The US Centers for Disease Control and Prevention (CDC) released new data in May showing that the number of new hepatitis C virus (HCV) infections reported to the agency nearly tripled between 2010 and 2015.
Approximately four times as many new infections were reported in 2015 compared to 2010, and the increase in incidence was most rapid in young people aged 20-29 and in the Midwest, New England and Appalachia.
The increase in new hepatitis C infections is being driven by an upsurge in injecting drug use in small towns and rural areas among people who have been abusing prescription opioids. There was a large outbreak of hepatitis C infections due to sharing of injecting equipment in the state of Indiana in 2015. This outbreak was brought under control by the establishment of an emergency needle and syringe programme which provided free needles and syringes in order to reduce sharing of injecting equipment, as well as testing for hepatitis C and HIV.
However, access to basic harm reduction measures that could reduce the risk of hepatitis C transmission is poor across much of the United States. Recently published US research shows that the vast majority (80%) of young people with HCV infection in the United States have to travel at least ten miles to access needle exchange programmes, and half lived over 37 miles from the nearest programme. Political hostility to needle and syringe programmes remains intense in many parts of the United States. The CDC noted that 18 US states have no laws permitting the establishing of needle and syringe programmes.
The CDC study identified a range of policy barriers to hepatitis C treatment and prevention in the United States, illustrating the factors that need to be considered when seeking to reform drug laws in order to improve access to health care:
- Requirements for a minimum period of drug abstinence in order to receive Medicaid-funded treatment for hepatitis C were in place in 24 states. Delaying access to treatment delays cure of hepatitis C and leaves individuals at risk of transmitting HCV to others.
- Only three states permitted sale of syringes without prescription to people who inject drugs, had decriminalised possession of needles and syringes and permitted their distribution.
- The lack of provisions in other states leaves people vulnerable to prosecution if they try to protect themselves by seeking or carrying clean injecting equipment, and leaves people engaged in syringe programmes vulnerable to prosecution too.
Policies on harm reduction in the United States and Canada are being debated as a result of the growth in opioid injecting and the rise in overdose deaths in recent years.
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