July 28th is World Hepatitis Day, a campaign started by the World Health Organization to push for global elimination of hepatitis by 2030. As a harm reduction and health promotion organization, the folks here at AVI Health and Community Services recognize the importance of this goal, so we wanted to take a minute today to talk specifically about hepatitis C (HCV) testing, treatment, and stigma. For more information about hepatitis A and B, click the links at the bottom of this post.
HEPATITIS C CAN’T WAIT FOR YOU TO GET TESTED!
In a report released in 2011 by Trubnikov et al., it was estimated that 44% of people living in Canada were living with a chronic HCV infection but unaware of their status. While another report released by the Public Health Agency of Canada in 2017 has shown that reported cases of HCV are on the decline, the fact remains that many people are living with undiagnosed (and therefore untreated) HCV.
HCV transmission occurs when the virus comes into contact with your bloodstream. In Canada, this most commonly occurs when folks share equipment used for preparing and using drugs by injection, or by sharing tattooing or body piercing equipment (including tattoo ink). HCV can also be passed by sharing personal care items (like toothbrushes or nail clippers) and through barrier-free sex (particularly anal sex). Even if you’ve only engaged in one of these activities one time, you run the risk of having been exposed to the virus and you might not even know it.
One of the reasons people may not know they are living with HCV is because over 50% of people living with the virus don’t experience any obvious signs or symptoms right away. In some cases, it can take years before a person shows symptoms, and even then, they may not immediately recognize said symptoms as a HCV infection. For a more detailed breakdown of HCV signs and symptoms, check out the links at the bottom of the post.
The only way to know for sure whether or not you have HCV is by getting tested. If you already get routine blood tests or STI tests, ask your healthcare provider to test you for HCV. Routine blood tests and STI tests don’t always include testing for HCV, so it’s important you specifically request to be tested. If you don’t get routine work done but want to get tested, check out youthco.org/test to find your nearest STI testing centre or visit getcheckedonline.com. If you’re wanting to get tested because you believe you’ve been exposed to the virus, be aware that HCV may not show up in your testing results for up to three months (or 6 months for folks with a suppressed immune system) after your initial exposure.
Knowing your status is the first step in HCV prevention and treatment, so don’t wait: go out there and get tested!
HEPATITIS C CAN’T WAIT FOR YOU TO GET TREATED!
While it can take a while for HCV symptoms to develop, that doesn’t mean the virus isn’t impacting your body. Hepatitis viruses inflame the liver and cause serious liver damage, and HCV is no exception to this. A chronic HCV infection can lead to advanced liver disease, and many of the late showing symptoms stem from this. Getting treated early is paramount in protecting your liver from further damage.
While there isn’t a vaccine available to prevent contracting HCV, treatment options for the virus have come a long way. Modern treatments are highly effective and completely cure 95% of people living with HCV. Treatment consists of taking 1-3 pills once per day for 8 to 12 weeks. While old HCV treatment options caused a great deal of side effects, modern treatment options have minimal side effects that lessen or vanish completely after a few weeks.
Treatment greatly improves the quality of life of people living with HCV, and many folks find themselves more energetic and in less physical pain (both symptoms of a chronic infection) after clearing the virus. If you’re concerned that cost is a barrier to treatment, don’t sweat it: treatment is free of charge to all BC residents. Talk to your healthcare provider about treatment options.
Something to note is that while HCV can be cured, this doesn’t mean a person becomes immune. People can become re-infected with HCV even if they have had it before, so be sure to keep getting tested even after clearing the virus.
Love your liver and prevent the spread of HCV by getting treated!
HEPATITIS C CAN’T WAIT FOR STIGMA TO GET BUSTED!
We’ve talked a bit about testing and treatment, but it’s important to note that testing and treatment are made inaccessible to many folks living with HCV infections. Stigma is a major barrier for many people when it comes to accessing care, particularly amongst people who use injection and other stigmatized drugs.
In a 2021 literature review conducted by Harris et al. on the impacts of HCV stigma, a common trend was that people who use drugs are often dismissed or dehumanized by healthcare providers due to stigmatizing attitudes about drug use. The review also found that stigma is viewed through a risk-prevention narrative and an individualized problem for people living with HCV rather than a systemic issue built into systems of power (like the healthcare system). Many people who use drugs have reported being hesitant to access testing and treatment because of stigma, and this barrier to care is reflected in higher rates of HCV infection within communities of people who use criminalized drugs. We can’t talk about testing and treatment if we don’t also address the reality many folks living in the margins face when trying to access care and advocate for the provision of compassionate and non-judgemental care for folks living with HCV.
Additionally, successful treatment of HCV often relies on access to resources and stable housing, something many folks living with HCV don’t have the privilege of having. HCV prevention and treatment is more than access to safe health care, it’s also access to affordable housing, transportation, nutritious food and clean water, etc. Stigma has a deep impact on people’s ability to keep up with treatment because it impacts these intersecting factors. These barriers to access are further compounded when we look at other social determinants of health impacted by stigma, discrimination, and structural violence such as race, gender, and socioeconomic status.
Health equity and HCV treatment and prevention are inextricably linked to social injustice and inequality. As such, taking steps to challenge discriminatory attitudes and policies in your community is an important step to ensuring equitable access to care for folks living with HCV. For healthcare providers, this means committing to providing culturally safe care and challenging systemic racism, classism, transphobia, homophobia, etc. in our workplaces. Speak up when you witness discriminatory practices and attitudes in your workplace. Advocate for policy changes to better serve more marginalized service users. For members of the community at large, advocate for affordable housing. Challenge stigmatizing attitudes and actions in yourself, your family, your friend group, your workplace, and your neighbourhood. Take the initiative to get involved in your community and educate yourself about ways we all perpetuate and are complicit in structural violence.
When stigma is ignored and unchallenged, it deeply harms the most marginalized members of our community. Stand in solidarity with your neighbours living with HCV by addressing the social harms that impact the health and wellbeing of us all. Just like HCV can’t wait for testing or treatment, social injustice and stigma can’t wait to be addressed: it is all of our responsibility to advocate for health equity by challenging stigma, advocating for material change, and showing up for our neighbours.
Special thanks to folks with lived/living experience of HCV as well as the folks at CATIE for supplying the information for this post. If you want to learn more about HCV, reach out to AVI’s education team or check the links below.
Hepatitis A fact sheet: https://www.catie.ca/en/fact-sheets/sti/hepatitis-a
Hepatitis B fact sheet: https://www.catie.ca/en/fact-sheets/sti/hepatitis-b
Hepatitis C in-depth guide (includes signs and symptoms): https://www.catie.ca/en/practical-guides/hepc-in-depth
M. Harris, D. Guy, C.A. Picchio et al., Conceptualising hepatitis C stigma: A thematic synthesis of qualitative research, International Journal of Drug Policy, https://doi.org/10.1016/j.drugpo.2021.103320
Social Determinants of Health: https://www.who.int/health-topics/social-determinants-of-health