Viral Hepatitis C Pandemic: Challenges and Threats to Its Elimination

Laura Krekulova; Radkin Honzák; Lee W. Riley


J Viral Hepat. 2021;28(5):694-698. 

In This Article

Psychiatric Insight

The biggest barrier to elimination of HCV infection among PWID lies in the conflicting approach of health professionals and PWID (or addicted) patients to the problem. While PWID patients want to 'have their cake and eat it too', at the same time, healthcare professionals expect them to behave like the standard patients. This, of course, is impossible. The PWID lifestyle, their way of earning and raising money for their daily dose of drugs, is often linked to criminal activity. This evokes prejudices even against those who would like to be treated. This attitude has been evident since the needle syringe exchange programme began. PWID are perceived not only as 'weird', but as universally dangerous 'jailbirds' who are unpredictable, from the spread of pathogens to physical violence.

At such a moment, the amygdala begins to work in the doctor's brain far more than his prefrontal cortex, and the doctor's emotions overshadow logical reasoning. Suddenly, the patient is not a patient, but an enemy who threatens him. But, all this usually does not cross the threshold of the mind, and there remains only an unpleasant feeling coupled with an urgent desire to get through this situation as quickly as possible. Then, the doctor's emotional evaluation allows him to easily forget all about ethical principles and, on the contrary, to convincingly justify his own behaviour.

At the very beginning, medicine made a mistake when it decided to regulate primarily social pathology like other diseases. This is not an effective way, as new knowledge has shown. So, today there are problems even when objective medical pathology predominates the clinical picture.

Currently, we see a solution in establishing specialized workplaces that will deal with PWID in full extent and not rely on a rapid change in the attitudes of most health professionals, who argue that they are defending not only themselves but also their 'normal' patients. While the education of PWID is important, the education of doctors, nurses and pharmacists to change their attitudes may be a long-term process with uncertain outcomes.