Hepatitis is a serious viral condition, causing inflammation of the liver. It is more common in people who use drugs and those who experience homelessness.
If left untreated, viral hepatitis can cause irreparable damage to the liver that may require a transplant. It’s a fairly serious health condition in the United States and with rapidly increasing infections among vulnerable populations.
What is Hepatitis?
There isn’t just one type of hepatitis. Viral hepatitis is the name for a host of viruses including: hepatitis A, B, C, D, and E.
Each type of hepatitis is more common than others; some are involved with particular behaviors — like drug use and unprotected sex — and others are more common among people who experience homelessness.
Here’s a quick breakdown of each type of viral hepatitis, who it’s transmitted, and how common it is among certain groups of people.
Hepatitis A is transmission if a person ingests fecal matter, even in microscopic amounts. How does this happen? Simply, contamination. Food and drinks could be contaminated from a service person not washing their hands before serving a customer, or during homelessness when there is little access to clean drinking water and uncontaminated food. There is also a lack of hygiene facilities for people experiencing homelessness.
In general, the CDC says that hepatitis A can last from a few weeks to a few months, but most people make a full recovery with little damage to their liver.
Hepatitis B & C
Hepatitis B and C are spread through bodily fluids, like semen, blood. It can also transmit through birth, unprotected sex, blood transfusions, sharing toothbrushes and razors, and drug equipment. Hepatitis C is most common among people with substance use disorder (addiction).
The CDC says that hepatitis B can be a mild, serious, or life-long chronic condition. Similarly, hepatitis C can be mild to chronic, although most people with hep C develop a life-long virus. Approximately 15-25 percent of people infected with hep C will develop liver disease which could lead to cirrhosis, liver cancer and even failure, requiring a liver transplant. Whereas 50 percent of people with hepatitis C develop a chronic infection, and up to 25 percent will develop cirrhosis.
Hepatitis D & E
Hepatitis D can only occur in people with hepatitis B. It too is spread through bodily fluids. Whereas hepatitis E is transmitted through contaminated water sources and is more common in developing countries.
What is the Scope of Hepatitis in the United States?
Hepatitis B and C are the most common in the United States. Around 862,000 Americans are living with chronic hepatitis B infections and 2.4 million Americans have hepatitis C. Unfortunately, hep C infections are increasing rapidly, with around 50,000 new cases per year.
Hepatitis A is also a problem. According to the CDC, ten states reported more than 6,500 infections in 2018, with 40 percent of infections among people who experience homelessness.
Why Do Drugs Make it More Likely to Contract Hepatitis
Drug use is complex and often involves decreased inhibitions leading to risky behaviors, such as sharing needles and other drug equipment, and having unprotected sex. The National Institute on Drug Abuse states that each person with hep C that uses drugs is likely to infect around 20 others. What’s more, drug use impairs the function of the liver, increasing the risk of developing chronic liver diseases.
Similarly, people who experience homelessness are more likely to use substances to self-medicate. Over 3 million people are homeless in the United States and this population is at a three times higher rate of contracting hepatitis A.
The reason for this disproportionate rate of infection is because, typically, houseless people have less access to resources such as clean needles making it more likely that they would share needs and drug equipment.
Both hepatitis A and B have vaccines to prevent infection. In fact, the CDC has approved hepatitis A vaccination for at risk groups, including people who use drugs and all people experiencing homelessness.
Unfortunately, there are no vaccines for the other types of hepatitis, and there is no medication for hepatitis B. However, there are treatments for hepatitis C in its earlier stages of infection. There are also a lot of preventive measures to avoid hepatitis.
How to prevent Hepatitis in Drug Use
The CDC recommends regular testing for hepatitis B and C. In addition, there are a number of harm reduction strategies that can also be used to reduce the risk of transmission and infection, including:
- Using clean needles only, not sharing them
- If reusing needles, follow instructions on how to clean them with bleach and flush them out
- Ensure you use condoms when having sex.
Local shelters and harm reduction organizations provide a range of services for people who use drugs and/or experience homelessness, including free syringes, sharp disposal containers for used needles, wound cleaning, free condoms, and testing. These organizations also help refer people to other services, like mental health care, medical help, housing, and shelter.
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