Since the transmission of HCV is similar to HIV and IDU is the primary risk factor for HCV infection, and coinfection of these two blood borne diseases cause morbidity and mortality, harm reduction approach and the strategies that addresses the social and economic harms that impact an individual, community, or society are paramount in preventing the epidemic.
Hepatitis C is the major cause of chronic hepatitis, cirrhosis, and liver cancer in the United States and the identification of Hepacivirus of the family Flaviviridae in 1989 led to an explosion of research and development of specific tests for detecting anti-HCV and HCV RNA as well as recognizing it as a common cause of chronic liver disease. (Chapter 5: Viral Hepatitis, p. 61). According to WHO estimates there are "about 180 million people, some 3% of the world’s population, are infected with hepatitis C virus (HCV), 130 million of whom are chronic HCV carriers at risk of developing liver cirrhosis and/or liver cancer" and three to four million persons are newly infected each year, making HCV a "viral time bomb". It is also estimated that 3.9 million Americans are infected with HCV, with ‘prevalence rates as high as 8-10% in African Americans’. The route of HCV transmission is mainly through injectable drug use that account for nearly 90% of new infection, as well as through blood transfusion and perinatal infection. (WHO2). (Initiative for vaccine Research (IVR). 2008). It is estimated that there are 1-2 million homeless youth in the United States and a national study of homeless youths found that "68% are 15-17 years old. 57% are Caucasians. 17% African American. 15% Hispanic. and 12% from other ethnic origins" (Nyamathi et al, 2005). It is found that approximately 16-25% of those infected with HCV are co-infected with HIV, and due to shared risk factors HIV/HCV co-infection is common among homeless and urban poor. Edlin &. Carden (2006) argue that though HCV is four times more prevalent than HIV infection and viral transmission is uncontrolled among IDUs with ‘incidence rates ranging from 16% to 42% per year’ the efforts of the US government to "control this pandemic have largely ignored the population in whom its biology and epidemiology are being played out with the most devastating effects." (Edlin &. Carden, 2008).
The Disease: Its detection and symptoms
Hepatitis is an inflammation of the liver and its symptoms include jaundice, dark urine, extreme fatigue, nausea, vomiting, and pain. There are five major types of hepatitis viruses, named A, B,C, D, and E type, of which A and E are caused by ingestion of contaminated food or water, and "hepatitis B, C, and D usually occur as a result of parenteral contact with infected blood fluids." (Hepatitis. 2008). HCV infection is categorized into acute and chronic and specific symptoms in the acute stage are nausea and vomiting, fatigue, loss of appetite, fever, head ache, and