, culturally and spiritually - with medical professionals. A number of health practitioners have commented on feeling limited in providing effective care and support, if the clients reach them at all.

In collaboration with Somali, Pakistani, and Bangladeshi community groups, counsellors, psychotherapists, clients, imams and GPs, Maslaha developed these four short films - Talking From The Heart - in three spoken languages (Somali, Urdu and Bengali/Sylheti) with English subtitles, which can be used by primary care practitioners with their clients, or with community groups.

The films combine medical and religious advice to find a new language of communication, address stigma, and demystify support and therapy.

The latest news and comments about our work in mental health...

AT Medics

London’s largest group of NHS GP practices, with a strong track record of providing high-quality care, for over 75,000 patients across 15 primary care sites. Specialising in primary care, AT Medics work to provide innovative, high-quality healthcare with local communities co-designing the model of care.  AT Medics commissioned and funded the resource.


Midaye Somali Development Network

Based in Ladbroke Grove, Midaye supports the local Somali community through information sessions, welfare advice, English classes, events and workshops, supplementary schools, and arranging individual and group therapy.

“Well done to everyone involved, I am very proud and amazed how clear and easy to understand the clips are. I like the way the topics are divided, what surprised me more and really attracted to the film the knowledge of the Imam and how he is encouraging the community by providing the right information and backing these up with the Qur'an and what Allah said to the Muslims.
Fadumo was excellent, her professionalism really came out; everything she said was very encouraging.
I can imagine a lot of work went into this, but it is worthwhile as the film came out to be very powerful and can encourage the Somali speaking community to seek help at the right time.”
Filsan Ali, Midaye Somali Development Network


Mind Tower Hamlets & Newham

Supported throughout the research stage, as well as script development. Mind representative Abdirashid Gulaid features in one of the project films.


Mind Harrow (Hayaan Project)

Supported throughout the research stage. The Hayaan Project is run by Abdi Gure for the local Somali community, providing bi-weekly information sessions on a variety of topics, including health issues.

Hayaan website


Marlborough Family Service (NHS)

A family therapy centre based in St John’s Wood. Three therapists from there – Rabia Malik, Manu Rahman, and Rakhee Haque – feature in the project films and supported throughout script development. 

“I can simply tell you, it's really a WONDERFUL job you have done… Me and my whole family watched the video together, they were happy, particularly my son-in-law, who is working as a GP in Nottingham. He appreciated much and said that it would be a good helping guide for GPs to talk with their clients of mental health issues from the point of culture and faith.”
Manu Rahman, Marlborough Family Service (therapist in Bengali film)


Ebrahim College

An Islamic college based in Whitechapel, running classes, courses and supporting the local Muslim community.


York Way Mosque

Based near King’s Cross, the mosque also runs supplementary schools and classes for the local community.

Your healthy pregnancy


In partnership with Birmingham East and North Primary Care Trust and Health Launchpad at the Young Foundation, we have been working closely with health practitioners, local community organizations, pregnant women, mothers and many more to produce this unique resource with the aim of combating perinatal mortality.

Describes the period surrounding birth, and traditionally includes the time from fetal viability from about 24 weeks of pregnancy up to either 7 or 28 days of life.

Perinatal mortality
Fetal deaths after 24 completed weeks of gestation and death before 7 completed days.

BEN PCT has the second highest perinatal mortality rate in the country.  During our initial scoping exercise, we pinpointed some key issues from conversations with doctors, midwives, family support workers, pregnancy outreach workers, and mothers:

  • Problems around the degree to which families and patients connect  with services  - little understanding of the process/timescale, intimidated by hospitals and doctors, lack of awareness of how to expect to be treated
  • A failure to engage with services early enough
  • Understanding of the importance of a healthy lifestyle before/during pregnancy – food and diet, folic acid, exercise etc
  • Existing conditions e.g. diabetes
  • Major concerns around breastfeeding and a failure to persevere which has been influenced by misconceptions e.g. that it’s better to change to baby formula because baby will appear bigger/healthier
  • Cultural and wider perceptions of pregnancy
  • Mental health, including stress and depression
  • A lack of awareness of the availability of support and groups

In order to help tackle some of these issues, Maslaha has embarked on a unique series of films specifically aimed at pregnant Muslim women which will increase understanding and direct towards local available services. 

Some more statistics for BEN PCT:

  • Approximately 100,000 individuals in NHS BEN are living with a limiting long term condition (approximately 70% are of working age)
  • Second highest perinatal mortality rate in the country
  • Over 1 in 3 children in BEN live in poverty
  • Washwood Heath is ranked 10th across the UK for high child poverty levels
  • Men die an average 6 years earlier that the national rate
  • Cardio-Vascular Disease for men in BEN is the major driver for premature mortality
  • There is a greater than 6 year difference in average life expectancy in the six miles from Washwood Heath to Sutton town centre, one of the most significant divisions in the region
  • 2007 Index of Multiple Deprivation ranked this area as the most 14th deprived local authority in Britain
  • Half of the city’s ten priority wards fall within BEN
  • The rank of income scale places Birmingham as the most deprived in Britain in terms of income and employment. Worklessness in BEN is particularly concentrated in its most deprived wards: Kingstanding, Washwood Heath and Shard End

Tips on how to look after yourself and your baby during pregnancy

This work has been funded by Birmingham East and North PCT and Health Launchpad.

Diabetes in Westminster


Type 2 diabetes is up to six times more common in people of South Asian descent, and up to three times more common in those of African and African-Caribbean descent, as demonstrated by the figures below :

  • General population – 4.3% in men and 3.4% in women
  • Black Caribbean origin – 10% in men and 8.4% in women
  • Indian origin – 10% in men and 5.9% in women
  • Pakistani origin – 7.3% in men and 8.6% in women
  • Bangladeshi origin – 8.2% in men and 5.2% in women

In addition, according to the PBS model, the prevalence of diagnosed diabetes is lower than the expected prevalence, which suggests that there could be a number of people with diabetes who have not yet been identified in practice .

This work has been funded by Westminster Primary Care Trust.

Special thanks also to:








Diabetes in Tower Hamlets


Why Diabetes in Tower Hamlets?
melvinhengTower Hamlets has a large Muslim community (36%) and understanding how religious beliefs and cultural values shape behaviour and attitudes to healthcare is essential if their needs and health problems are to be addressed. The PCT identified diabetes as a priority, as there are an estimated 13-14,000 people with diabetes in the borough, largely occurring within the Asian community – a prevalence rate of three times the national average.  

Feedback from patients and service providers has been extremely positive.  Many patients were very appreciative of an approach which incorporates faith and information in their first language, and expressed a desire for more resources covering other illnesses prevalent in the community, such as asthma, gastric problems, heart conditions and depression. Consultants and nurses were particularly pleased to have been directly consulted, allowing them to inform the development of a useful resource.  Their engagement with the pilot was instrumental in ensuring its relevance to everyday practice, and their feedback following the pilot will inform further improvements to this approach.

“There was a young, intelligent man who came to me with Type 1 diabetes who told me he was going to fast during Ramadan and I said ‘please don’t, you will die’.  I gave him the DVD and said, ‘maybe you will find something in here to help’.  He got through Ramadan, though I don’t know how or what he did, so if that stopped him from being admitted to hospital, if you save one person, then that’s brilliant.”  

Nurse, Diabetes Clinic, Mile End Hospital

“My dad has diabetes, and I think it’s really useful that it’s in Sylheti.  It would be really good if you could do another project for depression in different languages, especially in Bengali, but also other minority languages as well, because that’s a real problem here in the community.”

Patient, Female, 22, Shah Jalal clinic

“My wife suffers from diabetes, and this DVD is good, it’s very good.  I speak English, but it’s nice to have it in my mother tongue as well.  Also, it would be good to know more about asthma, how to take medicine, gastric diseases”    

Patient, Male, 63, Mile End Hospital

“The Islamic point of view is very good; it’s more inclusive and reaches more people.  Other resources we have been given before have been useless; the patients cannot understand the advice.  This is particularly good for people who have just been diagnosed, but also good as a reminder for long-term sufferers.”

Diabetes Nurse, Varma Surgery


Watch our films and visit our website to learn more about how to look after your health if you have diabetes.

This resource was commissioned by Tower Hamlets PCT.

Caring for your heart


Maslaha focused on the Washwood Heath and Bordesley Green area of Birmingham, with an 80 per cent BME community – the majority of which are Pakistani (80%).  The PCT has identified significant problems in these areas, including:

  • Poor quality infrastructure, with many surgeries occupying converted houses poorly suited to their purpose
  • Little change in services since the 1970s
  • Some GPs seeing as many as 50 patients in three hours, despite long waiting hours
  • High unnecessary prescription of antibiotics
  • A vast proportion of patients do not need to see a GP, but visit because of reasons such as psycho-social problems, free prescriptions, worry, and little knowledge of how to manage own health

According to practitioners, the highest risk group is men in their 40s, however women also play a pivotal role as they tend to be more motivated than men and are often in charge of diet.  The typical vicious circle leads to a combination of poor diet, high salt intake, smoking and a lack of exercise contributing towards weight gain leading to abdominal obesity, which South Asians are particularly prone to.

The website and DVD is actively being used by Amaanah Surgery, two schools in the local area and through a local youth organisation called Comm:Pact.

Dr Khalid, who is a partner in Amaanah surgery, said: "This has been the most useful health intervention we have used as it reaches patients directly. There has been a real demand for the DVDs and when we have marketed the website, I know there has been a real surge in use."

Follow our progress and thoughts...

This work has been funded by Birmingham East and North PCT and Health Launchpad.

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