Hep C and IDU

Welcome to 2009, loyal subscribers!

Interesting news story, below, on the rise of Hep C among IDUs, and the role of NSP to turn the tide. The story is about the UK, but this issue is global.

Happy New Year!
Rob



http://www.guardian.co.uk/society/2009/jan/07/drugs-hepatitis-c-society-needle-exchange

A dose of realityAn increase in cases of hepatitis C among injecting drug users has led to calls to reverse the dramatic fall in needle exchangesDiane Taylor The Guardian, Wednesday 7 January 2009 Article historyIn terms of its public profile, hepatitis C is a poor relation of the HIV virus. However, an estimated 170 million people worldwide are infected with the blood-borne virus, and many of them have no idea they are walking around with it until years or even decades later. Twenty years after becoming infected, one in six people develop serious liver damage; after 30 years, the figure is nearly a quarter.

New figures published by the Health Protection Agency show that there has been an increase in hepatitis C among injecting drug users. In the late 1990s, a fifth of injectors became infected within three years of starting to inject, but now around 50% of injectors have the virus.

Because the virus is able to survive outside the body for longer than HIV, it is relatively easy to become infected with it, and the main route of transmission in this country is among drug users who share injection paraphernalia.

It is with this group that the most effective harm reduction work can be done and the Department of Health, the National Treatment Agency and Exchange Supplies have launched a campaign urging drug users not to share injecting equipment.

However, Sara McGrail, an independent drug policy specialist, is concerned about a dramatic fall in the number of needle exchanges. She says: "I'd like to see more of these needle exchanges, and they should offer extended access and support. At the moment, a lot of needle exchanges are open only from 9am to 5pm.

"Harm reduction is mentioned only once in the new drugs strategy, and this is a real missed opportunity. For the last 10 years, the government has pursued a policy of trying to reduce demand for drugs. What we need is pragmatic harm reduction, because access to clean needles saves lives."

David MacKintosh, policy adviser to the London Drug Policy Forum, says that one of the most effective ways to prevent the spread of the virus among drug users is to reach people when they first start injecting. "We need to go back to what we used to do, with more outreach to drug users, including better education and more needle exchange programmes," he says.

It was Margaret Thatcher's government that pioneered the use of needle exchanges and other harm reduction measures to prevent an epidemic of HIV among drug users in the 1980s. The policy was extremely effective, and when hepatitis C emerged as another threat, the distribution of clean needles helped to curb the spread of this virus.

Erin O'Mara, editor of Black Poppy, the health and lifestyle magazine for drug users, believes peer education could go a long way toward reducing the spread of hepatitis C. "People who sit in crack houses and those under 18 may be under the radar of drugs services," she says. "Peer educators who are also sitting in those crack houses or in drug users' kitchens can get those safety messages across."

While hepatitis C is a potentially fatal condition that is on the increase, Graham Foster, professor of hepatology at Queen Mary, University of London, sounds a note of optimism. The condition, he points out, is usually treatable with a drug regime and, even at a cost of several thousand pounds, is much more cost effective than caring for someone with liver failure.

"Things are getting a little better," Foster says. "Barriers to treatment are coming down, although we've still got a long way to go. We haven't jumped forward, but we are certainly inching forward ."