Hepatitis has become a global epidemic. Such viral infections can cause cirrhosis of the liver and hepatocellular carcinoma. Nine percent of the global population, or 550 million people, are infected and one million die from the disease every year. Most of these deaths are in lower-income countries. Hepatitis infections have definitive links with poverty beyond death rates; poverty is an identified risk factor for the disease. Here are four ways poverty impacts the hepatitis epidemic:

1. Poverty Impedes Diagnosis
   Many people are unaware they have hepatitis. Indeed, 90 percent of people with hepatitis C are not diagnosed. Undiagnosed people may not take precautions in preventing transmission.Many diagnostic tests are expensive, putting them out of reach for lower-income countries. For example, the liver biopsy test is not only expensive, but it requires trained histopathologists to analyze the tissue sample. In Africa, medical professionals who are experts in liver diseases are generally not common. This includes those who would analyze the histology sample.Furthermore, lower-income countries don’t typically have high-quality laboratories that can test for hepatitis. The centers that do exist are usually found in urban areas, neglecting those in rural locations.
2. Poverty Reduces Access to Treatment
   Lower-income countries have limited access to hepatitis treatment. Forty-one percent of the population lives in places without public hepatitis funding. One treatment, known as PEG-INF/RBV, can cost EUR 25,000 for full course therapy in Europe. This figure does not consider any of the follow-up care or further tests.There are also tests which guide the treatment of hepatitis. They identify the strain and how much virus is in a person. They’re expensive and as such not always routine.
3. Patents Make Drugs More Expensive Than They Need to Be
   Drugs are protected as intellectual property by patents. These protection laws prevent other companies from creating comparable, generic drugs at lower prices for twenty years after invention. The intention is to encourage research and development by drug companies. In reality, when only one company makes a drug the company has free range with pricing and often sets a high price tag. These patents make some hepatitis drugs too expensive for patients in lower-income countries.
4. Reuse of Syringes is Common in Lower-Income Countries
   Syringes can be contaminated with hepatitis. When they are reused without sterilization, they can pass along the infection. One reason that dirty syringes are reused is because of poorly trained healthcare workers. Also, lack of funding forces medical professionals to reuse syringes. If this practice continues, so will the epidemic.The good news is that there are treatments and cures for hepatitis. There is a complete cure for the hepatitis C strain and preventative vaccines for hepatitis A, B and E. The World Health Organization (WHO) is optimistic in defeating the hepatitis epidemic. They have prioritized its eradication and are creating guidelines to help countries with this process.

Previously, the WHO prioritized fighting a global epidemic during the HIV outbreak. HIV therapy once cost $10,000 per patient, per year. That is now down to $100. Today 10 million people receive treatment, in contrast to the mere 20,000 who were once treated in developing nations.

Hopefully, with focus and funding, the future of hepatitis can follow the pattern set by the HIV outbreak, and poverty’s impact can be eliminated.

– Mary Katherine Crowley

Photo: Flickr