Jackson (Name changed), a people living with HIV (PLHIV) and co-infected with Hepatitis C Virus (HCV) in India. He lived for more than 20 years of his life with the co-infection just because he could not afford the HCV treatment. The last thing Doctor said was ‘He could have lived longer with timely access to HCV treatment’.
Anni (Name changed), a young female who inject drugs in Indonesia does not know how or when she got infected. She does not know what HCV is or how it is transmitted. She used to share needle with her partner because she could not access harm reduction services due to stigma and fear of arrest by police.
Saroj (Name changed), a 27-year-old injecting drug user in Nepal did not qualify for the opportunity to go abroad to work because he was diagnosed with HCV during medical checkup. Since then for the past 3 years he is living with the virus wasting productive years of his life unemployed.
These are just 3 recent stories from among the 150 million people living with chronic HCV infection worldwide. In 2013, HCV was ranked as the seventh highest cause of mortality globally(1), with an estimated 1.45 million preventable deaths per year from acute infection and hepatitis-related liver cancer and cirrhosis(2). 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. Despite the significant burden on lives, communities and health systems, hepatitis has been largely overlooked as a health and development priority until very recently.
In September 2015, the United Nations General Assembly adopted the 2030 Agenda for Sustainable Development(3), which, in its Goal 3 target 3.3 reads – “By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.” Though explicit as a global public health threat, such global recognition has not necessarily resulted in country action. The end of the three stories could have very well been stories of hope, had they received timely HCV treatment.
World Health Organization (WHO) recognized people who inject drugs (PWID) as the population at higher risk of viral hepatitis infection because of the shared use of contaminated injecting equipment(4). Globally, it is estimated that 67% of PWID are infected with HCV. The reality is that most PWID are unaware that they are infected and HCV treatment rates among them are very low(5). There are a number of reasons for this, including the asymptomatic nature of virus itself, paucity of strategic information, cost of treatment and lack of funding for HCV interventions leading to a pandemic, which is further exacerbated by criminalization of drug use, as well as gender and behavior-based stigma and discrimination in the health settings.
Since WHO issued the first Guidelines for the screening, care and treatment of persons with hepatitis C infection in 2014, several developments in terms of medicines, strategies and guidelines, and funding have occurred, but the barriers still continue to impede the effective implementation of these developments.
The Asian Network of People who Use Drugs (ANPUD) has grave concerns based on the updated 2016 guidelines and recommends the following actions to the governments in Asia.
- Since effective programming stems from the quality and availability of data in the country, we urge Asian governments to invest resources in generating national and sub-national data on HCV among PWID.
- We urge Asian governments to develop and endorse national guidelines and strategies for diagnosis, treatment and care of people living with HCV based on the national data, WHO guidelines and the 69th World Health Assembly Global health sector strategies on viral hepatitis 2016-2021 – with meaningful engagement of people who use drugs.
- We strongly urge Asian governments to ensure equitable access to treatment with the new direct-acting antivirals (DAAs).
- We urge Asian governments to scale up quality harm reduction interventions as preventive measures and integrating the harm reduction into the national guiding documents and investment frameworks.
- We share our grave concern towards the criminalization of people who use drugs and recommend that governments to opt for a public health approach to drug use and related harms.
- We urge Asian governments to exercise TRIPS flexibilities to ensure that the generic DAAs are easily available, accessible and affordable in all the countries in the region.
For further info: Please contact Bikas Gurung at [email protected]
- 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.
- World Health Organization. New Recommendations in the Updated WHO Guidelines for the Screening, Care and Treatment of persons with Chronic Hepatitis C Infection. 2016.
- United Nations General Assembly resolution A/RES/70/1. Transforming our world: the 2030 Agenda for Sustainable Development 2015.
- World Health Organization. Technical Considerations and Case Definitions to improve Surveillance for Viral Hepatitis. 2016.
- World Health Organization. Guidelines for the Screening, Care and Treatment of persons with Chronic Hepatitis C Infection: Updated Version April 2016. 2016.