Hepatitis B Discrimination Reporting

The Hepatitis B Foundation Stands Against Discrimination of Individuals Living with Hepatitis B.

Thank you for agreeing to participate in this discrimination registry. Your responses are not attached to your name or any other personal identification to ensure answers will be completely confidential. Please feel free to skip any questions that you are not sure how to answer or that you are uncomfortable answering. If you have any questions regarding this survey, please contact discrimination@hepb.org.

The purpose of this registry is to document and track discrimination related to hepatitis B. Discrimination is defined as the unjust, unfair, or prejudicial treatment of a person on the grounds of their hepatitis B status. In other words, being treated differently because of one’s hepatitis B infection. For someone with hepatitis B, this can mean exclusion, denying benefits, denied employment, education, training, goods or services, or having significant burdens imposed on an individual due to their infection status.

Part I: Demographics
These questions gather demographic information. Please check the box with your answer or select “Prefer not to answer” if you do not wish to disclose this information.

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* 1. In what country do you live?

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* 2. In what city and state do you live?

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* 3. What is your age?

0-17 years

18-29

30-39

40-49

50-59

60 or older

Prefer not to answer

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* 4. What is your gender?

Male

Female

Prefer not to answer

Other (please specify)

Part II Discrimination:
The following questions are related to discrimination against people living with hepatitis B. Please answer the questions to the best of your ability.

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* 5. Have you ever experienced discrimination due to hepatitis B status?

Yes

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* 6. Do you know of someone living with hepatitis B who has experienced discrimination?

Yes

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* 7. Please state the date of when the event occurred (if you cannot recall a date then a general time period. Ex: 2016 or summer of 2018):

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* 8. If you are willing, could you provide information on your specific experience with discrimination (where it happened (including country, city, location), how it happened, why, any consequences)?

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* 9. Where did the discrimination occur? (check all that apply)

Employer (can include government job or military)

Online (Social media)

In Public (Restaurant, Park)

Health facility/Hospital

Private residence or home

Educational Setting (Pre-School, Primary Education, Secondary Education,College, University, Professional School)

Place of Worship

When applying for a travel visa (Immigration Visa)

Other (please specify)

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* 10. Was the decision to get testing for hepatitis B your choice?

Yes, it was my choice to be tested for hepatitis B

I chose to be tested for hepatitis B, but it was under pressure from others

I was forced to be tested

I was tested without my knowledge

I only found out after the test had been done

Other (please specify)

Part III Additional Support:

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* 11. In the United States, hepatitis B is a protected condition under the Americans with Disabilities Act (ADA). If you are located in the United States, are you interested in filing a claim with the Department of Justice (DOJ) based on your experience with discrimination related to hepatitis B? If yes, the Hepatitis B Foundation might be able to assist with this and will reach out if you provide contact information.

Yes (If yes, please provide your email or phone below)

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* 12. Would you like to speak to someone at the Hepatitis B Foundation about your experience with discrimination?

Yes

Not sure

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* 13. If you answered yes to question 11 and/or 12, please provide your contact information (email and phone number) in the textbox below.

Thank you for taking the time to complete this survey. We assure you that your information will be kept confidential, and nothing will be traced back to you or shared with anyone other than the Hepatitis B Foundation staff. If you have any questions or concerns, please do not hesitate to reach out to the Hepatitis B Foundation at the email, discrimination@hepb.org. If you responded 'yes' to questions 11 and 12 and provided your email address, we will be in touch to speak with you directly about your experience with discrimination. Thank you for your time.