Issue:  Vol. 48 / No. 11 / 15 March 2018

Hep C task force launched


Dominique Leslie, co-chair of the city's new hepatitis C Task force, and member Ryan Clary hope to get off to a quick start with awareness campaigns for the disease. Photo: Jane Philomen Cleland
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In an effort to address a growing public health concern, Mayor Gavin Newsom has established the San Francisco Mayor's Hepatitis C Task Force. The 30-member group, which officially convened in November after more than a year of planning, will hold meetings open to the public on the second Monday of each month.

"We are eager to shed light on this silent epidemic and identify specific recommendations for the mayor to develop a comprehensive plan to fight this disease," said Task Force Co-Chair Dominique Leslie.

"The key is going to be public awareness and educating medical providers to ask questions and get people tested," added task force member Alan Franciscus of the Hepatitis C Support Project.

The task force includes treatment activists, public health officials, medical professionals providing both conventional and complementary treatment, and social service providers. Members represent the diversity of communities heavily affected by hepatitis C, including the leather/SM/kink community, sex workers, people with a history of injection drug use, and current or former prisoners. More than half identify as LGBT, nearly half are people of color, and a third are currently living with or have been successfully treated for hepatitis C.

The Centers for Disease Control and Prevention estimates that 3.2 million people in the U.S. have chronic hepatitis C; some 12,000 of them live in San Francisco. There were an estimated 17,000 new infections nationwide in 2007, but hepatitis C typically causes no symptoms during its earliest stages – or only mild symptoms that resemble the flu – and many people do not learn they are infected until they develop advanced liver damage years later.

Hepatitis C virus is transmitted most efficiently through direct blood contact, for example sharing needles to inject drugs or hormones or reusing tools for piercing or tattooing. But a significant proportion of people with hepatitis C have no apparent risk factors and do not know how they got infected.

In recent years it has become evident that HCV sexual transmission is more common than previously believed, with several outbreaks among HIV-positive gay and bisexual men in Europe and the U.S. Reported risk factors include fisting, "rough sex," group sex, and nasal drug use. About one-third of HIV-positive people are coinfected with HCV.

"I found out I was hep C coinfected about three years ago, but I was likely infected sexually more than 20 years ago," said task force co-chair and longtime HIV/AIDS public policy advocate Randy Allgaier. "I was never considered in an 'at risk' category, so my doctor and I never talked about an HCV test. Even I thought hep C was a disease associated with injection drug use. I am very open about my AIDS, but when I was diagnosed as hep C positive I had a hard time telling people – there was a great deal of stigma that I had to deal with."

New HCV infections have fallen dramatically since the virus was identified in 1989, but many people who acquired the disease during the 1970s and 1980s are only now reaching advanced stages of liver damage.

Hepatitis C can be treated with interferon-based therapy, but the cure rate for the most common type (genotype 1) is only about 50 percent and it can cause difficult side effects such as depression. New types of HCV drugs are in the pipeline, but they also do not cure everyone. Furthermore, many people are considered ineligible for treatment for a variety of reasons, including substance abuse.

Left untreated – or if treatment does not work, as was the case for Allgaier – HCV can cause liver cirrhosis and liver cancer. Hepatitis C is now the leading reason for liver transplants in the U.S.

"I was diagnosed in 1990 and was denied treatment twice, mostly because of being transgender," said Leslie, who has been in recovery from drugs and alcohol since 1988 and works as an HIV prevention and substance use counselor. "Now I am faced with needing a liver transplant."

The mission of the new task force includes identifying services for people with hepatitis C in the city and creating a comprehensive set of policy and funding recommendations. It will also work on prevention efforts and awareness campaigns to get the word out to at-risk populations and the general public.

As one of its first official actions, the task force sent letters to House Speaker Nancy Pelosi (D-San Francisco) and Representative Jackie Speier (D-San Mateo) asking them to co-sponsor the Viral Hepatitis and Liver Cancer Control and Prevention Act of 2009.

"Our ambitious game plan is to have recommendations to the mayor by the end of 2010 and then continue to convene in 2011, during which I hope we'll see quick and aggressive implementation by the mayor and the city," Allgaier said.

The next meeting of the SF Mayor's Hepatitis C Task Force will take place February 8 at 5:30 p.m. at 25 Van Ness Avenue, third floor conference room.

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