Bloodborne HIV: Don't Get Stuck!

‘Where harm reduction policies went up, hepatitis C (HCV) incidence went down, study finds’. Nothing very surprising about that, is there? Harm reduction strategies, such as free needles and syringes and substitution therapies for injecting drug users (IDU), safe healthcare, etc, reduce harm; sort of tautological, really.

But countries like the US have resisted providing support for harm reduction strategies, refused to put much money into them, and often refused to allow recipients of US donor funding to allocate money to harm reduction.

This refusal to adopt harm reduction strategies has been going on for decades, and could have reduced a lot of HIV transmission as well. The above article is about a study covering harm reduction among IDUs over a period of 25 years.

It finds that HCV infection rates remained high in two US cities and a Canadian city, but dropped in an Australian and a Dutch city. This is because harm reduction strategies were very limited in the US and Canada, but not in The Netherlands and Australia. Should I repeat that for those who continue to resist (till death…etc)?

Decades ago, perhaps even longer, objections to harm reduction strategies were based on the claim that, for example, making clean needles and syringes available would encourage use of injected drugs and even increase use, comprehensive sex education would increase unsafe sex, and the like.

Utterly ridiculous, and shown to be so time and time again. But that’s the sort of argument that conservative people (whether they would identify themselves as conservative or not), professional politicians and many religious people continue to cling to.

Some people were persuaded, perhaps for political rather than rational reasons, to drop their insistence on using these infantile arguments against harm reduction when HIV became the headline health issue, a status it still holds in many countries, but many were not.

Comparing HIV and HCV, hundreds of millions of people are infected with HCV, far more than the few tens of millions of people infected with HIV. Annual deaths from HIV in the US, which has the worst epidemic in the rich world, stand at over 12k; from HCV, the figure in 2014 was close to 20k.

HCV, unlike HIV, is curable. As with any infectious disease, treating people would reduce the number of new infections to the extent that the epidemic could be controlled, and kept at a much more manageable number (although eradication would, of course, be preferable).

But the treatment is so expensive that even most people in rich countries are not able to afford it. This was the case with HIV for a while, but big pharma still manages to make a very large profit, even after negotiating a very lucrative piece of PR about price reduction. So it seems likely that the same could be done for HCV drugs, should there ever be the political will to achieve this goal.

A combined harm reduction and cost reduction strategy would have a massive impact on HCV prevalence. Since HIV is so easily transmitted through IDU, this would at the same time address the second biggest contributor to the US HIV epidemic (the first being anal sex among men who have sex with men).

But another form of harm reduction, safe healthcare, would have an even greater impact on the HIV and the HCV pandemics. Far more people are infected lgobally with HCV through routes other than IDU, especially in high HIV prevalence countries. The highest HCV prevalence in the world is in Egypt, where it was mostly a result of unsafe healthcare.

Although the HIV politbureau of UNAIDS, WHO, CDC and others don’t like to talk about HIV transmission via unsafe healthcare in high HIV prevalence countries, except to bluntly deny it, it is likely that the rate of new infections would mysteriously drop like a stone in countries that adopt a well supported, well funded safe healthcare program.

If harm reduction strategies reduce harm, and this has been known for decades, why is there so much resistance? Skip the dumbass excuses about clean injecting equipment increasing injected drug use and comprehensive sex education increasing unsafe sex, it’s well demonstrated that the opposite is the case. So, what could UNAIDS, WHO and CDC have against HCV and HIV harm reduction strategies? Just the fact that they work?