Prevention practices toward hepatitis B virus and associated factors among male barbers in the selected districts in Mogadishu, Somalia: a cross-sectional study

In many parts of the world, a haircut is a routine moment of care, but for the men who wield the razors and clippers, it can also be a daily gamble with invisible dangers. One of the most persistent threats is the hepatitis B virus, a microscopic invader that attacks the liver. This virus spreads easily through tiny amounts of blood, even when that blood is not visible to the naked eye. In a barbershop, where sharp blades touch skin and sometimes nick it, the tools themselves can become carriers if they are not cleaned properly between customers. While vaccines exist to protect against this virus, and simple hygiene habits can stop its spread, these protections are not always in place, especially in regions where health systems are still recovering from years of conflict. Understanding how the people who hold the razors actually behave is essential, because their daily choices determine whether a routine shave remains safe or becomes a vector for a disease that can lead to lifelong illness or even cancer.

A team of researchers set out to understand exactly what was happening in the barbershops of Mogadishu, the capital of Somalia. They focused on the men who work there, asking how they protect themselves and their customers from the hepatitis B virus. The study took place over a month in the summer of 2026, covering four distinct districts of the city. The researchers spoke with 384 barbers, a group carefully selected to represent both the official, registered shops and the informal, unregistered stalls that line the streets. Using a structured interview, they asked detailed questions about the barbers' lives, their work habits, what they knew about the virus, and most importantly, what they actually did when they picked up a razor. They looked for specific actions, such as washing hands before touching a client, changing the blade for every single person, disinfecting combs, and wearing gloves. They also checked whether the barbers had ever been tested for the virus or received the vaccine.

The results painted a picture of a profession where safety is often compromised. Among the barbers interviewed, nearly two-thirds were practicing unsafe methods that could easily spread the virus. Only about one-third were following the recommended safety steps. The most common failures were not just about forgetting to wash hands; they involved the core tools of the trade. More than half of the barbers admitted to reusing towels without sterilizing them, and a significant number did not change their combs between clients. Perhaps most concerning was the fact that the majority of these men had never been screened for the virus themselves, and almost 60 percent had never received the protective vaccine. While some barbers did change their blades after each customer, this good habit was often undermined by other risky behaviors, such as failing to disinfect the instruments or not treating accidental cuts with antiseptic.

The study also dug into why these differences existed, looking at the lives of the barbers to see what influenced their choices. It turned out that a barber's education level was a major factor. Those who had attended school were far more likely to practice safe hygiene than those who had not. Similarly, the amount of money a barber earned made a huge difference. Those who earned at least 100 US dollars a month were much more likely to have safe practices, likely because they could afford to buy new blades, disinfectants, and gloves. Surprisingly, the number of years a man had been working as a barber did not make him safer; in fact, those with five or more years of experience were less likely to follow safety rules than those who were newer to the job. This suggests that without regular training, bad habits can become deeply ingrained over time. The length of the workday also mattered, as those working eight hours or more were less likely to maintain safe practices, possibly due to fatigue or the pressure to serve more customers quickly.

Interestingly, the researchers found that simply knowing the facts about the virus was not enough to guarantee safe behavior, though it was still important. While many barbers knew that the virus spreads through blood and that vaccines exist, this knowledge did not always translate into action. The study also looked at whether a barber's attitude toward safety mattered. While those with a positive attitude seemed more likely to be safe in initial checks, this link disappeared when the researchers accounted for other factors like education and income. This suggests that a positive mindset alone cannot overcome the practical barriers of low income or a lack of training. The study did not find a link between the age of the barber and their safety practices, meaning that neither the young nor the old were inherently safer than the other.

The findings point to a clear need for change that goes beyond just telling people to be careful. The researchers suggest that interventions must be practical and tailored to the reality of the barbers' lives. Training should not rely on written manuals, which many barbers cannot read, but should instead use visual demonstrations and simple language to teach how to wash hands, change blades, and sterilize tools. Because money plays such a large role, making safety supplies affordable is just as critical as teaching the skills. The study also highlights that experience does not equal safety, meaning that even veteran barbers need regular refreshers to unlearn bad habits. Ultimately, the work in Mogadishu reveals that preventing the spread of hepatitis B in barbershops requires a combination of education, economic support, and a shift in how safety is practiced every day, ensuring that a simple haircut remains a safe and healthy experience for everyone.