To the best of my knowledge, Vietnam veterans have been the victims of the largest outbreak of HCV in the United States to date. The largest cohort was born in 1954. We know that there are many transmission routes in which this blood-borne virus entered the bodies of our troops from the period beginning at bootcamp to the day of discharge. HCV has been circulating in the human population ineffectively (ex. sex, household contacts, etc…) for hundreds of years but it exploded exponentially in the mid-2oth century due to medical interventions like transfusions and vaccinations. Vaccinations and IV drug use shared the same practice of re-using needles or needles and syringes and this is a highly effective way of transmitting HCV.
Given the ubiquity of heroin in Vietnam, how many soldiers were actually IV users in-service? Where is the data? I’ve found one official document from 1973 that attempts to answer this and other drug-use related questions: The Vietnam Drug User Returns. Isn’t that a demeaning and horrible title? The word “user” is singular but it might as well be plural, so harmful is the picture it paints.
I was sure it would indicate widespread IV drug use in our soldiers. I found the opposite.
This focused study used military records (page 9), urine tests, VA records, and follow up interviews. Summary: In Sept. 1971, 13,760 Army enlisted men returned from Vietnam to the U.S.. They had urine tests for drugs (except marijuana)at departure. Only 1,400 tested positive for any type of drug at the time of departure.Then they took 470 samples from the larger general group and 495 samples from the drug positive group and followed up with them months later.
The study tried to answer 11 questions, one of which was how the soldiers ingested narcotics. “The most common method of administration was by smoking. Only 8% had injected a narcotic in Vietnam” (viii). Later it says that sniffing was the second most common method of administration.
(Note: There is no solid evidence that sniffing a chemical has transmitted HCV according to a CDC slide I came across recently.) A chart indicates skin popping as a possibility but injecting was last method chosen and “rare.”
Question: Why so few soldier injectors?
“Injection in Vietnam was not necessary because the heroin was so cheap and pure” and the tour of duty was only one year for most soldiers (page 32).
Pre-Vietnam, 7% had tried heroin. And this group continued to smoke it in-service with about 8% using an IV at least once. And 91% of those who didn’t inject narcotics, stopped using them when they returned home (page 62).
The soldiers were highly critical of heroin and considered it dangerous even though it was the most available drug–available within an hour (page 26). This is just one group selected from one month chosen by the study designers because they felt heroin use would be the highest at this time. But again, I repeat: they found injecting to be rare.
The percentage of IV use was less than I expected but this small group was still capable of effectively transmitting HCV to other IV-users and non-users in combat. Studies on current IVDUers might shed light on just how dangerous contact with this group was to the health of their fellow soldiers. Combat exposure and other types of contact with the blood of this small IVDU group WAS a risk factor for HCV transmission to the larger group. It’s obvious that exposure to IVDUers in Vietnam should be on a list of risk factors because even though HCV hadn’t been “seen” or cloned, they KNEW for decades prior to the Vietnam War that hepatitis was associated with needles, diabetic needles, etc…
My sense is that IV drug use in Vietnam among soldiers was not the smoking gun when it comes to the massive HCV outbreak but it must have contributed to it within certain clusters of soldiers. It would be good to find an honest statistician to work on this problem. We know that 99-100% of these soldiers got vaccinations with unsterile medical device guns. A large percentage of injured soldiers received blood. Donating blood is also a risk factor. I’ve seen percentages of unsafe contact with Asian sex workers at around 48%. If a prostitute averaged three/four intercourses a day for the previous year, a soldier was exposed to someone who was consistently having rough sex with perhaps as many of 900 different clients. A female’s internal organs aren’t designed for this and mucosal damage would be inevitable. She could become infected or pass hepatitis infections easily. If menses was present, the transmission risk F > M would be even greater. Having physical contact with only one sex worker (M or F) could have transmitted hepatitis.
Soldiers (100%) also received unsterile haircuts and shaves in compounds or by village barbers. At least 50% of the soldiers this study engaged in combat activities even though the war was winding down.
An intriguing mention of hepatitis sticks out: “Hepatitis and infections at the administration site were not uncommon as they are among addicts in the states, because narcotics were seldom injected” (page 32). I’d like to know the background on this–which virus were they referring to since HCV hadn’t been discovered? I’ve lost track of all the government papers I’ve read that attribute the high rate of HCV in veterans to their in-country IV use (no) and blood transfusions (yes). This is because one crappy but influential researcher cites another ad infinitum until all the citations are like a chain letter that just keep multiplying in their circles.
Vietnam Drug User Returnees. Yup, that’s how Vietnam veterans were viewed by our government–a notion that persists. Is it any wonder that these soldiers weren’t welcomed home until 2011 by the Senate? March 30 is Welcome Home Vietnam Veterans Day. Hoorah? I just want the facts about the HCV outbreak to be addressed. Save the conciliatory speeches for someone else.