For US veterans, support for continued engagement in hepatitis B (HBV) care has been lacking. Listen in as Richelle Gaiter, CMSGT Retired USAFR, shares her experiences with HBV care as an Air Force veteran and what can be done to improve HBV care for veterans and civilians alike.
For US veterans, support for continued engagement in hepatitis B (HBV) care has been lacking. Listen in as Richelle M. Gaiter, DMSc, MPAS, Med, shares her experiences with HBV care as an Air Force veteran and what can be done to improve HBV care for veterans and civilians alike. Topics include:
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Link to program page:
https://bit.ly/4vAqSJT
Presenter:
Richelle M. Gaiter, CMSGT Retired USAFR, DMSc, MPAS, Med
Family Medicine, Prevention, Patient Education
Crescent City, California
This transcript was automatically generated from the audio recording and may contain inaccuracies, including errors or typographical mistakes.
Hepatitis B, Military Service, and the Long Road to Care Podcast: Barriers and Solutions for US Veterans
Hello and welcome to Decera Clinical Education’s Infectious Diseases Podcast. I’m your host, Dr. Karen Straube-West.
In today’s episode, Richelle Gaiter, CMSGT Retired USAFR and patient advocate, shares her personal experiences with hepatitis B care as an Air Force veteran and discusses what can be done to improve HBV care for veterans and civilians alike.
To view the full educational program, please visit the show notes for this episode.
Now let’s get started
Richelle Gaiter: I joined the Air Force in 1984, at a time when very little was understood about hepatitis B virus, HBV. My diagnosis was incidental in that I was not symptomatic, but it was discovered when I donated blood. What followed was isolation rather than education or reassurance. Health care providers, double-gloved, wrapped everything in plastic, and even kept me from my newborn for several days when he had jaundice. Intentionally or not, I was treated like a pariah. The message was clear: "You are a risk."
As I neared the end of active duty, I became symptomatic and was treated with interferon for several months. It was grueling therapy, but the best that could be done in that era. When I separated from active duty in 1995, I received no meaningful guidance about follow-up with the Department of Veterans Affairs, especially considering that I was coming from overseas. There was no structured transition into long-term liver care. I was not granted disability.
For years, I had no follow-up because at the time of separation, my liver enzymes were normal. It wasn't until much later that I was diagnosed with markedly elevated liver enzymes and started on tenofovir. Even then, care was intermittent. I did not engage with the VA because I did not understand I was eligible. I only re-entered the VA system about eight to nine years ago because I took a job as a physician assistant within the system and an onboarding physician questioned why I was not in care.
Only then did I receive appropriate ratings for conditions that were previously denied. My access to consistent HBV care happened because I worked in healthcare, but what about the veterans who don't work in healthcare?
My experience reflects several persistent barriers. First, stigma and outdated perceptions of infectious diseases. My early experiences of isolation created lasting mistrust in the healthcare system and resulted in long-term avoidance of care.
Then a poor transition from active duty to VA care highlights how historically, veterans were not systematically educated on eligibility, enrollment, or the need for longitudinal surveillance or chronic conditions like HBV.
I, like many veterans, was initially denied benefits. This delay led me to disengage from the system entirely, and I would have been lost to follow up if I hadn't taken a job within the VA system many years later. There's also often a lack of clarity on eligibility, particularly for reservists and older veterans.
In the past, reservists who did not deploy were often ineligible for disability benefits, reinforcing the perception that VA care was not available to them. There's also a significant lack of targeted outreach to older veterans. While service members separating in the last 10 to 15 years are generally well-briefed and medically-assessed before discharge, earlier generations were not. In remote California, I routinely meet veterans unaware they qualify for VA services, particularly post-Vietnam era seniors whose records were lost and who may now be newly eligible. Access gaps in rural communities prevent healthcare from reaching those who need it most.
What has improved? To the Air Force's credit, transition briefings are now standard, and separating members receive both physical assessments and education on VA enrollment. Reservists are encouraged to document injuries during deployment. Altogether, the system today is far more proactive than it was in 1995. My own VA care since re-engagement has been excellent.
However, there is still much room for improvement. Based on both my lived and clinical experience, I propose several strategies to meaningfully improve engagement in HBV care for veterans. First, I believe a proactive, registry-based approach is key to identify veterans with prior HBV diagnosis or abnormal liver enzymes. Direct outreach is critical for preventing loss to follow-up, especially in rural regions.
To rectify historical gaps in healthcare after discharge, education campaigns targeted to older veterans should be implemented with clear messaging that eligibility rules have changed, and prior denials can be re-evaluated. As veterans often trust other veterans, peer-driven education by a community talks, VFW, American Legion Partnerships, perhaps, and local health fairs can bridge knowledge gaps for older and younger veterans alike. On the clinical side, embedded HBV screening prompts in primary care and community clinics would prevent missed opportunities for treatment, particularly in rural non-VA settings where veterans may present without denying their veteran status.
Finally, trauma-informed infectious disease care, acknowledging the stigma that many experienced - experienced in the 1980s and 1990s, can help to actively rebuild trust in healthcare and support continued engagement. Chronic hepatitis B is a manageable disease with effective antiviral therapy and surveillance strategies to prevent cirrhosis and hepatocellular carcinoma. Clinical tools are no longer the primary barrier to HBV care. Awareness is. That is, for many veterans, particularly those who serve before a structured transition programs. The issue is not unwillingness to engage. It is not knowing that they can. My story is not unique. The opportunity now is to ensure that no veteran with chronic hepatitis B remains out of care, simply because no one told them they belonged in it.
Thank you, Richelle, and many thanks to you, our listeners, for joining us.
To view the full program and download the accompanying slides, please click the link in the show notes.
To get access to all of our new podcasts, subscribe to the Decera Clinical Education Podcast on Apple Podcasts, Google Podcasts, or Spotify.
Thank you and have a great day!