Australasian Viral Hepatitis Conference Hears Call to Urgently Integrate Law into the Response to Hepatitis B

For decades now, researchers and advocates have emphasised the power of law to shape both public health outcomes and the individual lived experience of communicable disease and health.

The criminal law has been a major focus of this discussion. There is evidence, for example, that countries that continue to partially or fully criminalise activity like sex work, injecting drug use, or same-sex sexual acts achieve ‘significantly lower levels’ of knowledge regarding HIV status and viral suppression, all of which create unnecessary barriers to ending HIV. Research and advocacy regarding hepatitis C makes a similar case for the role of law in the response to hepatitis C. Hepatitis C has a high prevalence among people who inject drugs and among incarcerated people, with a close and complex relationship to criminal law, all of which contributes to the stigma and discrimination associated with the condition.  

While our understanding of the relationship between law, HIV and hepatitis C has been growing over time, far less is known about the relationship between the law and hepatitis B. We do know, however, that migration is one area of law that impacts people living with hepatitis B in Australia, and that migration law and policy can create barriers to testing and accessing care in Australia and other countries. But more work is urgently needed to truly understand and modify the legal environment, so it produces more desirable outcomes for affected people. And for that to occur, law and legal research need to be integrated into our response to hepatitis B.

This relationship between law and hepatitis B was the focus of a recent keynote address delivered by Health+Law chief investigator David Carter.

‘People living with and affected by hepatitis B are made deeply vulnerable by our current legal arrangements – both real and imagined’, David argued at the 14th Australasian Viral Hepatitis Conference, held on Larrakia country, Garamilla (Darwin) in August 2024. ‘We have a legal environment that asks too much and provides too little support.’

In his address, David made a passionate case for the need to more meaningfully address the law in Australia’s response to hepatitis B. ‘Lawyers and legal services need to be urgently integrated into the response. Law reform must be achieved. There is so much to be done and so much to be gained.’

As recent work published by Health+Law shows, 60 percent of clinician-respondents from a sample of the Australian BBV sector see legal issues generating a ‘severe’ impact on the health of their patients or clients, and around 50% see legal issues generating a ‘severe’ or ‘serious’ impact on their ability to provide health care. These impacts are also well known among peers and staff in community organisations who work with people living with hepatitis B. As David’s keynote described, ‘people living with hepatitis B [in Australia] are exposed to rights violations, discrimination, testing procedures without prior informed consent or adequate supports.’

In emerging findings from Health+Law’s national legal needs study (LeNS), migration law is a significant focus. Across Australia, participants in LeNS describe the harms that migration law can generate for those affected by hepatitis B. This includes students being barred from industry placements, volunteers barred from participating in community and religious events, and prospective employees rejected through pre-employment medical screenings. It includes coercive testing and the non-consensual disclosure of hepatitis B status. It includes visa applications rejected, with health and other supports lost due to the health requirements imposed by Australian migration law, and people diagnosed but left entirely alone to address their condition, with no effective advice or referrals. In many cases, this legal environment causes people to creatively adapt to its pressures, including resorting to the illegal importation of medication as a means to avoid official health-system record of their hepatitis B status.

‘The law operates as a kind of hidden curriculum to all of these interactions’, David explained, ‘and through that contact it changes people’. ‘Very often’, he continued,

the legal rationale that influenced these interactions with employers, universities, clinicians, churches, partners and the state was vague or incorrect. Sometimes they even refer to a legal requirement that is simply fictional. But their effects on the health, quality of life and human rights of people affected by hepatitis B are fact.

While the precise health impacts of these interactions with the law are yet to be fully understood, emerging data from LeNS suggests that some kind of ‘withdrawal’ – from health care, treatment, community, education, relationships and more – is a common response among affected people. Reflecting on interviews from the project, David said that ‘repeatedly, almost universally, people living with hepatitis B are force to adapt by withdrawing, making the most momentous changes to work, study, living arrangements to protect themselves.’

The theme of this year’s Australasian Viral Hepatitis Conference was ‘Strength in Unity’, with aims of ‘exploring ways to harness the strength of our community, celebrate the Aboriginal and Torres Strait Islander workforce, and forge partnerships for change’. Finding out more about the legal experiences and needs of people living with hepatitis B through interviews and surveys is at the core of Health+Law’s research. And this involves working closely with peers and staff in community organisations across Australia.

Community members, clinicians, lawyers, educators, migration agents, interpreters, community leaders, service workers, peers and many others are already involved in the work of Health+Law. Through this work, we aim to better understand how the law affects people, and we can also learn what might be done to redirect the flow of events towards more desirable outcomes. This work requires a partnership approach, and will require a partnership approach to law reform too.

A list of the community partners supporting LeNS is here.

If you are living with hepatitis B and are interested in participating in LeNS you can register your interest here.

Find out more about the Australasian Viral Hepatitis conference here.

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