Many people might not know this but hepatitis C is a major public health issue.
It is much more prevalent than better-known blood-borne viruses (BBVs) such as HIV, and can have devastating effects on people’s health. Untreated it can lead to cirrhosis, liver damage, liver cancer and liver failure. It’s one of the reasons that the United Nations recognises the issue on World Hepatitis Day each year.
The good news is, there is now a cure for hepatitis C. Since the inclusion of highly effective treatments on the Pharmaceutical Benefits Scheme, treatment and a cure is now within reach of most Australians.
Australia has been a leader in responding to hepatitis C with policymakers, researchers, health professionals and the community coming together for a national response. Late last year, the fifth National Hepatitis C strategy was released, which mapped out a plan to enable Australia to meet the global target of eliminating the disease by 2030.
This Strategy recognises that there are groups in the community that are disproportionally impacted and need tailored responses.
Detainees in Australian prisons are some of these vulnerable community members given that generally there are much higher rates of hepatitis C in prison populations than in the general population. However, access to effective treatments and the sustained commitment of health and justice staff have resulted in a significant reduction in the rate of hepatitis C here in the ACT.
Nevertheless, a fully comprehensive public health response has been hampered by custodial dilemmas.
While needle and syringe exchange programs (NSPs) are widely available across the community and are a major contributor to Australia’s low transmission rates for a range of BBVs, the introduction of this program within our local prison has been rejected by custodial officers several times, most recently in 2016.
This has meant that while hepatitis treatment has been available and effective, re-infection post-treatment within prison environments could become an issue.
Re-infection creates additional impacts on health and additional risk to others. This is one of the reasons we need to move this issue out of the ‘too hard basket’ and once again re-examine how we might reconcile the strong evidence around the effectiveness of this approach with concerns of people working in custodial settings.
There are legitimate concerns for those who work within custodial settings about how this might work and how to manage the risks. There is a need to work out the practical considerations of how a NSP might work in a prison environment.
It is, however, hard to understand how a regulated system can be more dangerous than the current system that is operating, where we know that injecting equipment is circulating within the prison, equipment is being reused, re-infection is occurring, and both employees and detainees are currently at risk.
We now have a strong collective commitment from Governments, health professionals and others across Australia about the need to do something about this issue (as articulated in the National Strategy).
There is also growing evidence about how these types of programs might work, with more countries introducing NSPs in custodial settings, including Spain and Switzerland. Canada is also moving to introduce NSPs in prisons to reduce transmission of a range of BBVs.
Our treatment options for people in our local prison is working well and we need to ensure we don’t undermine these great efforts. It is also the case that despite its inability to implement the policy, the ACT Government has a long-standing commitment to establish an NSP in the prison.
Drug policy reform is often complex and challenging. When we engage with this issue, I believe we need to overcome our own assumptions, recognise new evidence and perspectives and work to find common ground to ensure that the needs of all key stakeholders are met in seeking to achieve better public health outcomes for the whole community. Canberra has a history of leading the nation in a whole range of social justice and health policy areas – what are some of the areas of reform that you believe have been good for our community?
If you want to find out more about the experiences of people with hepatitis C leaving custodial settings, AIVL has recently released a report documenting these experiences.
Rebecca works with a number of organisations working on issues related to hepatitis.