 Hepatitis C is a virus that is transmitted by blood-to-blood contact so it's very common in people who've had poor quality medical practice or people who use drugs and inject drugs into their veins. Once you have the virus the virus will go to the liver and once the virus is in the liver over 20, 30, 40 years it will slowly cause the liver to scar and eventually the liver will reach a stage cirrhosis. Once you have liver cirrhosis from Hepatitis C you have a very high chance of getting a liver cancer or the liver failing so it's really important that we find people with Hepatitis C before they have cirrhosis before their liver is permanently damaged. What is the most effective form of treatment for Hepatitis C? We now have a large number of different treatments they're all tablet-based treatments they're all very effective they all have very few side effects and I think we can now safely say to our patients with Hepatitis C if you take the tablets you'll get cured. How was your experience with interferon when you were treated with interferon how was it? It was terrible it was like a chemotherapy I had like so many side effects with high fever muscular pains my hair fell out my skin became very dry I coped with depressions one after another I felt suicidal sometimes I felt very weak I've done it for one year it didn't work but it was very hard. How is the new treatment compared to that? So there's no nothing to compare it's very easy to take I didn't feel no side effects. How does it feel now after Hepatitis C? I feel lighter and I feel like I don't have like any more nothing in my body that one day would kill me like it did to some friends of mine and families. If you inject drugs you will very often share needles you will share syringes the paraphernalia the so-called works and that puts you at very high risk of infection but these are the people who are likely to pass the virus on and in my view these are the people we need to target treatment so we can stop the virus in its tracks. These are exactly the people who are excluded in several countries from treatment why is it so? This is pure stigma pure bias the WHO makes very clear that everyone should be treated the easel and the American liver associations all recommend that everyone should get treatment so there is no excuse for not treating people who inject drugs because they're the groups who need it most. In the UK so major barriers for people who inject drugs are stigma they don't want to disclose this is a particularly issue for women who have children they may not want to be identified as a drug user so even asking for a hepatitis C test may inadvertently out them. Doctors also create barriers by refusing to treat people who inject drugs creating requirements that people cease injecting or people cease using particular drugs when that's actually not supported by national and international guidelines. We feel like we don't deserve to ask for treatments because we were told like you destroy your health so much how come you are like demanding for better health and that is a label that is art to take. When we speak about drug users who are more than 90 percent of new infections we have also to speak about criminalization because that is a huge barrier to go to any treatment to any health treatment and that is something what need to be addressed. Why do you think the testing level of migrant populations is so low? Lack of awareness first of all lack of awareness you know systems are challenging but if there is good information appropriate cultural appropriate in languages people can understand it's much easier for people to be you know insensitized. Many people say that the drug is very expensive so it's not you know governments kind of afford it what would you be your message to government? The message to governments is very simple you either pay now or you pay much more later because if you don't treat hepatitis C early when it's easy to treat it will cause cirrhosis it will cause liver cancer and that's even more expensive to treat so the most effective way the most cost effective way of treating hepatitis C is treat it early treat it in people using drugs so they don't transmit it you'll spend a lot less money than waiting till people are dying of the disease. One of the major barrier and that's largely recognized is the price of the new treatment when there is a patent when there is the monopoly there is only one company allowed to sell the product so basically the company can ask for whatever the price they want. USA we have like Sovaldi was priced around $80,000 it was called the 1000 pill generic medicine is today available for $200 the cure so it's much more cheaper it's just the same drug but it is manufactured by someone else than the patent holder at Metsan du Monde we are advocating for countries to better negotiate prices and use the legislation that allow country to suspend patent and intellectual property rights to allow for generic production or import. Many pharmaceutical companies claim that they keeping the prices high because they need a lot of money for research and innovation. Sophos Bivier is a molecule that has been developed by a small American firm called Pharmacet that spent let's say millions of dollars to develop the drug the patent has simply been bought by Gilead science for 11 billion of dollars so the price paid by Gilead has actually nothing to do with the cost of the development of this drug. For many countries hepatitis treatment for a huge population is not achievable but at the same time we see that pricing prices are going down that in some countries also in Europe the prices are quite affordable for example in Spain in other countries it's more than 10 times expensive so that is a very curious situation and we saw examples of civil society and advocacy for example in Georgia and other countries that they can they achieve great successes in bringing prices down. What do you call an excellent example of national hepatitis C response like can you maybe tell us some concrete examples? Well we had exciting examples from my perspective for again from Scotland if you want to do something it is so easy you can deliver the drugs via pharmacies community pharmacies which are reachable in a range of 20 minutes from from every patient you can go to the pharmacy you have you make your test and you get your pills there is no medical specialist needed anymore and we also have excellent examples in in in Europe for example the Swedish drug user union who who established user academies where they teach each other on an hcv prevention and so on so that is really amazing to see and that is the most effective way to do it. What what do governments need to do to eliminate hepatitis C? It needs to be well planned and developed into a national hepatitis strategy and also a national action plan that's an important starting point and to bring everybody together and very importantly among the stakeholders there needs to be the community and civil society really nothing can move forward without good community engagement and activity. One of the important things in terms of the Australian story is is the role of the community and and how much involvement they had in terms of discussing with the government and working with the government to really advocate for access for all so no restrictions based on disease stage no restrictions based on drug and alcohol use and then to allow for broadened prescribing by general practitioners so it's not restricted by specialists and what's amazing is that you know we've you know had these therapies since since March of last year and you know there's 230,000 people with hepatitis C in Australia and and we have treated 30,000 people in nine months of these new therapies being available we've cured more people last year than we have in in two decades of of interferon based therapies. Why harm reduction is important in people getting access to treatment of hep C? Harm reduction as a program based on outreach approach when when the peers when the people from community trying to reach those who are usually hard to reach this is really works. We have a great hepatologist in Belgium and he's make the difference for me when I was in hospital for other diseases I had long problems and he came to my bed and he said you know there is something we can do about your hep C and now this hepatologist is my colleague and we have our C body project with him and it shows that drug users a good hepatologist and a low threshold center this I call this the triangle that this works very well. What can we learn from from the literature about reinfections? Is it a real risk that if we treat people they will reinfect with the same behavior? I think we've got to be very aware of that risk in some populations and to study it and monitor it. I think we've been reassured by some studies and very importantly among the injection drug users they're extremely good response to treatment even if they're actively using drugs. So I think the important message is that we need to monitor this carefully. It should never be a reason for not treating but we need to make sure that treatment is always linked to prevention and good harm reduction educational messages. What would you recommend to other drug users who are still live with the virus? I recommend that they demand the human right to health even if they choose to keep on doing drugs we have the right to health we have the right to meds and if there is a cure let's go and get it because there's no use dying of a disease when there is a cure and very easy to do.