From
less achieved stabilisation of infection rates in the main affected groups, and so far minimised the spread to other populations.
Doug’s Desk
What were the elements of success underpinning the Australian response to HIV ? According to Wodak & Crofts (1996) the initial response came from immunologists and haematologists who were extremely effective public health practitioners. The HIV response also had an independent task force that was able to exert pressure on commonwealth and state health services. In addition to this both the AIDS task force and NACAIDS were chaired by high profile figures with whom people in the general community could identify.
“Doctors are people who prescribe medications, of whose effects little are known, to patients about whom they know even less.” (Anonymous)
By contrast Wodak & Crofts note that the response to the HCV epidemic has mostly depended upon the efforts of a small group of hepatologists who lack the broad focus of their HIV counterparts. They also claim that the general public are not so fearful of hepatitis C as they were of HIV which was perceived by Australians generally to be an imminent threat to public health requiring quick and decisive action. They claim that it is hard to get public advocacy for an illness like HCV which is linked in the minds of the general public with injecting drug use, an illegal and widely condemned behaviour.
This epigram has always been attributed to Voltaire who didn’t think much of doctors but loved gardeners. It contains two themes, the first questions the efficacy of treatments, the second questions the amount of knowledge the doctor has about the patient. The Treatment Seminar organised by the Department of Human Services and the Hepatitis C Council on the 3rd of August (see William’s article pg 4) went someway towards addressing the first theme, but the latter until fairly recently, rarely gets a mention apart from occasional articles by Alex Wodak and Nick Crofts. In this edition I would like to look at the make up of our affected community and our role in response to the HCV epidemic, and what we can learn from the Australian response to HIV. My aim is to encourage debate, not necessarily to provide answers. For some years now both Alex Wodak and Nick Crofts have been writing articles drawing attention to particular problems experienced by some of the groups which comprise the general hepatitis C community, and like most people looking for answers to difficult problems they have sought models of success from other areas of health. The most obvious model of relative success has undoubtedly been Australia’s response to the HIV epidemic, that has more or
8
The article mentioned above was published four years ago and its main thrust was a call to reframe the HCV epidemic as a public health issue as opposed to a clinical one with the public health association providing the leadership. Needless to say these issues are still with us, as is evidenced by a recent article by Crofts, Loveday & Kaldor (1999) drawing attention to much the same issues and this is despite the recent launching of the First National Hepatitis C Strategy. “Similarities between the two epidemics include the targeting of some of the most vulnerable and politically disenfranchised groups, raising issues of discrimination, resource allocation and priorities for effective action. To most in the community, hepatitis C is a disease of other people, requiring no action for their own protection. The people who are affected are often socially stigmatised. There is no immediate political constituency for the major groups affected by hepatitis C, injecting drug users and
Hep C Community News
Issue 13
8