The following information is written by and provided in partnership with the Tennessee Department of Health:
2020 has been a difficult year for all of us. This Spring and Summer have made us all think more about our health, and how important it is that we take care of ourselves today to prepare for the problem that could be just over the horizon.
This year has also put into sharp focus all the reasons we have for not being proactive about our health. Health care is expensive and, for many of us, challenging to access. Health information is hard to understand and is changing every day. The evolution around HIV is a perfect example of this. HIV treatment gets easier to access for Tennesseans every year, and in the last decade has gone from a process which a person might delay to one where getting into treatment as soon as possible changes how a person lives with the disease. On top of that, HIV prevention tools now include PrEP, a daily pill.
The realities around prevention and treatment for hepatitis C have gone through a similar evolution. The term hepatitis refers to inflammation of the liver, and can be caused by many different things. These causes include fatty liver disease, over-consumption of alcohol, exposure to toxins and chemicals, some drugs and medications, and infections. In Tennessee, one of the main causes of hepatitis is the hepatitis C virus.
Hepatitis C virus is ten times more infectious than HIV, and one in four people with HIV will experience hepatitis C co-infection. As the use of injection drugs continues to rise statewide, so too does hepatitis C; approximately 53% of people who inject drugs have hepatitis C (source).
LGBTQ people are more likely to misuse substances, including both drugs and alcohol, than others. Discrimination and stigma can contribute to over-dependence on alcohol and drugs for LGBTQ people (source). LGB youth are 25% more likely to drink alcohol, twice as likely to use ecstasy and cocaine, and four times as likely to use heroin and meth (source). LGBTQ people are also less likely to have health insurance than others, particularly youth, seniors, and transgender persons, putting significant barriers between them and routine medical care (source, source, source). These realities mean that LGBTQ people are more likely than others to come into contact with HIV and hepatitis C, while also having unique barriers to health care.
In Tennessee, access to hepatitis C screening and treatment has increased dramatically in the last few years. This is huge for LGBTQ people who are at elevated risk for hepatitis C, because it can now be cured in most people while the consequences of lack of treatment compound significantly over time. Over 90% of people with hepatitis C can be cured with 8-12 weeks of oral medication (source). If left untreated, complications include chronic hepatitis C infection (75-85 out of every 100 people), chronic liver disease (60-70 out of a 100), cirrhosis (5-20 out of a 100), and death (1-5 out of 100) (source). Cirrhosis and liver cancer cause about 1 in 5 percent of hepatitis C-related deaths, as treatment options are limited for these conditions (source).
Hepatitis C is a health concern where knowledge about screening and treatment is critical, and can mean the difference between three months of treatment and years of chronic health issues. Hepatitis C screening is a two-step process that starts with an antibody test (which will always be positive for anyone who has ever been exposed to hepatitis C) and an RNA confirmatory test (which can tell you if you currently have hepatitis C). Antibodies to hepatitis C are not protective, and you can be re-infected even if you have successfully completed past hepatitis C treatment.
If you think you might have hepatitis C, your local health department can provide you with testing and treatment options. Here is a list of health departments in Tennessee that you can use to find the location most convenient for you.
If you have a positive hepatitis C test, or if you have had a positive test in the past but need support finding free or low cost treatment, Tennessee has Viral Hepatitis Case Navigators who provide resources to patients seeking hepatitis C treatment. To get started, contact your local health department and ask to be connected to a Viral Hepatitis Case Navigator.
If you want to get involved in the statewide effort to better coordinate work around HIV, sexually transmitted infections, hepatitis C, and substance misuse, click here to learn more about the End the Syndemic Tennessee initiative.