28 LISTENER JUNE 1 2019
HEPATITIS C CURE
no NGO services for hep C in New Zealand,
right at a time when there should be. The
Aids Foundation does fantastic work and
this year it had an email campaign where
it was looking for 500 people with undi-
agnosed HIV in New Zealand. Well, we’re
looking for 50,000.
“And there’s nothing. The Hepatitis Foun-dation is for hep B – everything it does on
the side for hep C is because it just hap-
pens to have the resources left over. There’s
no funded advocacy. I think there should be,
and I think we, as Hep C Action, should be
in line for some of the funding. It’s crazy
- we’ve got 40-1 hep C infections to HIV.”
Not taking the cure, Freeman emphasises,almost inevitably means an early death. The
infected population includes younger adults
- there are still nearly 1000 new infections a
year in New Zealand, nearer 10,000 in Aus-
tralia – but three-quarters of people with the
virus were born before 1965.
“We see people who are 60 often in pretty
good health,” says Freeman. “But by the
time they’re 65, they’re getting really sick.
Come age 65, the hep C demographic just
disappears. They’re all dead. There’s no one
there, they’re gone.”
Those demographics, says Gane, call for
“two different public awareness campaigns”.
Even before the new antivirals were funded,
he worked to get the diagnosis and monitor-
ing for the 5000-10,000 people who inject
drugs in New Zealand moved to commu-
nity facilities, such as needle exchanges, and
beyond hospitals, where many of them had
had bad experiences. Those places will still
be the best route to such high-risk groups.
“Then there’s the much larger population
of people who have no association with
injecting at the moment, but who may have
been exposed in their teens and twenties.
And those people are in their forties and fif-
ties now. The best way to engage with them
is through their GPs or some other commu-
nity site, such as a pharmacies.
“There, people can be treated by a GP.
But we’d like to go further. If treatment is
so innocuous, we’d like nurses to be able
to prescribe it. We’d like pharmacists to be
able to prescribe it. We’d like ready access to
this treatment in the future, because it is so
easy, so safe and you don’t need to monitor
people when they’re on it.”
Actually, what Gane would really like is
for all of us to get the test.
“That’s something that is not beingconsidered in New Zealand, but is being
considered in a number of countries.”
Heal thinks it will happen. “Testing is
coming down in price all the time and we
think every adult once in their life, barring
new risk factors, should have a test. That’s
how countries are going to achieve national
elimination.”THE HARDER PART
Neither Pharmac nor manufacturer AbbVie
is saying what each treatment with Maviret
will cost taxpayers, but Gane suspects we’ve
negotiated one of the lowest prices in the
world. Ultimately, it will be much cheaper
than dealing with the awful complications
that come with untreated hepatitis C.
As Australia has discovered, finding the
money for hep C antivirals is the easy part.
The harder part is cultural: finding the mes-
sage that will bring in people for testing and
moving past the drug-related stigma that
may have prevented them doing so in the
past. It means reaching people who may be
profoundly isolated.
“At least with HIV, which was mostly a
disease of gay people, they had that com-
munity, and they had the support around
that,” says Freeman. “With hep C, there isn’t
a community, because people, even if they
were involved with the drug network, part
of the purpose of getting clean is to break
off from that network. If you didn’t get it
from that source, which is about half the
people, you have no relationship to anyone
else with hep C. So, there’s no network sup-
port around it. It’s staggeringly isolating.”
The battle in both countries will benefit
greatly from political decisions made in the
1980s to introduce needle exchanges and
opioid-substitution therapy as harm-reduc-
tion measures. (Australia went further in the
late 1990s, when the first medically super-
vised injection room opened in Sydney.)
These services are either controversial or
simply unavailable in many other countries.
Beating the disease will require a simi-
lar social and political commitment, the
embrace of a view that, as Gane puts it, “we
don’t care how you got hep C; have a test
and if you’ve got it, we’ll cure you”.
Gane says about 100 New Zealanders
a week are now starting treatment with
Maviret and “if we can keep that up, we’ll
get rid of hep C within 10 years”.
Keeping it up, as the experience across the
Tasman shows, will be the challenge. And
if Heal gets her way, we’ll do it by changing
the conversation with a butterfly. l“This afternoon, there are
10,000 New Zealanders
driving home from work
going, ‘Oh, jeez, I’m
feeling tired’, where it’s
hep C and they don’t
know they’ve got it.”
Taking the test
Hepatitis is a viral infection that
causes inflammation of the liver.
There are five known strains: A, B,
C, D and E.
Hepatitis A and E are usually
short-term infections and are
typically spread through faecal
contamination.
Hepatitis B can be spread by
blood-to-blood contact or other
bodily fluids, while C is almost
always transmitted by blood-to-
blood contact (until 1992, blood
was not screened for hepatitis C
before transfusions). Hepatitis C
is more likely than B to become
a chronic infection: as many as
85% of people infected with C will
develop a chronic infection that
may be carried for 20-30 years.
The outcome of hepatitis C is
often cirrhosis and liver failure or
liver cancer.
Perhaps the biggest difference
between B and C is that there is
a vaccine available for B. The vac-
cine is also protection against the
lethal hepatitis D, which occurs
only as a coinfection with B.
Getting tested for hep C is as
easy as asking your GP. If you’re
uncomfortable discussing it with
your own doctor, or unable to
afford a visit, give blood – the
compulsory screening test before
donating is free and will tell you
whether or not you have the virus.
Work & Income also provides
grants to see your doctor. For fur-
ther information, visit the Hepatitis
Foundation’s website hepatitis-
foundation.org.nz or its Facebook
page, or call 0800 33 20 10