It has been nearly a decade since medical science provided a cure for hepatitis C (hep-C), a potentially deadly viral infection that affects the liver and can lead to severe health complications if untreated.
The legacy and ongoing toll of hep-C remains complicated by racial inequality, income disparity, and stigma.
Yet incidents of hep-C infection and mortality in the United States remain stubbornly—some would say unforgivably—high, infecting tens of thousands of Americans every year, and killing as many as 15,000 annually, with over two million people affected across the country.
Meanwhile, the legacy and ongoing toll of hep-C remains complicated by racial inequality, income disparity, and stigma around drug use, as the virus is most commonly transmitted through injection drug use.
Black, Latinx, and Asian Americans were less likely to receive treatment for the disease.
Studies abound showing that hep-C affects Black and other BIPOC Americans at disproportionately high rates, with Black Americans being 1.4 times as likely to develop an infection and twice as likely to die from hep-C as non-Latinx Whites, according to the US Department of Health and Human Service’s Office of Minority Health.
And those racial disparities are not just related to infection rates: Black, Latinx, and Asian Americans were less likely to receive treatment for the disease, a 2016 study published in the journal Medicine found.
Other social disparities besides race are also associated with hep-C infections and treatment rates, according to another study in the Journal of Urban Health. The study found positive associations between hep-C infections and factors including neighborhood poverty, educational levels, and the proportion of non-English-speaking households.
So, the reasons for both the persistence of the disease and the barriers to its successful treatment are numerous—but given that a relatively simple cure already exists, they can and should be eliminated, writes Dr. Francis Collins, a former director of the National Institutes for Health, who now leads the current White House effort to eliminate hep-C, in a recent op-ed for the New York Times.
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“Put simply, we are squandering one of the most important medical advances of the 21st century. It’s time to eliminate this threat to the health of Americans,” writes Collins.
The hurdles to doing so, asserts Collins, are relatively straightforward: they include economic barriers, stigma, and a lack of access to appropriate healthcare for populations most affected:
The cost of curative medications remains stubbornly high, so many insurance companies and Medicaid programs have erected barriers to coverage, requiring, for instance, abstinence from drugs and alcohol before people can receive treatment, referral to a specialist, or that the patient already shows liver scarring. Relatively few doctors offer treatment, and many sites where people at risk come for care do not even offer testing, let alone the cure. The result is that fewer than one in three people diagnosed with active infection get timely treatment.
“We are squandering one of the most important medical advances of the 21st century.”There is a clear path forward, Collins says, urging that Congress move forward with funding for a plan by the Biden administration to eliminate hep-C infections, announced this October. The plan calls for some $15 billion in funding over five years to bring new hep-C infections down as close as possible to zero.
Another angle to solving the US hep-C problem, only tangentially touched upon in Collins’s op-ed, lies in the area of harm reduction initiatives.
The National Harm Reduction Coalition notes that as a disease primarily transmitted by injection drug use, clean needle initiatives such as needle exchanges and free needle services have shown to be an effective way to prevent hep-C transmission.
By making screening for hep-C available and accessible to drug users, the group has argued, those infected get crucial treatment and can reduce the risk of further spreading the infection.
The goal, Collins writes, is ambitious but not unattainable. Other countries, including the United Kingdom, Australia, and Egypt, have made impressive strides in reducing the incidence of the disease. And curing the infection in a patient prevents transmitting the disease to someone else, meaning that “every case treated today means multiple cases averted in the future.”