We are simply not the Priority

ANPUD Statement on the World Hepatitis Day 2018

Please direct your queries to:

Bikas Gurung

We are simply not the Priority

“People do not lose their rights simply because they use or sell drugs”

An estimated 110 million people have a history of Viral Hepatitis C (HCV) infection and 80 million have chronic viraemic infection worldwide.[1] In 2013, HCV was ranked as the seventh highest cause of mortality globally,[2] with an estimated 1.45 million preventable deaths per year from acute infection and hepatitis-related liver cancer and cirrhosis.[3] South and East Asia are the regions with greatest numbers of deaths attributed to viral hepatitis, while Central Asia has one of the highest mortality rates. In Southeast Asia, 78% of the 408,000 deaths related to viral hepatitis is attributed to Viral Hepatitis B and C (HBV and HCV), ranking cirrhosis of liver as the top 5 causes of death among the age group 15-59.[4][5] Despite the significant burden on the lives of our communities and health systems, hepatitis has been largely overlooked as a health and development priority until very recently.

In Asia, people who use drugs (PUD) have typically been excluded from access to health care and treatment in many countries. We have either been denied access outright or discouraged to seek health services through the implementation of bad laws and policies that criminalize drug use and possession for personal use. This discrimination has led to a terrible situation where our community suffers the most from preventable HIV and HCV infections and related deaths, from overdose-related deaths and from the politically motivated war on drugs that has been used to brutally murder our friends and families. No matter which segment of society we belong to — the fact remains that we are pushed to the edges of the society, where it becomes convenient for all to ignore our health and other human rights issues.

“Not that there has been no progress in terms of HCV response: certainly there are, but when we it comes to addressing the needs of people who use drugs – we are simply not the priority” – Anand Chabungbam, Regional Coordinator of the Asian Network of People who Use Drugs (ANPUD).

The World Health Organization (WHO) has recognized people who inject drugs (PWID) as the population at higher risk of viral hepatitis infection because of not having access to clean needles and injecting equipment.[6] In 2009, the WHO, UNODC and UNAIDS technical guide recommended HCV diagnosis and treatment service as part of the comprehensive package of interventions for the prevention, treatment and care of HIV among people who inject drugs.[7] In September 2015, the United Nations General Assembly adopted the 2030 Agenda for Sustainable Development, which in its Goal 3.3 targets to eliminate the epidemics of several diseases including viral hepatitis.[8]

WHO Director-General Dr Tedros Adhanom Ghebreyesus in a video statement said “We have a clear vision for elimination, and we have the tools to do it. But we must accelerate progress to achieve our goal of eliminating hepatitis by 2030.”

In papers enormous progress have been made however it is a whole other story for our community to benefit from it. The state of harm reduction services designed to save lives of people who use and inject drugs is severely insufficient and stagnant. A recent report by the Harm Reduction International (HRI) found serious neglect for harm reduction funding in low and middle-income countries (LMICs) – “In 2016, just 13% of the required amount of funding was allocated to harm reduction in LMICs.[9]

Source: Harm Reduction International (HRI)

People who use drugs and their organizations have a vital role to play in the process of translating these words into action. Criminalizing laws & policies and stigma & discrimination inhibit us from performing our role effectively. Yet we have been performing at different level of responses to eliminate HCV – from as a patient to peer support, as a HCV prevention outreach to an advocate. Governments should start to realize and recognize the high level of contributions our community members have made till date and create enabling environment for us to contribute more.

“We do have a clear vision and tools for elimination like the WHO DG said but what we lack is the fund to achieve our goal of eliminating hepatitis by 2030.” said Bikas Gurung, Program and Communication Manager of ANPUD.

“We need a Global Fund to fight against Hepatitis C Virus,” he further added.

We recognize and welcome the level of progress being made with respect to the commitments and advancements of newer, safer and more potent pan-genotypic Direct Acting Antiviral (DAA) regimens. But at the same time, we insist on the full implementation and access to affordable diagnostics and treatment services without any delay because millions of lives are at stake. Since effective programming stems from the quality and availability of data in the country, governments should invest resources in generating national and sub-national data on HCV among people who use drugs. National guidelines and strategies for diagnosis, treatment and care of people living with HCV should be developed through meaningful engagement of people who use drugs. Finally, governments must ensure equitable access to affordable diagnostics and treatment with the new DAAs.

The Asian Network of People who Use Drugs (ANPUD) is a regional community network committed towards advocating for equal rights and opportunities for people who use drugs. This statement is issued to observe the World Hepatitis Day 2018 and to bring our issues and needs into attention of broader stakeholders.

Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver.


[1] WHO Guidelines on testing 2017

[2] Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. The Lancet.

[3] World Health Organization. New Recommendations in the Updated WHO Guidelines for the Screening, Care and Treatment of persons with Chronic Hepatitis C Infection. 2016.

[4] WHO Global Health Estimates 2015. Available from: http://www.searo.who.int/entity/hepatitis/data/hepatitis_data_statistics/en/

[5] Top Ten causes of death http://www.who.int/gho/mortality_burden_disease/causes_death/top_10/en/

[6] World Health Organization. Technical Considerations and Case Definitions to improve Surveillance for Viral Hepatitis. 2016.

[7] WHO, UNODC, & UNAIDS. (2009). Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users.

[8] United Nations General Assembly resolution A/RES/70/1. Transforming our world: the 2030 Agenda for Sustainable Development 2015.

[9] Harm Reduction International (HRI). The neglect for harm reduction funding in low- and middle-income countries. 2018.

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