Controversies in and challenges to our understanding of hepatitis C

Table 1 Factors impeding our understanding of HCV issues world-wide

Societal attitudes to the infected community

Injecting drug use is seen as a moral weakness and thus not needing to be addressed

Infection is the fault of the infected individual

Why should society expend money on those who undertake illicit activities?

Societal attitudes to prisoners

Prisoners are imprisoned to be punished

Prison sentences are usually relatively brief so the prisoner can wait for assessment and treatment

Drugs are not available in prison so there is no need for prevention measures against HCV

Societal attitudes affect Health care worker attitudes

More discrimination against HCV infected individuals occurs in health care settings than in the general community

Patients unwilling to disclose (their condition?) for fear of discrimination leading to poor care

All these issues decrease open disclosure and impair a full understanding of HCV transmission.

Table 2 Reducing the number of new HCV infections

Actions that are required to achieve a reduction in new infections:
Acknowledging the existence of the epidemic
Overcoming denial of the pathogenicity of the HCV
Accepting that this disease is more prevalent than HIV
Defining the natural history more accurately
Increasing understanding of the biology of the HCV
Requires a greater funding base for research
Greater collaborative effort between clinical and research centres
Defining transmission risks accurately
Working with injecting user groups an essential requirement
Studies with the virus will allow a great expansion of knowledge
Responding to these risks adequately
Governments must commit to addressing the epidemic
Increasing access to treatment
Define clinical pathways
Optimise access to treatment for those with more severe disease
Advertise treatment efficacy more clearly
Improving treatment efficacy