Hep C among IDU: need for improved evidence-based and non-discriminatory policies and services
need for improved evidence-based and non-discriminatory policies and services
A new report entitled “Hepatitis C Among Injecting Drug Users in the New EU Member States and Neighboring Countries: Situation, Guidelines and Recommendations” shows that inadequate political commitment, prevention and neglected treatment interventions exist in the new EU member states, Russia and other Eastern European countries. In 13 of these countries, home to an estimated 2.1–3.3 million injecting drug users (IDUs), the prevalence of hepatitis C is as high as 70%-90% among IDUs, depending on the setting. At the same time, most IDUs do not have access to evidence-based prevention services and are systematically denied hepatitis C treatment, care and support.
The report, developed by the Central and Eastern European Harm Reduction Network (CEEHRN) in partnership with medical professionals and civil society representatives, summarizes the epidemic as well as governmental and local responses in 13 countries as well as evidence for hepatitis C prevention, treatment and support targeting drug users.
The growing hepatitis C epidemic could be managed by a commitment to address the needs of IDUs. The report calls for strengthening national advocacy efforts by raising awareness about the issue and building the capacity of health care specialists and service providers in order to enhance their knowledge and ensure non-discriminatory services and treatment practices. “Governments must take much more effective action now to prevent unnecessary deaths from this serious, but treatable disease. The biggest hurdle we are facing is that hepatitis C has not been made a priority”, said one of contributors Charles Gore of The Hepatitis C Trust. In order for hepatitis C to be put on the public health policy agenda, the report also calls on EU-wide hepatitis C actions.
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Hepatitis C spreads rapidly among IDUs due to the high infectivity of the virus (about 10 times higher than HIV). Unlike HIV, it can be transmitted by sharing not only needles and syringes but also other injecting equipment (which comes into contact with and carries infected blood particles). Hepatitis C often presents no symptoms, and the vast majority of infected people are not aware of their status. This is even more common among IDUs, since a large part of this group is not reached by services and remains outside of the health care system. At the same time, hepatitis C presents a critical public health problem. Hepatitis C becomes chronic in about 85% of those infected, leading to liver disease like cirrhosis, liver failure and cancer. An estimated 250 000 people die annually of hepatitis C-related causes. Morbidity and mortality from HCV infection are expected to continue to risiein the coming decades. Yet only 2 out of the 13 countries studied have a strategy/program to manage hepatitis.
Access to prevention services for IDUs, including outreach, needle exchange and opioid substitution therapy varies across Europe and although better in Central than Eastern Europe, is still inadequate; in Russia the coverage might be as low as 2%. HCV testing and counseling is poorly linked to already established services for IDUs and is available at needle and syringe exchange and substitution therapy programs in only 5 countries, which also results in low hepatitis C literacy in IDUs communities.
In at least 9 out of 13 countries drug use is indicated as contraindication to hepatitis C treatment in treatment guidelines, with the exception of Slovenia, where hepatitis C treatment for drug users is recommended in cooperation between specialists in infectious diseases and drug addiction treatment. Even people undergoing drug substitution therapy are often declined treatment, while international guidelines state that drug users can not be excluded from treatment.
Further information:
Simona Merkinaite, Vilnius, Lithuania
Phone: +370 5 2609007
E-mail: simona@ceehrn.org
The electronic version of the report in English as well as Fact sheet with key facts and issues in English and Russian can be found at CEEHRN website at www.ceehrn.org/hepatitis.
Russian version of the report will also be available shortly. The information will be distributed separately. For printed copies, please write to simona@ceehrn.org.
With kind regards,
Simona Merkinaite
Central and Eastern European Harm Reduction Network
Address: Pamenkalnio 19-6, Vilnius 01114, Lithuania
Tel.: +370 5 2609007, 2691600
Fax: +370 5 2691601
Mob.: +370 6 8254401
E-mail: simona@ceehrn.org
Web: www.ceehrn.org
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