Hey Bronxites! Let’s play a game of two truths and a lie regarding Hepatitis C.
- Out of the 10 neighborhoods with the highest rates of people newly reported with chronic Hepatitis C in New York City, five were located in the Bronx.
- The main mode of transmission for Hepatitis C is sexual transmission.
- There is no Hepatitis C vaccine.
I played this little game with my small group of friends who are pre-med, pre-dental and other pre-health majors, and 83% of them chose three as the lie. And if you did too, unfortunately and unexpectedly, that is the common wrong answer. And before you beat yourself up for choosing the wrong answer, don’t worry. When I learned that Hepatitis C was spread mainly through HCV-infected needles in an interview with Meg Chappell, the program director of the Empire Liver Foundation, a nonprofit organization based in New York aimed at educating health care professionals on Hepatitis C, I was surprised — shocked even.
Growing up in Indonesia before migrating to the United States, I heard the name “Hepatitis C” being thrown around as a sexually transmitted disease and something I didn’t have to worry about. It wasn’t until I moved to Malaysia that I met Jake*, a person who didn’t realize that he had Hepatitis C until he had severe liver cirrhosis to the point where he desperately needed a liver transplant. I still remember how his face contorted as he looked up to the sky and asked if “he was going to die.” As someone who was careful about everything and anything under the sun, it didn’t make sense that Hepatitis C was only a sexually transmitted disease. Thus, when I moved to the U.S., I expected things to be different — and they were, to a certain extent. Yes, technological advancements and research in the U.S. are incomparable to Indonesia, and yes, New York’s strong public health infrastructure and renowned academic and medical institutions are a cornerstone toward Hepatitis C prevention. Nonetheless, even in a high-income country, the same story of social inequities persists.
Hepatitis C, the liver infection caused by the Hepatitis C virus (HCV), may be dangerous, but it can also be prevented. Currently, it is estimated that more than 70% of all Hepatitis C cases remain undiagnosed until symptoms become severe, specifically resulting in cirrhosis (severe scarring of the liver) for 15-30% of the population and even six different types of cancer. With frequent diagnostic tests, this can easily be prevented. Furthermore, the prevalence of adults in New York with active HCV infections as of 2020 is a whopping 91,000, with most cases concentrating in the Bronx area. Instead of tackling the problem of Hepatitis C head-on and becoming an example to other cities, we became the victims.
So Bronxites, what are we going to do about it? Are we just going to continue to let a disease ravage us, or are we going to stand together to make a difference? Below, I have outlined some solutions to combat this epidemic.
First and foremost, considering that the virus can live up to 63 days in a syringe or up to five months if placed in lower temperatures, there is a need to establish more needle exchange programs. Although needle and syringe exchange programs are found to be highly effective, specifically by reducing HCV transmission by 76% and HCV prevalence by 29% in New York, there are still only 23 main needle exchange programs in New York and only three in the Bronx. Thus, in order to remove the systemic barriers to access to clean needles, there needs to be more advocacy and work toward increasing the number of needle exchange programs in the U.S. as well as the manpower required. It is clearly proven that clean needle programs greatly decrease the risk of HCV infection. All we need to do is gather the manpower and resources to expand this across the U.S. Although we cannot control the lifespan of the virus, we can help people feel empowered to take control of their own health.
Further, it is necessary to implement routine HCV testing. Instead of the current opt-in model for HCV testing (patients choose to test for HCV), advocating for opt-out HCV testing (patients are immediately enrolled in testing unless they decide not to) in both urban and rural clinics, correctional facilities and drug treatment centers is imperative. Implementing an opt-out model will not only enhance surveillance of HCV (because it would provide a better estimate of the prevalence of Hepatitis C), but also help to overcome systemic barriers to testing. If we truly want to solve the health care inequities associated with Hepatitis C, it is important to establish equity, especially by providing everyone with the same resources. Thus, making sure that everyone, regardless of where they live, their socioeconomic status, or the color of their skin, is able to get routine testing will allow for earlier detection of HCV and reduce transmission of HCV among the whole NYC population, especially in the Bronx.
So, Bronxites, what are you going to do about this problem? How much are you willing to invest in your community? Curbing the Hepatitis C epidemic is hard but feasible; there are many resources available to curb the epidemic. The only thing holding us back is your help. How much are you willing to advocate for? How much work are you willing to put in?
One Bronx, one community, one goal: curbing this hepatitis epidemic together.
*Note: To protect the privacy of individuals, names have been changed.
Clarissa Natasya Sofian is a public health student at the University of Washington.
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