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9. Conclusion

Hepatitis C presents communities in Canada with enormous, multifaceted challenges. From the perspective of the hepatitis C community, there is an awareness issue: those who are at risk may know little about either the virus and its transmission or the disease and its symptoms/progression. Further, those who are already infected may not even be aware of this fact. There is also a prevention issue: that of identifying and modifying the behaviours and circumstances that increase the risk of hepatitis C infection. Once people test positive for hepatitis C, or the symptoms of hepatitis C begin to appear there may also be a support issue. For example, immediate, practical assistance may be needed to deal with physical problems such as nausea and fatigue, social problems such as isolation and stigma, economic problems such as the inability to keep a job and high medication costs, and emotional issues such as fear and shame.

Overarching all of these concerns is the fact that hepatitis C tends to thrive in conditions of poverty, homelessness and despair. This knowledge forms the backdrop for the work of many communities, whose tasks include identifying and locating groups at risk, meeting them "where they are at" and finding sensitive and appropriate ways to address their needs. At the same time, they must develop the resources, skills, systems and infrastructures needed to carry out these tasks capably. Finally, they must monitor the effectiveness of their approaches and keep abreast of new developments and research.

Viewed in this light, progress at the community level in year two has been solid, useful and encouraging. The increase in funded projects multiplied opportunities to heighten community hepatitis C awareness/knowledge and provided new chances for innovation in service approaches and educational tools, especially in urban Canada. It also led to improved skills and capacities on the frontline. At the same time, project experience in 2000-2001 helped to highlight the need for greater clarity in some areas (e.g., the meaning of "partner"). It also pointed to several other areas in need of closer attention including: the hepatitis C needs of rural and remote populations; reporting and evaluation requirements; the role of poverty in the spread of hepatitis C and the importance of building a "determinants-of-health perspective" into all stages of community initiatives, from planning through to evaluation.

Overall, a firm foundation has been laid for curbing hepatitis C infection rates and ameliorating the effects of hepatitis C on various population subgroups, their families and social networks. It has been hard work, and the results have been incremental rather than spectacular. But the importance of these early expenditures of resources and effort lies principally in their ability to generate guidance for the future. And, as this report shows, useful lessons have indeed been forthcoming - lessons that, if studied carefully, can help point a clearer way forward.

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1. It should be noted that a standard reporting tool has been developed and will be implemented across all regions in fiscal year 2001-2002. Projects must report once per year using the tool.

2. The term "region" as used in this report refers to one of the following: Atlantic Region (Newfoundland and Labrador, Prince Edward Island, Nova Scotia, New Brunswick); Quebec; Ontario/Nunavut; Manitoba/Saskatchewan; Alberta/Northwest Territories; British Columbia/Yukon. Program Consultants in each regional office are charged with administering, tracking and securing reports from all projects funded in their respective regions by the Hepatitis C Prevention, Support and Research Program.

3. Subject to the receipt of their written reports by the deadline of February 15, 2002.

4. Public health units and health district authorities/boards sponsored various projects undertaken by fledgling hepatitis C groups/organizations, working in partnership with them.

5. The Program's funding application form defines "p artner" as "a person or organization who makes a contribution to the project (funds, time, expertise, services, space, publicity, equipment, materials, etc)."

6. In such cases, the project reports and other materials were reviewed to establish "implied determinants", which were then verified with regional project consultants.

7. Implying changes in the populations infected/affected, and in the social environment.

8. Implying changes in the population at risk, and in the social environment.

9. Implying changes in community and other organizations and their staff and volunteers.

10. With three notable exceptions: physician specialists with an interest in liver disease, such as hepatologists and gastro-enterologists; public health physicians; and family physicians working in community health centre settings.

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