Behind the Story: Hepatitis C and Needle Exchange
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July 10, 2009 – Reporter Kenny Goldberg tells host Gloria Penner about his reporting on the rise in hepatitis C and the difficulty in implementing clean needle exchange programs at the local level.
Related story: The High Cost of Hepatitis C
GLORIA PENNER (Host): This week, KPBS rolled out a series of special reports on the rapid spread of hepatitis C, an infectious disease that affects the liver. In its chronic form it's a serious illness which can result in long term health problems and even death. The main risk factor in the spread of the hepatitis C virus is intravenous drug use. Contaminated, reused needles are the culprit. Health studies have shown that the simplest way to prevent the spread of the disease is to dispense clean needles. KPBS' Kenny Goldberg is the journalist behind this series. He joins me now. Kenny, welcome. KENNY GOLDBERG (KPBS News): Thank you. PENNER: So lets find out just how serious it is. First of all, why is the current infection rate alarming, and what's it like in San Diego? GOLDBERG: Well, the current rate is about two percent of the adult population in the United States has hepatitis C. In San Diego, county officials say its about 4,100 people officially are affected with the disease, but doctors tell me thats really understated because most people who have hepatitis C don't know it because for decades it can be asymptomatic. Somebody may not show symptoms at all until it really manifests itself later on. PENNER: How is it spread? GOLDBERG: Its spread through blood to blood contact. So contact with contaminated blood. It used to be that major risk factors were a blood transfusion or an organ transplant. But in the early 90's, they started screening for hepatitis C and HIV in the blood supply. So since then, people who've gotten hepatitis C have become infected using IV drugs. PENNER: And what about the treatment? I mean, what is it and is it effective? GOLDBERG: The treatment consists of two drugs: one taken orally, one thats self injected. And for the main genotype of hepatitis C it's about 50 percent effective. The treatment itself though causes very painful flu-like side effects. It's really tough for people. But nonetheless they can get cured about 50 percent of the time. PENNER: From my understanding is that doctors and health providers saying that clean needles might be the simplest way to prevent the spread of hepatitis C. And you actually went to New York and did a report on that. GOLDBERG: Thats right. I went to New York to contrast what they're doing in New York and what the attitude of public health professionals in New York compared to San Diego. In the city of San Diego, we have a mobile needle exchange program that operates twice a week. One night in North Park and one night in East Village. But the county of San Diego, which is ruled by the Board of Supervisors, they won't approve clean syringe exchange. They don't believe in it. They think it sends the wrong message to kids, that if we dispense clean syringes to drug addicts that we're in essence condoning drug use. Whereas in New York, they have 12 syringe exchanges that are publicly funded around the city and they have a completely different attitude. The health commissioner there told me that look, people that shoot drugs, we know they're going to do it so we'd like them to do it as safely as possible so they're not spreading disease. PENNER: But you say that the county says no. And what is their argument against it? GOLDBERG: That it sends the wrong message to kids, that if we dispense clean syringes to drug addicts, that we're encouraging drug use, we're fostering drug use, and therefore they just don't want to condone that. PENNER: Is that a valid argument? GOLDBERG: No, its not valid at all. Its a belief, but its not based in science. The research says the clean syringe exchanges reduce harmful behavior, like needle sharing, they actually reduce drug use, and also clean syringe exchanges are a way for people to get into treatment. So they don't just hand out materials for people to use drugs, they try to develop a relationship with clients, and eventually, hopefully get somebody into drug treatment. PENNER: But thats interesting. What you're basically saying is that health policy decisions are being made by politicians in San Diego County. What is the attitude of doctors and healthcare workers toward politicians making healthcare decisions? GOLDBERG: Well they're really upset about it, because, I mean, public heath policy extensively should be guided by science, should be guided by research. And yet in this county the people that are making these decisions are ignoring the research, they're ignoring the science, and they're basing the public health decisions on their personal beliefs. PENNER: Okay, well thank you very much, Kenny Goldberg. GOLDBERG: Thank you. PENNER: Joining me now to weigh in with their comments on how San Diego is dealing with hepatitis C are Kent Davy, editor of the North County Times, and Vicente Calderón, editor of the Tijuana Press. Well, Kent, let's start with Kenny's comment about the fact that politicians should not be making healthcare decisions. What's your impression of that? KENT DAVY (North County Times): Politicians of course make healthcare decisions. It's happened always and it will always happen because a great deal of America's healthcare is provided by tax dollars in one way or the other. And as soon as there's tax dollars involved, politicians will decide on the allocation of resources. Now that doesn't mean they make necessarily wise choices of what to do with tax dollars and making those policy decisions. This particular topic falls in that range of things that have a certain kind of political dynamite to them, though particularly for conservative, tend to be Republican politicians who tend to want to run against things that are perceived as liberal ideas. PENNER: So the City of San Diego says lets go ahead with the clean needle exchange, the county says lets not touch it. So, we're talking about conservative versus liberal there? DAVY: Absolutely. It's analogous to the notion of should, say, federal dollars or tax dollars generally go to planned parenthood organizations to distribute condoms. Same kind of argument shows up. There's good public health policy arguments who say, gee, if you distribute condoms you have an effect on teen pregnancy. On the other hand you've got politicians push back and say wait a minute, not in my world. PENNER: Now, these are IV drug users in many cases, and somehow when we think about drugs, we think drugs coming across the border from Mexico. But I don't know how much of a problem hepatitis C is in Baja California. VICENTE CALDERON (Tijuana Press): I think it's a problem, not extraordinarily. I think there's a general concern about this communicable disease in Baja California. I think there's a project, a national effort, led by the doctor Gloria Losada, who go out where there are high risk populations, and they are tying to include the hepatitis with other very serious cases that are not well treated. PENNER: Do Tijuana or Rosarita have a clean needle exchange? CALDERON: I'm not sure if Rosarita does, but I know that Tijuana has one, and they go even, for example, to the channel of the river Tijuana Rio where there's drug addicts or homeless people that don't have any healthcare. And they see this as a very high risk group, because they use a lot of drugs - there's a lot of drug consumption there - thats when they are using the needle exchange program. It's a small exchange program but its apparently working - and they do that with AIDS, with hepatitis, and other transmittable diseases. PENNER: Is it an expensive program? CALDERON: I think, I'm not sure, but I think since it has some support from this side of the border, that's a binational effort, its not a big issue on the general budget of the health department. PENNER: So, finally, Kent, I mean when you talk about politicians making health decisions because of tax dollars and the dollars involved, is this not the best use of funds for the County of San Diego? DAVY: Well, there's two pieces of the argument there. One is, it is undoubtedly the case that it is the city and then North County cities as well that have the most significant problem with intravenous drug users as opposed to the county probably in general. So I would guess that there's a political calculation that goes on the amount of supervisors who say I can appeal better to my conservative base if I stay away from a program that way on the city side the city goes, you know, if this is a problem we need to take care of it and it makes scientific sense to do so. PENNER: Well politics and business, that takes us right next to our next subject.