Hepatitis C among people who inject drugs

Hepatitis C among people who inject drugs is presented as both a serious medical consequence of injection and a measure of how poorly care reaches people affected by the opioid crisis. In Virginia, infection could remain undiagnosed or untreated for years, even after a person stopped using drugs; when care finally became available, the disease might already be advanced. The accounts of Tess Henry, two patients whose families described their deaths, and local health workers connect those outcomes not simply to individual decisions but to gaps in insurance, treatment, prevention, and public attention.

Infection and the Hidden Burden

The book places hepatitis C within the wider consequences of injection drug use, alongside overdose and other harms that can persist after active drug use has ended. Tess Henry was diagnosed with hepatitis C during a severe period of illness, while her mother, Patricia, was trying to secure long-term rehabilitation for her. Her case makes the disease part of a broader crisis of interrupted treatment and instability rather than an isolated medical detail.

The scale of infection was difficult to see. At a Remote Area Medical clinic, free hepatitis C testing was offered for the first time. A pharmacy professor estimated that 75 percent of people who injected drugs in the region had contracted the virus and did not know it. The estimate underscored the difference between the prevalence of illness and its visibility: without testing, people could carry an infection without knowing they needed care. The clinic also distributed take-home naloxone kits and training to almost 400 people, addressing overdose risk alongside the need to identify and treat disease.

Illness Beyond Drug Use

Two accounts show how hepatitis C could continue to shape lives long after drug use had stopped. A forty-two-year-old patient of health worker Teresa Gardner Tyson died after untreated hepatitis C, despite having been free of drug use and injection for eight years. He could not afford a specialist. By the time treatment could be arranged, the damage was too advanced for him to recover. His father, who owned a cemetery, described burying his son near his office so he could visit him daily.

Reggie Stanley, forty-five, died in a Charlottesville hospital while waiting for a liver transplant after twelve years with untreated hepatitis C. He had been sober for several years. Tyson had tried urgently to find him treatment, but, like 90 percent of her patients, he was uninsured, and she could not persuade a gastroenterologist to provide charity care. When Stanley reached the transplant list, his disease had progressed too far. His death received little public notice, despite the years in which earlier treatment might have been possible. His obituary recalled a graduate of Clintwood High School who had been a musician and was loved by many, restoring an individual life to a pattern that could otherwise be reduced to a statistic.

Access, Insurance, and Delayed Care

The cases unfolded within a state where Virginia’s legislature had repeatedly rejected Medicaid expansion under the Affordable Care Act. In June 2014, statehouse Republicans stopped a Democratic governor’s proposal; the book describes the decision as leaving federal funds and insurance coverage for 400,000 low-income Virginians unclaimed. In states that expanded Medicaid, the program helped pay for treatment, counseling, and addiction medications, and covered people whose incomes were too high for Medicaid but too low for private insurance. Virginia’s choice therefore shaped the practical availability of care for people with addiction and related illnesses, including those who needed testing or treatment for hepatitis C.

The consequences of being uninsured were visible beyond the patients with the most serious outcomes. A fifty-four-year-old substitute teacher had been without insurance for decades. Her husband, a former Walmart worker disabled by strokes, had Medicare, but she relied on free services at Remote Area Medical events and occasional visits to the Health Wagon, a mobile medical program. She delayed seeing her family doctor until she was very ill; even then, a discounted cash visit cost $63. Her circumstances illustrate the thin and improvised safety net in which preventive care and timely treatment could be difficult to obtain.

Distance added another barrier. Two patients at the medication-assisted treatment clinic run by Dr. Sue Cantrell in Lee County, Virginia, either walked or hitchhiked to appointments, sometimes from more than five miles away. Cantrell noted that simply getting people to appointments was a substantial challenge in a rural area. Access to a test, specialist, or treatment therefore depended not only on whether a service existed, but also on whether an uninsured patient could travel to it and return for follow-up.

Public-Health Response and Its Limits

Cantrell, the region’s health-department director, had warned state supervisors about the epidemic roughly two decades earlier, but her concerns had been dismissed as a regional problem. After the HIV outbreak in Scott County, Indiana, she held town-hall meetings in Virginia’s coalfield counties during the summer of 2017. Although Virginia had passed legislation paving the way for syringe-exchange programs, coalfield legislators had voted against the bill, citing local law-enforcement concerns. Cantrell’s staff taught people to clean syringes between injections and distributed cleaning supplies; she sometimes offered food to encourage patients to get tested and return for their results.

The book contrasts this hesitant response with experience across the border in West Virginia, where a syringe-exchange program was associated with lower overdose deaths and substantially greater access to treatment and disease-prevention services. The comparison gives prevention a practical meaning: reducing risks linked to injection and helping people connect with care were not separate from addressing the opioid crisis, but part of the same public-health work.

Tyson’s account of Stanley’s death sharpened the argument for treating hepatitis C before it became an emergency. She described upstream treatment as more affordable than waiting for patients to return to an emergency department with advanced disease and require extended hospital stays. She later succeeded in obtaining free Harvoni, an expensive hepatitis-curing drug, from its manufacturer for patients. That development offered a concrete treatment route, but it did not erase the earlier failures to secure care for people who were uninsured or unable to find a specialist.

Narrative Significance

The hepatitis C accounts widen the book’s attention from the immediate crises of addiction to the diseases that endure, quietly, alongside and after them. Overdose can make a crisis visible in a moment; untreated hepatitis C appears here through delayed diagnoses, unsuccessful efforts to secure charity care, a missed opportunity for earlier intervention, and deaths that attracted little public response. The contrast shows why survival from drug use does not by itself ensure access to health care.

Rural geography and economic insecurity shape who can reach that care. Uninsurance, long travel distances, sparse specialist availability, and resistance to prevention programs repeatedly separate need from treatment. By following individual patients as well as clinics and health officials, the book makes the costs of that separation legible: a potentially treatable infection can become fatal not because treatment is unimaginable, but because the steps required to reach it are too often unavailable in time.