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J. Douglas Hudson, LMFT
Hepatitis C Support Project
New Orleans, Louisiana was the stage for the 2004 National Harm Reduction Conference sponsored by the Harm Reduction Coalition, with co-sponsorships from a myriad of national foundations, policy groups, and community-based organizations including the Hepatitis C Support Project. From November 10-14, 2004, leaders in the fields of medicine, social work, chemical dependency and mental health counseling, peer advocacy, and prevention education rallied for increased funding for healthcare, stronger alliances between organizations and individuals providing services, and expanded educational outreach to the general public regarding growing infection rates of hepatitis C (HCV) throughout the United States.
Numerous conference sessions included discussions of hepatitis C. A large number of attendees expressed interest in receiving provider technical support, more resources for networking, and disease education.
State of Treatment Services
One word that describes the difficulty of providing prevention and support services for HCV-infected individuals: FUNDING. Hepatitis C infection rates have passed HIV cases over the past year, creating the increased need for direct psychosocial and primary care services for people with HCV. Not only are basic care services at a premium, the potential for a dramatic rise in the need for liver transplants over the next ten years is likely.
Ninety percent of HCV infections in the United States are with intravenous drug users (IVDU’s). Creative questions from Daniel Raymond from the HCV Harm Reduction Project in New York challenged participants to think about how we as providers approach advocacy, prevention, and treatment. Controversial questions included, “Can we prevent HCV transmission?” and“Should we try to remove the stigma of HCV transmission only to drug users to help further HCV policy reform in national, state, and local governments?” Many participants addressed the questions creatively, suggesting means to overcoming the barriers through improved HCV-focused prevention methods, as well as public policy education and increased advocacy. Communications regarding these issues can be sent to Daniel at the Project in New York: http://www.hepcproject.org/.
Various presenters at the conference talked about the severe under-funding that HCV faces. It is estimated that the annual budget for HCV prevention and support services is about 10% of what is needed to meet the growing service requirements due to the large increase in infection rates. Conference attendees agreed that policy makers need to hear from the constituency regarding the urgency of increased funding to manage this pandemic. Check the HCV Advocate section on advocacy for means of contacting public officials and other ways of being involved: http://www.hcvadvocate.org/community
Even though many of us are “working under fire” with difficult policies and a general lack of public awareness, innovative strategies for educating prominent public figures with respect to policy are underway.
On October 26, 2004, New Jersey Governor James E. McGreevey signed an executive order allowing certain cities to provide sterile syringes to IVDU’s. See a copy of the executive order, which mentions needle exchange as a effective intervention in reducing the spread of HCV at http://www.infectioncontroltoday.com/hotnews/
Until this move, New Jersey was one of only two states nationwide that did not provide access to sterile syringes to prevent the spread of HIV and HCV. Send Governor McGreevey a thank you!
Marcia Bisgyer of Safety Works in Mamaroneck, NY spoke of the need for a revolutionary examination of the current prevention guidelines for hepatitis C. An article written by Marcia regarding the new guidelines included in a needle exchange program can be read on the CDC website: http://www.cdc.gov/idu
Methadone and harm reduction remains a mysterious and controversial approach. The Treatment Improvement Exchange (TIE) is a resource sponsored by the Division of State and Community Assistance of the Center for Substance Abuse Treatment to provide information exchange between CSAT staff and State and local alcohol and substance abuse agencies. The TIE website is : www.treatment.org; under search, type methadone and harm reduction for articles on theories and practices on this subject.
New approaches to harm reduction treatments in opiate maintenance were discussed by a panel of treatment and peer advocates. Kevin Irwin from the Yale School of Sociology spoke about the need to overcome barriers to physician participation in providing Buprenorphine treatment for opiate users. Barriers sited included limitations of existing laws, government documentation requirements, staff demands and availability of supplies, among others. For information on this study contact Kevin Irwin at the Yale School of Sociology.
With many new advancements being discussed, another theme continued to remind us to return to the basics for advocacy and treatment: assist patients to articulate desires; inform them of the best treatment options available; promote a safe and positive environment; individualize all treatment plans; and, understand the challenges and complexity of issues facing individual patients.
Networking and Building Resources
Ann Shindo, CDC HCV Coordinator for the state of Oregon, convincingly echoed the need to develop and increase our community voice, build coalitions—GET POLITICAL!, and utilize CDC Coordinators for information, networking, and collaborations. An Oregon group has launched a new website, www.hepcchallenge.org, which reflects the “power of people working together” to inspire information sharing and motivation, along with up-to-date educational resources.
If you are wondering how to become more active in promoting HCV awareness in your community, region, or nationally, contact your state CDC HCV Coordinator (http://www.hcvadvocate.org
/hepatitis/hepC/hepc_coordinators_usa.htm). Not all states have HCV Coordinators. All states have HBV Coordinators, so you may want to contact an HBV Coordinator
coord18.htm) for referrals to hepatitis C advocacy groups.
The following is a list of dedicated organizations enthusiastically working to increase the availability of services for those affected and infected with HCV. This is only a brief list of the many knowledgeable and active organizations currently contributing to the advancement of awareness through policy work, counseling, and treatment for HCV and HIV/HCV co-infections:
•Harm Reduction Coalition: http://www.harmreduction.org/
•Street-Works, Nashville, TN:
•Helping Individual Prostitutes Survive (HIPS), Washington, DC: http://www.hips.org/
•New Mexico AIDS Services, Albuquerque, NM:
•Western North Carolina AIDS Project, Asheville, NC:
•Atlanta Harm Reduction Center, Atlanta, GA: http://www.atlantaharmreduction.org/
•Illinois Primary Healthcare Association, Chicago, IL:
•Lower East Side Harm Reduction Center, New York, NY: http://www.leshrc.org
•Positive Health Project, New York, NY: http://www.positivehealthproject.org/
•UCSF Urban Health Study, San Francisco, CA:
•Caribbean Harm Reduction Coalition, St Lucia, West Indies: http://caribbeanharmreduction
•NO/AIDS Task Force, New Orleans, LA:
•Drug Policy Alliance: http://www.drug
•Monterey County Needle Exchange Project, Monterey County AIDS Project, Monterey, CA: http://www.mcap.org/
•Human Rights Watch, New York, NY: http://www.hrw.org/
•For state and local health departments: http://www.cdc.gov/other.htm#states
•For local support groups in your area: http://www.hcvadvocate.org/
Or contact Alan Franciscus at the Hepatitis C Support Project for further information on ways to be involved in HCV advocacy: email@example.com.
If you would like to list your support group for HCV, HIV/HCV, or HBV on our websites, please send your information to CD Mazoff at firstname.lastname@example.org.
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