December 14, 2018
The Rohingya Refugee Crisis: Stories Of Survival
In the United States, hepatitis C now kills more people than any other infectious disease. Between 2011 and 2016, new hepatitis C infections in the U.S. more than tripled.
The Center for Disease Control in 2016 noted: “the greatest hepatitis C burden falls on baby boomers – those born from 1945 to 1965 – many of whom have been unknowingly living with the infection for many years.” Most recently, the widespread opioid epidemic has contributed to the rising number of hepatitis infections in the United States.
Our colleague Dr. Niklas Luhmanne—who is an infectious disease and harm reduction advisor at our headquarters in Paris—participated in a 2017 roundtable discussion with members of the International Network on Hepatitis in Substance Users (INHSU) to recommended concrete actions for improving access to care for drug users. The outcomes of this discussion were released earlier this year. Below are some of the key recommendations that came from this discussion.
Despite the evidence that indicates the effectiveness of harm reduction services such as needle distribution programs and opioid substitution therapy, less than 1% of drug users live in countries where these services are readily available to them. In countries like Kenya, 42% of drug users are infected with hepatitis C. Since 2012, Doctors of the World has been operating mobile health units to distribute clean needles to vulnerable communities in Kenya. We also support the Kenyan government with health training, awareness building workshops, and increasing the availability of substitution treatments.
However, there are still areas of the country where harm reduction services are inaccessible or blocked. The INHSU recommends that governments should strive to expand and better support these initiatives.
In addition, communities and policymakers need to combat stigma and discrimination in healthcare settings and educate practitioners in best practices when treating drug users for hepatitis C.
Around the world, many drug users infected with hepatitis C do not obtain the appropriate healthcare for fear of being arrested. Fear of arrest not only prevents drug users from accessing care, but, even after arrest, hepatitis C treatment is often non-existent in jails and prisons. In many ways, this criminalization creates a vicious cycle in which hepatitis C infected drug users are moved through a variety of different legal systems without ever getting the care they desperately need.
The INHSU coalition recommends that governments decriminalize non-violent offenses such as drug use and possession, provide alternatives to imprisonment, and implement hepatitis C treatment programs in prison facilities.
Doctors of the World is a proud supporter of Support. Don’t Punish, a global initiative working to promote drug policies based on public health and human rights.
In 2014, we worked with our partners at the International Network of People Who Use Drugs to develop an evidence-based position paper, that demonstrates to health professionals and policymakers how repressive drug policies remain both a major driver of hepatitis C transmission and a significant barrier to treatment.
With a new election on the horizon, and support for criminal justice reform higher than ever among the electorate, we believe now is the time to make meaningful changes that protect people and prevent further harm.
While expanding access to healthcare and decriminalization are vitally important, these initiatives will mean nothing unless we address the exorbitant prices of treatment for hepatitis C. For many years, exclusive patents on hepatitis C treatments like sofosbuvir, which has a 96% success rate, have allowed large pharmaceutical companies like Gilead to sell the drug at outrageously high prices. At one point in the U.S., Gilead was pricing sofosbuvir at over $86,000 for a 12-week treatment. While prices have fallen thanks to more generic versions of the drug hitting the market, Gilead continues to price their own generic treatment, launched just this year, at $24,000.
In 2015, Doctors of the World challenged Gilead’s monopoly on behalf of more than 8 million chronic hepatitis C sufferers in Europe, becoming the first medical NGO to contest a drug patent with the European Patent Office. Although Gilead still remains powerful within the pharmaceutical industry, these efforts have forced the company to make significant price reductions and opened the door for more competition and increased accessibility.
However, more work can and should be done. In many cases, drug users can’t even afford to get a diagnosis. This contributes to a huge disparity in knowledge around hepatitis C. 9 out of 10 people living with viral hepatitis are completely unaware that they are infected. Ensuring access to affordable diagnostics and treatment are key components in getting hepatitis C infected drug users the care they need.
Marginalized communities are disproportionately affected by drug use, and are thus the most impacted by hepatitis C infection. At Doctors of the World, we recognize the role that social justice plays in solving public health crises. Whether it’s working with sex workers in France and Mexico, or providing access to harm reduction services in Myanmar, our work is centered around on-the-ground advocacy that speaks directly to marginalized communities. The end of hepatitis C comes when we meaningfully engage with people directly affected, empower these communities to be the leaders in the solution, and build a more equitable and healthy society for all.