Around an estimated 254 million people globally are living with chronic hepatitis B – and far more, beyond those with chronic infection, are impacted by it in some way. And yet, despite being the world’s most prevalent blood-borne virus, knowledge about the legal dimensions of hepatitis B is astonishingly scant. Results from Health+Law’s national legal needs study show the law can have huge implications for people living with chronic hepatitis B, including triggering or amplifying legal problems. But more widely, researchers have paid very little attention to the legal environment surrounding hepatitis B. This is in spite of calls from the community and public health experts to recognise that biomedical interventions alone will not eliminate hepatitis B.
To identify the research evidence that is already out there about hepatitis B and the law, our most recent article reports on the first-ever systematic global review of research on the legal, or ‘justiciable’ issues, affecting people living with chronic hepatitis B in high-income countries, and the how those issues affect their health and wellbeing.
What we do know
To establish this terrain, our team searched multiple legal, medical and social science databases as part of a global ‘stocktake’ of the literature. This results in 40 studies offering something significant to this area of knowledge. They included a range of research traditions and methods, from qualitative approaches to legal and policy analysis. And they emerged from Europe, Canada and the United States, among other places, with the largest number from Australia.
To synthesise the overall findings from this admittedly modest body of research, our review posed three questions:
What justiciable (or legal) issues do people living with hepatitis B experience?
In what areas of law do these issues emerge?
What health-related impacts do these issues produce?
Even a review of this modest size showed that people living with chronic hepatitis B experience legal challenges across the spectrum of areas of law, including employment, public health, tort law, education, criminal law, and more. However, there were other specific findings to emerge from this research.
Discrimination and migration law are key problem areas
The two most frequently identified areas of legal issues in this archive were anti-discrimination law and migration law. As our forthcoming reports discuss in some detail, this parallels the contemporary Australian experience.
Globally, a major theme across the literature is the role of discrimination in the lives of people living with hepatitis B, and studies document it across employment, education and healthcare settings. For example, pre-employment screening for blood-borne viruses may limit job opportunities for people living with hepatitis B, particularly in fields such as health care and childcare. Similarly, discriminatory practices in educational settings have historically affected children living with hepatitis B.
Migration law creates problems in jurisdictions where hepatitis B status affects visa eligibility or long-term residency applications. People living with hepatitis B and their families who are on temporary visas often face additional barriers to accessing both private health insurance and public health schemes like Medicare.
Legal issues create barriers to health care
This is one of the clearest findings from the review. Again, examples include migration laws that create eligibility rules for public health access, which often become hurdles to testing, treatment and monitoring for hepatitis B. In some jurisdictions, migrants and non-citizens face high out-of-pocket costs or are entirely excluded from certain services.
Relatedly, some studies describe legal requirements to test (and report on) hepatitis B, including screening during pregnancy or migration-related health assessments. While these policies may support broader public health goals, they raise concerns about privacy, consent, involuntary testing, and involuntary disclosure. And fear of disclosure – particularly in contexts where health information may be shared without consent – can discourage people from testing or engaging with health care.
The mechanics of these laws are sometimes complicated
Importantly, many of these legal provisions are not explicitly about hepatitis B but rather are ‘facially neutral’ – that is, they are laws that apply more broadly.
For example, laws governing immigration status, employment practices or healthcare access are generally designed to apply to broad swathes of the community. However, when they are applied in practice, they can have unintended and sometimes discriminatory consequences for people living with hepatitis B. While laws and legal frameworks may not explicitly target hepatitis B (or other conditions), they may interact with health status in complex ways.
Towards an enabling legal environment
Understanding these nuances is important. Alongside other Health+Law work, this global literature review suggests that legal issues frequently generate negative health-related impacts for people living with hepatitis B. But the opposite may also be true in some instances: that is, law has the potential to play a positive, protective role. When they work, legal protections against discrimination, for example, should support equitable access to health care and therefore contribute to better health outcomes for affected populations.
Global health organisations increasingly emphasise the importance of an enabling legal environment in efforts to eliminate viral hepatitis. But we can’t improve the legal environment if we don’t understand how it operates. The most striking finding of this review is how limited the global evidence base remains. Only 40 studies is a paltry result given the hundreds of millions of people living with the virus, and in contrast to decades of far more established bodies of legal work on HIV and other conditions.
This highlights an urgent need for further research at the intersection of law, public health and lived experience of hepatitis B – to make the legal, policy and system reforms needed to better support people living with chronic infection and to advance elimination goals.
We’re grateful to The Journal of Law and Medicine for featuring this work.
Read the full article here
Citation: David J. Carter, Negar Jamshidi, Dion Kagan, Anthea Vogl, James Brown, Hamish Robertson, ‘The Health-Related Impacts of Law among People Living with Hepatitis B in High-Income Countries: A Systematic Review of Literature’, Journal of Law and Medicine, (2026) 32 JLM 916