Download Hepatitis C and Injection Drug Users: A New Lens for HIV Policy

Out of Sight, Out of Time:
Injection Drug Users,
Hepatitis C, and HIV Policy
Daniel Raymond
Hepatitis C Policy Analyst
Harm Reduction Coalition
[email protected]
www.hepcproject.org
Hepatitis C Harm Reduction Project
Hepatitis C Shatters Our
Paradigms for IDUs & HIV
Outreach?
Prevention?
Education?
Treatment?
Hepatitis C Harm Reduction Project
Looking at HIV and
Hepatitis C together…
Hepatitis C
HIV
Hepatitis C Harm Reduction Project
…Brings IDUs into Focus…
Hepatitis C
IDUs
HIV
Hepatitis C Harm Reduction Project
…and Brings other Systems into View
Mental
Health
Care
IDUs
Hepatitis C Harm Reduction Project
Primary
Care
Envisioning IDU-centric
Policy Models
Substance
Use
Treatment
Mental
Health
Care
IDUs,
HIV,
&
Hep C
Hepatitis C Harm Reduction Project
Needle
Exchange
Primary
Care
Jails and
Prisons
Hepatitis C
and IDUs
HIV:
Policy
Prevention
Treatment
Hepatitis C Harm Reduction Project
Hepatitis C
and IDUs
HIV:
Policy
Prevention
Treatment
Hepatitis C Harm Reduction Project
IDUs are the Blind Spot
in HIV Policy & HCV Advocacy
We don’t “see” IDUs in most discussions about Prevention, Access to Care &
Treatment, funding for Support Services, Housing, Research, Global AIDS….
Hepatitis C Harm Reduction Project
IDUs: Caught in the Political
Crosshairs of the War on Drugs
How can drug users organize when
drug use itself is criminalized?
Who will advocate for drug users
and against stigma and moralizing?
What are the political costs of
supporting an IDU health agenda?
Hepatitis C Harm Reduction Project
Hepatitis C
and IDUs
HIV:
Policy
Prevention
Treatment
Hepatitis C Harm Reduction Project
HCV Transmission: It’s All About the Blood
Hepatitis C Harm Reduction Project
Social Networks Matter
So Why
Aren’t We
Working
with and
through
Social
Networks in
Prevention
for IDUs?
Hepatitis C Harm Reduction Project
Hepatitis C
and IDUs
HIV:
Policy
Prevention
Treatment
Hepatitis C Harm Reduction Project
Taking a Closer Look at
HIV Care and Treatment for IDUs
HIV+ IDUs fare
worse across a
range of metrics:
• Delayed receipt of HAART
• Poorer adherence
• Less likelihood of
virologic, immunologic
response to HAART
• Greater incidence of
AIDS-defining illnesses
• Poorer survival due to
increased AIDS- and nonAIDS-related mortality
Ryan White Planning Councils
have largely not assessed,
planned for, or allocated funds
for the special needs of active
substance users, including for
substance abuse treatment nor
have they addressed particular
barriers in receipt of HIV care.
Finkelstein et al., appendix to the IOM
report: Public Financing and Delivery of
HIV/AIDS Care: Securing the Legacy of Ryan
White (2004)
Hepatitis C Harm Reduction Project
A Microeconomic Perspective on
Hepatitis C Treatment
Supply
Demand
• Low reimbursement for
providers (vs. procedures)
• Mixed messages about need for
treatment
• Need for intensive patient
management & support (e.g.
physician extender)
• Competing priorities – drug
use, housing, other health issues
• Lack of on-site psychiatric
care
• Fear of biopsy
• Little training in addictions
medicine, HIV
• Physicians may ration
expensive HCV treatment to
“ideal patients”
• Distrust of medical system
• Concerns about treatment side
effects – particularly depression
• Limited knowledge from peer
experiences with HCV care and
treatment
Hepatitis C Harm Reduction Project
Bringing It All into Focus:
Who Are the Players?
HCV Advocacy:
Planning Councils and
Advisory Boards
• NHCAC
CDC, HRSA, NIH,
SAMHSA
• Local/State
• HCAP
Communities
Harm Reduction:
Legislators
Substance
Abuse Tx?
HIV Policy:
• Needle Exchange
• Federal
• Drug Policy
• State
• Researchers
• Local
Hepatitis C Harm Reduction Project
Envisioning
IDU-centric
Policy Models…
Poster from the Hepatitis C
Harm Reduction Project.
[email protected]
www.hepcproject.org