Roundtable discussion: how lessons learned from HIV can inform the global response to viral hepatitis

Abstract

IntroductionBy Jeffrey V Lazarus.In the last few years, as viral hepatitis has become amore prominent issue on national and internationalhealth agendas, talk of“learning from HIV” has becomequite common. It is understandable for researchers, pol-icy-makers and activists to make this link, given the nota-ble commonalities between HIV, hepatitis B and hepatitisC. All are life-threatening blood-borne viruses that affecthundreds of millions of people worldwide. All can remainasymptomatic for many years, making it difficult to pro-mote awareness of their danger. Ignorance about all ofthe major forms of viral hepatitis, particularly B and C,understandably reminds many people who are workingto confront this issue of the early years of the AIDS epi-demic, when a combination of misinformation andunwillingness to candidly address stigmatised behavioursand social inequalities led to a widespread failure to for-mulate a cohesive public health response.Other parallels might be elucidated, and there is cer-tainly good reason to think of the global HIV, hepatitisB and hepatitis C epidemics as having similar trajectoriesin some regards. Nonetheless, the differences betweenHIV and viral hepatitis– in terms of how these varieddiseases manifest both biologically and socially– shouldmake us wary of oversimplifying the connection.As discussions about hepatitis policies and strategiesgain momentum at the national and global level, it isbecoming increasingly important to articulate the“lessons learned” from the HIV field. Pertinent issuesinclude disease preventionmeasures, testing and earlydiagnosis, the scale-up of treatment, and barriers to ser-vice uptake and retention in care. Key social and politicalfactors associated with viral hepatitis call to mind otherpossible lessons relating to the value of civil societyengagement, leadership and governance issues, resourcemobilization including innovative financing, the causesand consequences of stigma, and the role of socialscience in addressing health threats.This is clearly a rich and important realm of inquiry–and it is time to move beyond the general calls to learnfrom HIV and begin to systematically formulate specificlessons. As a preliminary step, the following roundtablepresents the insights of a range of experts who were invitedto reflect on how experiences from the global response toHIV might inform the global response to viral hepatitis.Kicking off the discussion is Jens Lundgren, a renownedHIV researcher, head of the new WHO CollaboratingCentre on HIV and Viral Hepatitis and co-founder of theHIV in Europe Initiative. His perspective is much broaderthan that of a medical doctor gazing at his own disease. Inthe next two pieces, Jordi Casabona of the EpidemiologicalCenter for HIV/AIDS/STI of Catalonia and Lucas Wies-sing of the European Monitoring Centre for Drugs andDrug Addiction (and colleagues) consider surveillance andmonitoring issues. Sounding a cautionary note about the“discourse of hope and expectation” associated with hepa-titis C treatment, Magdalena Harris, a qualitativeresearcher at the London School of Hygiene and TropicalMedicine, critically reflects on treatment as prevention.