hepatitis c, drug use and stigma liz allen. what it is hepatitis c? hepatitis c is a blood-borne...
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Hepatitis C, Drug Use and Stigma
Liz Allen
What it is Hepatitis C?
• Hepatitis C is a blood-borne virus
• Can cause serious damage to the liver
• First indentified in 1989
• Known as non-A, non-B hepatitis
• Test developed in early 1990’s
What is Hepatitis C?
Hepatitis C virus (HCV) is spread through exposure to
infected blood
• Prior to 1991 transmission through blood transfusions or
blood products
• Sharing of equipment using in injecting drug use
HCV
Less common routes of infection
• Mother to baby transmission
• Unprotected sex
• Medical & dental treatment abroad
• Tattooing, ear or body piercing
• Sharing razors, toothbrushes and other toiletries
• Needle stick injuries
HCV
• Around 75- 85% of those infected will develop chronic Hepatitis C infection
• Of those that become chronically infected 5 to 15% will go on to develop cirrhosis of the liver within 20 years
• Often referred to as the silent epidemic
• Most show no symptoms
HCV
• No vaccination for HCV
• Treatment for HCV
• Effectiveness of treatment can depend on the
strain of the virus & stage of disease
• Treatment can last between 24 & 48 weeks
• Some people experience side effects
HCV in Scotland
• 24,419 diagnoses– 12% have died
• 59% ( 14,397) are known to have injected drugs representing 89% of those with known risk factor
( Health Protection Scotland, 2008)
HCV in Scotland
• Approximately one in 240 of Scotland's
population have been diagnosed HCV positive
• Number of undiagnosed cases exceeds the
number of diagnosed cases
• Estimated that 1% of Scottish population are
infected
HCV in Scotland
Figure 1: Hepatitis C epidemiological landscape (estimates): Scotland, 2006.
HCV in Scotland
Hepatitis C Action plan for Scotland
Phase I: Sept 2006- Aug 2008 - £4 million
Phase II: May 2008-March 2011- £43 million
Action Plan
• Investing in the public health of
Scotland
• Investment should over the longer term
significantly reduce the problem of
HCV in Scotland.
Action Plan
• “ improving testing, treatment, care and support services for those infected with a major emphasis being placed on increasing the numbers of people receiving treatment. The plan also recognises and addresses the social care needs and the drug addiction problems of infected persons through actions aimed at improving links between clinical, addiction and mental health services”
• Hepatitis C Action Plan for Scotland Phase II: May 2008- March 2011 p4
Hepatitis C and Stigma
What does the research say?
The vast majority of people with HCV have a history of injecting drug use, they are frequently assumed by others to be injecting drug users, blamed for acquiring the disease and viewed as ‘irresponsible’, ‘immoral’ and ‘unworthy’.
What does the research say?
• HCV related stigma in health care settings arise from practitioners negative views of injecting drug use
• Practitioner negative attitudes toward people with HCV are the result of their lack of awareness and or information about injecting drug use
What does the research say?
People that have never been an IDU frequently report that they have received inadequate and judgmental care for hospital staff because practitioners assume that they acquired the virus through Injecting drug use
What does the research say?
Other factors maybe involved
• Illicit drug use• Poverty• Ethnicity, • Homelessness,• Prostitution • Mental illness
All may have an important part to play in the stigma experience by those with HCV.
HCV and stigma
Stigma may cause people
• To avoid testing, treatment and care
• Not to disclose their Hep C status or injecting drug use to others.
HCV and stigma
Fear of stigma
• Fear of how they maybe treated accessing health services
• Fear of how their family and friends may see them
HCV and stigma
• Day et al (2004)
• 40% of respondents reported experiencing HCV related stigma in
the previous 2 years.
• Current IDUs were more likely to report discrimination than past IDUs or those that never injected.
HCV and stigma
Zickmund et al ( 2003)
• 57% ( 147) of respondents reported HCV related stigma.
• Outcome of this stigma included anxiety, depression, decreased quality of life, feeling of loss of control and difficulty coping.
HCV and stigma
Hepatitis C patient Journey Evaluation: Finding from an initial scoping exercise.
• The majority of participants, 80% (61/76) reported that they had not experience discrimination.
• Of the remaining 20%, six respondents reported negative reactions from family, friends and neighbors.
• Eight respondents reported discrimination when accessing hospital services or dental treatment
• And 2 respondents experience problems with employment.
HCV and stigma
There are often institutional and
structural forces with in health care
systems that can result in
discrimination despite the positive
attitudes of staff towards those with
HCV.
HCV and stigma
Institutional policies such as
• Who is eligible for treatment
• Who receives treatment
• Types of support available
• Strict Appointment times
• Methods of referral
• Infection control policies
Stigma and harm reduction
Stigma that is associated with drug use
can hamper the harm reduction
approach that is essential in helping to
prevent HCV infection among injecting
drug users.
Stigma and harm reduction
• Staff attitudes and prejudice
• Lack of privacy
• Lack of discretion
• Location of service
• Restrictive policies determined by staff
Stigma and harm reduction
• Recreational/ occasional users
• Steroid users
• Women with children
Can experience shame/ embarrassment at
accessing harm reduction services
Conclusions
• Stigma can arise from a lack of awareness and knowledge.
• The need to educate health care practitioners, But
• It is not a guarantee that the recipients of such education will integrate this knowledge in to clinical practice.
Conclusions
There is a need for services for testing and treatment that are specifically for IDUs with Hepatitis C
It is unclear if the stigma associated
with injecting drug use is part
or whole of the hepatitis C related stigma
