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24. Risk of Hepatitis C Virus Infection Among Injection Drug Users

Let me show you a little bit about what we think has happened in the injection drug users, since that is the population that accounts for almost 2/3 of the infections. If you look at a number of studies that were done, some back in the 80s in Baltimore, and then a family of studies that have been done in New York and Chicago looking at relatively young injection drug users and looking at hepatitis C based on the duration of their injection drug use - If you go back to the Baltimore group what you saw was that people acquired their infection very rapidly: within 6 months to a year of initiating drug use, almost all drug users were infected. But if you look at what's been happening now in the late 90's, and probably what is going on now, is that you see, for instance, in Chicago, and this is a bit more of a non-urban population, that acquisition of infection takes longer. Unfortunately, after 6-7 years, 60-70% of these people are infected. If you look in New York, in Harlem, or in parts of the Lower East Side of New York, again you see that acquisition occurs at a relatively steady state, but there are windows of opportunity in terms of prevention, and that probably people in these populations are doing something to protect themselves. The problem is that it may not be that they can protect themselves all of the time. We need to do things differently, or figure out new ways to prevent this infection, remembering that this is not a vaccine preventable disease.