By: Marcus J. Hopkins, Blogger
Native Americans (NAs) in the United States have largely gotten the shaft. Forced from their native lands, herded into reservations, and the victims of innumerable false promises and broken agreements on the part of the U.S. government, NAs have also had the misfortune of being disproportionately impacted by infectious disease. Such is the case with Hepatitis C (HCV). According the most recent Surveillance for Viral Hepatitis report released, this year, by the Centers for Disease Control and Prevention (CDC), NAs have by several integers the highest rate of HCV per 100,000 people out of any race demographic with a rate of 12.95 (CDC, 2017). The Cherokee Nation – the second-largest NA tribe in the U.S. – has decided to actively come out swinging against HCV.
Roughly 130,000 Cherokee Nation (CN) tribal citizens live in northeastern Oklahoma within the tribe’s boundaries, and within this community, aggressive measures are being taken to combat the disease. Dr. Jorge Mera (seen in the photo being honored by the Obama Administration for his Hepatitis C program), Head of Infectious Diseases at Cherokee Nation in Tahlequah, OK has worked with various agencies and private partners to create a comprehensive approach to dealing with their HCV epidemic (Taylor, 2017):
- Using newer Direct-Acting Antivirals (DAAs) to treat and achieve Sustained Virologic Response (SVR) in infected tribe members
- Partnering with Gilead Sciences (makers of three currently available HCV DAAs – Sovaldi, Harvoni, and Epclusa) to receive funding for screening kits and research through the Gilead Foundation
- Adopting a proactive compulsory screening policy of screening all tribe members aged 20-69 for HCV (rather than just the Baby Boomer Birth Cohort), as well as offering tests to all children of any mother who screens positive for HCV
- Expanding screening locations to include dental clinics to screen tribe members who may not access other healthcare services
- Pushing and receiving approval for the establishment and funding of a tribal Syringe Services Program (SSP – Syringe/Needle Exchange) within the tribe’s territory (Hays, 2017)
This type of aggressive approach to combating HCV is, in fact, the type of action that Viral Hepatitis (VH) advocates have been pushing for years, but the unique circumstances under which tribal healthcare operates allows for more freedom than in the greater U.S. “Because Cherokee Nation citizens, under a treaty right with the United States Government have access to medical care, tracking them, and screening them is slightly easier than might be so for other US populations,” explains Dr. Mera (Taylor). Additionally, since their focus is on a smaller, specific population, the CN is able to focus its care on a smaller pool of individuals, rather than attempting to address the healthcare needs of millions of citizens.
That said, HCV transmission does not occur within a vacuum – tribe members do come in contact with people who fall outside of the tribe’s jurisdiction, meaning that, even if the CN’s efforts to screen, track, and cure all members of the tribe within its boundaries are 100% successful, they are still susceptible to new infections by way of contact with those outside of their community. This means that the types of progressive Harm Reduction, screening, and treatment measures being undertaken by CN need to be replicated in the state of Oklahoma, as well as the surrounding states (and eventually, the entire U.S.) in order for their efforts to not be undermined by failures to provide similar services on the parts of state and Federal governments.
These tactics also serve as a roadmap for dealing with HCV in some of the states hardest hit by the disease, particularly in smaller Appalachian states like West Virginia and Kentucky, where geography and smaller, more remote populations make reaching, screening, tracking, and treating not only HCV, but every health condition more difficult.
The tribe will present its progress at the World Indigenous People’s Conference on Viral Hepatitis in Anchorage, AK on August 08-09, 2017. For more information on that conference, please click on the following link: WORLD INDIGENOUS PEOPLES’ CONFERENCE ON VIRAL HEPATITIS
- Centers for Disease Control and Prevention. (2017, June 19). Surveillance for Viral Hepatitis – United States, 2015. Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: Division of Viral Hepatitis. Retrieved from: https://www.cdc.gov/hepatitis/statistics/2015surveillance/index.htm – tabs-6-5
- Hays, H. (2017, August 09). Cherokee approves needle exchange program. Waynesville, NC: Smoky Mountain News: News. Retrieved from: http://www.smokymountainnews.com/news/item/20505-cherokee-approves-needle-exchange-program
- Taylor, B. (2017, August 09). CHEROKEE NATION AMERICAN INDIAN TRIBE SHOWING IT IS POSSIBLE TO ELIMINATE HEPATITIS C. London, UK: World Hepatitis Alliance: News. Retrieved from: http://www.worldhepatitisalliance.org/news/aug-2017/cherokee-nation-american-indian-tribe-showing-it-possible-eliminate-hepatitis-c
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.