Almost half of injecting drug users could be living with Hepatitis C

Almost half of injecting drug users surveyed are living with the potentially deadly Hepatitis C virus, a new study has found. Meanwhile, a drug available globally that could cure them remains unavailable in the country.

Released Tuesday by the non-profit organisation TB/HIV Care Association, the study is the largest ever to chart how many people in the country carry the virus, which causes liver damage and can be transmitted sexually and via shared needles, according to United States medical research organisation Mayo Clinic. To do this, researchers tested more than 3 400 people thought to be at high risk for the virus because of possible risky sexual behaviour or sharing needles: men who have sex with men, sex workers and drug users, mostly those who inject drugs.

The study was carried out in Cape Town, Johannesburg, Pretoria, Mthatha, Pietermaritzburg, Port Elizabeth and Durban.

Overall, 13% of people were found to be living with the virus and close to half of all these infections were among injecting drug users. Overall almost 40% of the study’s participants were HIV positive. Overall almost 40% of the study’s participants were HIV positive.

The study found high rates of Hepatitis C and HIV co-infection (29%) among Pretoria drug users, which TB/HIV Care Association strategic advisor Andrew Scheibe Andrew Scheibe attributes to the city’s long-standing injecting drug use culture.

In 2017, Tshwane became the first city in Gauteng to offer drug opioid substitution therapy (OST) or legally prescribed medication that helps people to reduce or stop using drugs such as heroin without debilitating withdrawal symptoms. OST has been shown to help reduce illegal drug use, overdose deaths and new HIV infections among people who use drugs, according to a 2011 study published in the Bulletin of the World Health Organization (WHO).

[WATCH] Chasing the dragon, stalking a virus: Life, heroin and Tshwane’s needle exchange

The new study also found that 4% of those surveyed had Hepatitis B, a virus that — like Hepatitis C — can be spread via contact with sexual partners or infected needles and damages the liver. Unlike Hepatitis C, there is no cure for Hepatitis B but vaccines can protect people from contracting it, the Mayo Clinic says.

The study recommended expanding access to Hepatitis B vaccination for high-risk groups as well as OST and needle exchange programmes that can help reduce the risk of infection for people who use drugs.

Globally, more than 1.34 million people died from viral hepatitis in 2015 with deaths outpacing those caused by HIV, according to the WHO’s 2017 Global Hepatitis Report.

But hepatitis has been largely ignored in South Africa, Charlotte Maxeke Academic Hospital’s head of infectious diseases Sarah Stacey says.

“We should be worried about hepatitis because it kills people.”

Historically, Hepatitis C has been priced out of reach of most costing up to R120 000 for a year course. Newer medication could drop that price by up to two-thirds, according to international nonprofit the Drugs for Neglected Diseases Initiative.

But newer drugs have yet to be approved for use by regulator the South African Health Product Regulatory Authority. Once these are registered they will be available in certain sectors, but cost will still be a major barrier to widespread access to them, Schiebbe warns.

South Africa’s draft hepatitis treatment and prevention guidelines still need to be passed by the national health council, national health department medical advisor Kgomotso Vilakazi-Nhlapo says. She estimates an extra R4-billion will be needed over the next five years to decrease hepatitis infections.

Vaccinating people at risk of Hepatitis B, and expanding health services such as OST as well as Hepatitis C treatment — when it becomes available — are part of the country’s national HIV plan.

But implementation of the strategy remains the responsibility of provinces, explains South African National Aids Council’s Nevilene Slingers.

“Provinces make sure that the drugs and money to buy the drugs is available.” 

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harm reductionHepatitis Cinjecting drug usersHIV

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