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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