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HEP REVIEW JULY - OCTOBER 2015 edition 88

A YEAR OF BETTER LIVING A NEW ETHOS Part 2 of your Why treating step-by-step guide to hep C and better health deliving OST NEW HEP C together works TREATMENTS so well PBAC says YES to PBS funding

Stories! Jules... highs & lows | SS... hep C in prison | Sean... tackling stigma Horrorscopes • Recipes • Crossword


HEP REVIEW EDITOR/DESIGN/PRODUCTION Bruce Cherry EDITORIAL COMMITTEE Tim Baxter Miriam Chin Paul Harvey Alastair Lawrie Stuart Loveday Rhea Shortus CONTRIBUTERS Charlie Stansfield Dr Ses Salmond, Rhoslyn Humphreys Wayne, Ali, Zh HEP REVIEW ADVISORS Dr David Baker, Prof Bob Batey, Ms Christine Berle, Rhoslyn Humphreys, Prof Greg Dore, Jenny Douglas, Prof Geoff Farrell, Prof Jacob George, Prof Geoff McCaughan, Dr Cathy Pell, Dr Ses Salmond, Prof Carla Treloar, Dr Ingrid van Beek, Dr Alex Wodak PROOFREADING/SUBEDITING Zhang Wilson Adrian Rigg Cindy Tucker CONTACT phone: 02 9332 1853 fax: 02 9332 1730 email: hepreview@hep.org.au post: Hep Review PO Box 432, Darlinghurst NSW 1300 office: Level 4, 414 Elizabeth St, Surry Hills, Sydney Cover image by Exposition by RAF expositionbyraf.com

HEPATITIS INFOLINE 1800 803 990 2 / HEP REVIEW /#88 / JUL-OCT 2015

© 2015 Hep Review ISSN 1440 – 7884 is published every four months by Hepatitis NSW (HNSW) Level 4, 414 Elizabeth St, Surry Hills, NSW, 2010. HNSW is an independent community-based, non-profit membership organisation and health promotion charity. We are primarily funded by the NSW Ministry of Health. Hep Review is mailed free to HNSW members – membership is free for people living with viral hepatitis in NSW. We accept contribution of articles about health and personal aspects of hep C or hep B. Contributions to Hep Review are subject to editing for consistency and accuracy. Contributors should supply their contact details and whether they want their name published. We’re happy for people to reprint information from this magazine, provided Hep Review and authors are acknowledged and that the edition number and date are clearly visible. This permission does not apply to images, graphics or cartoons. For reprint permission email hepreview@hep.org.au Although Hep Review takes great care to ensure the accuracy of all the information it presents, Hep Review staff and volunteers, HNSW, or the organisations and people who supply us with information cannot be held responsible for any damages, direct or consequential, that arise from use of the material or due to errors contained herein. The views expressed in this magazine and in any flyers enclosed with it are not necessarily those of Hepatitis NSW or our funding body. Information, resources and advertising in Hep Review do not constitute endorsement or recommendation of any medical treatment or product. HNSW recommends that all treatments or products be discussed thoroughly and openly with a qualified and fully HCV-informed medical practitioner. A model, photographer, or author’s hep C or hep B status should not be assumed based on their appearance in Hep Review, association with HNSW or contributions to this magazine. Hepatitis NSW would like to acknowledge and show respect for the Gadigal people as the traditional custodians of the land on which Hep Review is published. We’d also like to extend that acknowledgement and respect to all Aboriginal nations in NSW and across Australia.


JULY 2015 edition 88

Contents

HEP REVIEW

Features 10

24

46

PBAC says yes

A year of living better

DISCOVER: A new ETHOS

New treatments recommended for PBS funding

Part 2 of your 2015 guide to step-by-step hep C self-management

Why treating hep C and delivering OST together works so well

A YEAR OF

YES! !SEY YES! Regulars 4 Inbox 5 Editorial 6 Letters 14 Local news 16 World news 18 We remember 40 Going Viral Discover research into viral hepatitis 42 49 Research recruitment 52 Horrorscope 53 Puzzles 54 Clinic listing 62 Hello Hepatitis Infoline

LIVING NSP BETTER Extras We remember Vivienne Yates Ray Jackson

My story 18

Living with hep C? 36 Watch ‘That Sugar Film’ a look at sugar’s effect on the body and the liver. Multicultural Community Support 50 Anna and Olivia - a helping hand

Jules 12 shares her story of the highs and lows that hep C has brought to her life SS 22 shares his story of clearing hep C in prison, and his message for other people in prison Sean shares his story of tackling stigma and discrimination

42

Our cover features Sergio from regional NSW. Sergio volunteered to be part of Hepatitis NSW’s Photocall Project. Thank you! hep.org.au / HEP REVIEW / 3


CONNECT INBOX

Dear Hep Review, I find Hep Review to be a very useful and informative magazine but as a person with medically acquired hep C I feel that there are too many articles and info for people who inject drugs. So more information and help for those with medically acquired hep C would be more useful. Yours, HG Thanks for your letter, HG. At Hep Review we work to provide information that is relevant to a variety of people - it’s great to hear that you find the magazine useful! We know that our readers come from many different backgrounds, including having acquired hep C in different ways. We also know that in Australia, over 80% of people who are living with hep C have acquired it through shared drug-injecting equipment and we try to make sure we’re including relevant articles, information and news. We hope you (and others) continue to find useful information to support you in living with, managing, and treating your hep C no matter how you came by it!

22 years of stories. Share yours with us. Hep Review magazine is a lifeline for many people, linking them to news, information, views and stories. We want to hear from you about your story together we’ll share it with our community. We pay $50 for stories published. hepreview@hep.org.au

Ed. Dear Hep Review, Your mag is really good. Personally I would like to see more stories of people’s experiences on the treatment and advice on how they coped, if they had a hard time, or if they had to care for children. And is it possible to have treatment if you are an older patient? I’m 49 and I’ll be 50 soon. I struggle with working and babysitting my granddaughter so going ahead with treatment is scary for me. I feel less alone reading the stories. I’m rather fearful of treatment so I’m looking forward to when the new treatment will be given the green light. I’m very interested in this issue and I will be calling the Hepatitis Infoline. FE Thanks FE! It is really good to hear that reading other people’s stories helps. You can definitely still take treatment at 50 years old! Although there may be other health factors that impact this - your liver clinic can give you more information about this. And you’re not alone in finding the idea of treatment scary, either! Calling the Hepatitis Infoline is a great idea - they’ll be able to give you the latest news on the new treatments - 1800 809 990. Also there’s great online support from other people in similar situations to yours. See the hepcaustralasia.org ad on page 7. Ed.

4 / HEP REVIEW #88 / JUL-OCT 2015

Hep Review The liver health magazine for people in New South Wales

HEP REVIEW Subscribe today

1800 803 990 Write to us at: Hep Review Hepatitis NSW PO Box 432, Surry Hills 2010 or email hepreview@hep.org.au


EDITORIAL

editorial BRUCE CHERRY

A

s we head into winter, it warms the heart to know that things are heating up on the treatment access front. The Pharmaceutical Benefits Advisory Committee has recommended that the new treatments be made available to any Australian living with hep C. Cue cheering! It’s not the final hurdle, but we’re definitely getting closer to Equal Treatment Access. If, however, treatment is not the only thing on your mind, then there’s plenty in this edition to keep you interested. My own hot tip is to check out ‘That Sugar Film’ (page 36). If you’re like me and tend to sometimes treat sugar as a separate, essential food-group (yes I can finish six cinnamon donuts in under two-minutes) then this is definitely worth checking out. But even if your approach to sugar is slightly more restrained, this doco is an eye- ...reading opener when it comes to sugar’s effect on these stories the liver. On a more personal level, Jules, SS and Sean share their stories of living with hep C and the various challenges and opportunities it has led to for them – from balancing mental and physical health, to facing down ignorance and discrimination. Many readers tell us that this is what they enjoy most about Hep Review – reading these stories of struggle and survival is a powerful way of connecting to a community of people who often have more in common than just living with hep C. It’s a community that I have enjoyed working with for the last five years, and work that I will miss. This will be my last edition as editor of Hep Review, as I’m moving overseas.

of struggle and survival is a powerful way of connecting to a community of people who often have more in common than just living with hep C.

My thanks to Hepatitis NSW for the opportunity to be involved in their work towards a world free from viral hepatitis – it’s been a pleasure.

You oughta be thankful a whole heaping lot for the people and places you’re lucky you’re not. Dr Seuss

Take care of one another. Bruce Cherry Editor hep.org.au / HEP REVIEW / 5


LETTERS

letters Hello,

In this edition we feature letters from readers across NSW. Some names and details have been changed to protect our reader’s privacy.

My name is FC and I am an inmate at a NSW Correctional Centre. I’d like to let you know a few things about personal behaviours while on the inside to address the spread of hep C. I am hep C positive and I don’t know it all, but I’d like to share some of my experiences. Firstly, FINCOL is your friend. And it’s a good friend at that. Getting a clipper hair-cut? FINCOL the clippers and combs between uses and wash down with cold water. There are the obvious ones as well – don’t share razors and toothbrushes, and dispose of them safely if you’re done with them. I give mine a quick rinse with FINCOL before I either return it or dispose of it. Let your celly know that you’re positive for hep C. He is your celly – look after him. It is common courtesy and in my experience every time so far they were also positive, bar one. Speaking of which, for all my brothers out there who like to cuddle up and keep each other warm in that “extra special way” condoms and lube are available in all wings and pods (although ALL vending machines here at Bathurst are empty and have been for a long time (Note to Ed. Could someone please address this issue for us inmates? Seems to be a problem at all Centres). Some other basics, as all sentenced inmates would know, after having done awareness programs during their early days, FINCOL is your friend if you take bark (skin) off and bleed. Clean

6 / HEP REVIEW #88 / JUL-OCT 2015

the wound and cover, disposing of anything that has blood on it. Be careful not to create a situation where blood-to-blood contact is possible. Clean up and disinfect any blood spilt, as you by now know – who’s your friend? That’s right – good old FINCOL is! And now another one to cover: using on the inside. As much as it may be denied by the powers that be, it’s a fact of life on the inside that I doubt can or will be stopped. Big ups and YAAAHH to the groups that are pushing for sterile injecting equipment to be readily accessible within prisons. Unless attitudes change I reckon an obvious conclusion can be easily arrived at - very few inmates will ‘speak up’ or are empowered to, due to the fear of reprisals of adverse nature. The repercussions are scary to start contemplating, not just for hep C but HIV transmission within the prison population and the wider community. Again, who’s your friend? FINCOL. Always clean your fit out with FINCOL after each and every use, followed by flushing with cold water, a fact of life inside is that fits get re-used but a simple clean-out goes a long way, and remember most fits come in via the tucker chute boot which equals bloody and bacteria-filled environment. So – one last time – who’s your friend? FINCOL! Thanx brothers, luv ya’s! FC Thanks so much for your letter, FC. We reckon your advice about FINCOL is spot-on (cont. over)


hepcaustralasia.org The largest online support community for people living with hep C in Australia run by people with hep C for people with Hep C “What I love about hepcaustralasia is that it gives me a place to go where everyone is in the same boat. We can talk freely about our experience without having to disclose to the wider world. And, most importantly, it provides valuable advice and support for those of us on treatment. It is a long, hard road but it’s made a lot easier by having sympathetic, like-minded people to talk to.”

Dee hepcaustralasia forum moderator

hepcaustralasia.org is proudly supported by Hepatitis NSW hep.org.au / HEP REVIEW / 7


LETTERS

letters (cont.) In terms of whether or not you choose to tell someone you have hep C, it’s always going to be up to each person what they’re comfortable with, but it’s good to hear that your experiences of this have all been good ones. We’ve contacted Corrective Services NSW about some of the issues you’ve raised and it turns out there was some miscommunication around machine refilling - this has now been fixed. We also changed one thing in your letter - it’s much better to use cold water than hot when rinsing fits as cold water is more likely to wash any blood out, whereas hot water can cause tiny bits of blood to harden and remain in the fit. Thanks again for your letter and for looking out for your brothers on the inside. Ed. To Editor, I am an avid reader and I follow quite a lot of the new subjects and some of the old ones too. I am in prison and on the mail list to receive the mags and the election campaigns and newsletters from you. One story that’s been biting me has dropped off of late. The prison fit exchange in Canberra’s Alexander Maconochie Centre. This is the one thing I’d like to see occur in Oz. The clinics in England found that diamorphine hydrochloride produced great improvements – better than our methadone

treatment. Hep Review hasn’t done a follow-up or pushed the issue – I haven’t seen it in User’s News either. You have great power with your mags and people need something less painful to withdraw off than the ‘done so please spread the word again that those trials in England proved their value! A two-week dry-out instead of three months of terrible side-kicking agony off ‘done and people get clean and don’t need to stay on the programme due to the old “Don’t jump off the ‘done ‘cos it’s a long withdrawal and 100 times worse than the gear!” So people can get help for the bad time and wean off very easily and quickly instead of 30 years on the program like Aussie users of smack. Please try to get some stats and spread the word here how much better things could be! And what we can do here to try and get the same trials now that America’s War on Users is slowly losing momentum.

Dear Hep Review, Last year, while visiting a Hepatitis C forum, I read a story from your magazine that somebody had posted. It was called Glen’s story: Dealing with deniers” (Edition 73, June 2011) The story was written by a man who had been treated with interferon for 48 weeks (and failed) and a couple of years later was still dealing with unresolved post treatment side effects. He complained about health care professionals not helping him and at the end he said. “I’m still pissed off with health professionals who did not believe me when I said that the treatment gave me years of side effects. It still eludes me, why did they do that?”

I’m one of those “health care professionals”. When I read that I thought, surely he’s not talking about me. I put my job on the line to help a patient get a liver transplant and I became a Hepatitis C speaker for Yours truly, Schering and later an Anemia Speaker for Amgen so I could RB help the Hep C patients I cared Dear RB, thanks for raising this for. Me, a little nurse with an accent who was petrified to with us. speak in public. Those patients made me who I am. I am a You’re right - as an aspect better person because of them. of harm reduction, working So surely he didn’t mean me. towards better drug-treatment options for people in Australia is an important area of work for But Glen’s eyes kept staring back at me from the page. It Hepatitis NSW. was as if he was saying to me: In terms of your question about “I trusted you and you let me what is going on with the AMC down”. prison NSP trial - we’ve got I read his story several the latest on that in the news times. By the third time, I section on page 14. started noticing something Cheers, Ed.

8 / HEP REVIEW #88 / JUL-OCT 2015


very interesting. All the post treatment side effects had one thing in common...HIGH CORTISOL. All of them. It was as if all the side effects formed a chorus line and one by one screamed, “Cortisol... cortisol...cortisol!”. I thought of other things people complained about and, sure enough, they can all be caused by high cortisol. I decided that there was only one thing I could do. I had to go find the answers for Glen. I had to figure out what causes post treatment side effects... and I wouldn’t stop until I did. It turned out to be easier than I thought. I have a background in Clinical Research and my research partner and Dr Robert Gish, one of the top hepatologists in the US, provided their assistance. Forgive me for making this so long. The reason I am writing to you is because, now that I have Glen’s answer, I need help finding Glen. I realise that the story is several years old and he may be fine by

LETTERS

now. But I want him to know that although we don’t always have the answers, many of us “health care professionals” do care (even if we’re an ocean away). Sincerely, Silvia Hinojosa-Price, R.N., D.E. Kidney Institute of the Desert/John F Kennedy Memorial Hospital HCVets.com Educational Website & Support Forums Dear Silvia, Your passion is inspriing and impressive! Unfortunately, we cannot provide contact details for any of our clients. I have tried to find a contact for Glen but haven’t been able to track one down.

Have something to say? Write to us at Hep Review Hepatitis NSW PO Box 432 Surry Hills 2010 or hepreview@hep.org.au

Hopefully, if Glen is still reading then he may get your message this way. Thanks again for getting in touch and for your care for our communities. Ed. hep.org.au / HEP REVIEW / 9


PBAC says

YES! !SEY YES!

to EQUAL TREATMENT ACCESS 10 / HEP REVIEW /#88 / JUL-OCT 2015

#ETAwin


EQUAL TREATMENT ACCESS

So what’s next? If you haven’t already heard the news, then get with it (and subscribe to our monthly newsletter The Champion). The Pharmaceutical Benefits Advisory Committee (PBAC) have recommended that the new hep C treatment drugs: • Sofosbuvir • Sofosbuvir/ledipasvir • Daclatasvir/sofosbuvir all be made available to Australians under the Pharmaceutical Benefits Scheme (PBS). Hepatitis NSW has warmly welcomed the recommendations. These new drugs were considered by the PBAC at its March 2015 meeting – and the positive recommendations follow submissions from a record number of community members, from NSW and around Australia, calling for Equal Treatment Access. Thanks to everyone who has supported our Equal Treatment Access campaign by signing petitions, writing submissions and spreading the campaign. This is the important first step in the process for having these drugs listed on the PBS, which is essential for them to be accessible to as many people as possible. One of the most encouraging signs is that the recommendations for approval come with no restriction by stage of disease.

However, before they are PBS-listed, the Government and the companies need to agree on acceptable prices, and then the Government needs to make funding available for these treatments. In practical terms, this means there could be interferon-free treatment options for people with hep C genotypes 1, 2, 3 and 4 by the end of 2015 provided the negotiations on price are successful and that the Federal Government’s Cabinet gives approval to fund them. And coming up at the July 2015 meeting of the PBAC is the consideration of more new hep C treatment drugs: • Paritaprevir with ritonavir, ombitsavir and dasabuvir (Viekiva Pak) • Simeprevir (Olysio)* • Ribavirin (Ibaryr)* * for use in combination with interferon-free therapies. The closing date for submissions to support approval of these new drugs was 10 June. Hepatitis NSW and many community members made strong submissions - now the wait is on to see whether people with hep C in Australia can get the same choices as their peers in the USA, Europe snd elsewhere overseas, subject to the additional two hurdles above being successfully cleared. The fight for Equal Treatment Access is not over yet – but we are part way.

Get the latest treatment news, tips on living well with viral hepatitis and notice of community events and courses Subscribe to The Champion at hep.org.au/join-c hep.org.au / HEP REVIEW / 11


MY STORY

My story Jules Hero is not a word I associate my life or myself with, I feel, however, that in relation to my life as a person living with hep C, I have been blessed with many heroes - doctors, nurses, peers, friends, family, partners and associations including Hepatitis NSW, Hepatitis Victoria and Hepatitis Australia - throughout my life. I have lived with hep C for approximately 32 years - I became infected with hep B and C when I commenced using drugs intravenously - most specifically speed and heroin - in the early 1980s. Clean and/or new syringes (also known as fits) were incredibly difficult to buy in this period occasionally, you could access syringes through purchasing them at medical supply shops or forward-thinking and compassionate chemists. It was also a legal offence to have syringes on your person - thus, syringes were hidden and shared over and over - sharpening the actual needle on matchboxes and assisting the barrel to continue sliding with Vaseline. Washing the whole instrument in hot water sometimes including soap - was the common method means of attempting to keep the syringe clean. I was blessed to clear hep B - and to not become infected with HIV.

measures such as the supply of syringes, and other strategies were part of the service delivery of the workplace. I was working at the organisation formerlly known as VIVAIDS in the early 1990s when we undertook an educational forum pertaining to hep C - just post hepatitis non-A non-B being renamed hep C. I had been diagnosed with non-A non-B hepatitis in the late 1980s. The health and medical community organisation which oversaw VIVAIDS at the time supported the aforementioned education forum - and supported those of us employed at VIVAIDS and its clients who chose to undertake pre-test counselling in relation to hep C. Without going into specifics, it became immediately apparent that there were many of us that were infected - and minimal information was available specifically at this time addressing hep C. I was incredibly lucky with both the pre and post-test counselling I received at the time. Overall, over the years I have received comprehensive, current and holistic support from many health workers and providers. I have been both included and supported in decisions regarding my diagnosis. As hep C has impacted my ability to work, I have gone from a busy, complex job to part time and now occasional work due to my consistent fatigue.

I continued to use drugs intravenously for many years – whilst also experiencing extensive periods of living without drugs or minimal use of alcohol and other drugs in between these periods of losing myself to addiction.

I am honoured to have worked as a volunteer addressing my experience of living with hep C for Hepatitis NSW for over ten years – and am now equally privileged to begin in a similar position speaking to health workers next week in regional Victoria for Hepatitis Victoria.

I studied, trained and became active in peer based education and community work. I was very proud and challenged in a positive way to become employed both in paid and unpaid work in which progressive and preventative health

Aside from hep C impacting my energy level enormously – I have been diagnosed with chronic fatigue as an impact of hep C – my already organic severe depression has also been heightened over the years.

12 / HEP REVIEW /#88 / JUL-OCT 2015


Being diagnosed at fifty with bipolar also altered my ability to access hep C treatment currently available, as my specialist decided my affiliation with thoughts of suicide (as an outcome of the bipolar) could be exacerbated by the medicine for hep C. I was therefore deemed inappropriate for current treatment options as my hepatitis is not perceived as needing immediate treatment – despite my having lived with the virus for such a long period. Although considering myself highly fortunate in relation to the impact of hep C upon my life. I suffered, as little as two years ago, enormous (and devastating at the time), discrimination from both residential workers and clients in womens housing where I was residing due to being both homeless and in a state of crisis as a consequence of my mental health at the time. Ignorance, lack of education and – (from my perspective) lack of wanting to address stigma and discrimination, universal precautions and the like in relation to a client (being myself), allowed for some hideous bullying to take place when relevant training – which Hepatitis NSW immediately offered at no cost – could have transformed both my experience and others living in the housing terrified of being exposed to living with hep C. Training did not occur – relevant resources were not supplied to clients or staff (although offered by Hepatitis NSW) – and eventually, I left the service having experienced hellish bullying, threats and intimidation from the clients – and indifference and apathy from the staff. I was very lucky – I eventually had options in relation to safe housing, so many do not. So many are not free from discrimination. I think that my primary message in relation to visibly living with hep C is that regardless of

MY STORY

how one transmits the virus, or one’s lifestyle, universal support, treatment, resources and referrals should be available without discrimination or harm of any sort to that person. Education, research, support and funds in relation to the virus are paramount to stop further discrimination occurring for people living with the virus. The virus can be so debilitating – no one needs further obstacles to clutter their path and their life. I have enjoyed thus far a complex life. Hep C is a part of that life. I am extremely fortunate in the fact my life and health has been immensely enhanced in relation to hep C due to information and support I have obtained over the years and my accessing both complementary medicine and medicines available through the PBS. I believe kindness, education and generosity are all vital aspects of how we as individuals, and as a society, address issues of complexity. Thank you! Jules’ story appeared originally in Hepatitis Victoria’s magazine Good Liver

Thanks for sharing your story, Jules (not pictured). We want to hear from you about your story together we’ll share it with our community.

hepreview@hep.org.au hep.org.au / HEP REVIEW / 13


NEWS

LOCAL NEWS NEWS - NEW SOUTH WALES - AUSTRALIA

TRANS-PACIFIC PARTNERSHIP - EXPENSIVE MEDICINES BUT CIGS AND ALCOHOL EASIER TO FIND The Centre for Health Equity Training Research and Evaluation at the University of UNSW has issued a review of the TransPacific Partnership Agreement, warning that under the proposed terms the price of medicines is likely to increase, while tobacco and alcohol sales are likely to become less restricted. The review was compiled by health specialists from the universities of Sydney, NSW and La Trobe and is based on leaked drafts of the trade agreement. The concerns raised by the review are not new, and it is difficult to see how the TPP will improve the health of either people living with hep C or the general population. Concerned? Check out the campaign from CHOICE to keep yourself informed: choice.com.au Seach: TPP A STEP FORWARD FOR PRISON NSP? The Public Health Association of Australia (PHAA) has welcomed the ACT Government’s latest efforts to progress the implementation of a Needle and Syringe Program (NSP) in the ACT prison, including finalisation of a new Enterprise Bargaining Agreement for custodial officers. However, PHAA is concerned that ultimate implementation of the program is still limited to the endorsement of custodial officers via a ballot rather than all stakeholders. “We believe the input of custodial officers is integral to the

development of a workable model for the implementation of a NSP in the Alexander Machonochie Centre (AMC). Most importantly, it is also clear that the deed is signed in ‘good faith’ recognising ‘it is Territory policy to introduce a Needle and Syringe Program’.

better public health outcomes for the ACT community,” said Mr Moore.

“It is not appropriate that custodial officers should ultimately have the power to veto the implementation of a workable model,” explained PHAA CEO Michael Moore, “especially when their members have been integrally involved in the development of the proposal”.

POLICE UNION CALLS FOR SPITTERS TO BE JAILED

“It is important and appropriate that custodial officers are involved in the development of a model for the implementation of a NSP in the prison, including the establishment of operational protocols that address health and safety concerns. However, as only one group of stakeholders set to be affected by the NSP in the AMC, they should not be allowed to actually block the implementation of an important public health measure designed to prevent the spread of blood-borne viruses (BBVs) among detainees and the broader community. “The implementation of key public health measures should be based on evidence, not popular opinion. The evidence from such programs run overseas indicates that they can operate safely and effectively in prison contexts. Likewise, community-based NSPs – while not always popular with everyone – have been shown to dramatically reduce the incidence of BBVs among at-risk populations, thereby reducing the risk to the broader community. “We call on the ACT Government to ensure that the best interests of all stakeholders are served in the development of evidence-based policies and programs to promote

14 / HEP REVIEW #88 / JUL-OCT 2015

Hepatitis NSW strongly supports the introduction of NSP in prisons in NSW and across Australia.

THE NSW Police Union is pushing for anyone who deliberately spits or splatters blood at an officer to face up to 14 years in jail. The Police Association of NSW is also calling for powers that force anyone who transmits a bodily fluid including spit, blood or urine to emergency workers, to be tested for diseases. What could this mean for the number of people being jailed? As at 30 June 2014 the number of adult prisoners in New South Wales prisons was 10,566, an increase of 7% (669 prisoners) on 2013. The adult imprisonment rate was 181.7 prisoners per 100,000 adult population, an increase from 173.2 prisoners per 100,000 adult population in 2013. The most common offence/ charge for which prisoners were remanded in custody was acts intended to cause injury (19% or 2,031 prisoners), followed by illicit drug offences (16% or 1,646 prisoners) and offences against justice procedures, government security and operations (11% or 1,190 prisoners). ABS Spitting on police is currently considered an assault under the Crimes Act, but Police and Emergency Services Minister Stuart Ayres says the Government is happy to enter discussions on whether the laws need strengthening. “Mandatory testing of bodily fluids projected at police is something the


NEWS

LOCAL NEWS NEWS - NEW SOUTH WALES - AUSTRALIA

Baird government is seriously considering.” Hepatitis B transmission can be prevented through vaccination. According to the NSW Police Force website, applicants to the NSW Police must supply proof of hepatitis B vaccination, or proof of commencement of Hepatitis B vaccinations. Spitting on someone represents zero risk for transmission of hep C or HIV. Adapted from news.com.au ICE INQUIRY SHOULD HAVE HEALTH AND HARM REDUCTION FOCUS Regular consumers of mainstream media will have noticed a significant increase in coverage of issues surrounding amphetamines, and in particular the drug ‘ice’, over the past six months. In particular, the Commonwealth Government has taken up this topic with gusto, and has set up two processes in response. First, it has established a Parliamentary ‘Inquiry into Crystal Methamphetamine’. There are a couple of issues with this investigation, however, including the fact the Parliamentary Joint Committee on Law Enforcement has been tasked to conduct it (rather than, say, the House of Representatives Standing Committee on Health, which is currently conducting an inquiry into Hepatitis C). This means that, given the membership and responsibilities of this group, the inquiry is largely focusing on ‘law and order’ issues – and, as a result, is not treating methamphetamine use primarily as a health issue.

This focus – law and order, not health – is also reflected in the terms of reference for the inquiry, with five terms of reference focusing on the first pillar of harm minimisation (supply reduction), one term of reference focusing on the second pillar (demand reduction) but zero terms of reference looking at what Hepatitis NSW believes should be a central focus of any approach to drug use in Australia: harm reduction. Second, the Commonwealth Government has established a ‘National Ice Taskforce’ within the Department of Prime Minister and Cabinet. On the positive side, this taskforce has a much broader focus. From its website: “[t]he Taskforce and its secretariat will work closely with government agencies, expert groups and the community to examine existing efforts to address ice, and to identify opportunities to improve education, health, law enforcement and other policies to combat the impact of ice in the community.” Although it is still worth noting it is headed by the former Chief Commissioner of Victoria Police, Mr Ken Lay.

And one final point to consider on this issue – while media reports about ice have increased dramatically in 2015, the Sydney Morning Herald reports that, in fact “[a]mphetamine use is stable and use across the population has actually gone down since 1998” while “[t]he proportion of Australians who have used ice in the past 12 months is around 2 per cent.” Which is a strong argument for ensuring that, whatever policies are adopted in coming months are not simply ‘knee-jerk responses’, and do not jeopardise the overall need to prevent new transmissions of blood-borne viruses, including hep C.

Want to stay up-to-date with the latest hep C news?

In terms of both the Parliamentary Inquiry into Crystal Methamphetamine, and the National Ice Taskforce, Hepatitis NSW will be making submissions.

Subscribe to our monthly newsletter The Champion

As expected, we will be focusing on the issue of harm reduction, and in particular on ensuring that any response to the issue of ‘ice’ prioritises the reduction of transmissions, and risk of transmission, of blood borne viruses, including hepatitis C. This is essential both to reduce the overall size of the hepatitis C epidemic in Australia – and for the long-term health of people who inject drugs.

Go to: hep.org.au/join-c/ Choose from our Community or Professional editions

hep.org.au / HEP REVIEW / 15


NEWS

WORLD NEWS NEWS - INTERNATIONAL

FASTER, EASIER, STRONGER, SHORTER

bad strategy to start with the most difficult groups.”

Speed and efficacy – those are the two factors that are defining hep C treatments these days.

Abridged from pharmacydaily.com.au

With the days of a year spent on treatment for hep C slowly but surely becoming a thing of the past, the pressure is on to offer the best options. Of course it’s not just a question of improving health outcomes – the economic side of things is a major factor. And there is a lot of money at stake. Gliead Sciences Inc. made more than AUSD$15 billion in 2014 from sales of their hep C treatment drugs Sovaldi and Harvoni. The gold star that the pharmaceutical giants are hunting for is a treatment that will work quickly and well for anyone, regardless of the genotype of hep C they have, the degree of liver damage they have or the level of virus in their system. New treatments not yet available in Australia can cure many people in just 12 weeks, but researchers and bean counters have their sights set on achieving cure within 6 weeks. Whilst this has already been achieved by some people with hep C, those people are classed as ‘easy-to-treat’ meaning that they don’t have much liver damage, and don’t have other conditions which effect length of treatment. Treatment has definitely come a long way of late, but there’s further to go. “If you can treat (a) very difficult population, then by default you should be able to treat the easier-to-cure patient with that same regimen,” said Fred Poordad, a hepatologist and vice president for academic and clinical affairs at the Texas Liver Institute in San Antonio. “It’s not a

WHO TO IMPROVE ACCESS TO LIFE-SAVING MEDICINES FOR HEP C The World Health Organisation (WHO) has published the new edition of its Model List of Essential Medicines, which includes the new treatments for hep C. The publication is part of moves by the organisation to open the way to improve access to innovative medicines that show clear clinical benefits and can have enormous public health impact globally. “When new effective medicines emerge to safely treat serious and widespread diseases, it is vital to ensure that everyone who needs them can obtain them,” said WHO Director-General, Dr Margaret Chan. “Placing them on the WHO Essential Medicines List is a first step in that direction.” It noted that increasingly, governments and institutions around the world were using the WHO list to guide the development of their own essential medicines lists, because they know that every medicine listed has been vetted for efficacy, safety and quality, and that there had been a comparative costeffectiveness evaluation with other alternatives in the same class of medicines. The list is updated every two years by an Expert Committee, made up of recognised specialists from academia, research and the medical and pharmaceutical professions.

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This year, the Committee underscored the urgent need to take action to promote equitable access and use of several new highly effective medicines, some of which were currently too costly even for high-income countries. Essential antiviral fixed-dose combination therapies for HCV include: Harvoni (ledipasvir and sofosbuvir, Gilead Sciences) and Viekira Pak (dasabuvir/ombitasvir/ paritaprevir/ritonavir, AbbVie). Also mentioned on the essential medicines core list were Baraclude (entecavir, BristolMyers Squibb) and Viread (tenofovir disoproxil fumarate, Gilead Sciences) for the treatment of hepatitis B virus infection. “Treatments for hep C are evolving rapidly, with several new, highly effective and safe medicines on the market and many in the development pipeline,” said Dr Marie-Paule Kieny, WHO Assistant DirectorGeneral for Health Systems and Innovation. “While some efforts have been made to reduce their price for low-income countries, without uniform strategies to make these medicines more affordable globally the potential for public health gains will be reduced considerably.” Abridged from citifmonline.com ACTIVISTS CHALLENGE GILEAD OVER HEP C TREATMENT PATENT ISSUE A legal advocacy group has filed a lawsuit against pharmaceutical company Gilead Sciences, seeking a court order to prevent the company from obtaining a patent for its hep C treatment drug Sovaldi (sofosbuvir).


NEWS

WORLD NEWS NEWS - INTERNATIONAL

Patent challenges against Gilead were announced by the Initiative for Medicines, Access and Knowledge (I-MAK), a legal advocacy group, in Argentina, Brazil, Russia and Ukraine. Similar challenges have already been made in India, Egypt and the European Union.

WHO SOUNDS HEP B ALARM IN VIETNAM

Priti Radhakrishnan, a co-founder of I-MAK, said in a conference call that Gilead has attempted to seek exclusive rights to sofosbuvir and that this is an abuse of patent laws. I-MAK assert that Gilead is unfairly claiming the ownership of existing public knowledge.

Vietnam is among nine Western Pacific countries to be placed by the World Health Organisation (WHO) on a list of nations where hep B infection is alarmingly high.

According to Radhakrishnan, it is unethical on Gilead’s part to claim the treatment as its own innovation when previously published information and existing compounds led to the evolution of the drug. International patent law requires a company to prove that a drug is novel, non-obvious and useful in order to receive patent rights to a treatment, said Tahir Amin, an I-MAK co-founder and the group’s director of intellectual property. Dr. Jennifer Cohn, the access campaign medical director for Doctors Without Borders, said the set criteria to obtain rights to a drug is not being fulfilled by Gilead, thus it doesn’t deserve patents for sofosbuvir. “We didn’t really say we want to charge $1,000 a pill. We’re just looking at what we think was a fair price for the value that we’re bringing into the health care system and to the patients”, said Gregg Alton, vice president at Gilead. Abridged from mainenewsonline.com

Vietnam is one of the countries whose hep B infections have reached an alarming rate as 10-20 percent of its population has contracted the disease, local health authorities have warned.

Hep B is the leading cause of liver cancer world-wide, with 25 percent of patients developing cirrhosis and then liver cancer if untreated. The hep B virus is mainly transmitted through blood, from mother to children during birth, or via unprotected sexual intercourse. Hep B is a potentially lifethreatening liver infection caused by the hep B virus, which can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer, according to the WHO. Most people do not suffer any symptoms during the acute infection phase, but some people have acute illness with symptoms that last several weeks, including yellowing of the skin and eyes, dark urine, extreme fatigue, nausea, vomiting and abdominal pain, the health organisation said. Meanwhile, a small subset of persons with acute hepatitis can develop acute liver failure that can lead to death, the WHO warned. Abridged from tuoitrenews.vn

MEANWHILE, IN EGYPT . . . The World Health Organisation (WHO) has found that Egypt has the highest prevalence of hep C in the world, with approximately 22 percent of Egyptian blood donors testing antibody positive. Lacking in infrastructure to deal with the virus, Egypt suffers from a particularly high morbidity and mortality rate, with 40,000 people dying from the disease each year. It is estimated that roughly 15 million Egyptians are currently living with hep C. Every year there are 170,000 to 200,000 new hep C cases. In response to the epidemic, Egypt has opened its first factory for the local production of sofosbuvir. Pharmed Healthcare – a joint venture between Indian, UAE and Egyptian partners – is overseeing the factory opening, which took place in May 2015. The company successfully obtained a license from American firm Gilead Sciences to manufacture and market the drug in Egypt. The CEO of Pharmed Healthcare, Muhammad Mabrouk, says that the medication will be available in Egypt from June of this year. Last year, the health ministry secured a deal with Gilead Sciences to import the drug for $US 900, a 99 percent discount compared to the US cost of $US 84,000 for a three-month treatment. Egyptian health minister Adel elAdawi, who attended the factory opening, reassured that the ministry is working to lower the prevalence of the virus by raising awareness and treatment. Abridged from egyptianstreets.com

hep.org.au / HEP REVIEW / 17


We remember VIVIENNE YATES Vivienne Yates was one of Hepatitis NSW’s regular, longstanding mailout volunteers – one of The A-Team who handled the Hep Review mailouts. Vivienne was a hard-working woman who we remember as quiet, gentle, wise, friendly and unassuming.

Hepatitis NSW PHOTOCALL PROJECT

Your photos, your stories Share your photos with your communities.

Images by Exposition by RAF

Email us at hepreview@hep.org.au for more information.

18 / HEP REVIEW #88 / JUL-OCT 2015

We will miss you, Vivienne. RAY JACKSON Ray Jackson, a Wiradjuri warrior for human rights, was one of Australia’s most vocal and knowledgeable deathsin-custody campaigners. A fighter for Koori justice – or “fkj”, as he always signed his weekly emails – Jackson spent nearly 30 years holding our police, prison and court systems to account every time an Aboriginal or Torress Strait Islander person died in custody. Ray Jackson waged war against all deaths in custody, not just those of his people. May you rest in peace, Uncle Ray.


halc WHAT CAN YOU DO ABOUT DISCRIMINATION? If you feel that you have been discriminated against or victimised, you can make a complaint to the NSW Anti-discrimination Board or the Australian Human Rights Commission. Complaints of vilification can also be made to the Board. HALC can provide you with legal advice and representation to help you with your complaint.

“It’s so much better to talk to someone than bottling it all up inside, especially if you are on treatment.”

“HepConnect definitely helped me, and I am motivated by other people who have been through the treatment.”

“I like being able to help people who are going through what I’ve been through, I wish HepConnect was around back when I was on treatment.”

“Throughout my 24-week treatment she was the only person I had contact with that had hep C. It meant so much to me to actually speak to another person who has been affected by hep C.”

CALL 1800 063 060

HIV/AIDS LEGAL CENTRE www.halc.org.au

Hep Connect

treatment peer support

1800 803 990 hep.org.au / HEP REVIEW / 19


FACT: You cannot tell by looking at someone if they have hep C

MYTH

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MYTH FACT: There is no vaccine for hep C MYTH: You can be vaccinated against hep C

FACT: Hep C only lives in blood

VI SI T www.hep.org.au

FACT: Treatment = cure for up to 80% of people (in 2015)

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MYTH: There is no cure for hep C

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HEP C MAGIC SQUARE

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HEPATITIS AWARENESS WEEK

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MYTH: Hep C lives in sexual fluids and saliva

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HEPATITIS INFOLINE

1800 803 990

MYTH: You can tell if someone has hep C

NSW 2015

HEPATITIS AWARENESS WEEK

INSTRUCTIONS: 1. Cut along the orange dotted line. 2. Fold square in half, fold out, then fold it in half the other way and fold out. 3. With the blank side up, fold each corner into the middle. 4. Turn the magic square over and repeat (again folding each corner into the middle).

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5. Place the magic square with the numbers side up and fold in half (into a rectangle shape). 6. Slide your thumb and pointer finger of both hands behind the corners and press together so that the magic square bends and forms a point in the middle. 7. You now have your magic square conversation starter to use during your event!


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FACT: The hep B vaccine is safe and effective. Getting your child vaccinated is the best way to protect them against hep B

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FACT: Many people with hep B can live a normal life. Check-ups every 6 months, and treatment as needed, help people with hep B live normal, healthy lives

MYTH: The hep B vaccine is dangerous for children and babies.

MYTH: You can tell if someone has hep B

HEP B MAGIC SQUARE

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HEPATITIS INFOLINE

1800 803 990

MYTH: You can get hep B from hugging and kissing

FACT: You can’t get hep B from hugs or kisses. You CAN get hep B from unprotected sex, sharing injecting equipment, or from your mum during birth or breastfeeding

NSW 2015

HEPATITIS AWARENESS WEEK

INSTRUCTIONS: 1. Cut along the orange dotted line. 2. Fold square in half, fold out, then fold it in half the other way and fold out. 3. With the blank side up, fold each corner into the middle. 4. Turn the magic square over and repeat (again folding each corner into the middle).

5. Place the magic square with the numbers side up and fold in half (into a rectangle shape). 6. Slide your thumb and pointer finger of both hands behind the corners and press together so that the magic square bends and forms a point in the middle. 7. You now have your magic square conversation starter to use during your event!

hep.org.au / HEP REVIEW / 21


MY STORY

My story SS

Thanks for sharing your story, SS (not pictured) Hep Review magazine is a lifeline for many people, linking them to news, information, views and stories. We want to hear from you about your story together we’ll share it with our community. hepreview@hep.org.au

22 / HEP REVIEW #88 / JUL-OCT 2015


MY STORY

I found out I had hep C in 1993. I was in prison, and I didn’t know the first thing about hep C or about how you could get it. Pretty soon after I’d gone to prison I had some tattoos done, and what do you know, along with the tattoos came hep C. When I found out I was really shocked. I didn’t know what hep C was about and I thought my life was ending. I knew I’d have to get some help. I’m the sort of a person who has had to be pretty self-protective in prison – I couldn’t just open up, but I had to break that barrier. I didn’t know much about hep C so I started asking questions. I talked to the lady at the clinic about it and she said I should get my liver checked. Back then they used to stick a prod in your liver and they were going to do that – a biopsy, but I backed out on doing that! In the meantime hep C definitely had a big impact on my life. In 2002 a prison clinic sent a letter to my house that contained information about my hep C status. When my girlfriend read that, well she thought she could get hep C from me through sex and that was that. So after that I didn’t want to tell anyone until I’d got rid of hep C. I’d been in and out of prison for a few years but then I got done for selling speed and got a sentence of three years, ten months. I spoke to the nurse at the Tamworth prison clinic, whose name was Helen, about doing the treatment. It was going to take a year but because I was in for such a long time then it seemed like a good chance to do it. I started my treatment in Tamworth, then got transferred to Parklea – the clinic staff didn’t miss a beat – it didn’t interfere with my treatment at all. It was better down there because the set-up was bigger. Tamworth is more of a holding jail for transferring prisoners. Treatment was really difficult at first – I got the cold shivers and about a month in I got really paranoid and just started thinking stupid things. They put me on a bit of a sedative, it was helpful but I think that I’ve had some ongoing effects from that in terms of depression. I still have no regrets about doing it – to get rid of

hep C is the best thing I could do for myself – I reckon I’ve added at least ten years to my life and that’s got to be worth it. I finished treatment in 2012 at Parklea. Since then I have gained weight, I’m not skinny and lethargic any more. I’ve got energy and I’m motivated, whereas before the only thing that got me going was a shot of speed – especially when I was sick. These days I stay away from fatty foods and I drink a lot of water. I train twice a week – either walking or running. Plus I stay away from tatts and any other sharp objects! I just think to myself, why take the risk when I’d have to do treatment all over again, wasting all that time and effort – my time, and everyone’s time who was involved. I’ve just had another check-up and my hep C is definitely gone. When I talk to the boys in here about doing treatment the main thing I tell them is that staying mentally strong is important. The first couple of weeks of interferon were really hard – your moods swing and your body struggles but after that you settle into it and the main thing then is staying focused on what you’re trying to do – get rid of hep C. I was going to pull out a couple of times when I was half-way through treatment but I had great support from the nurse at Parklea – Sue. Talking to her was what helped me get through it. My mate told me he had hep C, and I asked him if he wanted to do the treatment, and I explained to him about it and that he should get in there and do it early. If you want to get rid of it (hep C) then do the treatment – it’s a rocky road but it’s worth it in the end. When you’re halfway through your treatment you are nearly there. You come home and – you’re not getting out with hep C you’re not lethargic or feeling sick all the time. All the options are there.

Image by Exposition by RAF

hep.org.au / HEP REVIEW / 23


A YEAR OF LIVING BETTER

A YEAR OF

LIVING BETTER

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ometimes our lifestyle choices, such as alcohol, tobacco, drugs, sugar and fast foods are more unconscious habits rather than real choices. For many of us, whether we are living with hep C or not, these habits can combine with a lack of exercise, stress and poor sleep to severely damage our health, giving us symptoms of tiredness, brain fog, depression, nausea and liver pain. But we can change this!

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AUTHORS

A year of living better is a step-by-step series designed to help you achieve better health, in manageable chunks. This is the second issue in our guide to improving your health and vitality one step at time. Last edition we looked at improving digestion through mindful eating (sit, breathe, slow down, chew, enjoy), including protein in every meal, eating a rainbow of fresh fruit and vegetables and what fats to increase, reduce and avoid. In this installment we start with sleep, which is fundamental to our health and wellbeing, and then look at some specific liver-friendly, bitter and fermented foods that you can add to your diet to improve digestion and liver health. After reading each section, decide what will inspire you and then write “My action� on your planner (and then put your planner somewhere where you will be reminded of your plan.

Ses was awarded her PhD from the School of Medicine and Public Health at the University of Newcastle in 2013 on the Hep573 Study, a clinical trial of silymarin alone and silymarin combined with antioxidants in the treatment of chronic hepatitis C. She was awarded the Douglas Piper Young Investigator Award in Clinical Sciences by the Gastroenterological Society of Australia in 2010. She has been published widely in medical and naturopathic textbooks. Rhoslyn Humphreys is a naturopath and medical nutritionist as well as a yoga and meditation teacher. Rhoslyn holds a Bachelor of Naturopathy, an Advanced Diploma of Nutrition Medicine and an Advanced Diploma of Yoga. Like to see the referenced version of this article? Email hepreview @hep.org.au

Images by Exposition by RAF

Imagine making and sustaining 12 healthy habits in a year that last a lifetime.

Ses Salmond has been in practice as a naturopath, herbalist and homeopath for over 20 years

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Certain herbal teas, such as chamomile and passionflower can be a great replacement for alcohol or caffeinated beverages and a yoga nidra or relaxation CD listened to at bedtime can be a great way of helping the body and mind unwind. Create your own bedtime routine, write it out and follow it and visit the site below for some great suggestions on how to improve your sleep quality with dramatic benefits for health. >>> getselfhelp.co.uk/sleep

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To improve sleep: • Avoid caffeinated drinks after midday and alcohol within 3 hours of bedtime • Avoid napping and using the bed for activities other than sleep • Ensure a comfortable and quiet sleep environment. • Try to avoid worrying, planning or thinking about important matters near bedtime.


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Oats are a great source of soluble and insoluble fibre; start using recipes for porridge and bircher muesli such as the ones on pages 30-31. Try using yoghurt as a topping, though beware — low-fat yoghurts sometimes have lots of added sugar so check the label! Your best bet is plain, natural yoghurt; low fat if you are trying to lose weight or manage your cholesterol.

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Some good examples include: Rolled oats, wheat biscuits, shredded wheat, and bran flakes.

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Most packaged cereals are 20% to 30% sugar, so look for low sugar (aim for less than 10g sugar per serve), high-fibre alternatives (over 3g fibre per serve) with a good amount of protein (less than 300mg per 100g).

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Breakfast - the most important meal of the day

If you’re a chronic breakfast skipper, all is not lost! Believe it or not, you don’t need to sit down to a large, heavy meal first thing in the morning. Start with something small and light, such as a piece of fruit, a tub of yoghurt, a smoothie, a boiled egg or even just a glass of milk. Keep at it every day (they say it takes 66 days to form a new habit!) and branch out to different, more filling foods when you’re ready.

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Broccoli is known for its cancer fighting and detoxifying properties. It is relatively high in fibre and is a great source of omega 3, vitamins B1, B2, B5, B6, B9, A, C, E, K, and essential minerals calcium, iron, magnesium, selenium, phosphorus, potassium and manganese.

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Watercress is a great source of omega 3, vitamins B1, B2, B5, B6, B9, A, C, E, K, and essential minerals calcium, copper, magnesium, phosphorus, potassium and manganese.

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Bitter, liver-friendly foods can also have other health benefits and are full of nutrients.

rocket cauliflower broccoli brussels sprouts chard bitter melon dandelion leaves kale asparagus artichokes coffee dandelion coffee dark chocolate

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Bitter foods promote liver, immune and digestive health by stimulating the bitter taste receptors. These receptors wake up the digestive and immune system to get ready for food by producing saliva, bile and digestive enzymes. This stimulates appetite, digestion and immune function. Therefore try a bitter salad before your main meal.

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Bitter foods boost your digestion and contain liver-friendly nutrients to support liver health and reduce the risk of cancer.

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Gut health equals good brain health. Ninety five percent of serotonin is made in the intestines. So if you are feeding your gut good bacteria with probiotics, prebiotics and increased dietary fibre you will feel healthy, happier and less stressed. The most common strains of “good bacteria”, usually labelled on foods, as “live cultures”, are acidophilus, bifidobacter and lactobacillus. When choosing a fermented, probiotic containing food, make sure you chose a food that is actually fermented, not just preserved with brine, vinegar, or lemon juice.

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In clinical studies the inclusion of a range of probiotics and prebiotics reduced fatty liver disease.

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Pre and probiotics improve gut health, immune function and digestion, which in turn supports liver health.

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Probiotic organisms or “good bacteria” can be found in fermented foods and are great to include in the diet.

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Adopt a Fermented food

Try these: kefir sauerkraut kimchi natto yoghurt lassi miso tamari soy sauce tempeh apple cider vinegar Try making your own! fermentationrecipes.com/

Prebiotic foods include: asparagus, artichoke, onions, garlic, oat bran, brown rice, legumes and herbs.

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livingwell LIVINGWELL is a FREE course for people living with hep C who are looking for ways to improve their health. The course is run by people who have hep C or have cleared it.

Slow release porridge Ready in 10 minutes Serves 1

WHEN: Evenings,

INGREDIENTS

weekends or day sessions

• 45 grams (1/2 cup) oats (45g of oats = 4.4g of fibre) • 2 dessertspoons of LSA (linseed, sunflower and almond) • 1 dessertspoon of pepitas (pumpkin seeds) OR walnuts OR Brazil nuts • Fruit (fresh is best) - use what is in season! • 2 dessertspoons full-fat natural yoghurt

HOW OFTEN: 4 or 6 week courses WHO: You and other people with hep C WHERE: Hepatitis NSW Lvl 4, 414 Elizabeth St (near the corner of Elizabeth St and Devonshire Sts) Surry Hills NSW 2010 INTERESTED? CONTACT KYLE ON: P 02 8217 7707 E kleadbeatter@hep.org.au

METHOD 1. Add a half cup of water and the oats to a pot and simmer over a very low heat (you may want to add more or less water, depending on how you like your porridge. 2. Stir the porridge slowly as it simmers, once it has reached a thick consistency, remove from heat and pour into a bowl. 3. Add some protein to increase the satiety (sense of fullness) - this is the LSA and nuts. 4. Top with a serve of fruit such as 2 dessert spoons of berries, a banana or some fruit compote (rhubarb, apple, cinnamon etc), dried coconut flakes are a great source of fatty acids for sustainable energy 5. Top with 2 dessertspoons of full-fat, natural yoghurt.

HEPATITIS INFOLINE

1800 803 990

30 / HEP REVIEW #88 / JUL-OCT 2015


A YEAR OF LIVING BETTER

Remember Sleep - every second counts!

Bircher muesli Ready in 10 minutes (with some pre-prep!) Serves 2

This will help with weight management, as protein helps make you feel fuller for longer and will balance blood sugar levels, aiding restful sleep and repair. Reduced carbohydrate and adequate protein will also reduce the fat content in the liver.

INGREDIENTS

Breakfast is your friend

• • • • • • • • •

Kick-start your day with a nutritious, energysustaining breakfast. Go for low glycaemic index, minimal added sugar, high protein, high fibre and moderate sodium products.

1 gala apple, unpeeled, quartered, core removed 1 cup (90g) rolled oats 1/2 cup (125ml) apple juice 1/2 cup (130g) natural yoghurt, plus extra to serve Large pinch ground cinnamon 1/4 cup (25g) flaked almonds 1/4 cup (30g) walnuts 2 tablespoons pepitas (pumpkin seeds) Blueberries and banana, to serve

METHOD

Eat bitter and fermented foods

1. Coarsely grate the apple. Mix the grated apple, rolled oats, apple juice, yoghurt and cinnamon in a bowl until well combined. Cover and place in the fridge for 1 hour or overnight.

This will optimise digestion and maximise the benefit and the enjoyment of food.

2. Combine the flaked almonds, walnuts and pepitas in a small bowl.

In the next issue we will look at stress, exercise, good hydration, and finally, putting it all together to optimise your health and vitality!

3. Stir half the nut mixture through the muesli with 1/2 cup of yoghurt if the muesli has been soaking overnight. (If the muesli has been soaking for 1 hour, add a little extra yoghurt only as desired.) 4. Top with the remaining nut mixture, sliced banana and blueberries to serve.

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this is part 2 of a 3 part series - stick this poster on your fridge or wall for easy reference and write in some of your health challenges and goals.

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(good bacteria improves gut health & digestion)

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A YEAR OF

LIVING BETTER

hep.org.au / HEP REVIEW / 33

2

5


LIVER LOVING RECIPES

A YEAR OF LIVING BETTER Buckwheat or oat pancakes Eggs – any style

Ready in 20 minutes Serves 4

Don’t forget eggs with wholemeal toast for breakfast - versatile and convenient! From scrambled or boiled eggs with toast, to a power-packed vegetable omelette with spinach, mushrooms and left-over baked vegetables.

INGREDIENTS

+

METHOD

Try avocado on your toast as a great source of healthy fats.

• • • • • • • • •

120g buckwheat flour or oat flour 1 egg 1/2 teaspoon salt 250ml rice milk 1/3 of ripe banana 4 teaspoons honey 1 teaspoon baking powder oil for frying crushed nuts

1. In a medium mixing bowl, mix together the flour(s), salt, and baking powder. 2. Add the egg and milk and mix until just combined. The batter should have some small to medium lumps. 3. Preheat your pan over medium-low heat and brush with oil. 4. Using a ¼-cup measure, scoop the batter onto the warm pan. Cook for 2 to 3 minutes until small bubbles form on the surface of the pancakes (you’ll know it’s ready to flip when about 2cm of the perimeter is matte instead of glossy), and flip. Cook on the opposite side for 1 to 2 minutes, or until golden brown. 5. Top with banana, honey and crushed nuts and serve.

34 / HEP REVIEW /#88 / JUL-OCT 2015


LIVER LOVING RECIPES

Rocket, pear & walnut salad Baked kale chips Ready in 10 minutes Serves 4

Ready in 20 minutes Serves 4

INGREDIENTS

INGREDIENTS

• • • • • • •

• • • • •

2 big handfuls of rocket 1 large clove of garlic, diced very finely 1 pear, thinly sliced 1 handful walnuts, crushed shaved parmesan 2 teaspoons olive oil salt and pepper

METHOD

1. Wash the rocket and then drain of water 2. In a large bowl add the diced garlic, sliced pear, crushed walnuts, olive oil and salt and pepper to the rocket, and toss the salad together. 3. Place in service bowl and top with the shaved parmesan and extra walnuts.

1 bunch of kale 1 large clove of garlic, diced finely coconut oil crushed almonds salt and pepper

METHOD 1. Quarter the kale leaves, and remove the thick spine. 2. Mix the leaves with coconut oil, garlic, salt and pepper and almonds. 3. Arrange leaves (not overlapping) on a baking tray. 4. Bake at 150 °C for 15 minutes or until crisp.

4. Serve immediately

DID YOU KNOW? Kale is a stronger antioxidant than blueberries are!

hep.org.au / HEP REVIEW / 35


LIFESTYLE Living with hep C?

Watch ‘That Sugar Film’

W

hen I went to see this film with a friend, she bought us choctops on the way in. I ate my ice-cream quickly, so that it wouldn’t melt all over me and because I grew up with lots of (hungry) older siblings. About 20 minutes into the film I was seriously starting to regret my snack choice.

That Sugar Film, by Australian actor Damon Gameau, is a documentary about the health effects of consuming large quantities of hidden sugar in our food supply. Forty teaspoons of sugar a day - that’s what Damon star/ victim of the doco sets out to eat for 60 days straight. This sweet journey into sugar’s effect on the body and mind is startling — not because we don’t already know that we should try to avoid eating too much sugar. What is startling is just how significant and wide-ranging sugar’s effects on our minds and bodies can be. This is not a scientific study it’s one person’s experiment, but that said, there’s plenty here to get you thinking about how much sugar you eat, and where it might be hidden. Tend to pick up the low-fat yoghurt or sour cream? Think again - it’s been packed with sugar to give you enough of a good ‘mouth-feel’ that you won’t notice the missing fat. On a health kick so choosing a mid-morning fruit juice instead of a can of coke? This may be hard to swallow, but the juice probably has more sugar.

36 / HEP REVIEW #88 / JUL-OCT 2015


LIFESTYLE

The cherry-on-top of Damon’s experiment is that he deliberately chooses to source his sugar intake from foods with hidden sugar. These are typically low-fat products and foods commonly thought of as ‘healthy’. This includes food like commercial breakfast cereals, flavoured yoghurts, muesli bars, dried fruit, fruit juice, jarred sauces and other packaged food or meal replacement style drinks. We watch as Damon has check-ups with his GP and a liver specialist. The news is not good. Prior to beginning the diet, Damon came in on tests as slightly more healthy than most Australian men his age. After two months on this high sugar diet, Damon finds that his body and health has been significantly affected. Biochemical tests show the initial signs of fatty liver, he puts on a total of 12kg and reports mood swings and a decline in his overall mental state. full of sugar and may be the reason that you’re struggling to lose weight or manage your health. Look a bit closer – read the ingredient list and compare products using the per 100g column on Limit your sugar intake, and you could significantly the nutrition information panel. improve your health. There are a few take-away messages in the film, and a few that we’ve added.

Be wary of foods that claim to be healthy (natural, low-fat, lite, etc) as they can be packed

Eat five serves of vegetables a day, two serves of fruit per day and aim for the majority of your diet to come from foods that are unprocessed (meat, nuts, seeds, legumes and high-fibre grains). In reality, good nutrition is about overall diet quality and what foods you eat regularly rather than individual foods or nutrients being either your best friend or your nutritional enemy. Some foods are just more nutritious than others, and the best evidence for long-term good health is a diet rich in whole, fresh vegetables and fruits.

Please note, if you are considering attempting any form of diet, consult your doctor first to ensure you can do so without risk to health. hep.org.au / HEP REVIEW / 37


MY STORY

My Story: SEAN There are lots of nice things about clearing hep C through treatment. One of the nicest is being able to say, “I used to have hep C, but I don’t anymore.” So when Sean went to see a surgeon about having surgery on his spine he told him that he had undertaken treatment for hep C the previous year, and was now hep C free. “The world of gastroenterologists believes in a cure, but I don’t,” was what the surgeon said. “I’d have to wear a spacesuit to do your surgery.” Sean was furious. “I didn’t go through almost twelve months of treatment to have someone, especially a doctor, turn around and tell me that it didn’t mean anything, when I knew that it had worked.” Having worked for several years in Hepatitis NSW’s treatment peer-support service HepConnect, and the positive speaker service C-een & Heard, Sean knew that there was something that he could do. After meeting with Hepatitis NSW, Sean contacted the HIV/AIDS Legal Centre – HALC. “It didn’t take them long to tell me that they thought I had a case.” says Sean. “Jennifer (from HALC) has done a lot of work with the tribunal and she was great.” That was about a year ago. “Yeah, it’s taken a while, and we were in mediation, we didn’t go to court. It felt like it wasn’t going anywhere, but then they made us an offer (to settle) and so finally I felt like I was getting somewhere.”

38 / HEP REVIEW #88 / JUL-OCT 2015

Sean settled out of court for an outcome that he was happy with it. “It’s important to remember that settlements aren’t just about money – they can be about changing practices too...he (the surgeon) seemed to think he knew all about hep C and

“ I’d have to wear a spacesuit to do your surgery.” professional practices, but he had also done things like write ‘Biohazard’ on a referral form for an injection I had to have. So he obviously had some things to learn.” Sean is grateful for the support he received from both HALC and his colleagues at Hepatitis NSW. “As I said, Jennifer was just amazing, and Sarah (from Hepatitis NSW) was a big support throughout the whole thing. I’m pretty happy with the way it has turned out.”

Thank you Sean, for sharing your story and for following through with formal action to right this wrong. Many people with hep C endure discriminatory behaviour from other people, all too often in healthcare settings. People often feel it might be too hard to take action to address discrimination – that it might


take too much effort to follow formal avenues of redress. Sean has proved it can be done. Sean’s win is a win for all people with hepatitis C. -Ed.

If you or someone you know has experienced discrimination because of hep C, you can call the Hepatitis Infoline 1800 803 990 or HALC on 9206 2060 to speak to someone about doing something about it.

GET BLOODY SERIOUS A workshop (mostly) about hep C A comprehensive workshop that will help you work better with your clients around hep C The motto of this workshop is:

THINK. PLAN. ACT Upcoming workshop dates

Friday 17th July, 2015 Friday 30th Oct, 2015 Friday 29th Jan, 2016 Friday 29th April, 2016 Register: 1800 803 990

working towards a world free of viral hepatitis hep.org.au / HEP REVIEW / 39


GOING VIRAL

Nepean Community & Neighbourhood Services When Hepatitis NSW’s Going Viral partnered with Nepean Blue Mountains Local Health District to support Nepean Community and Neighbourhood Services through project grants to deliver hep C information to local young people they amazed everyone by delivering two separate projects.

PROJECT 1

PROJECT 2

When staff at Glenmore Park Youth Centre noticed that a number of young men and women attending were getting backyard tattoos, they knew that aside from admiring the artwork, they could pass on some of the useful hep C prevention information they had recently acquired in their Going Viral training.

Koolyangarra is the Aboriginal Family Centre at Cranebrook. This service is part of Nepean Community & Neighbourhood Services and is the largest provider of Aboriginal services in the Penrith area.

As a result they developed a grant idea called ‘Think Before U Ink’ - a project that raised awareness around the possibility of contracting hep C through unsafe tattooing practices. What did the project involve? The Glenmore Park Youth Centre art project ran four workshops during the Centre’s drop-in time offering the young people an opportunity to develop their ideas, collaborate with each other and hone their designs. And all of this while engaging in health education discussions regarding hep C, what it is and does and how to stay safe. The fourth and final workshop was facilitated by the tattoo artist Richard Anthony. Richard and the young people involved talked about how important it is to find tattoo artists and body piercers who have a reputation for good work - which includes safe sterilisation and equipment handling. The group also discussed how to recognise a business that uses safe sterilisation practices.

Koolyangarra programs include Aboriginal playgroups, cultural programs, women’s groups, youth mentoring and family support. NCNS also run the Glenmore Park Youth Centre. The Centre has a number of young Aboriginal people attending who were aware of the local needle & syringe bin which motivated their grant proposal. What did the project involve? The Kooly Prevent/Art Project was five workshops, run over a number of weeks and supported by facilitators. The young people who attended designed a culturally-derived artwork that they then painted onto the local needle and syringe bin. During the workshops youth workers delivered health education messages to the young people and engaged them in discussions about hep C and safe practices. With the added bonus of the work being done outside in a public space where passers-by would stop to watch, providing opportunities for the young people to convey their newly learned messages.

The talking turned into artwork, designed by the young people and aimed at informing or reminding The overall aim was to engage the local young people in an interesting conversation about people to be aware of safer body art practices. Hepatitis C, their health and their culture by Two designs were chosen and turned into engaging them artistically. This, in turn, would temporary tattoos. They were used as an lead to them instigating conversations in engagement tool during Youth Week activities in their community, among peers, challenging 2015. misconceptions around hep C.

40 / HEP REVIEW /#88 / JUL-OCT 2015


GOING VIRAL

“The kids are really proud of the work they did on the bin. It looks amazing, which gives them an excuse to talk to other kids about hep C transmission, especially through tattooing.� Joy Impiombato General Manager, NCNS

hep.org.au / HEP REVIEW / 41


DISCOVER

DISCOVER RESEARCH INTO VIRAL HEPATITIS

HEP C AND CANCER RISK Researchers have long known that people with hep C are at increased risk of liver cancer. But a new study recently presented at the European Association for the Study of the Liver’s 50th International Liver Congress in Vienna, Austria, found that hep C may also raise the risk of developing other cancers. It is well established that infection with hep C can increase a person’s risk of liver cancer. After 40 years living with hep C: • • • •

30% of people won’t develop liver damage 45% of people will develop liver damage 20% of people will develop liver cirrhosis (liver scarring) 5% of people will develop liver failure or liver cancer

But how does hep C affect an individual’s risk of developing other cancers? A study by researchers at the Kaiser Permanente Southern California (KPSC) tried to answer that question. Dr. Lisa Nyberg and colleagues assessed all cancer diagnoses that had occurred at KPSC among people with hep C and without, aged 18 and older between 2008 and 2012. The researchers found that, compared with people without hep C, people with hep C are not only

at increased risk of liver cancer but of other cancers, including non-Hodgkin lymphoma and prostate and renal cancers.

Still, the team believes their findings warrant further investigation into the association between hep C and cancer risk.

The team identified 2,213 cancer diagnoses among people with hep C during the 5-year study period. When liver cancer was excluded, 1,654 cancer diagnoses remained. Among people without hep C, 84,419 cancer diagnoses were identified, with 83,795 cancer diagnoses remaining after the exclusion of liver cancer.

“This data adds to the evidence bank linking hep C with an increased risk of cancer,” says Dr. Laurent Castera, vice secretary of the European Association for the Study of the Liver, “and highlights that there is still a long way to go in order to fully understand this complex and devastating disease.”

Based on their findings, the researchers calculated that people with hep C were 2.5 times more likely than people without hep C to be diagnosed with cancer, including liver cancer. When liver cancer was excluded, cancer risk was still almost two times higher for people with hep C, according to the study.

Adapted from medicalnewstoday.com

Commenting on their findings, Dr. Nyberg says: “The results suggest that cancer rates are increased in the cohort of hep C people versus the people without, both including and excluding liver cancers. These findings certainly point to the suggestion that hep C may be associated with an increased risk of cancer.” Dr. Nyberg adds that these findings should be interpreted with caution, however, because the study results were modified when the researchers accounted for certain confounding factors, such as smoking status, alcohol intake, obesity and diabetes.

42 / HEP REVIEW #88 / JUL-OCT 2015

ANTIHISTAMINE REPURPOSING NOTHING TO SNEEZE AT With new hep C treatments being the biggest pharmaceutical money-spinners of the past year or two, the need for cheaper options is pressing. It’s a problem that researchers at the National Institutes of Health (NIH) and Hiroshima University have been working on for the last 10 years. They’re searching for new, better drugs to treat hep C by screening thousands of existing drug compounds — many of which are already approved and on the market. And they’ve had some contenders — the researchers have determined that a class of antihistamines may be


DISCOVER

repurposed to treat hep C. The drug chlorcyclizine HCI (CCZ) — a drug that’s been approved since the 1940s — was shown to be the most promising inhibitor of the virus, the new research found. The researchers of the new study report that CCZ can specifically target hep C, and prevented infection in mice by blocking hep C from entering liver cells. That’s a different mechanism from the current drugs, which block replication of the virus once it gets into the cells. “This is certainly new compared to the existing drugs,” says Dr. Jake Liang, head of the liver disease branch of the National Institute of Diabetes and Digestive and Kidney Diseases at the NIH, and a lead author of the study. “I think that’s the exciting part of our research: We are finding a new class of drugs that are active against hep C.” The drug showed promising results when tested on a population of mice who were infected with the virus. The researchers discovered that when the mice were given the drug on a daily basis, there was a significant decline in their viral levels. “That’s typically what we look for when we test any drugs,” says Dr. Liang. (cont. next page)

Questions? Head to HepNSW Online Forum hep.org.au/forums

HEPNSW ONLINE FORUM A place to connect

This is a forum where you can discuss issues related to viral hepatitis. Whether you are a health worker or someone affected by viral hepatitis, you are welcome to join this forum.

www.hep.org.au/forums/ hep.org.au / HEP REVIEW / 43


DISCOVER

DISCOVER RESEARCH INTO VIRAL HEPATITIS

The findings are still preliminary, and there are several steps that need to be taken before there’s any clinical use available for people. The scientists still do not know if the drug has the same effect in humans, how exactly it works and what form the treatment should take. “We want to caution people that these drugs have not been tested in people yet,” says

the drug is already approved, his team doesn’t have to go through a slog of regulatory approval for trials, and that the FDA is Dr. Liang says his team is working interested in drug repurposing, which appears to be a growing on understanding how CCZ and area of drug discovery. antihistamines in general could contribute to the treatment of hep The same process was recently C. They will be initiating a small used to identify drugs during the proof of concept trial in humans Ebola outbreak. Liang says his which will look at the effect of team is also looking at ways to short-term CCZ dosing on the infection. Dr. Liang says that since modify and optimise CCZ to make Dr. Liang. “They should not run out and take this medicine to treat hep C.”

Sydney . Wednesday 7 – Friday 9 October 2015

Abstract submission 12 JUNE 2015 Accommodation 4 SEPTEMBER 2015 44 / HEP REVIEW #88 / JUL-OCT 2015

Early bird 21 AUGUST 2015 Final Registration 1 OCTOBER 2015


DISCOVER

I have hep C

EASY READ BOOKLETS

it more effective and suitable for humans. With CCZ costing about $0.50 a tablet for allergy-related uses, the big question is whether a new hepatitis treatment that could come from existing drugs would be more affordable. Dr. Liang says he doesn’t have a “clear answer” to that question, but he says he envisions a few scenarios where the treatment could bring down costs. “If this particular class of drugs turns out to be effective against hep C, it could be used in combination with existing drugs to perhaps shorten the duration of use,” he says. “Instead of [taking the drugs] for three or six months it could be [taken] for four weeks. That will certainly reduce the cost of the drugs because you are not taking them for as long.”

6 - 12

MONTHS

MONTHS

Abridged from time.com

Want to stay up-to-date with the latest hepatitis C research? Subscribe to The Champion Go to: hep.org.au/join-c/

NEW

Order online hep.org.au/resource-library hep.org.au / HEP REVIEW / 45


DISCOVER

DISCOVER RESEARCH INTO VIRAL HEPATITIS

HOW TO DO HEP C CARE AND TREATMENT: THE ETHOS STUDY On the face of it, there is strong logic to the argument of incorporating hep C treatment in settings where a lot of people with hep C are present (opioid substitution treatment settings, OST). But, there are a number of issues that could be problematic in the co-located services.

The ETHOS study is designed to evaluate an innovative model for providing hep C assessment and treatment among people with a history of injecting drug use in NSW. The core components of the ETHOS model include the provision of on-site hep C nursing and physician assessment and treatment in clinics with existing infrastructure for addiction care (the majority of services had limited previous experience in providing hep C care).

The introduction of hep C treatment into drug treatment services will require an unprecedented engagement with a group of people who have experienced significant marginalisation. This expansion is not just a matter of generalising specialty services to other contexts. There is a substantial risk that success rates will be disappointing, and that stereotyped ideas about people who inject drugs, their priorities and their attitudes towards their own health will be reinforced.

Study recruitment was performed through a collaborative network of nine clinics (six OST clinics, two community health centres and one Aboriginal community controlled health organisation including 1 rural, 1 regional, and 7 urban clinics) undertaking hep C assessment, treatment and monitoring among people with a history of injecting drug use. Two services incorporated peer workers employed by the NSW drug user organisation, New South Wales Users and AIDS Association (NUAA).

These questions were addressed in a NHMRC Partnership Project supported by NSW Health. The Chief Investigators were: Greg Dore (Kirby Institute), Paul Haber (University of Sydney), Jason Grebely (Kirby), Carolyn Day (University of Sydney), myself - Carla Treloar (Centre for Social Research in Health, Lisa Ryan (of NSW Health, at that time), Rosie Thein (University of Toronto).

We conducted interviews with clients, staff and peer workers involved across a number of the ETHOS clinics. In short, what we found was that our scepticism was broadly misplaced. Most participants (staff and clients) found the combination of co-location, visibility and immediacy as facilitative of hep C care.

46 / HEP REVIEW #88 / JUL-OCT 2015

Clients at ETHOS sites said things like: “It’s in your face so it’s available to you ... We come here anyway. We feel safe coming here. So why wouldn’t you feel safe to go and talk about (hep C) as well?”

I wouldn’t have been able to do (hep C treatment) if it wasn’t accessible through this clinic here and now ... and it’s great. It’s great. I’m probably one of the people that need it the most. “I’m so bloody thankful they’re there ... ‘Cause I probably wouldn’t have walked into the opportunity [undertaking hep C treatment].” However, this model of care didn’t work for all. And the comments of this smaller group of client participants were focused on their negative feelings about OST:


“I mean if I had my way, I’d pick up six take-aways and not come here at all. I like to pick mine up, my ‘done up, and then pretend I’m just a normal person in my head ... but ... it’s very hard to get away from the scene when every time you come in here you’re at that scene.” “I just find it really depressing, this place. It just really gets me down ... you just wanna get on with the future ... you don’t wanna be in that box (as drug user) ... I mean I haven’t used drugs for 20-something years.” Staff, although some may not have had high expectations of the program at its inception, were also typically positive about the experience and the impact of the program for clients and filled a gap that OST services had not been able to address: “And while [hep C care] was really, really important, one of

DISCOVER

the most important things we do, we couldn’t kind of do it good because of the manpower and the hours we just didn’t have.”

are just things that don’t need to be spoken but they’re already understood.” Health worker

We also had a role in examining how the peer support component of the ETHOS study worked.

The peer worker program was noted as facilitating more effective use of health resources (peer workers did the “ground work” of educating and supporting clients, freeing up time of the clinical staff); mediating issues within the OST clinic (that might not be related to ETHOS); and, having an overall impact on the “culture” or “feel” of the clinic (that is, the peer workers’ presence generated a “friendlier vibe”).

Again, this was a very positive experience for clients, peer workers and health workers: “I like that we have our own peers who are in the same predicament as we are. Encouraging and helping others in the same predicament. For someone like me … instead of having a text book person there, I listen more to [peer support workers] because they’ve been there, they’ve done that.” Client participant “I like the idea of, of a service user being the expert and ... helping other service users. I think that’s a good way to go ... There

To stay up to date with what’s happening on the ETHOS study, visit Professor Carla Treloar’s blog carlatreloar.wordpress.com

hep.org.au / HEP REVIEW / 47


CHECK IT OUT

EDITION 19

PART ONE

Two young men clash on the football field of a Juvenile Justice centre. Tempers run high. Fists fly and blood is spilled, leading to questions and concerns...

2 TM-ED19_v2.indd 2

16/04/2015 9:45:09 AM

Featuring a comic developed by community, puzzles and basic information about hep C, Transmission Magazine is our easy-read publication.

3 TM-ED19_v2.indd 3

16/04/2015 9:45:11 AM

READ IT ONLINE hep.org.au/news-stand/ SUBSCRIBE Call 1800 803 990 48 / HEP REVIEW #88 / JUL-OCT 2015


RESEARCH RECRUITMENT

RESEARCH

clinicaltrials.gov

Studies currently recruiting people living with viral hepatitis

THE HEPATITIS C TREATMENT OUTCOME STUDY

www.hcvstudy.bond.edu.au

You are invited to take part in a study designed to determine some of the physical, psychological, and social factors associated with hep C treatment outcomes. The primary objective of this research is to increase understanding of individual profiles that are associated with better Hepatitis C treatment outcomes. Contact Simon Langston slangston@bond.edu.au Bond University

Clinicaltrial.gov is a US-based database of most of the clinical trials that are happening all over the world, including Australia. To find what you need, you can use the homepage search bar, and enter your search terms eg. “Hepatitis C” and “Bathurst”. You can also use the Advanced search to narrow down your search results, so that you only see studies that are currently recruiting participants, for example.

LIVER HEALTH PROJECT People living with hep C in Australia are invited to take part in a study about the experiences of living with hepatitis over time, including disclosure, well-being, employment, discrimination, stigma and resilience. You will take part in three confidential research interviews. To take part you must have been diagnosed with hep C, live in Australia and be over the age of 18. Each interview will take approximately one hour and can be conducted face-to-face if you live in Sydney or over the telephone at a time convenient to you. You can be reimbursed up to $50 per interview. Contact Jeanne Ellard J.Ellard@Latrobe.edu.au 02 9385 9496 La Trobe University

BETTER TESTING: RESPONDING TO CHRONIC HEP B www.latrobe.edu.au/arcshs/surveys/better-testing

A study for people who have been diagnosed with hep B in Australia to talk about when and how they were diagnosed. Participation includes a 30 minute phone interview.Participants who wish to be interviewed in a language other than English may request the presence of a translator. Participation is completely confidential. There is a $20 gift in appreciation of participation. To take part in an interview, participants must be 18 years or older and have been diagnosed with hep B in Australia.

centerwatch.com Centerwatch.com is a US-based database of clinical trials. CenterWatch provide patients and their advocates information on clinical trials, specific drugs, as well as other essential health and educational resources. • • • • • • • •

Search clinical trials Receive email notifications about specific clinical trials Review results from completed clinical trials Search drug information Learn about volunteering for a clinical trial Learn about the informed consent process Read an overview of the clinical trials process Find disease-specific health associations and other educational resources

Contact Duane Duncan d.duncan@latrobe.edu.au or Jack Wallace j.wallace@latrobe.edu.au hep.org.au / HEP REVIEW / 49


MULTICULTURAL COMMUNITY SUPPORT A helping hand

Anna & Olivia When Anna* received the news from her doctor that she was pregnant with her first child, she was overjoyed. However, she struggled to celebrate because her pregnancy testing had also come back with a piece of troubling news: the hep C test came back positive. “The diagnosis was a shock for me”, Anna says, “I did not expect it at all, although I could think of a time in the past when I suspect I was infected.” It has been more than fifteen years since Anna had volunteered for a charity in postSoviet Russia, working with homeless people, where, she guesses, she was exposed to the virus. “As volunteer workers in the early 90s, we’ve had quite a lot of exposure to people’s bleeding wounds. There was no access to disposable gloves at the time.” As is typically the case with hep C, there were no distinct symptoms throughout the interceding years. Fortunately for Anna, the prognosis given to her at a Sydney hospital was reasonably positive: female, mid- 30s, and otherwise healthy – her doctor gave a promising 85 per cent chance of clearing the virus through interferon/ribavirin treatment. In a way, Anna was lucky to have been diagnosed during her pregnancy, rather than years or decades down the track by which time her prognosis may have been very different. She was encouraged to go enjoy her pregnancy, childbirth and come back to her liver clinic for treatment after finishing breastfeeding her baby. As the side effects of hep C treatment can be extreme, her doctors recommended being well prepared and having a strong support network. For Anna, the medical aspects of her treatment were managed very well by 50 / HEP REVIEW #88 / JUL-OCT 2015

her team at the liver clinic. However, some of her psychosocial support came from an unexpected source, a ‘co-worker’ from the Multicultural HIV and Hepatitis Service (MHAHS). The MHAHS connects people from culturally and linguistically diverse backgrounds who are considering or undergoing hep C treatment (or living with HIV), with MHAHS support workers (co-workers) from similar backgrounds who provide one-to-one support. Co-workers are provided with core training in viral hepatitis, HIV and the health care system. They are trained to work with clients with sensitive and complex issues, and receive ongoing supervision and education to maintain the high quality of service. Coworkers assist their clients by providing emotional as well as practical support, and improving access to health care and other services. Co-worker support varies depending on each client’s situation and needs. In most cases, co-workers come from the same language and cultural background as their clients. However, for Anna, who had migrated from Russia ten years ago and was a fluent English speaker, language was not an issue. Therefore, the co-worker she was matched with was based on life experiences and personality. Anna and Olivia, the co-worker, first met before the treatment started, and were in contact every week or two – either by phone or meeting face-to-face. “I think the biggest benefit was the social contact I provided,” Olivia says. “Anna needed someone to talk to. Her family is in Russia,


her husband worked crazy hours, and she was so exhausted by the treatment, while taking full care of her two and a half year old child, that it was difficult for her to get out and meet with friends.” Debilitating sideeffects often precipitate isolation for people undergoing hep C treatment. They may struggle to get out of bed, let alone work and organise social engagements. A person’s isolation can be further impacted by not telling people around them about their diagnosis and treatment. While Anna was not concerned with the discrimination often associated with hep C, for professional reasons she chose not to disclose. This left her with only few people she could talk to openly about going through treatment. Olivia was a willing and non-judgemental listener, an opportunity to debrief and someone Anna could trust to respect her decisions and maintain confidentiality. Adhering to treatment was difficult for Anna, due to the adverse side effects she experienced. “The first couple of monthS of being on treatment were incredibly hard,” Anna recalls, “Fatigue and body aches were the worst part. There were times when I felt like I was one step away from lying down and departing from my body. All the emotional support that I have received was really helpful. I was very fortunate to have had help, guidance and support from the MHAHS and also from Hepatitis NSW. I do wish that all hepatitis affected people get the care and support, empowerment and understanding that I have had!”

MULTICULTURAL COMMUNITY SUPPORT

experiences with treatment, suggesting tips and coping strategies. While co-workers provide one-to-one support, they are not stand-alone helpers. They can work collaboratively with their client’s case managers and health care team. Co-workers provide insights into how culture impacts a persons understanding of their condition and treatment, health literacy and health-seeking behaviours. Anna’s course of treatment lasted six months, during which she successfully cleared hep C. Another six months later, a follow-up test confirmed the results and she was pronounced cured. Looking back at her treatment experience, Anna is grateful she wasn’t alone. “Walking down that road was tough. To know there was someone who signed up to walk that road with me, I cannot tell you what a difference it made and how much I appreciated it.” The Multicultural HIV and Hepatitis Service provides one-to-one emotional support to culturally and linguistically diverse people in NSW who are considering or undergoing hep C treatment, or living with HIV. To make a referral, please contact the MHAHS on 9515 1234. The service is confidential and there is no cost involved. *Names have been changed for privacy reasons.

Co-workers support their clients by providing understanding and encouragement. In some cases, they are able to share their own hep.org.au / HEP REVIEW / 51


HORRORSCOPES

HORRORSCOPE*

*please note that these horrorscopes are like election promises: neither real nor accurate.

Aries

Leo

Sagittarius

You may find yourself saying exactly the wrong thing this month. This simple motto may help: Silence is golden, duct tape is silver.

You are likely to start planning a trip quite soon. But then you’ll suddenly think: ‘Why bother? It would be a waste of my pay TV subscription to go away this year.’

Alienating yourself from your friends and family will harm your chances of them wanting to help you move house. And totally stuff up your chances of getting anything good in their wills.

It’s probably time to think about why your close friends have stopped answering your messages.

Taurus Mars is in your second house of fame and free biscuits this month. This means you have too many houses. Sell at least one and give the cash to a climate-action charity.

Gemini A meteor shower in your sign this month signals a change in your hairstyle. This will be a relief for your loved ones, but especially for your boss. In other news, pay attention to your knees, you’ll need them later in life.

Cancer Some people say that no news is good news. Don’t listen to them, they probably work for a billionaire media mogul intent on making sure the public is as ill-informed as possible. Instead, subscribe to some independent news sites and start researching the best ways to hoard water - you’ll be well in when the dams run dry.

52 / HEP REVIEW #88 / JUL-OCT 2015

If you find yourself lost in thought a lot this month, it’s probably because it’s unfamiliar territory.

Virgo A close friend will ask to borrow money this month. My advice: stop answering your phone. You’re a level-headed optimist, Virgo, but remember, even though you think there’s some good in everybody, you haven’t actually met everybody.

Libra There’s a saying that might be useful for you this month: “When life gives you lemons, sometimes life really means it.” Be prepared to pull some catsbum mouth, and remember, life is uncertain, so always eat dessert first.

Scorpio Pluto rules your sign, which makes it really sucky for you that it’s no longer seen as a ‘real’ planet. Get your own back by refusing to accept other things that are ‘real’, choose climate change and you’ll be in good company.

Capricorn You will recieve an email notifying you that you have won $75 000 000, 000, 000. Congratulations! You now have more money than exists in the entire world. Use it to develop a better email filter.

Aquarius Art holds up a mirror to life, but this month you’ll wish that art would just stay quietly in the corner playing with some mouldy plasticine. This would be a good time to throw out any old sandshoes you have lying around - the smell will only come back as soon as you start wearing them again.

Pisces You will feel an overwhelming desire to kiss everyone in sight today. Only you can say how this will end. My advice? Stay home with a DVD box-set of Louis Thereux docos. You won’t want to kiss anyone but Louis after you watch them.


CROSSWORD

puzzles

ACROSS 1. New treatment drug (10) 7. I am, you are, she ‘__’ (2) 8. Not straight (4) 9. Tiny amounts (6) 10. This bird in a group is part of a murder (4) 12. What a mountaineer does (6) 14. This organ works to get rid of toxins from the body (5) 16. Make fun of someone (5) 17. Not the future (4) 18. Produce/make eg radiation (4) 20. Something that doesn’t work (3) 21. Anger (3) 22. Seller (6) 24. Microwaved (slang) (5)

Find solutions at hep.org.au/news-stand 1

2

3

4

5

6

7 8

9

10

11

12

14

13

15 16

DOWN

17 18

19

20

21 22

2

23 22

23

L G D W R N A L C O H O L T N

S Y R I N G E L I R C P N F O

H E A L T H Y E G U O E P H I

S T E R I L E W V H M R E E P

T C H D A M A G E T M A X P M

N A D M Z F J N N E U W E A A

E O N O I S S I M S N A R T H

V T A O Q K O V H T I D C I C

E E N T I P J I Y S T O I T M

R M E C P T U L O J Y O S I O

P I E A K L A T S T L L E S N

D T C E N N O C P E E B E R I

R I A P E R P S U P H O R T T

U F R A N T I B O D Y L U L O

B P E I N F O L I N E E C Z R

1. Recieve Hep Review regularly by organising one of these (12) 2. Cleaning product available in all NSW prisons (6) 3. Drug treatment acronym, methadone is an example (3) 4. Going ‘_’ NSW hep C prevention project (5) 5. Suggested (11) 6. Donkey (3) 11. This season is coming (6) 12. Good at using imagination (8) 13. Basic (8) 15. This alien wanted to go home (2) 19. Repair (4) FINDAWORD ALCOHOL ANTIBODY APPOINTMENT BLOODAWARE CARE CEENANDHEARD CHAMPION COMMUNITY CURE DAMAGE DIET EDUCATION EXERCISE FIT HEALTHY HEPATITIS

HEPCONNECT INFOLINE LETSTALK LIVINGWELL MONITOR PCR PREVENT REPAIR STERILE SUPPORT SYRINGE TEST TIMETOACT TRANSMISSION WELL

hep.org.au / HEP REVIEW / 53


CLINIC LISTING C - Hep C treatment & monitoring B - Hep B treatment & monitoring F - Fibroscan

MONITOR MANAGE TREAT

CLINIC

CONTACT

SERVICES

The Albion Centre Surry Hills

9332 9600

C

CLINIC HIGHLIGHT

Bathurst liver clinic Bathurst Hospital

6330 5346 0407 523 838

Hunter New England Local Health District Liver Clinics (02) 49213478

Bega District Hospital Interferon Treatment Unit

6492 3255

HNE Liver Clinics provide culturally appropriate and friendly services. They provide education and information on viral hepatitis and access to hepatitis treatment. They also provide information and support to patients preparing for treatment, supportive counselling during all stages of treatment, ongoing case management and health monitoring in relation to liver care.

54 / HEP REVIEW /

B

F*

*fridays only

C

B

F

C B

HEPATITIS INFOLINE 1800 803 990 INFO, SUPPORT, REFERRALS

Burwood Endoscopy Centre

9745 3988 C endoscopy@iinet.net.au

Canberra Gastroenterology Hepatology Unit

6244 2195

Canterbury Hospital – 9767 6372 Outpatients Liver Clinic legan@ med.usyd.edu.au Coffs Harbour Health Campus – Clinic C

6656 7865

Coffs Harbour Sexual Health Clinic 916

6656 7865

Concord Hospital – Liver Clinic

9767 8310 melissa.kermeen@ sswahs.nsw.gov.au

C

Treatment through Bankstown Hospital Outpatients Clinic

B

F

C

C

B

C

B

C F


CLINIC LISTING

C - Hep C treatment & monitoring B - Hep B treatment & monitoring F - Fibroscan

MONITOR MANAGE TREAT

CLINIC

CONTACT

SERVICES

Central Coast Hepatitis C Clinic

4320 2390 helen.blacklaws@ health.nsw.gov.au

CLINIC HIGHLIGHT

Centre for Addiction Medicine, Westmead

9840 3462

Hunter New England Local Health District Liver Clinics (02) 49213478

Clinic 16 Royal North Shore Hospital

9462 9500

HNE Liver Clinic Locations

Clinic 33 6588 2750 C Port Macquarie hdc@midcoast.com.au Community Health Centre

John Hunter Hospital - New Lambton

Eastern Suburbs Endoscopy Centre Bondi Junction

9387 6600 C paullgoodman@ gmail.com

Excel Endoscopy Centre, Campsie

9718 0041 excelendocentre@ C B gmail.com

C

B

F*

*two days/month

C

B

F

C

B

F

B

F*

*one day/month

Tamworth Newcastle Cessnock Raymond Terrace Taree

4320 2111 C

Gosford Hospital – Endoscopy Unit Gosford Hospital – Teaching & Research Unit (Wyong)

F*

4320 2390 C

4827 3913 Goulburn Community Health Centre Holdsworth House Medical Practice – Byron Bay/Sydney

B

*one day/month

6680 7211 (Byron) 9331 7228 (Sydney)

B

F*

*one day/month

C

C B

hep.org.au / HEP REVIEW / 55


CLINIC LISTING C - Hep C treatment & monitoring B - Hep B treatment & monitoring F - Fibroscan

MONITOR MANAGE TREAT

CLINIC

CONTACT

John Hunter Hospital – 4921 3478 Hepatitis Service Newcastle

Kirketon Road Centre (KRC) Kings Cross

9360 2766 phillip.read@sesiahs. health.nsw.gov.au

9722 8400 Lidcombe Hospital – Outpatients Liver Clinic

I MY

SERVICES

C F

C

B*

F

*one clinic/month

C

6620 7539 mark.fuller@ncahs. health.nsw.gov.au

C B F

Liverpool Hospital – Department of Gastro & Hepatology

8738 4074 miriam.levy@ sswahs.nsw.gov.au

C B F

Manning Clinic

6592 9315

Lismore Liver Clinic

Treatment

referred to C B Newcastle

Taree Community Health Centre

HEPATITIS INFOLINE 1800 803 990 INFO, SUPPORT, REFERRALS

56 / HEP REVIEW /

Narooma Community Health Centre

4476 2344

Nepean Hospital Outpatients

4734 3466 vincenzo.frageomeli@ health.nsw.gov.au

Nepean Private Specialists Centre

4722 5550

C

C B F

C


CLINIC LISTING

C - Hep C treatment & monitoring B - Hep B treatment & monitoring F - Fibroscan

MONITOR MANAGE TREAT

Is your hepatitis clinic or treatment centre located in NSW but not listed here? Contact us with the details and we’ll add you to our clinic directory!

CLINIC

Northern Rivers Gastroenterology Lismore

CONTACT

SERVICES

6622 0388

nrgstaff@tpg.com.au

6392 8600 Orange Interferon Treatment Unit Orange Community Health Centre

Orange Base Hospital

C B

C F

6369 3000

C F

Prince Of Wales Hospital Liver Unit

9382 3100 cherie.raby@ C B F sesiahs.health.nsw.gov.au

Royal Prince Alfred Hospital AW Morrow Liver Clinic

9515 7049

St George Hospital – Hepatology & Liver Clinic

9113 3111 C B F Lisa.Dowdell@ sesiahs.health.nsw.gov.au

St Vincents Specialist Medical Centre Lismore

6622 0388 nrgstaff@tpg.com.au

C B

St Vincents Hospital – Viral Hepatitis Clinic

8382 3707 viralhepatitis@ stvincents.com.au

C B F

Sydney Clinic for Gastrointestinal Diseases

9369 3666

Wagga Wagga Hospital Hepatitis Treatment Unit

6921 2711

C B F

C B

C B* *referred to private rooms hep.org.au / HEP REVIEW / 57


CLINIC LISTING C - Hep C treatment & monitoring B - Hep B treatment & monitoring F - Fibroscan

MONITOR MANAGE TREAT

I MY

CLINIC

CONTACT

SERVICES

Westmead Childrens Hospital

9845 3989

C B

Westmead Drug and Alcohol ServicesKings Cross

9840 3462

C F

Westmead 9845 7705 jacob_george@ Gastroenterology Hepatology Department wmi.usyd.edu.au Wollongong Hospital Hepatology Unit

4222 5180

C B F

C B F

Check out our online hepatitis service directory at hep.org.au

In prison and want to get treated for hep C? You need to make an appointment to see the Justice Health nurse at your Centre and tell them that you would like to be treated for hep C. It may take some time – they will do some preparation work to find out which treatment is best for you – after that you will join the waiting list for treatment. You can find out more about treatment by calling the Hepatitis Infoline - dial number 3 on the common calls list.

58 / HEP REVIEW #88 / JUL-OCT 2015


female

male

trans/Intersex

2. Carefully rip or cut out this page

6. Secure the top back edge (the shaded bit below) with sticky tape

hep.org.au / HEP REVIEW / 59

...............................................................................

5. No one will be able to see what you’ve written

m. Other (please describe)

1. Fill out the survey

l. Working in AOD (alcohol & other drugs)

k. Working in NSP sector

j. Person who used to inject drugs

i. Person who currently injects drugs

h. Community or youth worker

g. GP or allied healthcare worker

f. Ex-prisoner

e. Current prisoner

d. Person with hep B

c. Partner, family or friend of someone with hep C

4. Then fold this bottom part back along the bottom dotted line

b. Person who has been cured of hep C

3. Fold the top part of the page back along the top dotted line

a. Person with hep C

7. Please describe yourself (circle as many as you want)

.............................................................................

6. Are you Aboriginal or Torres Strait Islander?

.............................................................................

5. Is a language other than English spoken at home?

.....................................................................................

4. For the purposes of the prize draw, what is your first name and your contact phone number or, if you are currently inside, your MIN?

3. What is your postcode? (or prison name) .......................?.....................

2. What is your gender?

1. What is your age?

COMPETITION

Enter to WIN a $100 Coles/Myer gift card!

It’s easy! Just give us your feedback to help us develop a better magazine. For each edition we draw one winner from all entries received who have provided a name and contact number. Draw entry open to NSW residents only. Limit one entry per person.

Fill out the survey on this page and the next OR go to http://bit.ly/HReviewSurvey TO SEND

7. Post the form in your nearest mailbox

8. Or fax both sides of this form to 9332 1730


READER FEEDBACK 1.

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2.

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I think this magazine is useful to Strongly agree me

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HEP REVIEW

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CONTACT DETAILS FOR GIFT CARD PRIZE DRAW

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I have called the Hepatitis Infoline I have looked up the (www.hep.org.au) website I know more about staying healthy with hepatitis I have phoned one of the clinics listed in the magazine I have talked to someone else about hepatitis I have changed my lifestyle (what I eat or drink, or how much I exercise) Other - please tell us below

Thanks for your feedback!

Congratulations and thanks to M.C - winner of $100 gift card for Edition 87

60 / HEP REVIEW #88 / JUL-OCT 2015

If you have other feedback about Hep Review email hepreview@hep.org.au


(A test for hep C antibodies is not enough)

hep.org.au / HEP REVIEW / 61


HELLO HEPATITIS INFOLINE

hello HEPATITIS INFO, SUPPORT, REFERRAL CONFIDENTIAL

1800 803 990

Hello Hepatitis Infoline is brought to you by the Hepatitis Infoline team. The questions are based on real-life calls and emails but details have been changed to protect our clients’ privacy.

H

i Hepatitis Infoline, this is a bit of an awkward question, but it’s been bothering me so here goes. My boyfriend and I don’t have hep C, but I am worried that I could get hep C if he puts his fingers inside me, if he hasn’t washed his hands first. I guess I’m thinking that he could have touched various surfaces (such as on buses or door handles etc.) and that this might put me at risk of hep C. Is that the case? Yours, Feared of fingers

Thanks for your question, and it’s not awkward or unusual! People worry about this kind of thing quite often. The answer is no – you’re not at risk of hep C. Hep C is transmitted via blood to blood contact only. Two people (where one person is living with hep C) need to be bleeding and exchange blood for transmission to occur. Hep C is not classified as a sexually transmissible infection; if there is no blood involved, people cannot become infected or pass hep C on via sexual activities. There is a risk of passing on hep C during sex if blood is present. People should avoid blood-toblood contact during sex. This is especially important for men who have sex with other men.

There is an increased risk of sexual transmission for men who have sex with men who are HIV positive. In terms of everyday surfaces, hep C may survive on different surfaces (if there is a blood from a person with hep C on a surface) for up several hours, but to cause infection, that blood needs to enter a person’s blood stream somehow. High risk activities for passing on hepC are: • Sharing injecting equipment • Unsterile medical procedures (possible in countries with low hygiene standards) • Backyard tattooing / piercing Good hand washing habits though, are absolutely essential to protect us all for our overall health and wellbeing as there could be other bacterial or viral infections out there on various surfaces that all come in contact during day to day activities. Hope this info helps! If you have further questions, please contact Hepatitis Infoline (9am-5pm Mon-Friday except Thursday 1pm-5pm) and speak with one of our friendly staff. Yours, Hello Hepatitis Infoline

Have a question for Hello Hepatitis Infoline?

Send your question to email@hep.org.au or call the Hepatitis Infoline on 1800 803 990 62 / HEP REVIEW #88 / JUL-OCT 2015


Like Hep Review? Yes! (We hope) And we want to keep you happy!

We’re changing the way membership works at Hepatitis NSW to make it more relevant to our communities. It’s now FREE for people living with, or with lived experience of, viral hepatitis in NSW and we have great membership deals for professionals, organisations and people in other states & territories, too. You’ll be able to use our new website to renew and update your details and keep your subscription current for Hep Review and our other great resources. We’ll be writing to or emailing you soon to let you know all the details.

Alcohol & Other Drugs Support & Information Services NUAA

People who inject drugs and want to access peer based info and support can call NUAA (the NSW Users & AIDS Association). phone: 8354 7300 (Sydney) 1800 644 413 (NSW regional)

ADIS

NSW Health drug and alcohol clinics offer confidential advice, assessment, treatment and referral for for people who have a problem with alcohol or other drugs. Call the Alcohol & Drug Information Service (ADIS) for assistance. phone: 9361 8000 (Sydney) 1800 422 599 (NSW regional)

FAMILY DRUG SUPPORT

FDS provides assistance to families to help them deal with drug issues in a way that strengthens family relationships. phone: 1300 368 186

hep.org.au / HEP REVIEW / 63


NSW HEPATITIS AWARENESS WEEK JULY 27 - AUGust 2, 2015

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