Hepatitis is an inflammation of the liver that is most often caused by a virus, though infections, diseases, and toxins may also contribute.[i] The five predominant viruses are Hepatitis A, B, C, D, and E, with B and C leading to chronic disease for hundreds of millions of people. Hepatitis A and E are generally caused by consuming infected food or beverages, whereas B, C, and D involve contact with infected bodily fluids. Hepatitis D only affects people with Hepatitis B.[ii] Vaccines exist for every one of these viruses except for Hepatitis C,[iii] and as such it constitutes a greater risk for many people.
Hepatitis C was discovered in the 1980s and typically occurs when the Hepatitis C virus attacks the liver. It affects about 170 million people worldwide.[iv] In Canada, it is estimated that 242,500 people have Hepatitis C, but about 20% of these people are unaware of this diagnosis.[v] An acute infection lasts from the first 6 weeks to 6 months, and in about 25% of infected people, the virus disappears on its own.[vi] For the remainder of people, the infection is chronic after this point. Some who contract it never feel sick whereas others experience symptoms like loss of appetite, fatigue, nausea, fever, pain in the abdomen and abdominal swelling, bruising, dark urine or blood in the urine and stool, and jaundice[vii]. Progression may be slow, taking 20-30 years.[viii] Because symptoms do not appear for some until they have sustained severe liver damage, Hepatitis C is often referred to as a silent disease. Chronic hepatitis may lead to fibrosis (scarring of the liver), liver failure, cirrhosis, and liver cancer.[ix]
The Hepatitis C virus is spread via contact with infected blood. This can happen through sharing snorting or injecting equipment (like straws and needles), receiving a blood transfusion in an area where it is not screened for Hepatitis C (this only applies to transfusions that took place before 1990 in Canada), sex, sharing personal hygiene items (like toothbrushes, razors, nail files, etc.), using unsterile equipment for tattoos, piercings, electrolysis, and acupuncture, and during child birth.[x] People who were born between 1945 and 1975, have been in jail, have stayed in a region where rates are high (like India, Vietnam, Pakistan, etc.), have multiple sex partners, have rough sex, and have another infectious disease or sexually transmitted infection are at elevated risk.[xi]
The diagnosis for Hepatitis C involves an antibody test and then a qualitative polymerase chain reaction test. If a person tests positive, regular blood tests to assess liver function and general health is recommended. Although there is no vaccine available for Hepatitis C, vaccines for Hepatitis A, Hepatitis B, and pneumococcal disease are recommended and free to people with Hepatitis C. Exercising regularly, eating properly, and cutting down on alcohol may slow progression of the disease.[xii] Depending on the genotype of the Hepatitis C virus, treatment may be available. The standard treatment includes 2 or 3 medications used in combination like pegylated interferon, ribavirin, boceprevir, telaprevir, simeprevir, and sofusbuvir.[xiii] Liver transplantation is also required for some.[xiv]
Despite treatment options, there are a number of barriers preventing infected persons from accessing them. In low and middle income countries, high cost, the need for complex lab testing, and side effect profiles make treatment difficult to access.[xv] However, in high income countries, many barriers still remain. People may not be aware of treatment options (or the need to be tested regularly), may not feel it is a great enough priority for them, may possess negative perceptions or fear about treatment, may feel the waiting list is too long, or may feel they do not have a strong enough support network to help them get through treatment. Even if individuals possess medical insurance, many cite lack of financial resources as a barrier and may find it unfeasible to take off time at work.[xvi] Factors related to poverty like employment and housing insecurity and lack of transportation also constitute important barriers.[xvii] Furthermore, recognition of stigma plays a role in preventing infected persons from seeking treatment, as many believe there are negative assumptions made about their drug use, promiscuity, and HIV status.[xviii] Some also may find the treatment regimen and side/ psychiatric effects too difficult to deal with and may find injecting medication too triggering. Additionally, healthcare providers may be resistant to providing treatment to persons who identify as drug users, despite that studies suggest that rates of sustained virological response are similar between those who actively inject and those who don’t.[xix] Too few specialists (and testing locations) as well as healthcare providers who are unaware of treatment options and don’t spend adequate time assessing patients also hinder diagnosis. Barriers at the government level include lack of funding and poor treatment promotion.[xx]
Canadian Students for Sensible Drug Policy supports a number of initiatives and recommendations which decrease hepatitis risk. We consider problematic drug use to be a health issue and thus support harm reduction practices to reduce risk, like providing information and supplies, so things like needles and straws are not shared. Not only does this reduce risk of initial infection but evidence suggests that the risk of re-infection is lower when people have access to harm reduction information and supplies.[xxi] We also recognize the interaction between social determinants of health and rates of hepatitis and try to employ an anti-oppressive framework that empowers marginalized populations who are at an elevated risk of infection. This may include having respected activists speak at our national conferences on how to implement outreach programs, advocating for safer consumption and injection facilities across Canada, and speaking with stakeholders on high-risk populations like prisoners and street youth. Our mandate to decriminalize drug use would help overcome the stigma and other barriers that prevent reasonable access to treatment for numerous individuals. In the future, we would like to see more comprehensive teams to monitor and assist persons with Hepatitis C, a broader approach to address other determinants of health that affect treatment outcomes (like adequate housing), greater access to peer and harm reduction support, and better collaboration between governmental, educational, and health care stakeholders.