1Open Society Foundations, 224 West 57th Street, New York, NY 10019, USA. Electronic address: Daniel.Wolfe@opensocietyfoundations.org.
2Médecins Du Monde, 62 Rue Marcadet, Paris 75018, France.
3London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
4Open Society Foundations, 224 West 57th Street, New York, NY 10019, USA.
5International Network of People who Use Drugs, Unit 2C05, South Bank Technopark 90 London Road, London SE1 6LN, United Kingdom.
6Australian Injecting and Illicit Drug Users League, GPO Box 1552, Canberra ACT 2601, Australia.
7Treatment Action Group, 261 5th Avenue #2110, New York, NY 10016, USA.
People who inject drugs (PWID) achieve adherence to and outcomes from hepatitis C virus (HCV) treatment comparable to other patients. Nonetheless, this population has been excluded from treatment by regulation or practice. Approval of safer and more effective oral HCV medicines should offer greater treatment options for PWID, although high medicine prices have led to continued treatment rationing and exclusion in developed countries. In middle-income countries (MICS), treatment is largely unavailable and unaffordable for most PWID.
Human rights analysis, with its emphasis on the universal and interconnected nature of the economic, social and political spheres, offers a useful framework for HCV treatment reform. Using peer-reviewed and grey literature, as well as community case reports, we discuss barriers to treatment, correlate these barriers to rights violations, and highlight examples of community advocacy to increase treatment for PWID.
Structural drivers of lack of treatment access for PWID include stigma in health settings; drug use status as a criterion for treatment exclusion; requirements for fees or registration by name as a drug user prior to treatment initiation; and incarceration/detention in prisons and rehabilitation centers where treatment is unavailable. High medicine prices force further exclusion of PWID, with cost containment masked as concern about treatment adherence. These barriers correlate to multiple rights violations, including of the rights to privacy; non-discrimination; health; freedom of information; fair trial; and freedom from cruel, inhuman and degrading treatment.
Needed reforms include decriminalization of drug use, possession of drugs and drug injecting equipment; removal of exclusionary or discriminatory treatment protocols; approaches to strengthen links between health providers and increase participation of PWID in treatment design and implementation; and measures to increase transparency in government/pharmaceutical company negotiations and reduce treatment price.