Beyond Treated, Cured (Hepatitis C Barriers to Care)

National Viral Hepatitis Roundtable, People’s Harm Reduction Alliance, and Urban Survivors Union (Piedmont Chapter) are working together on a grant to discover barriers to care for people who use drugs related to Hepatitis C.

We received funding from Gilead which has allowed us to hold focus groups and make a short advocacy video.  We are currently looking for people who use drugs to help us as we develop educational tools and develop a communication campaign designed to help injection drug users, stimulant users, and women who use drugs protect themselves from hepatitis C.

Hepatitis C is a bloodborne virus

that remains highly infectious and lives outside the body for up to 3 weeks.[1]  Injection drug use is the most common mode of transmission for HCV.  To stay safe and free from this disease as an injection drug user, you must learn and practice infection control standards, which prevent blood to blood transfer from one person to another.  HCV is a highly viable virus, 10x more infectious than HIV. Unlike Hepatitis A and B, there is no vaccines available for HCV.  

Unfortunately, many people who use drugs do not receive a formal education around safer drug use, Hepatitis C, or receive useful information about how to inject properly until after they have already contracted HCV.[2] As a result 75% of people who have ever injected drugs have HCV, and a quarter of injectors contract HCV within the first 2 years of injecting. It is vital that we reach people before they initiate injection drug use.

We are currently in the middle of an opioid epidemic. It is important to remember that anyone can suffer with a substance use disorder.  Stigmatizing images in the media often fool people into believing that everyone who injects drugs is poor, uneducated and out of control. Anyone can use drugs and anyone can fall victim to chaotic substance use/addiction.  Many victims of the current epidemic are suburban, white, middle class members, who began using pain pills and transitioned to using injectable heroin.  The opioid epidemic killed more than 33,000 people in 2015.

There has been a huge push around the country to increase HCV education and prevention information, but it has not yet made its way into the NC high school health curriculum and is still surprisingly absent from many treatment centers and drug user service organizations. Too often required HCV classes lack cultural competence and fail to teach drug users important tools and strategies for avoiding HCV infection, while improving their overall health and safety. In spite of recent efforts to increase access to testing, over 50% of IDU’s are not aware they are infected with HCV. Many drug users are also denied treatment due to their status as an active user. The financial consequences of Hepatitis C cost more than every other reportable disease combined.

SYRINGE ACCESS

The criminalization of drugs, conservative policies, zero tolerance attitudes, stigma and tough love rhetoric all contribute to increased risk for drug users. Policy changes are necessary if we are to eliminate HCV.  Important Policy Changes which can improve drug user health include: Good Samaritan Legislation,  Naloxone Access, Syringe Exchange/ Drug equipment decriminalization & eliminating felony status for minor possession charges.

Until 2016 syringe exchange was illegal in North Carolina which created an environment where injection drug users were not able to take care of their health.  There are still many places in North Carolina, especially rural areas where access to syringes are severely limited. Syringe exchanges offer engagement with people who are actively using.  We can provide access to wound care, culturally competent prevention education, comprehensive wrap around services, buprenorphine and or methadone and other social services.

Addiction Treatment

Abstinence based treatment models which dominate the treatment industry often negatively affect health decisions made by drug users, because they are taught that abstinence is a necessary prerequisite for ANY positive behavior change [3]. Harm reduction challenges these messages and encourages any positive change, regardless of continued use. We know that as long as people are trying, staying positive, and don’t give up anything is possible.

Evidence shows that medication assisted treatment combined with syringe access reduce the odds of a new HCV infection by 80%.[4]  In spite of such successful numbers, ignorance and stigma have created a combination of barriers for people who use medication assisted treatment. MAT is the gold standard for opiate addiction yet people are regularly denied access to this treatment reasons which are not based I science.

HCV & YOUR BODY

Hepatitis C is sometimes called the silent killer because people do not experience negative health consequences for 20 years.  25% of people who acquire HCV will for whatever clear the virus on their own. If this happens the person can be re-infected with HCV just like someone who has been cured. Re-infection is cited as the reason many doctors refuse to treat active drug users. The most current research is very clear, that concerns of reinfection are not acceptable reasons to deny drug users access to treatment.[5]

HARM REDUCTION PLAN

A harm reduction plan should be integrated into the lives of anyone who is injecting drugs to prevent infection or reinfection. The plan should identify situations which might subject them to higher risk for sharing supplies or syringes.  Safer syringe injection procedures must be taught and practiced.  These include:  keeping a clean area, washing hands and injection site prior to injection, using sterile water and new cups for every injection and cleaning injection site and anything with blood on it thoroughly.  Lastly, disposing of all syringes in a puncture proof container.  In situations where a new syringe for every shot is not possible we recommend bleach to clean the syringe.  To kill the HCV virus the syringe must be soaked no less than 1 part bleach and 1o parts water for at minimum 2 minutes pulling the bleach and water up to the top of the syringe and squirting it out multiple times.  Other household items such as alcohol and hydrogen peroxide can be used to decrease risk if bleach is not available, but these are not as effective.[6].

Injecting pain pills and stimulants both increase risk for HCV due to the use of multiple syringes, complicated preparation process, and increased need to  inject.

WOMEN AND HEPATITIS C

With the increase in young people with hepatitis C there is a rise in children being born with HCV. Transmission from mother to child is low (5%) but still a concern.  Women who use drugs are at an increased risk for HCV biologically as well as socially.  Women have smaller surface veins making injection drug use more difficult. More blood = more risk. They often require help getting their shot and this increases risk for acquiring HCV.  Women are often left to use after their partner, and power imbalances in relationships increases risk among our participants.  Domestic violence is increased among injection drug using women.  Women are often afraid to seek services for their drug use because they fear seeking help might alert family or social services which put their families at risk for being separated.    Power- Unbalanced relationships- toxic -abusive relationships, difficult smaller veins, and inability to control their own injections all make injecting safely increasingly difficult.

[1] (Centers for Disease Control, 2017)

[2] (Kimberly Page, 2013)

[3] (PetersonI, MitchellI, HongI, Michael AgarII, & LatkinI, 2016)

[4] (Kimberly Page, 2013)

[5] (Kimberly Page, 2013)

[6] (Centers for Disease Control, 2016)

 

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