World Day of Social Justice: towards an equitable response to harm reduction and hepatitis

Written by Jessica Hicks, Head of Programmes at the World Hepatitis Alliance

The theme of World Day of Social Justice 2020 is “Closing the Inequalities Gap to Achieve Social Justice”. This feels particularly pertinent to me as I attend the First Regional Conference on Hepatitis Care in Substance Users (INHSU Africa) in Cape Town this week.

Despite the fact viral hepatitis is the second deadliest infectious disease in the world, it has been hard to get it recognised as a major health problem, never mind as a social justice issue. But there is no doubt that eliminating this deadly disease should be recognised as a social justice priority. Viral hepatitis impacts some of the world’s most marginalised and disadvantaged communities – including indigenous peoples, refugees, people in prison, and people who inject or use drugs – hardest.

“Despite the fact viral hepatitis is the second deadliest infectious disease in the world, it has been hard to get it recognised as a major health problem, never mind as a social justice issue.”

People who use drugs, in particular, face multiple and – compared to the general population – additional barriers to diagnosis and care. They are also disproportionately affected by hepatitis C; globally, 23 per cent of new hepatitis C infections and one in three hepatitis deaths are attributable to injecting drug use.

Viral hepatitis – and its prevalence among people who use drugs – is a global health issue. But, with around 14 million people in sub-Saharan Africa injecting drugs and only five countries providing needle and syringe programmes and opioid agonist therapy, it is clear that there is a need to focus on the regional response. Over the last couple of days at INHSU Africa we have heard how law enforcement approaches to drug use are dominant across the continent, and the impact that widespread discrimination and exclusion of people who use drugs is having on their ability to access their right to healthcare. This, in conjunction with limited prevention, testing and treatment services, means people are at high risk of contracting viral hepatitis and/or HIV, and that they are more likely to face stigma and discrimination than to access life-saving prevention or treatment.

A clear message has emerged consistently throughout the packed and varied programme at INHSU Africa: there is a real need for comprehensive harm reduction services for people who use drugs, including hepatitis C and HIV testing, which should be designed with and meet the needs of the people they serve. Human rights – and indeed social justice – must be at the heart of the response.

Something that has particularly stood out at the conference over the past few days is the amount of community involvement. Reflecting the principle of ‘nothing about us without us’, the patient voice and experience has not only been included, but has been central to the programme. It is people with lived experience of drug use and hepatitis who are leading discussions at the event and designing what a better and more equitable response to harm reduction and hepatitis/HIV prevention, testing and treatment services might look like.

While the focus of INHSU Africa has been improving the health of people who use drugs and tackling viral hepatitis (and HIV co-infection) in Africa, the emerging lessons are relevant to the global response to hepatitis. Only through reaching marginalised communities with integrated, accessible, human rights-focussed and person-centred services will we close the inequalities gap and achieve social justice for people affected by viral hepatitis.

“Only through reaching marginalised communities with integrated, accessible, human rights-focussed and person-centred services will we close the inequalities gap and achieve social justice for people affected by viral hepatitis.”