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Activist Strategies for Increasing Access to HCV Treatment in Low- and Middle-Income Countries

By Karyn Kaplan

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From the Introduction

Liver disease from hepatitis C virus (HCV) is one of the leading causes of death around the world. At least 185 million people have been infected and almost 500,000 people die from it each year. The hope for eradicating HCV has recently gained new momentum: effective treatments reaching a 100 percent cure rate in clinical trials are now available. But unaffordable drug prices and expensive diagnostic tools are keeping HCV cures from the majority of people who need them—those living in low- and middle- income countries (LMICs).

There are many significant barriers to HCV eradication: the lack of accurate epidemiological data, which are necessary for development of policies, programs, and resource allocation; the criminalization of people who inject drugs and the banning of harm reduction programs, which perpetuate ongoing HCV infection; and the absence of global and national political will (with few exceptions) to address the epidemic.

But AIDS activists have developed and implemented successful strategies to overcome similar challenges in addressing the HIV epidemic. From Johannesburg to New York, Río de Janeiro to Bangkok, activist-driven policies have helped more than 10 million people gain access to HIV treatment. Antiretroviral therapy (ART) has saved 4.2 million lives in LMICs—despite the belief among policy makers and world leaders that doing so would be impossible.

While HCV and HIV differ in significant ways (for example, HCV can be cured with short-course treatment, while HIV treatment is lifelong), lessons learned from three decades of AIDS activism are useful for the growing HCV activist movement.

Activist Strategies for Increasing Access to HCV Treatment in Low- and Middle-Income Countries presents a number of key strategies through real-world case studies and shows how strategies used to combat the AIDS epidemic can be—and have been—adapted to increase HCV treatment access.

These strategies are introduced in three sections:

Section One: Laying the Groundwork through Community Organizing

Strategy 1: Framing HCV Treatment and Prevention as Basic Human Rights, Particularly for Injection Drug Users
Strategy 2: Organizing People Living with HCV for Community Education and Mobilization
Strategy 3: Forming Alliances with Local, Regional, and Global Organizations to Influence Policy
Strategy 4: Demanding Global HCV Policies and Funding Streams

Section Two: Overcoming the Cost Barriers to HCV Treatment Access

Strategy 5: Negotiating Lower Prices with Drug Companies
Strategy 6: Challenging Intellectual Property Barriers through Patent Oppositions
Strategy 7: Overriding Patent Barriers through Compulsory Licenses and Parallel Importation

Section Three: Collaborating with Researchers to Build Your Case for HCV Treatment Access

Strategy 8: Using Mathematical Modeling to Predict Cost-Effectiveness and Public Health Benefits of HCV Treatment
Strategy 9: Advocating for Policies and Programs Based on Evidence Provided by Operational Research