Hepatitis in drug users: time for attention, time for action

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http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61132-X/fullte\

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The Lancet, Volume 378, Issue 9791, Pages 543 - 544, 13 August 2011

doi:10.1016/S0140-6736(11)61132-XCite or Link Using DOI

Published Online: 28 July 2011

Hepatitis in drug users: time for attention, time for action

ph J Amon a

In place of saints' days or public holidays, public health practitioners

celebrate disease days: World Cancer Day in February,1 Stroke Day in October,2

and World AIDS Day on Dec 1.3 The main reason for these days is to raise

awareness, a key part of which is the presentation of descriptive statistics:

without intervention, 84 million people will die of cancer between 2005 and

2015;1 every 6 s someone will die from stroke;2 and 33 million people are living

with HIV.3

In The Lancet, and colleagues4 review 4386 peer-reviewed sources and

1019 grey literature sources to estimate—at national, regional, and global

scales—prevalence and population estimates for hepatitis B and C in injecting

drug users (IDUs). The investigators provide the requisite bold statistics: 10

million IDUs might be positive for hepatitis C antibodies and more than 80% of

IDUs in 12 countries are estimated to be infected. More than 6 million IDUs

might be positive for hepatitis B core antibodies. The investigators do not

estimate the burden of death and disease from these infections, but it is likely

to be substantial: more than 1.5 million deaths occur every year from acute

hepatitis B and C infections, hepatocellular carcinoma, and cirrhosis.5

July 28 is World Hepatitis Day, and the article by and colleagues4 forms

part of the efforts to raise awareness about this disease. While focusing

attention on hepatitis is a challenge generally, mobilisation of action to

address the disease in drug users is even more difficult.

Drug users around the world face stigma, discrimination, mistreatment, and the

systematic violation of their human rights.6 Harm-reduction strategies that, in

addition to prevention of HIV infection, could help to reduce hepatitis B and C

transmission are widely underfunded or blocked by local or national governments

altogether. In June, 2011, the United Nations General Assembly feebly called on

nations to give “consideration, as appropriate” to implementation and expansion

of harm-reduction programmes.7 Not surprisingly, countries that do not find drug

users worthy of consideration often find harm reduction inappropriate.8

Through country-by-country estimates, and colleagues provide an

opportunity to examine striking disparities in rates of hepatitis B and C. Why

is the prevalence of hepatitis C antibodies in IDUs in Hungary 23%, whereas it

is about 90% in Estonia or Lithuania and 73% in Russia? Why do 85% of IDUs in

Mexico have hepatitis B core antibodies compared with 20% of IDUs in Uruguay?

These differences could be due to the limitations of the data: despite thousands

of studies reviewed, grade A reports (ie, a multisite seroprevalence study with

several sample types for at least one hepatitis marker) were only available for

20 of the 77 countries for which any data were available, and few studies

provided truly national estimates.4 However, the differences may also show

trends and patterns of drug use, or important differences in state policies and

investment in harm reduction. Large between-country variations emphasise how

high rates of hepatitis B, hepatitis C, or HIV infection in drug users are not

inevitable.9 Moreover, the estimates provide a powerful means for health and

human rights advocates to question government officials in countries with high

prevalences, and to caution governments in countries with low prevalences about

the potential costs (human and economic) of failing to put in place, or sustain,

effective, rights-based policies.

and colleagues4 conclude that improved recognition of hepatitis in IDUs

and development of comprehensive and effective strategies are needed. No doubt

this is true, to some extent. However, the history of HIV in IDUs shows that

much more than awareness and evidence-based approaches are needed to bring about

change.10 A lesson to recall is the importance of looking to those most affected

(ie, people who use drugs) for guidance and leadership in development of

effective responses and identification of barriers to their implementation.

Until governments abandon the failed so-called war on drugs11 and their reliance

on repression in response to drug use, we will continue to need days to

recognise and raise awareness of hepatitis in drug users. At the same time, we

should remember the harm that arbitrary detention, forced labour, physical

abuse, and torture causes to IDUs.12 Health is often proclaimed to be at the

centre of drug policy, but support for the protection and promotion of the right

to health, and other human rights, of drug users is often wholly absent.13

and colleagues4 provide us with a first step and powerful data to draw

attention to the problem of viral hepatitis in people who use drugs. The next

step is to challenge governments to act, and hold them accountable for

implementation of rights-respecting and evidence-based programmes.

I declare that I have no conflicts of interest.

References(cut)

[Guest guest]

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61132-X/fullte\

xt?_eventId=login & elsca1=ETOC-LANCET & elsca2=email & elsca3=segment

The Lancet, Volume 378, Issue 9791, Pages 543 - 544, 13 August 2011

doi:10.1016/S0140-6736(11)61132-XCite or Link Using DOI

Published Online: 28 July 2011

Hepatitis in drug users: time for attention, time for action

ph J Amon a

In place of saints' days or public holidays, public health practitioners

celebrate disease days: World Cancer Day in February,1 Stroke Day in October,2

and World AIDS Day on Dec 1.3 The main reason for these days is to raise

awareness, a key part of which is the presentation of descriptive statistics:

without intervention, 84 million people will die of cancer between 2005 and

2015;1 every 6 s someone will die from stroke;2 and 33 million people are living

with HIV.3

In The Lancet, and colleagues4 review 4386 peer-reviewed sources and

1019 grey literature sources to estimate—at national, regional, and global

scales—prevalence and population estimates for hepatitis B and C in injecting

drug users (IDUs). The investigators provide the requisite bold statistics: 10

million IDUs might be positive for hepatitis C antibodies and more than 80% of

IDUs in 12 countries are estimated to be infected. More than 6 million IDUs

might be positive for hepatitis B core antibodies. The investigators do not

estimate the burden of death and disease from these infections, but it is likely

to be substantial: more than 1.5 million deaths occur every year from acute

hepatitis B and C infections, hepatocellular carcinoma, and cirrhosis.5

July 28 is World Hepatitis Day, and the article by and colleagues4 forms

part of the efforts to raise awareness about this disease. While focusing

attention on hepatitis is a challenge generally, mobilisation of action to

address the disease in drug users is even more difficult.

Drug users around the world face stigma, discrimination, mistreatment, and the

systematic violation of their human rights.6 Harm-reduction strategies that, in

addition to prevention of HIV infection, could help to reduce hepatitis B and C

transmission are widely underfunded or blocked by local or national governments

altogether. In June, 2011, the United Nations General Assembly feebly called on

nations to give “consideration, as appropriate” to implementation and expansion

of harm-reduction programmes.7 Not surprisingly, countries that do not find drug

users worthy of consideration often find harm reduction inappropriate.8

Through country-by-country estimates, and colleagues provide an

opportunity to examine striking disparities in rates of hepatitis B and C. Why

is the prevalence of hepatitis C antibodies in IDUs in Hungary 23%, whereas it

is about 90% in Estonia or Lithuania and 73% in Russia? Why do 85% of IDUs in

Mexico have hepatitis B core antibodies compared with 20% of IDUs in Uruguay?

These differences could be due to the limitations of the data: despite thousands

of studies reviewed, grade A reports (ie, a multisite seroprevalence study with

several sample types for at least one hepatitis marker) were only available for

20 of the 77 countries for which any data were available, and few studies

provided truly national estimates.4 However, the differences may also show

trends and patterns of drug use, or important differences in state policies and

investment in harm reduction. Large between-country variations emphasise how

high rates of hepatitis B, hepatitis C, or HIV infection in drug users are not

inevitable.9 Moreover, the estimates provide a powerful means for health and

human rights advocates to question government officials in countries with high

prevalences, and to caution governments in countries with low prevalences about

the potential costs (human and economic) of failing to put in place, or sustain,

effective, rights-based policies.

and colleagues4 conclude that improved recognition of hepatitis in IDUs

and development of comprehensive and effective strategies are needed. No doubt

this is true, to some extent. However, the history of HIV in IDUs shows that

much more than awareness and evidence-based approaches are needed to bring about

change.10 A lesson to recall is the importance of looking to those most affected

(ie, people who use drugs) for guidance and leadership in development of

effective responses and identification of barriers to their implementation.

Until governments abandon the failed so-called war on drugs11 and their reliance

on repression in response to drug use, we will continue to need days to

recognise and raise awareness of hepatitis in drug users. At the same time, we

should remember the harm that arbitrary detention, forced labour, physical

abuse, and torture causes to IDUs.12 Health is often proclaimed to be at the

centre of drug policy, but support for the protection and promotion of the right

to health, and other human rights, of drug users is often wholly absent.13

and colleagues4 provide us with a first step and powerful data to draw

attention to the problem of viral hepatitis in people who use drugs. The next

step is to challenge governments to act, and hold them accountable for

implementation of rights-respecting and evidence-based programmes.

I declare that I have no conflicts of interest.

References(cut)