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第9回アジア太平洋地域国際エイズ会議参加報告書
 

(特活)アフリカ日本協議会 国際コーディネーター
小川 亜紀

概要

現在、世界の薬物使用者のうち、約300万人はHIV/AIDSに感染しており、その内、HIVウイルスに汚染された注射針を使用した薬物使用者の50-90%は、C型肝炎に感染しているとの報告がある。しかしながら、東南アジアなどアジア・太平洋地域での薬物使用者におけるHIVとC型肝炎の二重感染が極めて高いにもかかわらず、これらの国々の政府は薬物使用者の二重感染の問題についてほとんど言及していないのである。この対策には、ハーム・リダクションによるHCV感染予防の強化と、いまだに極めて高額なC型肝炎治療へのアクセスの拡大を図る必要がある。また、薬物使用者が、より積極的に治療にアクセスできるように、差別・偏見を解消しなければならない。政府や国際機関は、この課題にもっと真剣に向き合う必要がある。

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As my first conference in the Asia and the Pacific, the 9th ICAAP has been an opportunity to discuss and shed light to HIV/AIDS in the Asia and the Pacific. However, one issue that should have received more attention but has remained almost silent until a group of activists took up the stage during one of the plenary session is HIV and Hepatitis C (HCV) co-infection. International Organizations and government response has been almost silent compared to the severity of the HIV/HCV co-infection, especially in the Asia and the Pacific Region. Civil Society and community activist including Shiba Phurailatpam of the Asia Pacific Network of People Living with HIV (APN+) and Greg Gray of World AIDS Campaign called on International Organizations and government to “break the silence” in HIV/HCV co-infection. In solidarity with my fellow activists, I chose to write about HIV/HCV co-infection to raise awareness and to call on Governments and International Organizations to provide the political and social support and financial resources to ensure Universal Access to prevention, care and treatment to HIV, HCV, and HIV/HCV co-infection.

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A slogan "Hepatitis C + Silence = Death" was sprawled across the plenary stage of the 9th International Congress on AIDS in Asia and the Pacific. The activist climbing on the stage called for the governments and international organizations to break the silence on HIV and Hepatitis C (HCV) co-infection.

Hepatitis C, a viral infection that damages the liver, is the most common virus affecting Intravenous Drug Users (IDUs). Intravenous Drug Users are more at risk of acquiring HIV/HCV co-infection. Through Intravenous Drug Use, currently an estimated 3 million people are living with HIV/AIDS and 50%-90% of HIV-infected injection drug users are also infected with Hepatitis C.1

HIV/HCV co-infection makes treatment and efficacy of treatment for HIV and HCV far more difficult and complicated. According to International Coalition on AIDS and Development, “The co-infection can worsen the effects of both diseases. For example, if co-infected with HCV and HIV, the chances of developing liver disease are much higher and decisions around appropriate treatment for both diseases become far more complicated”.

There has been little mention about HIV/HCV co-infection at the Congress despite extremely high HIV/HCV co-infection rates in most parts of South East Asia and the Pacific and the rise of HIV transmission through Intravenous Drug Use in that region. In the 2008 Publication of The Global State of Harm Reduction by the International Harm Reduction Association, “Among people living with HIV, studies have found elevated HCV prevalence rates in China (0 - 99.3%), Thailand (4.8 - 98.8%), Vietnam (98.5%), and Indonesia (10 - 40%).”

Although the number of co-infection is high, there is still a lack of research and monitoring systems to provide data, limiting strategies and financing plans needed to ensure universal prevention, treatment and care to HIV/HCV co-infection.2

According to UNAIDS and the WHO, screening and treatment for HCV is best practiced if integrated with the HIV treatment, care and support framework. However to the already limited HIV interventions targeting Intravenous Drug Users, there are even a grim number of targeted HIV/HCV co-infection interventions. Intravenous Drug Users are less likely to be able to access to prevention, treatment and Care to HCV.

Prevention through harm reduction remains key in reducing and limiting the number of HIV and HCV transmission among Intravenous Drug Users, as endorsed by WHO, UNAIDS, UNICEF, UNESCO and UNODC. Harm Reduction includes needle and syringe exchange programs, opiate substitution therapy, exchange programs for other drug items, comprehensive HIV prevention and treatment and physco-social and economic support for people who use drugs.3 However, information, education and communication, coverage of and access to harm reduction4 programs are extremely low. Only 3% of IDUs in South Asia and 8% in East Asia currently have access to harm reduction. Some countries in South East Asia and the pacific still carry political and social opposition, or are uncooperative in providing harm reduction.

Intravenous Drug Users face stigma, discrimination and in most cases marginalization from communities and even healthcare workers. Furthermore, drug use is highly criminalized, with some countries carrying out death penalties for possession. Criminalization of drug use forces an already marginalized people underground and decreases the likelihood to seek information or services for HCV or HIV.5

Furthermore, as with ARVs, treatment for Hepatitis C6 remains extremely expensive and unaffordable to the millions living with Hepatitis C. The cost of Hepatitis C medicine, peylated interferon and ribaviron, which may require up to a year of administration, remains one of the major barriers in accessing treatment.7 In a press release by the activists on the stage, Nanao Haobam of the Asia Pacific Network of People Living with HIV (APN+) is quoted, “Almost every month my friends are dying and just in the last two months, five of them have lost their battle with Hepatitis C. Now, my doctor wants me to start on the treatment but it will be cost me 1500 USD per month. Where do I get that money?”

Despite the increasing number and the severity of HIV/HCV co-infection Governments and International Organizations has turned a blind eye in providing a sufficient and swift response. Whether through the lack of targeted interventions for HIV/HCV co-infection or remaining nonchalant to the cost of treatment is unaffordable to the majority of those affected - it has always been easy for Governments to escape responsibility of protecting human rights when the most affected are the poor, the stigmatized, and/or the marginalized, as shown in their slow response to HIV/AIDS epidemic. The case of Intravenous Drug Users and other marginalized population most at risk and most affected by HIV/HCV co-infection has been no different. Protecting Human Rights - the Right to Health- does not apply to selected populations; it applies to all including marginalized populations.

Governments and International Organizations must provide the political and social support and financial resources to ensure Universal Access to prevention, care and treatment to HIV, HCV, and HIV/HCV co-infection.

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1 Center for Disease Control and Prevention (2005) Coinfection with HIV and Hepatitis C Virus.
2 International Harm Reduction Association (2008) The Global State of Harm Reduction 2008.
3 International Coalition on AIDS and Development (2009) Hepatitis C and HIV: A Growing Threat to Universal Access.
4 Ibid.
5 Ibid.
6 APN+ Press Release at the 9th ICAAP (2009) Break the Silence on Hepatitis C co-infection: Refusal to recognize and treat HIV-Hepatitis C Co-   infection dampens optimism on Universal Access at ICAAP.
7 International Coalition on AIDS and Development (2009) Hepatitis C and HIV: A Growing Threat to Universal Access.