Tag Archives: CDC

Emory University and CDC Reveal HepVu

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

The latest tool in Viral Hepatitis advocacy has arrived: HepVu (www.hepvu.org). A project of Emory University’s Coalition for Applied Modeling for Prevention (CAMP) – supported by the Centers for Disease Control and Prevention (CDC) – HepVu is an interactive website that provides various data related to Viral Hepatitis (VH), with the greatest emphasis being placed upon Hepatitis C (HCV), the least accurately reported variant in the U.S.

The website features interactive maps detailing estimated prevalence data, rates of infection, mortality data, and regional impacts and comparisons on both the national and state levels. While HCV data released by the annual National Health and Nutrition Examination Survey (NHANES) conducted by the CDC produces national estimates, HepVu is the first analysis that uses a more nuanced formula that includes NHANES data, but also examines state-level reporting and statistics that includes electronic medical records (EMRs), insurance claims, and HCV-related mortality.

Other site features include infographics, explanations about the various types of VH, and the ability to print and download maps and data for use in advocacy efforts and reports. Dr. Patrick Sullivan, one of the researchers associated with creating the project, stated that making the site a resource for HCV-related advocacy and reporting efforts was an essential step in creating HepVu. This is the first HCV-related website (of which I am aware) that makes these data easily available for reprinting and citation purposes.

The contributing researchers to the website admit that this reporting is likely well below the actual prevalence and rates of infection, because screening, reporting, and tracking vary in quality and amount of data from state to state, in no small part because of a lack of Federal and state funding for HCV reporting, as well as adequate and standardized reporting requirements set by the CDC. Part of what makes this data so important is that it serves as a great starting point for advocating for increased funding for reporting and tracking – something that Congress has been slow to address, despite large increases in funding to address America’s opioid and heroin abuse crisis, the leading contributor to the rise in new HCV infections.

The primary limitation of the data presented on HepVu (and in general) is age: the vast majority of the data centers on 2010 and 2014 – seven and three years old, respectively. This complaint has been a sticking point for advocates and HCV-related organizations for several years, particularly because of the release of easily tolerated and highly effective Direct Acting Agents (DAAs) that serve as a curative treatment for HCV. Now that we have these tools to eradicate HCV, it is imperative that we begin operating on current information, rather than relying upon data that predates two presidential elections. This means that both Federal and state governments are going to have to step up to the plate and begin adequately funding screening, reporting, and tracking efforts, regardless of the high cost of these drugs.

HepVu is an excellent starting point, despite the data limitations, and so long as the statistics and information are regularly updated with more current information, it has the potential to become an invaluable tool in combating HCV and hopefully eradicating the virus from the U.S., entirely.

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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.

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Rural Americans Still Lack Access to Syringe Exchange Programs

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

The HEAL Blog  covers the expansion of Syringe Exchange programs as an effective and proven method of Harm Reduction to prevent the spread of HIV and Hepatitis C (HCV). While there have been some notable successes over the past few years, especially in states where rural transmission of both HIV and HCV is increasing, the stark reality is that these areas largely lack access to the Syringe Exchange programs that could help to stanch the spread of deadly diseases that are easily spread through sharing and reusing needles.

A new report from the Centers for Disease Control and Prevention (CDC), decreases in HIV diagnoses in People Who Inject Drugs (PWIDs) indicate success in HIV prevention. However, emerging behavioral and demographic trends could reverse this success (Wejner, et al, 2016). In terms of demographics of PWIDs, both African-Americans and Hispanic populations have seen consistent and rapid downward trends in all three areas: HIV diagnoses among PWIDs, those who shared syringes to inject drugs, and people who reported injecting drugs for the first time. Whites, but urban and non-urban, however, did not fare well in these measures.

In both Urban and Non-Urban settings, new HIV diagnoses amongst white PWIDs saw a slight increase; the same is true of whites who shared syringes to inject drugs; whites made up over 50% of people who reporting injecting drugs for the first time. This shouldn’t come as a big shock to those who have been following drug usage trends – the abuse of opioid prescription drugs and heroin in rural and suburban areas has spiked significantly, over the past twenty years, as we have covered in previous posts – areas where the population tends to skew heavily to the White.

Sign reading, "HIV Needle Exchange"

Indiana Needle Exchange

While Syringe Exchange Programs (SEPs) have grown more common in urban areas, people living in largely rural states, rural areas, and suburban areas have again fared poorly in this regard. A 2015 report from the CDC surveyed 153 SEP directors (out of the then 204, in March 2014), and found that only 9% of SEPs were in Suburban areas and only 20% in Rural areas (Des Jarlais, et al., 2015). The areas hardest hit by the increase in PWIDs – the Northeast, South, and Midwest – had a total of 11 SEPs in Rural areas; the West, by comparison, had 18 in Rural areas. While this data is from 2013, and more SEPs have been opened, it is difficult to get a definitive count of the number of operative SEPs.

From a health emergency perspective, we have a White HIV crisis brewing in rural and suburban America. Beyond the issues related to PWIDs, there is also the increase risk of sexual transmission from PWIDs to those who do not inject drugs. Whites have consistently represented the largest number of new infections, since the beginning of the epidemic (not to be confused with the disproportionate rate of infection amongst minority groups), and for the first time in 2014, White PWIDs had more HIV diagnoses than any other racial or ethnic population in the country (Sun, 2016). State and Federal laws – especially in rural states – continue to present barriers to establishing and funding SEPs in areas that are the hardest hit.

One of the most frustrating aspects of reporting healthcare statistics is the reporting lag; the references used in this post present data that is at least two years old. This problem exists because of the time it takes for states to finalize data, in addition to the time it takes for peer reviewing before publication. While there were 204 operating SEPs in the U.S. in 2013/2014, it’s now 2016, and we could use some updated numbers.

References:

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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.

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The Negative Impact of Opioid Drugs Upon Children and Young Adults

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

In early November 2016, a conference held at Xavier University in Ohio drawing hundreds of doctors, nurses, social workers, and addiction specialists began releasing shocking (though unsurprising) data related to the prescription opioid and heroin epidemic’s negative impact on children and teenagers. The findings indicate what many in healthcare already knew: we are at risk of creating a generation of children whose lives are fundamentally altered for the worse by addiction.

In the past few months, HEAL Blog has doggedly followed the unrelenting opioid-fueled devastation in the state of Ohio, and we have frequently brought to the fore the plight of children whose lives are have been put at risk due to their caretakers’ substance addiction and abuse. What we haven’t yet really covered has been the growing risk posed to children and teens whose access to opioids is made possible by their caretakers.

A study released in the Journal of the American Medical Association (JAMA) Pediatrics showed a 165% increase in opioid poisonings in children from 1997 to 2012 (Luthra, 2016). The rate of toddlers hospitalized more than doubled, and teens were found to be increasingly at risk of overdose (both intentional and unintentional) because they gained access to their parents’ prescription opioids without their knowledge. Both of these issues point to the need to better address overprescribing of opioid drugs, as well as to better stress the need for safer storage of prescription drugs.

Roughly 1 in 10 high school students admit to taking prescription opioid drugs for nonmedical reasons (McCabe, West, Boyd, 2013; Luthra, 2016), and roughly 40% say they got those drugs from their own prior prescriptions (Fortuna, Robbins, Caiola, Joynt, Halterman, 2016). This suggests that (1.) parents are not properly securing their own prescriptions and (2.) parents are not properly monitoring their children’s use and disposal of prescriptions. These suppositions raise questions about whether or not parents whose children or teens overdose should (or do) face negligence charges.

Prescribing guidelines continue to be tightened, as the U.S. Centers for Disease Control & Prevention (CDC) and the U.S. Food & Drug Administration (FDA) have both attempted to get physicians to limit prescriptions to shorter periods, and there is little evidence that imposing penalties upon people who fail to properly store or dispose of medications will have any appreciable impact on the adult behaviors. The concern, however, is whether or not those penalties will result in lower levels of abuse and poisoning on the part of children and teens.

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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.

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Hepatitis C and Aging

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award

By: Marcus J. Hopkins, Blogger

While we, here at HEAL Blog, have spent much of the year focusing on the vast increase in new Hepatitis C (HCV) infections amongst the Injection Drug User (IDU) population, what often gets left out of that picture is the effect that Chronic HCV has upon the aging Baby Boomer population. According to the U.S. Centers for Disease Control and Prevention (CDC), of the estimated 3.2 million people chronically infected with HCV in the U.S., approximately 75% were born between 1945–1965 – Baby Boomers (CDC, 2015). As such, the Community Access National Network (CANN) will be hosting a panel on HCV and Aging this December 08, 2016, in Washington, D.C.

BORN 1945-1965? CDC recommends you get a blood test for Hepatitis C

Photo Source: Examiner

Baby Boomers have faced significant risks that make them more likely to have been infected with HCV, not the least of which includes blood transfusions received prior to 1990, when routine screening for HCV became the norm. Additionally, because HCV may take many years to manifest, many people are unaware that they are infected, with estimates ranging from 45% – 85% (CDC, 2015). Additionally, recent CDC reports indicate that HCV kills more Americans than any other infectious disease (CDC, 2016), despite being a curable condition. Roughly half HCV-infected patients often fail to receive appropriate treatment, because they are unaware that they are infected.

For those patients who are aware of their condition, there is often fear associated with HCV treatments. HCV treatment has long been considered one of the least tolerated therapies in medicine, with older Pegylated interferon-based treatments requiring long regimens that left patients sick and unable to function. With the introduction of the Direct Acting Agents (DAAs), Sovaldi (Gilead) and Olysio (Janssen), in 2013, these concerns related to the tolerability of drugs were largely mitigated. In 2013, there were two DAAs specifically aimed at treating HCV; in November 2016, there are now nine different drugs on the market to treat various genotypes of HCV – Sovaldi, Olysio, Harvoni (Gilead), Viekira Pak (AbbVie), Daklinza (Bristol-Myers Squibb), Technivie (AbbVie), Zepatier (Merck), Epclusa (Gilead), and Viekira XR (AbbVie). Epclusa, released in July 2016, is also the first pan-genotypic DAA that can treat HCV across all genotypes. These HCV DAAs are not only more easily tolerated, but also have shorter treatment times (between 12-24 weeks, with current testing for 8-week courses).

Though the tolerability of HCV treatments has been largely addressed with these newer DAAs, new concerns have risen regard the cost of the regimens, ranging from $54,000 – $94,500 for twelve weeks of treatment (Zepatier and Harvoni, respectively). In addition, Medicaid, Medicare, Ryan White, and private insurers alike have imposed strict Prior Authorization pre-requisites for approving these treatments, many of which include waiting until liver fibrosis scores (scarring levels) have reached a certain severity before they will approve a patient for these regimens. These pre-requisites often include a daunting amount of paperwork that must be filed, several denials, and abstinence from various activities for extended periods before considerations will even begin to be made. These barriers prevent many Baby Boomers from receiving life-saving treatments that should be routine, but because of cost-related issues are often not.

Despite these concerns, testing for HCV is still not a requirement in emergent care situations, regardless of recommendations by the CDC. With HCV being the leading cause of infectious disease-related deaths, it is imperative that we, as a nation, take better care of our seniors, and all become more aware of the risks posed by Chronic HCV.

 

References:

  • Centers for Disease Control and Prevention. (2015, May 31). Viral Hepatitis – CDC Recommendations for Specific Populations and Settings. Atlanta, GA: Centers for Disease Control and Prevention: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: Division of Viral Hepatitis. Retrieved from: http://www.cdc.gov/hepatitis/populations/1945-1965.htm
  • Centers for Disease Control and Prevention. (2016, May 04). Hepatitis C Kills More Americans than Any Other Infectious Disease. Atlanta, GA: Centers for Disease Control and Prevention: Newsroom. Retrieved from: http://www.cdc.gov/media/releases/2016/p0504-hepc-mortality.html

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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.

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Intersection of Imprisonment and Healthcare

By: Marcus J. Hopkins, Blogger

“Nearly forty years ago, the U.S. Supreme Court ruled in Estelle v. Gamble that ignoring a prisoner’s serious medical needs can amount to cruel and unusual punishment, noting that “[a]n inmate must rely on prison authorities to treat his medical needs; if the authorities fail to do so, those needs will not be met. In the worst cases, such a failure may actually produce physical torture or a lingering death[.] … In less serious cases, denial of medical care may result in pain and suffering which no one suggests would serve any penological purpose” (American Civil Liberties Union, n.d.)

 

These words put forth in a Supreme Court ruling are vitally important in today’s society – one in which the Centers for Disease Control and Prevention (CDC) released its first ever National Survey of Prison Health Care, the results of which were rosy on the surface, but admittedly (on their part) limited in scope, because they only asked if the service was available, rather than checked to see if the services were actually delivered. In addition, numerous reports at the 2016 International AIDS Conference in Durban, South Africa point to a serious issue brewing in the world’s prisons, as the “War on Drugs,” mass incarceration of drug users, and the failure to provide proven harm reduction and treatment strategies has led to high levels of HIV, tuberculosis, and hepatitis B and C infection among prisoners—far higher than in the general population (Medical Express, 2016).

Two hands holding prison bars

Photo Source: News Limited

The U.S. is exceptional, when it comes to the number of inmates in prison for drug offenses: of the 182,924 inmates currently in Federal prison, 84,746 (46.3%) of them were there for drug-related offenses (Federal Bureau of Prisons, 2016). There are roughly 5 million drug-related arrests each year (Prison Policy Initiative, 2016), all of whom spend some portion of their time going in and out of the jail or prison population, which increases the risk of exposure to blood borne pathogens such a HIV, Hepatitis C (HCV), Hepatitis B (HBV), and Tuberculosis (TB) exponentially over that of the general population. As Injection Drug Users (IDUs) represent an ever-increasing percentage of new HCV infections in the U.S. and around the world, the risk of transmission amongst prison populations is an incredibly serious issue that needs to not only be watched, but addressed.

The unfortunate intersection of imprisonment and healthcare statistics is the reality of the HCV treatment landscape in our nation’s prisons. This has been brought into sharp focus, recently, by a Federal lawsuit against state prison officials in Tennessee, which asks the courts to force the state to start treating all inmates who have HCV (WBIR, 2016).. The Tennessean (part of USA Today) released a report in May 2016 finding that only 8 of the 3,487 inmates known to have HCV were being treated for the disease (Tennessean, 2016) – treatment to which these patients are constitutionally guaranteed, but for which few are ever approved. Further complicating the issue is that the number of HCV-infected inmates is likely much higher, but only a handful are ever tested, because “…acknowledging inmates have the disease means they must treat it.”

The lawsuit in Tennessee is just the latest in a string of Federal and class action lawsuits filed against state and Federal prisons over access to HCV drugs, which similar suits being filed in Pennsylvania, Massachusetts, and other states. Failure to adequately screen and treat all incoming patients for infectious diseases such as HIV and HCV is, in this writer’s opinion, a gross dereliction of duty on the part of prison officials that risks not only prison populations, but to all citizens at large, once those prisoners are released into general population. HIV and HCV that goes untreated is not only likelier to result to much more costly long-term health complications (and potentially death), but is also likely to result in greater overall infection rates, as untreated diseases are more easily spread from person to person.
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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.

 

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Partisan Poison Pills for 2017

By: Marcus J. Hopkins, Blogger

Each year, the House Appropriations Committee – specifically, the Subcommittee for Labor, Health, and Human Services (LHHS) – releases a funding bill for the coming Fiscal Year (FY). In what is very likely highly partisan politics on the part of Congressional Republicans during a highly volatile election year, several hefty cuts and prohibitions were introduced into the spending bill which will likely – and in this writer’s opinion, hopefully – result in a veto from the President.

House Appropriations Chairman, Hal Rogers (R-KY), stated the following:

This is the 12th and final Appropriations bill to be considered by the Committee this year. It follows the responsible lead of the legislation before it –  investing in proven, effective programs, rolling back over‑regulation and overreach by the Administration that kills American jobs, and cutting spending to save hard‑earned taxpayer dollars.

Pill with the words, Poison Pill

Photo Source: Venitism

Anyone familiar with the coded language of politics knows that this is partisan fodder to try and bolster so-called “Conservative” bona fides during an election year, and the Republicans on this subcommittee pulled out all the stops ensuring that American families and individuals pay the price for their political pandering.

The final version of the bill, which has yet to go to the full House, contains the following (taken from the Appropriations site):

  • Centers for Disease Control and Prevention (CDC) – $90 million ($20m above 2016) to expand efforts to combat prescription drug abuse (a positive step, in HEAL Blog’s view). The bill also continues the “…longstanding prohibition against using federal funds to advocate or promote gun control,” which essentially forbids the CDC from labeling firearms and gun violence a public health crisis without risking severe cuts;
  • Substance Abuse and Mental Health Services Administration (SAMHSA) – $581 million to address opioid and heroin abuse, including $500m for a first-ever comprehensive state grant program that will address the opioid epidemic nationwide (another positive step), but “…maintains a prohibition on federal funds for the purchase of syringes or sterile needles, but allows communities with rapid increases in cases of HIV and Hepatitis to access federal funds for other activities, including substance use counseling and treatment referrals” (a halfway step that still ignores and fails to fund “proven” and “effective” harm reduction programs);
  • Health Resources and Services Administration (HRSA) – “Saves” taxpayers nearly $300m by eliminating all funding for the “controversial” Family Planning Program, a program that has existed and been funded since 1970 that provides contraceptive care to avert unintended pregnancies, screening for sexually transmitted diseases and infections, HIV testing, and cervical cancer screenings. These programs provide voluntary family planning information and services for their clients based on their ability to pay (on a sliding scale), and the stripping of these funds is likely to have a disproportionate impact upon lower income Americans and minorities;
  • Centers for Medicare and Medicaid Services (CMS) – Strips $576m in funds from FY16, and comes in a $1 billion below the President’s budget request. “The bill does not include additional funding to implement ObamaCare programs, and prohibits funds for the Center for Consumer Information and Insurance Oversight and Navigators programs,” essentially leaving consumers to fly blind in order to appease the anti-Affordable Care Act Republican party platform (which the chairman cannot even call by its proper name).

If it seems like anything is missing, you’ll notice from that there is no new funding for Viral Hepatitis, despite numerous Congressional hearings where representatives bemoaned the high prices of Hepatitis C (HCV) drugs and wrung their hands about the bleak prospect of exponential increases in new Hepatitis B (HBV) and HCV infections, largely related to the very same opioid and heroin abuse they managed to fund.

This bill, should it make it out of the House and Senate, is yet another example of the now-all-too-familiar dance of “Two Steps Forward; Three Steps Back” that has occurred for the past six years of Republican control of Congress. While some improvements are made, the vast majority of proposals tend to result in cuts that are sold as “cost saving” and sacrifice “controversial” programs (controversial only to the 1/3 or less of American constituents) that should leave taxpayers feeling like they’ve be presented with false advertising. Hopefully, some of these…unique proposals will be removed before a final bill is sent to the President for approval, but in an election year – particularly the one of the length and actual controversy we’re currently forced to endure – virtually anything can, and usually does, happen.
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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.

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Carolina on My Mind

By: Marcus J. Hopkins, Blogger

Every year, legislatures around the United States pass legislation that is a mixture of good and bad, and this year, North Carolina’s bill, H972, is no exception.

First and foremost, H972’s primary function is to codify into law that recordings made by law enforcement agencies are not public record, and therefore are not subject to Freedom of Information Act (FOIA) or public records requests. This portion of the bill – which makes up two-thirds of the document, itself – is the likeliest portion of the bill to head immediately to court. It is not, however, within the context of the purposes of HEAL Blog to comment either on the legality or constitutionality of this section, and we will therefore move on to the next.

For our purposes, the final two pages of the bill authorize the establishment of state-sanctioned needle exchange programs in the state of North Carolina. This is a fantastic step forward in a state hard hit by the ravages of opioid prescription drug and heroin abuse. Injection drug users (IDUs) represent an ever-increasing percentage of new HIV and Hepatitis C (HCV) infections in the United State, and syringe exchange programs as a measure of harm reduction have largely shown to be effective in preventing the spread of disease by reducing the likelihood that IDUs will share needles.

Image promoting needle exchange for IDUs

According to the Centers for Disease Control and Prevention (CDC), injection drug use accounted for a full 6% of new HIV infection in adults and adolescents in 2014. That number is likely to rise considerably for the year 2015, with the recent spate of widespread infection in rural and suburban areas in Indiana, Kentucky, Ohio, West Virginia, and Massachusetts.

Indiana’s well-publicized example of the risk of HIV and HCV exposure via injection drug use was so vast, it inspired a usually vehemently opposed conservative legislature to agree to pass emergency permission to establish state-sanctioned syringe exchange programs in the hardest hit areas of the state. Similar circumstances prompted certain areas in Kentucky and West Virginia – areas where syringe exchanges have been long needed, but never funded – to establish localized syringe exchange programs in some of the most impacted areas.

While North Carolina’s legislature should be lauded for their passage of Needle Exchange provisions, there is some concern that its inclusion in a bill designed to make secret the recordings of law enforcements agencies and the constitutional concerns that raises may prompt the governor to veto the bill. If that occurs, it is hoped that the tireless advocacy efforts of NC State Senator Stan Bingham and State Representative John Faircloth – both Republicans – will find their way back into another bill, as this issue is vitally important to preventing the further spread of HIV and HCV in North Carolina and beyond.
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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.

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