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Hep C sufferers have nowhere to turn

Update: November, 20/2012 - 10:55

by Minh Thi

HA NOI (VNS)— Pham Thi Minh, a Hanoian office worker in her thirties, was shocked when she was diagnosed with the hepatitis C virus (HCV) after undergoing a medical examination before trying for her second child.

Minh said she earned only VND4-5 million (US$190-240) a month and could not afford the estimated cost of hundreds of millions of dong for HCV treatment.

Minh later managed to get treatment, but only thanks to financial support from both her own family and her husband's.

However, Minh suffered a lot of side effects from the treatment.

Minh said each time she was injected with medicine, she suffered from high temperature, dizziness and lost appetite.

"My weight fell from 62 kilos to only 48."

She added that the possibility of her treatment's success was also uncertain.

Struggling as she is, Minh is still one of the luckier ones who received treatment thanks to the support of her extended family.

Dong Duc Thanh, a 36-year-old official at a social organisation in Ha Noi, is among the much larger group who cannot afford treatment.

Having lived with HIV for 18 years, Thanh said he also became infected with HCV in 2005.

Thanh said he earned VND10 million (nearly $480) per month, above the average income level in Viet Nam, but could still not think about getting treatment.

"With the estimated cost as high as VND200 million ($9,500), there is no way I can afford treatment," said Thanh.

Unlike other patients who may seek support from their extended family, Thanh said he came from a family of low income workers, so he did not even tell them about his condition.

Thanh said to prevent his condition from worsening, he tried to limit alcohol use, spent some money on tonics, went to the hospital for regular examinations and avoided taking heavy jobs.

Although highly vulnerable to hepatitis C as the disease is spread through contact with contaminated blood, Thanh said many HIV-positive people were not even aware of the risks and some infected with the disease did not even know they had it.

"Even if some of us are diagnosed, we do not even dream of getting treatment," said Thanh.

Unlike hepatitis B, there is so far no vaccine available to prevent hepatitis C.

The importance of treatment, however, was pointed out by the European Association for the Study of Liver's 2011 report on HCV by Joseph Torresi, as it said approximately 40-80 per cent of HCV infections cleared after treatment.

Pham Hoang Phiet, chairman of the HCM City Liver and Gall Association, said if left untreated, 85 per cent of HCV infections transformed into chronic Hepatitis C after 10 to 20 years, while 30 per cent caused serious liver problems like cirrhosis and cancer.

The biggest challenge to treatment, as the patients pointed out, was the cutting price of medicine.

Dr. Fabio Mesquita, HIV senior advisor and team leader of the World Health Organisation's Office in Viet Nam, said a patient in Viet Nam needed about US$10,000 to be able to afford treatment for the common duration of 48 weeks.

Khuat Thi Hai Oanh, director of the Centre Supporting Community Development Initiatives (SCDI) said, however, that the price of medicine to treat HCV "did not have to be that high".

She said the price was also dependent upon Government policy.

Oanh added that the Government could make a difference by negotiating with pharmaceutical companies to reduce the price, and that insurance coverage of hepatitis C medicine, which is currently lacking, would also help reduce the burden on patients.

HCV patients in other countries with a higher GDP than Viet Nam such as Thailand, Egypt and Brazil bore much lower costs for treatment, as either their governments had negotiated a reduced price or offered them financial support, Oanh said.

Oanh and Mesquita are calling for the Government to reduce the price of medicine and make it accessible to more people.

Mesquita added that there were so far no official statistics on the number of people infected with HCV or national guidelines for its treatment, while public awareness of the disease was limited.

Experts said doctors who specialised in treating HCV had to follow international guidelines for treatment because there were no national guidelines available.

Thanh said there was a lack of awareness about the disease, and its dangers had only recently been addressed by the media.

Plus, only hospitals in big cities offered treatment for the disease, so patients from rural provinces had to commute.

There was also a lack of specialists for patients to seek advice from, said Thanh.

Minh and Thanh both said that more information was needed for the public to understand the disease.

In a report on the situation of HIV and Hepatitis C virus (HCV) co-infection in Viet Nam published in July in the Journal of International Association of Physicians in AIDS Care (JIAPAC), a group of doctors referred to hepatitis C as a "quiet epidemic" because public awareness about the disease, including that of policy makers and medical officers, was still low.

According to the report, drug addicts were those most likely to contract hepatitis C because of their injection habits, while other vulnerable groups included blood donors, those with a surgical history and medical officials.

The report also revealed that a person admitted to hospital more than once was over seven times more at risk of infecting the virus than someone who had never been admitted to hospital.

Dr Mesquita said in Viet Nam, up to 1.7 per cent of the northern population had hepatitis C while the proportion was up to 4.3 per cent in the south.

"The majority of people infected with hepatitis C are of a working age and their conditions cause a huge burden on the economy and the health sector," said Mesquita. — VNS

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