Hepatitis C Elimination Efforts in the United States Should Embrace Abolition

BY Prashasti Bhatnagar, JD, MPH

Despite the treatable nature of hepatitis C virus (HCV) infections through direct antiviral direct-acting antiviral (DAA) drugs, HCV rates remain rampant throughout the United States, particularly in correctional facilities. Recent investigations also reveal that HCV treatment efforts within jails and prisons are ineffective, flawed, and rife with misconduct and neglect. According to a 2022 STAT report authored by Nicholas Florko, many state prison facilities not only fall short in screening and treating incarcerated people with HCV, but also engage in egregious misconduct, such as avoiding mass testing of incarcerated people, providing incarcerated people with inaccurate information about available medicines, and refusing to treat incarcerated people.

There is growing momentum to develop and implement national viral hepatitis elimination efforts in the United States. In addition to the Department of Health & Human Services’ new national strategic plan to eliminate HCV from the United States by 2030, the Biden-Harris administration has also proposed a 5-year program to eliminate HCV in the United States. The program aims to significantly expand HCV testing, treatment, screening, and prevention efforts, particularly for people who are disproportionately impacted by HCV infections. With the opportunity to create a holistic public health response to eradicating HCV, it has become especially important to center and adopt abolition as an ethic in HCV elimination efforts.

In Investing in Community Care Is an Important Goal and Need for Eliminating Hepatitis C in the United States: An Abolitionist Perspective, we draw important connections between HCV elimination, the function of the carceral apparatus, and the growing movement towards decarceration and abolition. We argue that the carceral apparatus—which includes prisons, jails, and correctional facilities broadly—plays a fundamental role in increasing the risk of HCV transmission due to its harmful structure. Extensive research shows that incarceration is a key driver of health inequities: incarceration increases susceptibility to chronic infectious diseases like HCV; contributes to adverse physical and mental health outcomes; reduces life expectancy; and disrupts important social networks necessary for linkage to HCV treatment services. These negative conditions and consequences of incarceration make health promotion efforts within correctional settings ineffective and unsustainable, as well as legitimize systems that are harmful to health.

Moreover, the carceral apparatus is premised upon principles of punishment, racial subjugation and oppression, and white supremacy; it was never intended to be healing or life-affirming. As a result, we must push HCV elimination efforts to think beyond using jails and prisons as intervention points, and instead, adopt abolitionist principles to reallocate funds from the carceral apparatus to community-based prevention services. Community-based efforts offer an upstream approach to eliminate HCV, while centering people most impacted by HCV infections: incarcerated people who report injection use. This is because community-prevention efforts promote screenings and treatment services in trusted spaces, foster cross-sector collaboration across public health threats, and have the capacity to expand harm reduction strategies and organize towards breaking cycles of criminalization and punishment of drug use. Thus, reallocating funds from the carceral system to community-prevention efforts has the potential to not only divest from health-harming systems like the carceral apparatus, but also invest in effective and life-saving models like community care.

The main takeaway of our article is that HCV rates cannot be eradicated if we do not challenge and gradually eliminate our reliance on the carceral apparatus. Ultimately, we want to invest in life-affirming institutions, such as strong health policies and strong health systems. Joining broader calls for decarceration and abolition that unsettle and dismantle the health-harming carceral apparatus are, thus, integral for creating a systemic and holistic public health response to HCV elimination.

Article details
Investing in Community Care Is an Important Goal and Need for Eliminating Hepatitis C in the United States: An Abolitionist Perspective
Prashasti Bhatnagar & Sonia L. Canzater
First Published: October 28, 2022
DOI: 10.1177/15248399221129536
Health Promotion Practice

About the authors

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Prashasti Bhatnagar, Esq., M.P.H. is a Law/Public Health Post Doctoral Scholar at Kirwan Institute for the Study of Race and Ethnicity at The Ohio State University, a Ph.D. student and Eugene V. Cota-Robles Fellow at UCLA, and a Board Member for the Midwest Immigration Bond Fund. Her work is focused on exploring and implementing community-led interventions rooted in health justice, carceral & border abolition, and liberation. Originally from New Delhi, India, Prashasti received her J.D. from Georgetown University Law Center; M.P.H. from Johns Hopkins Bloomberg School of Public Health, as a Sommer Scholar, with a Certificate in Health Disparities and Health Inequalities; and B.S. in Sociology, summa cum laude from University of Minnesota, Twin Cities.