Through country-by-country estimates, Nelson and colleagues provide an opportunity to examine the striking geographic disparities in rates of hepatitis B and C. Why is the prevalence of hepatitis C antibodies in injecting drug users (IDUs) in Hungary 23%, while it is about 90% in Estonia or Lithuania and 73% in Russia? Why do 85% of IDUs in Mexico have hepatitis B core antibodies compared with 20% of IDUs in Uruguay? These differences could be due to the limitations of the data; despite thousands of studies reviewed, grade A reports (multisite seroprevalence studies with several sample types for at least one hepatitis marker) were only available for 20 of the 77 countries for which any data were available, and few studies provided truly national estimates.
However, the differences may also show trends and patterns of drug use, or important differences in state policies and investment in harm reduction. The large variations between countries show that it is not inevitable for IDUs to have high rates of hepatitis B, hepatitis C, or HIV infection. Moreover, the estimates provide a powerful means for health and human rights advocates to question government officials in countries with high prevalences, and to caution governments in countries with low prevalences about the potential costs (human and economic) of failing to put in place or sustain effective, rights-based policies.
Nelson and colleagues provide us with a first step and powerful data to draw attention to the problem of viral hepatitis in people who use drugs. The next step is to challenge governments to act and hold them accountable for implementation of rights-respecting and evidence-based programs.
Joseph J. Amon, Ph.D., is director of the Health and Human Rights Division of Human Rights Watch in New York. This was adapted from a commentary published online July 28, 2011 in The Lancet (Lancet 2011 July 28 [Epub doi:10.1016/S0140-6736(11)61132-X]).
