Breaking The Silence Around The “Silent Epidemic” Of Hep C

On May 14, many people — including program participants — converged on the steps of City Hall to raise awareness of the significant impact and value of alternatives to incarceration (ATI) and reentry programs.

That same day, advocates gathered on the same steps to raise awareness of the “silent epidemic” of viral hepatitis.

Fortune was pleased to serve on the planning committee of the NYC Viral Hepatitis Awareness Event, which coincides with May’s National Hepatitis Awareness Month, National Hispanic Hepatitis Awareness Day (May 15), and National Hepatitis Testing Day (May 19). Representatives and advocates — patients, health workers, city officials, community workers, friends, and families — shared their stories in hopes of encouraging action among New Yorkers to get tested and to demand better access to prevention and treatment. Together, we can work towards a Hep Free NYC!

 

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My name is Tommy and I currently live at The Fortune Society’s Castle Gardens residence.

I have been in a lot of prisons … and I have a lot of problems with my health and medical care I was fighting tooth and nail with these people providing care inside. They did not tell me I had Hep C until 2003. I peeked at my chart and saw they had it down that the Hep C was first noted in my chart in 1987. The health care providers in prison did not tell me about my Hep C status until another set of blood work nearly 20 years later and, all of a sudden, the nurse is concerned.

I contracted Hep C because of tattoos. I received my second tattoo inside Attica prison in 1987. I brought the guy doing the tattoo a clean needle, but he used the same toothpaste cap of ink that he had used with the last two guys who received tattoos from him. Even if you have a new needle, it does not mean anything if the ink is contaminated.

Me, personally, I do not trust hospitals and I do not like going to them. After being released six months ago, they got me going to see doctors there, doctors here … and sometimes I do not even go. If they are providing such poor care inside prisons and jails, then they could also be doing it out here. I know people in prison who have died from Hep C. In prison, they do not want to treat Hep C sometimes because the medications are so expensive.

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The Fortune Society’s Reentry Education Project (REP) supports healthcare providers in integrating culturally responsive and sensitive best practices into HIV prevention, treatment, and care delivery to patients who are justice-involved and living within underserved NYC neighborhoods. This year’s focus is on increasing awareness and understanding of HIV as well as Hep C prevention, treatment, and care needs of justice-involved men and women. Fortune is thrilled to be working with the New York City Department of Health and Mental Hygiene, The NYC Hep C Task Force, and other partners to:

• Reduce the barriers that justice-involved men and women face in accessing HIV and Hep C prevention, treatment, and care;
• Increase the number of justice-involved men and women who know their HIV and Hep C status; and
• Increase retention in care and viral suppression, thereby reducing new transmissions.

Viral hepatitis disproportionately affects Asian, African, African-American, Latino, and LGBT communities; people who inject drugs; and formerly or currently incarcerated men and women. Between 3.5 and 5.3 million men and women in the U.S. and 250,000 New York City residents are living with chronic viral hepatitis, and most do not know that they are infected. Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplants. In addition, it is a leading infectious cause of death in the U.S., claiming the lives of 12,000-18,000 each year.

According to the Centers for Disease Control and Prevention, one in three men and women in U.S. jails and prisons have Hep C. Twice as many incarcerated women are living with Hep C in comparison to incarcerated men. Hep C occurs at rates eight to 21 times higher among incarcerated people. NYC DOHMH surveillance findings show that, of the people newly reported with chronic Hep C between 2009 and 2012, 30% had previously been in prison or jail, and 39% had engaged in injection drug use. Overlapping risk factors that place justice-involved men and women at increased risk of contracting Hep C also include tattoo/body piercing at a location other than a professional tattoo parlor (14%).

High rates of Hep C among those who are incarcerated and under community supervision reflect how many justice-involved men and women come from under-resourced communities with limited access to prevention, screening, and treatment. Nearly 95% of men and women who are currently incarcerated will return to our communities and face difficulties restoring relationships, health care, housing, and financial security. Most formerly incarcerated men and women return to low-income neighborhoods with high levels of poverty, violence, substance use, and criminal-justice system involvement.

Access to health care can be difficult. Common barriers include a lack of access to health records, poor treatment, discrimination, stigma, difficulties navigating complex health care systems, and treatment interruptions due to justice involvement. Factors that contribute towards justice-involvement — such as poverty, violence, racial and gender inequality, discrimination, and stigma — also hinder HIV and Hep C prevention, treatment, and care.

Rates of Hep C among men and women with criminal-justice involvement have reached epidemic proportions. Estimated rates of Hep C, often co-occurring with HIV, have been as high as 31-49% among justice-involved populations. Vulnerability to Hep C is heightened by the many health care and access challenges occurring during reentry, including high rates of co-occurring conditions along with a lack of continuity of care, medication, coordination between institutions, insurance, and health education.

Better prevention and care for everyone is possible now more than ever with the availability of significantly easier, shorter, and effective treatments. Optimal prevention efforts, which best address both Hep C and HIV risk factors prevalent after release, include education; promotion of safer sex and needle practices; treatment; and safe, sober housing. We need to eradicate stigma and improve access to prevention, screening, and treatment for all New Yorkers.

Let us work together to raise awareness and address the silent epidemic of Hep C now and create a Hep Free NYC!

In recognition of National Hepatitis Awareness Month, NYC community-based organizations will be hosting screening events and educational workshops in conjunction with other events taking place throughout the country. NYC leaders call for action to address the impact of viral hepatitis and seek to increase public awareness of and concern about hepatitis B and hepatitis C; to improve testing, care, and treatment; and prevent liver disease and cancer. 

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*Written by Micaela Linder, Health Policy Researcher and Educator at The Fortune Society 

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