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HIV/AIDS Awareness

Beyond Silos: Addressing Dual Epidemics of HIV and Hepatitis C

Marissa Tonelli

Director, Health Systems Capacity Building, HealthHIV

Integrating the public health response to the HIV and hepatitis C epidemic improves health outcomes for people living with or at risk of HIV/HCV coinfection.

Over 2.3 million people around the world are coinfected with both HIV and hepatitis C (HCV). In the United States, an estimated 25% of people living with HIV are coinfected with HCV. With overlapping risk factors and modes of transmission, like injection drug use and sex without condoms, HIV and HCV have become closely intertwined epidemics impacting many of the same minority communities. Over the past decade, HIV/HCV coinfection has also been fueled by the national opioid crisis. The dual epidemics demand an integrated response now more than ever.

There are safe and effective ways to prevent the transmission of HIV and HCV. Using clean injection equipment and wearing condoms are important steps in protecting yourself. Syringe service programs (SSPs) provide access to sterile syringes and injection equipment, linkage to substance use disorder treatment, and prevention education. Research shows SSPs are associated with a 50% reduction in coinfection, and when combined with medication-assisted treatment, they can lead to nearly a two-thirds reduction in HIV and HCV infection. Implementation of these services alongside expanded HIV and HCV testing, community awareness initiatives and healthcare provider education are crucial to reduce HIV/HCV transmission.

Vigilance is key

COVID-19 has significantly impacted HIV/HCV prevention programs. Organizations, like SSPs and health departments, are forced to suspend outreach and walk-in services due to social distancing. For otherwise-healthy individuals with HIV/HCV coinfection, there appears to be no increased risk of contracting COVID-19. However, if COVID-19-related setbacks delay the HIV and HCV response, new infections and thousands of more deaths will occur nationwide.

HIV and HCV are highly preventable and treatable. But without public health efforts, we will likely continue to see increases in morbidity and mortality rates from HIV and HCV, which are significant on their own and further exaggerated in combination. We have the necessary tools to end these epidemics and prevent coinfection, but we must continue to invest in and expand existing initiatives that address HIV/HCV coinfection as well as adapt challenges presented by the COVID-19 pandemic.

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