Hepatitis C, Drug Use and Stigma

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Hepatitis C, Drug Use and Stigma Liz Allen
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What it is Hepatitis C?

• Hepatitis C is a blood-borne virus
• Can cause serious damage to the liver
• First indentified in 1989
• Known as non-A, non-B hepatitis
• Test developed in early 1990s

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What is Hepatitis C?

• Hepatitis C virus (HCV) is spread through
  exposure to infected blood
• Prior to 1991 transmission through blood
  transfusions or blood products
• Sharing of equipment using in injecting drug use

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HCV

• Less common routes of infection
• Mother to baby transmission
• Unprotected sex
• Medical dental treatment abroad
• Tattooing, ear or body piercing
• Sharing razors, toothbrushes and other toiletries
  
• Needle stick injuries

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HCV

• Around 75- 85 of those infected will develop
  chronic Hepatitis C infection
• Of those that become chronically infected 5 to
  15 will go on to develop cirrhosis of the liver
  within 20 years
• Often referred to as the silent epidemic
• Most show no symptoms

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HCV

• No vaccination for HCV
• Treatment for HCV
• Effectiveness of treatment can depend on the
  strain of the virus stage of disease
• Treatment can last between 24 48 weeks
• Some people experience side effects

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HCV in Scotland

• 24,419 diagnoses
• 12 have died
• 59 ( 14,397) are known to have injected drugs
  representing 89 of those with known risk factor
• ( Health Protection Scotland, 2008)

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HCV in Scotland

• Approximately one in 240 of Scotland's population
  have been diagnosed HCV positive
• Number of undiagnosed cases exceeds the number of
  diagnosed cases
• Estimated that 1 of Scottish population are
  infected

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HCV in Scotland
Figure 1 Hepatitis C epidemiological
landscape (estimates) Scotland, 2006.
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HCV in Scotland

• Hepatitis C Action plan for Scotland
• Phase I Sept 2006- Aug 2008 - 4 million
• Phase II May 2008-March 2011- 43 million

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Action Plan

• Investing in the public health of Scotland
• Investment should over the longer term
  significantly reduce the problem of HCV in
  Scotland.

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Action Plan

• improving testing, treatment, care and support
  services for those infected with a major emphasis
  being placed on increasing the numbers of people
  receiving treatment. The plan also recognises and
  addresses the social care needs and the drug
  addiction problems of infected persons through
  actions aimed at improving links between
  clinical, addiction and mental health services
• Hepatitis C Action Plan for Scotland Phase II
  May 2008- March 2011 p4

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• Hepatitis C and Stigma

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What does the research say?

• The vast majority of people with HCV have a
  history of injecting drug use, they are
  frequently assumed by others to be injecting drug
  users, blamed for acquiring the disease and
  viewed as irresponsible, immoral and
  unworthy.

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What does the research say?

• HCV related stigma in health care settings arise
  from practitioners negative views of injecting
  drug use
• Practitioner negative attitudes toward people
  with HCV are the result of their lack of
  awareness and or information about injecting drug
  use

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What does the research say?

• People that have never been an IDU frequently
  report that they have received inadequate and
  judgmental care for hospital staff because
  practitioners assume that they acquired the virus
  through Injecting drug use

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What does the research say?

• Other factors maybe involved
• Illicit drug use
• Poverty
• Ethnicity,
• Homelessness,
• Prostitution
• Mental illness
• All may have an important part to play in the
  stigma experience by those with HCV.

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HCV and stigma

• Stigma may cause people
• To avoid testing, treatment and care
• Not to disclose their Hep C status or injecting
  drug use to others.

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HCV and stigma

• Fear of stigma
• Fear of how they maybe treated accessing health
  services
• Fear of how their family and friends may see them

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HCV and stigma

• Day et al (2004)
• 40 of respondents reported experiencing HCV
  related stigma in
• the previous 2 years.
• Current IDUs were more likely to report
  discrimination than past IDUs or those that never
  injected.

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HCV and stigma

• Zickmund et al ( 2003)
• 57 ( 147) of respondents reported HCV related
  stigma.
• Outcome of this stigma included anxiety,
  depression, decreased quality of life, feeling of
  loss of control and difficulty coping.

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HCV and stigma

• Hepatitis C patient Journey Evaluation Finding
  from an initial scoping exercise.
• The majority of participants, 80 (61/76)
  reported that they had not experience
  discrimination.
• Of the remaining 20, six respondents reported
  negative reactions from family, friends and
  neighbors.
• Eight respondents reported discrimination when
  accessing hospital services or dental treatment
• And 2 respondents experience problems with
  employment.

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HCV and stigma

• There are often institutional and structural
  forces with in health care systems that can
  result in discrimination despite the positive
  attitudes of staff towards those with HCV.

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HCV and stigma

• Institutional policies such as
• Who is eligible for treatment
• Who receives treatment
• Types of support available
• Strict Appointment times
• Methods of referral
• Infection control policies

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Stigma and harm reduction

• Stigma that is associated with drug use can
  hamper the harm reduction approach that is
  essential in helping to prevent HCV infection
  among injecting drug users.

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Stigma and harm reduction

• Staff attitudes and prejudice
• Lack of privacy
• Lack of discretion
• Location of service
• Restrictive policies determined by staff

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Stigma and harm reduction

• Recreational/ occasional users
• Steroid users
• Women with children
• Can experience shame/ embarrassment at accessing
  harm reduction services

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Conclusions

• Stigma can arise from a lack of awareness and
  knowledge.
• The need to educate health care practitioners,
  But
• It is not a guarantee that the recipients of such
  education will integrate this knowledge in to
  clinical practice.

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Conclusions

• There is a need for services for testing and
  treatment that are specifically for IDUs with
  Hepatitis C
• It is unclear if the stigma associated
• with injecting drug use is part
• or whole of the hepatitis C related stigma

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• Liz Allen
• elizabeth.allen_at_uws.ac.uk