HepVu spoke with Dr. Gregory Dore about the barriers to Hepatitis C treatment among people who inject drugs in the U.S. and Australia.
Gregory Dore, MD is a Scientia Professor and the Head of Viral Hepatitis Clinical Research Program at the Kirby Institute at the University of New South Wales Sydney in Australia.
Q: Your career focuses on Hepatitis C and other infectious diseases, especially among marginalized populations such as people who use drugs and people who experience homelessness. What led you to focus on these diseases and populations?
I worked in East Africa at a mission hospital in the early ‘90s before I completed my training in infectious diseases. I was involved in HIV care at St. Vincent’s Hospital in Sydney, Australia during the height of the AIDS epidemic in the early- to mid-1990s. During that period in Australia, HIV was predominantly affecting Gay and Bisexual Men and people who inject drugs.
During the ‘90s, in Australia and many other countries, Hepatitis C was mainly managed by liver specialists. My previous experience with HIV gave me a real passion for improving the lives of marginalized populations, such as people who inject drugs. I saw Hepatitis C as an opportunity because there weren’t a lot of people from infectious diseases and public health getting involved in that work during the mid-to late ‘90s. I set up the Hepatitis C services at St. Vincent’s Hospital in 1999 and began my professional journey in Hepatitis C research and clinical care.
Q: You recently co-authored a commentary on the barriers to Hepatitis C treatment faced by persons who inject drugs in the U.S., published in The Journal of Infectious Diseases. The paper states that barriers to Hepatitis C care exist at the “systems level, as well as the level of medical providers and patients.” Could you talk about these barriers and how they impact the Hepatitis C epidemic in Australia and the U.S.?
Australia is very different from the U.S. One of the key differences is that although Australia is a federation of states, there’s a lot of federal leadership and strategic direction in public health. There has been a bipartisan approach to support public health strategies, including fighting HIV and Hepatitis C. This collaborative approach enabled us to have a very public health-centered and nonpolitical approach to HIV prevention, starting in the ‘80s and ‘90s. A major component of this approach was broad harm reduction. Needle syringe programs with federal government funding were in place from the early ‘90s, a stark difference to the situation in the U.S.
In the U.S., federal funding has not been able to be used to purchase needles and syringes for harm reduction programs. Australia provided resources for these programs because we felt it was important to protect highly marginalized populations by reducing their individual risks while not judging people for their lifestyle. The lack of federal funding in the U.S. is a system level issue that affects prevention services and public health infrastructure. This infrastructure is crucial, especially when marginalized populations may not have access to routine healthcare.
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