Health advocates are making a concerted push to raise awareness of a disease about which many people are uniformed despite its growing prevalence: hepatitis C.
July 28 was World Hepatitis Day, with the World Health Organization focusing its efforts around the theme: “Test. Treat. Hepatitis.” And, now, New York State has started a Hepatitis C Elimination Task Force, announced July 27 by Governor Andrew Cuomo.
The outbreak in the state is gathering force, and the best practices advice is now that when you get tested for HIV, get tested for hep C, as well. That’s not because of any specific link between the two epidemics, but rather due to the ease of managing your health care. In fact, many people who don’t consider themselves at risk for HIV could be infected with hepatitis C. Right now, such testing requires that a person ask for it.
In 2016, an alarming 14,745 new HCV infections were reported in New York — more than five times the number of new HIV diagnoses for the same year.
There is no obvious warning; a person infected with HVC can be otherwise healthy. The virus can hang out in the liver for years and cause no obvious discomfort.
New York State is responding with a new plan to unravel a critical dilemma, with public health officials estimating that half the infected population doesn’t know it. That problem carries a two-fold risk. First, hep C is treatable, so a person not knowing their status can unnecessarily harm their health. Treatment simply involves completing a regimen of medication and the virus disappears. An untreated person can also spread the disease.
The success in combating hep C is remarkable for a disease that wasn’t even identified until 1989. HCV lurks in the body and the blood. It was even spread by blood transfusion before it was identified.
Until recently, public health officials focused on populations 45-65 and older, many of whom have now received treatment and so are not infecting others. The assumption was that HCV infection incidence was declining.
That optimistic scenario is now outdated. The disease has spread, and young people are testing positive for it.
There are many ways to become infected, but the activists from VOCAL-NY and Housing Works that prodded Governor Andrew Cuomo and the State Health Department to prioritize the battle against HCV are active in keeping drug users healthy, through needle exchanges and other interventions. Injecting drugs is clearly one path for new infections, but so are needles in badly run tattoo parlors and straws shared while snorting drugs. The delay in authorizing Safer Consumption Spaces, where drug users can inject under the supervision of health care workers who provide harm reduction information, is one of the stumbling blocks to effective prevention efforts.
HCV infections can’t always be traced to a particular behavior because, unlike HIV, the hep C virus can live outside the body. State health officials advise that it isn’t easily sexually transmitted, but risks increase if partners have tears in their skin. It is also possible that infection can result from something as simple as sharing a toothbrush, given the virus’ resiliency outside the body.
The bottom line: get tested, and the only way to get tested is to ask for it. Every city sexual health clinic will test you for free. Go and ask for the full complement of STD tests, including for HIV, and tell them to test for HCV also. No appointments are necessary. If you visit your doctor’s office, insurance will pay for the test. But, again, your doctor is unlikely to suggest the test. You need to ask for it.
On my last visit to the city’s Riverside sexual health clinic on West 100th Street following a syphilis contact, I was in and out in an hour.
The rise in infections among 18- to 29-year-olds is particularly worrisome, that group including as it does women of child-bearing age. Infected young people, if untreated, will face major health problems later in life. Left untreated, HCV infection can be fatal.
The cost of hep C treatment keeps falling, and in the face of the epidemic barriers to treatment are toppling. The new rule is that if you test positive, you get the treatment — patients must no longer demonstrate that their infection has become serious.
New York State is now taking the epidemic’s resurgence seriously, providing money to Medicaid to cover treatment costs and allowing needle exchanges and similar service providers to become part of the testing network.
The state plan is the first in the nation “to take up the challenge,” said Housing Works CEO Charles King. Referring to Cuomo, King said the plan is “very much in line with his commitment in 2014 to end AIDS as an epidemic in New York State.”
This is an epidemic that affects heterosexuals as much as members of the LGBTQ community. Getting tested and then taking the medicine will cure the disease and eliminate the risk of transmission. Word of mouth always helps battle epidemics, so passing the information along to friends is a positive step everyone should take.
