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Internet resources for what you need to know about NYC Health
Five Favorite Sites For Beginners

The Topic
"Health" refers to the health issues facing the city, touching on everything from the mayor to Medicaid to managed care to mosquitoes.
The Context
New York City is one of the biggest public health challenges in the world. With 7 million residents--over 1 million of whom are uninsured--the city has the largest number of HIV cases and the largest number of intravenous drug users in the U.S. Efforts to contain a tuberculosis outbreak that threatened the city in the 1990's have been a major success--between 1992 and 1998, the deadly multi-drug resistant cases of TB declined by over 90 percent.

New York City has 20 public hospitals which served 1.5 million people in 1998 alone. Run by New York City's public Health and Hospitals Corporation, the hospital system now has a surplus of $21 million, following years of deficits and cutbacks.

The Reporter
Maia Szalavitz is author, with Dr. Joseph Volpicelli, of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." She writes frequently on health, science and public policy for the New York Times, New York Magazine, the Village Voice, and other publications.

by Maia Szalavitz

Hep C

(May '01) Though four times as many people have been infected with Hepatitis C than HIV in the U.S., the disease has not received anything like the amount of attention, funding and activism as AIDS has.

The silence about Hep C is partially because the condition is not as deadly as HIV. But, according to the Centers for Disease Control, four million Americans are Hep C positive and up to 40 percent of the one million who are HIV positive are also infected with Hep C, which complicates treatment for both conditions. Hep C is now the number one cause of liver transplants and up to 10,000 people die each year from complications of that disorder.

In New York, it is not known how many people are infected, but New York's Veterans' Administration Hospitals report that 12 percent of vets are infected, which is double the rate seen in other VA facilities. Seventeen percent of prisoners in the state are infected. Since Hep C is a blood borne disease, prisoners (who have high rates of IV drug use) and veterans (who have high rates of both past blood transfusions and IV drug use) are at extra risk.

"People really need to be educated on what the disease is and what the treatments for it are," says James Learned of the Hepatitis C Action and Advocacy Coalition (HAAC). "A lot of times their perception of it is so terrifying and not based on the facts."

Of those who contract the virus, 85 percent will become chronically infected and at least half of those who do will have some level of liver problems, often fatigue and nausea. Up to 20 percent of these will develop serious complications like cirrhosis and liver cancer within 30 years of infection and up to four percent will die from the disease.

Hepatitis C is not spread by casual contact, but it can be sexually transmitted, though this is far less common than with HIV. Before 1992, an effective blood test was not available to screen the blood supply, so about 300,000 hemophiliacs and other transfusion recipients became infected.

The major source of transmission now is IV drug use, accounting for about 60 percent of cases. Since New York has probably the largest number of IV drug users in the U.S., this is particularly important in the local epidemic. In January, the state's new needle laws went into effect -- legalizing possession of syringes and over-the-counter pharmacy sales of up to ten syringes per person per day. (For information on this program, click here.)

The city is also implementing several new programs to cope with the epidemic. "We've recently started offering free Hepatitis C testing and counseling at one of our sexually-transmitted disease clinics, Riverside on the Upper West Side", says Greg Butler, spokesperson for the NYC Dept. of Health. Those who test positive are referred to medical providers for treatment.

Hep C screening and treatment for people with HIV is also available free of charge at Bronx Lebanon Hospital and at the SUNY Downstate Medical Center. The CDC has just awarded the city a grant to cover the costs of hiring a Hepatitis C co-ordinator to streamline prevention and treatment services within the agency and to reach out to community-based organizations fighting the disease.

Hepatitis C is much more infectious than HIV via blood, and measures to reduce transmission short of always using clean needles, like cleaning syringes with bleach (which cuts the odds of HIV transmission but does not eliminate it) are even less effective with Hep C. The virus can survive for hours in a bloodstain.

While HIV is not known to be spread through shared toothbrushes or razors, Hep C can be and there is also the possibility that the disease could be contracted by sharing a straw used to snort cocaine with an infected person. Since it is hardier than HIV, Hep C is also more easily transmitted by unclean tattooing or body piercing needles.

Treatment for this disease is also tricky. No one really knows when to start it, and the drugs used have terrible side effects. At best, they only eliminate the virus completely in 25 percent of cases (the virus will be eliminated in about half the cases for six months or so, but then it returns). Those who start treatment before they have much liver damage do better than others. But since such a large percent will never have significant damage, there's a real danger of causing harm by administering unneccessary treatment.

The best treatment is currently considered to be a combination of the immune-modulator interferon-alpha and an antiviral drug called ribavirin. Hep C activists have fought with the drug's manufacturer, Schering-Plough, because it refuses to sell the drugs separately -- and since patients may need unusual combinations of doses or want to use a different company's formulation of alpha-interferon, the "bundled" drug can produce waste and extra cost.

Ribavirin outside the combination has not been approved by the FDA, but it is approved in other countries. After activists protested, one "compounding pharmacy" began to make the drug available in 1999 by using a regulatory provision which allows pharmacists to formulate drugs specifically to meet individual needs. Schering has applied to the FDA for single approval for ribavirin, but it has not yet unbundled the drugs.

Another combination, the anti-viral amantadine and interferon, has just been shown to clear the virus for six months in 46 percent of cases and produce a response for longer than six months in 36 percent of cases. Researchers are now preparing to study a "triple therapy" with ribavirin, interferon and amantadine.

Unfortunately, interferon can cause severe depression, as well as flu-like side effects. Patients have to take it for at least a year In people co-infected with HIV, interferon can lower T-cell levels. Ribavirin can cause life-threatening anemia.

Because of its link with IV drug use, Hep C is common in prisons -- and researchers estimate that one-third of the total population of infected people pass through the U.S. prison system each year.

This makes the prisons -- which do not provide clean needles or even much drug treatment -- sources of infection. The problem is exacerbated, according to Learned, because prisoners often are not told of their condition.

The disease presents a conundrum for the system: treatment is expensive, lasts at least a year and is not always effective. As a result, prison health authorities try to limit it -- and one way to do so is by not letting inmates know their Hep C status and by requiring long-term abstinence from drugs before permitting treatment. Says Learned, "It's complicated. There are clearly some true logistical issues but not telling someone about their infection is not the answer."

Learned advises that people who are at risk should get tested, educate themselves about the disease and its treatments, and not panic. Both Western and alternative treatments help many people and there are several new drugs in the pipeline. "Mainly, it's about harm reduction and not freaking out." he says.

To learn more:

Maia's Favorite Five Sites For Beginners:

  • New York City Department of Health - Includes health alerts (including West Nile info), information on restaurant sanitary conditions and information on various health-promotion programs.
  • New York State Department of Health - More health data for New Yorkers including information on how to sign up for Child Health Plus and Family Health Plus-- the insurance programs for those who are presently not covered by other plans.
  • Medscape - This site, aimed at doctors, allows you to search Medline, the database of medical journals, for free. Abstracts of most journal articles are available for free as well. Once you have some basic knowledge about a condition you are researching, you can look here to get a sense of what is going on in terms of study in the area. There is a companion consumer-focused site, CBSHealthWatch, which is linked.
  • American Cancer Society - Half of all Americans will face cancer at some point in their lives-- and the New York and Washington-based American Cancer Society web site provides a wealth of information for those dealing with the disease. Includes links to other major cancer sites and resources.
  • AIDS Information - A sort of "AIDS central" for New York city with links to major HIV/AIDS organizations and information sites.

Other Recommendations:

  • Quackwatch - Debunks medical scams and inflated claims made by "alternative" medical practitioners.
  • - A consumer health information site, affiliated with CNN.
  • Citizen Action - Healthcare is one of the primary focuses of this New York advocacy group. Includes information on New York's health plans for low income people lacking insurance.
  • Oncolink - An incredible research resource for cancer patients and others concerned about this disease.
  • National Alliance for the Mentally Ill - An organization of advocates for people with mental illness which includes information on treatment and support for various disorders like depression, bipolar disease and schizophrenia.
  • Insure Kids Now - Information on New York state's insurance program for poor kids and information on other state's policies, from the federal government and the governors' association.

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Gotham Gazette is published by Citizens Union Foundation and is made possible by support from the Robert Sterling Clark Foundation, the John S. and James L. Knight Foundation, the Altman Foundation,the Fund for the City of New York and donors to Citizens Union Foundation. Please consider supporting Citizens Union Foundation's public education programs. Critical early support to Gotham Gazette was provided by the Charles H. Revson Foundation, Rockefeller Brothers Fund and the Alfred P. Sloan Foundation.

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