#46 Hep C Community News

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Hepatitis

Community News #46 • December 2009

Prevention • Hep C & Lifestyle Factors: Part 2

Introduction

The Hepatitis C Council of South Australia provides information, education and support to the hepatitis C community and those at risk.

Street: Mail: Phone:

Fax: Web: Email:

3 Hackney Road, Hackney PO Box 782, Kent Town SA 5071 (08) 8362 8443 1300 437 222 (08) 8362 8559 www.hepccouncilsa.asn.au admin@hepccouncilsa.asn.au

STAFF

Welcome to the second special issue of the Hepatitis C Community News to focus on liver health, as well as the theme of prevention. On pages 8-9 you will find a beginner’s guide to good liver food, with more on health liver lunches on page 15. There’s even more information, including recipes, online at our ever-expanding website: just visit www.hepccouncilsa.asn.au once you’ve finished reading.

For prevention information and updates, see pages 1, 6, 7 and 13, and especially our interview with Antoin on page 5. And as for what our busy mascot, Oliver, has been up to, I think you need to look at page 12 for his latest, unexpected adventures. He even helped set a new Guinness Book of Records record.

As always, please get in touch and tell us what you think.

Executive Officer: Kerry Paterson

Next issue’s copy deadline is 26 February, and the magazine will be published in March. See you then.

Administration Coordinators: Lynn Newman Megan Collier

About the Cover

Info and Support Line Coordinator: Deborah Warneke-Arnold Info and Support Line Volunteers: Fred Will Debra Michele Coordinator of Education Programs: John McKiernan

Peer educators to the rescue!

Jack’s comic strip adventures written and illustrated by James Morrison.

Correspondence: Please send all correspondence to The Editor at PO Box 782, Kent Town, SA 5071, or email james@hepccouncilsa.asn.au.

Educator: Mahdi Nor Rural Educator: Kirsten Kennington Peer Education Coordinator: Maggie McCabe

Contents 1

Investing in NSPs

2

Cannabis & Hepatitis C

5

The Woolshed & After: An Interview

Publications Officer: James Morrison

6

Peer Education

Info and Resources Officer: Magdalene Rose

7

The Hepatitis B Vaccine

8

Great Liver Food

10

A Strategy for Hepatitis B

11

Hobart Conference

12

Oliver in Mascot Madness

13

Vending Machine Trial

Chairperson: Arieta Papadelos

14

Open Your Mind

Vice Chairperson: Catherine Ferguson

15

Love Your Liver Lunches

15

eBox Update

Information and Resources Coordinator: Cecilia Lim Info and Resources Volunteers: Gauri Karan Lyn Mark Phil Philip Yvonne

ICT Support Officer: Bryan Soh-Lim Project Officer: Caitlin Dowell Librarian: Joy Sims

BOARD

Secretary: Peter Underwood Treasurer: Darrien Bromley Senior Staff Representative: Kerry Paterson Ordinary Members: Lisa Carter Bill Gaston Carol Holly Stefan Parsons Justine Price Kristy Schirmer

Disclaimer: Views expressed in this newsletter are not necessarily those of the Hepatitis C Council of South Australia Inc. Information contained in this newsletter is not intended to take the place of medical advice given by your doctor or specialist.

We welcome contributions from Council members and the general public.

“No, Dougal, this cow is small, those cows are far away.”

Money Well Spent Investing in NSPs reaps a fourfold benefit

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very dollar spent on Australia’s needle and syringe programs (NSPs) saves state and federal budgets four dollars by preventing lifethreatening infections. These significant findings were part of the October-released report Return on Investment 2: Evaluating the costeffectiveness of needle and syringe programs in Australia, which was commissioned by the Australian Department of Health and Ageing.

The team from the University of NSW who wrote the report found that the 30 million needles and syringes distributed every year in Australia since the year 2000 have directly prevented more than 32,000 cases of HIV infection, and almost 100,000 cases of hepatitis C, representing a saving in healthcare costs of almost $1.2 billion.

Researchers at UNSW’s National Centre in HIV Epidemiology and Clinical Research, led by Associate Professor David Wilson, used a range of clinical, behavioural and economic data to analyse how effective NSPs have been in preventing the life-threatening infections HIV and hepatitis C, which are easily transmitted when people who inject illicit drugs do not have access to sterile injecting equipment.

From 2000 to 2009, this program cost a total of $243 million. The national needle and syringe program is made up of nearly 1000 sites around the country, including outlets, clinics, pharmacies and vending machines, which distribute sterile injecting equipment.

in rural areas. There are over 170 pharmacies that sell needles and syringes on a commercial basis.

Some outreach services are also provided. Disposal facilities are provided at all community CNP sites, most pharmacies and some local councils also provide disposal facilities.

The proportion of Australian users of injecting drugs that are in South Australia has remained relatively steady. The number of needles and syringes distributed through CNPs in South Australia increased during 2002-2004 but has started to decline in recent years. The average frequency of injecting

by IDUs in South Australia has remained steady but sharing rates have tended to increase slightly.

Despite this, the prevalence of HCV among South Australian IDUs has been steady, with a slight tendency for a decrease which is in contrast to most other jurisdictions. The incidence of HIV has remained relatively low among South Australian IDUs. The spending of $15m in the funding of CNPs in South Australia from year 2000-2009 has resulted in a saving of $93m in healthcare costs. The mathematical and economic modelling estimated that if CNPs are continued at the same level of funding in SA for the next ten years, $295m of net financial savings will accrue, and for twenty years it will be $605m.

“As well as the health care savings, NSPs have given us substantial

gains in quality and length of life in Australia,” explained the study’s health economist, Dr Jonathan Anderson. “The infections prevented by the program [mean that many] people lived in better health for longer”.

Associate Professor Wilson said that “after more than two decades of successful operation, NSPs remain a cornerstone of Australia’s HIV prevention strategy and a primary reason for why we have largely contained the epidemic in this country. Additionally, Australia’s NSPs have proven to be a foundation for preventing transmission of the more infectious hepatitis C virus.

“This study provides strong evidence to suggest that increased spending should be invested in expanding NSPs. Not only would it significantly reduce health burdens, but it will ultimately save Australian taxpayers substantial amounts of money.”

The report indicates that an additional 50% increase in distribution of sterile injecting equipment could lead to maximal returns, yielding a further 37% decrease in HIV and 23% decrease in hepatitis C cases over the next 10 years.

For more information, read the report in the HCCSA Library, or else download it at www.hepc.org. au/documents/2009ROI-2MB.pdf.

For the latest CNP developments in SA, turn to page 13

In our state, the Clean Needle Program operated by the Drug and Alcohol Services South Australia, commenced in 1989. Pharmacy programs in SA for distributing needles and syringes commenced in the early 1990s. South Australia has 81 CNPs, consisting of one primary outlet, 69 secondary outlets and 11 enhanced secondary outlets, in both metropolitan Adelaide and Hepatitis C Community News December 2009 •

Image (this page) © Arturo Ponciarelli Image (opposite page) © bandido of oz Image (over page) © Udit Kulshrestha

Hepatitis C Community News • December 2009

Cannabis Can it help, or can it hinder, living with hepatitis C?

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ecent research on using cannabis and the effects it has on people living with hepatitis C has uncovered some interesting data. While long-term frequent cannabis use may be detrimental to people with chronic hepatitis C, making liver fibrosis worse, other research has shown that medicinal use of cannabis during interferon-based therapy can relieve side effects and help patients stay on treatment, thereby improving their chances of sustained response. Here and over the page we present the results of these studies.

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he management of sideeffects from the treatment of hepatitis C can often be difficult. Many patients turn to cannabis for relief, based on widespread anecdotal evidence of its pain-reducing effects.

Unfortunately, until now, there has been little research into cannabis use and its effect on treatment outcomes.

Enter a study published recently in the European Journal of Gastroenterology and Hepatology. Entitled ‘Cannabis use improves retention and virological outcomes in patients treated for hepatitis C’, it provides a valuable starting point for future research.

“To define the impact of cannabis use during hepatitis C treatment, we conducted a prospective observational study of standard interferon and ribavirin treatment in 71 recovering substance users, of whom 22 (31%) used cannabis and 49 (69%) did not,” explain the report’s authors, headed

by Diana Sylvestre of the Department of Medicine in the University of California and the Organization to Achieve Solutions in Substance-Abuse (OASIS), California.

Of these 71 patients, 17 stopped therapy early. Of these, only one was a user of cannabis. “Overall, 37 patients, or 52% were end-of-treatment responders, 14 (64%) of them cannabis users and 23 (47%) non-users.”

A total of 21 out of the initial 71 (30%) had a sustained virological response: 12 of the

22 cannabis users (54%) and nine of the 49 non-users (18%), which corresponds to a posttreatment virological relapse rate of 14% in the cannabis users and 61% in the nonusers. Overall, 48 (68%) were adherent, 29 (59%) non-users and 19 (86%) cannabis users.

So what does this mean?

“Although cannabis users were no more likely than nonusers to take at least 80% of the prescribed interferon or ribavirin, they were significantly more likely to remain on HCV treatment for at least 80% of the projected treatment duration (95% versus 67%).”

It’s important to note here that use of cannabis is usually viewed far more seriously by the legal authorities in the United States, where this study was conducted, than it is in South Australia. As the authors note, “illicitly obtained marijuana ... may be highly variable in its content of bioactive compound, leaving in question a true quantitation of the amount of cannabis that may or not be beneficial.

Significant limitations are introduced by our observational study design; however, with legal proscriptions against cannabis use limiting its study, the design and conduct of randomised, prospective research studies is virtually impossible at this time.”

undue alarm. The widespread use of illicit cannabis during HCV therapy highlights the inadequacies of our current side-effect management strategies; our study suggests that cannabis use may offer benefit for some patients undergoing HCV treatment by helping them maintain adherence to the frequently debilitating medication regimen.

“However, the mechanisms through which cannabis exerts its benefit are unclear, and controlled studies may further elucidate the mechanisms through which cannabis may impact upon clinical outcomes during HCV treatment..”

The full report of this research is available at www. waitingtoinhale.org/science_ news/cannabis_hepc.pdf.

The researchers concluded that “our results suggest that the modest use of cannabis does not appear to impact negatively upon HCV treatment outcomes and need not elicit Hepatitis C Community News December 2009 •

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aily marijuana use may contribute to the progression of liver fibrosis in people with chronic hepatitis C, according to a report published last year in the journal Clinical Gastroenterology and Hepatology.

Researchers from the University of California at San Francisco interviewed 204 patients with chronic hepatitis C between 2001 and 2004, assessing demographic characteristics, HCV risk factors, and their use of cannabis and alcohol.

Participants underwent virological testing and liver biopsies, which were scored according to the Ishak system, which measure liver fibrosis in stages from F0 to F6. In this scale, F0 indicates no fibrosis, F1 minimal and F2 mild fibrosis, and F3 to F6 indicate increasingly severe fibrosis. Of the study participants, 27.5% were rated F0, 55.4% F1 to F2, and 17.2% were rated F3 to F6.

The median age of the study participants was 47 years. 69%

Hepatitis C Community News • December 2009

were men, 49% were white, 21% were co-infected with HIV, most were in the low-income bracket, and for 70% the presumed route of HCV infection was injection drug use. The median lifetime duration of alcohol use was 29 years, with a median of about 2 drinks per day. Obviously there was a lot of variation in the lifestyle factors of this test’s subjects.

Regarding marijuana, 13.7% of the participants reported daily cannabis use within the past 12 months, 45.1% reported occasional use, and 41.2% said they never used marijuana.

Daily cannabis use was not strongly associated with mild (F1-F2) fibrosis compared with absent (F0) fibrosis. However, daily cannabis use (compared with occasional or no use) was strongly associated with moderate to severe (F3-F6) fibrosis.

Other independent predictors of moderate to severe fibrosis were a greater lifetime duration of moderate or heavy alcohol

use, and a greater number of portal tracts (these are islands of connective tissue containing branches of the portal vein and hepatic artery, running side by side, that bring blood to the liver, as well as containing bile ducts, which carry bile in the opposite direction to the blood flow) in the liver.

Independent predictors of mild fibrosis were a higher HCV viral load, and a medium or high number of portal tracts. However, age, sex, race, duration of HCV infection, HCV genotype, HIV status, body weight, tobacco use, and lifetime alcohol use were not significantly associated with mild fibrosis.

In conclusion, the researchers wrote that “daily cannabis use is strongly associated with moderate to severe fibrosis.” They recommended that “HCV-infected individuals should be counselled to reduce or abstain from cannabis use.”

The Woolshed and After The Woolshed, getting off drugs, and hepatitis C

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he Woolshed, a 70-acre property near Strathalbyn, is a residential therapeutic community for men and women aged from 16 years with drugor alcohol-related problems.

The Woolshed provides a drugfree environment, and offers a structured program to develop living, work and interpersonal skills through education, counselling, group work and recreation activities. It has associated halfway houses in Adelaide and links with self-help groups.

Antoin, who volunteers at the Hepatitis C Council of SA, kindly agreed to talk to us about his experiences at the Woolshed and the Council.

“I’ve been in the Woolshed program for seven months now.

The program they run is a 12month program, in four 3-month phases. It’s pretty intense, so it’s not for everyone. You have to really want to change, really desire it. The staff work really intensely

with you, hand in hand. When I went there, I was on my knees.

Now I’m in so much better health, and I’ve put on 15 kilos.

“I stay at Tuesday House, which is one of three residential houses run by the Woolshed, where you go as part of the halfway program.

It’s a way of moving between the Woolshed institution and getting back to living in the community. At Tuesday House we have a weekly meeting, where we all get together and talk about where we’re at, talk about our “brain space”, and how each person’s week has been.

There are currently nine people staying there.

“With the Shed, you have a PP, or personal program, where you are expected to set yourself goals to achieve, as well as coming up with future goals. For me, for example, part of that is getting back in contact with my children—I’m a single dad with two daughters— and spending time with them regularly, looking after them. And I’m looking after my health, getting in better shape.

“For a lot of people those goals also include working out their long-term housing plans—will they go to the Housing trust, or a coop, or get help from the Towards Independence program.

“Then there is the TP, or treatment program, where you work closely with counsellors to sort yourself out. And it doesn’t end after the 12 months. There’s always ongoing support available, so you can go back for help or even to stay for a week if you need it.

“For me, finding out I had hepatitis C was really strange. I’d been in gaol, and the judge actually told me—he must have seen medical reports on blood tests I’d had done in there. It just blew me away. So I went in for a new blood test in October ’08, and the doctor said I was positive for hepatitis C. But he didn’t really know much about the virus, or what that meant.

“Now, lots of people who’ve been through the Shed have had treatment, and cleared the virus.

A bloke who’d been there in the past came in for a visit, and he was talking about having had treatment, so I said, “Well, he must have been positive for it, so I’ll have a word with him.”

“I talked with him, explained my situation, and got some information about treatment. And I found out about the Hepatitis C Council when Alan, one of the peer educators, came up when the Woolshed was hosting one of the Love Your Liver Lunches (see page 15 for more).

“So I talked to people at the Council, and I had a PCR test done, and that came back negative—I was really lucky to be one of the 25% of people who just spontaneously clear the virus. That was so fortunate, because I’d been thinking about treatment, weighing up whether I should do it.

“Because the Woolshed program is 12 months, and treatment can be another 12 months, I wasn’t sure how to do it—if it really knocked me around, that’s another year when I can’t really spend the time I need to with my daughters. So I was really lucky not to need to do that. You can’t really do hepatitis treatment at the same time as you’re at the Woolshed—both things are just too full-on to do at the same time.

“Now I’m volunteering at the Council, which is great: it’s a really supportive place to be working, very warm and friendly.

I’m looking forward to building up my skills for the future, and I want to be able to help people living with hep C. I’ve had plenty of experience to draw on, unfortunately—when I was using it was “research”, as we sometimes called it—so I know what other people have been going through, and I want to be able to use all of that to help them.”

Hepatitis C Community News December 2009 •

Peer Education

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CCSA’s Peer Education program has now been running for more than a year. Originally set up by Lola Aviles, it is now under the auspices of experienced hepatitis C educator and artist Maggie McCabe. The Council’s peer educators have training, knowledge and personal experiences of hepatitis C. And they are happy to share that with community members, and members of the general public.

Three of the peer educators—Mark, Yvonne and Megan—recently talked about their experiences of the program, and how it has affected them. Here’s some of what they had to say.

MARK: I’ve learned a lot about myself. Knowing that you’re making a difference is great. Before I joined the Council, I didn’t really know much about it. Getting peers out into the community, getting information out quickly, is really, really important.

MAKE A NOISE!

YVONNE: I see the highlights as the people I spend a lot of time with.

When they remember me, and sometimes bring along a friend who they’ve told about me, to hear what I have to say, that’s so rewarding.

MARK: I’ve enjoyed making friends again—real friends, people you feel that you can trust and you can go to when you need to. You don’t make friends like that in the drug community. If I hadn’t got this peer ed job, I hate to think where I’d have ended up. The support from the hepatitis community and from the Vietnamese community is just great.

Hepatitis C Community News • December 2009

By getting involved in community, developing friendships, and being open and honest with people, they realise you’re not there to boss them around or tell them what to do. You just want to use your own experience to help other people.

It can be rewarding—you give people as much information as they can absorb, and hopefully they go away and make use of it.

MEGAN: I’ve been doing a lot of sessions in the women’s prison. It’s sometimes uncomfortable, doing them. I was in the prison system 30 years ago, so it can be confronting.

But it’s good to see that you can do bad things—or make bad decisions—but still make a good life in the end.

Working with prisoners, the challenge is that it’s really slow to see change take place. The prisoners really embrace what you do, but the prison officers aren’t so keen.

Another challenge for me is that a lot of that life experience that’s relevant to what I talk about in peer education sessions is experience from a long time ago in my life. Reflecting it back to other people and drawing on it again can be interesting. But the rewards of making a difference are fantastic.

MARK: My next challenge is going to be going on treatment. I’m doing it for my health, but also because I feel like a bit of a hypocrite telling people about it and its benefits when I haven’t experienced it. But I’ve been researching it, and I think this is the best time for me to go

for it. I’m feeling good, my health is the best it’s been, and I think it’s time.

Going out to drug clinics or clean needle programs—it reminds you of where you’ve come from. I’d been off drugs for six months before I started doing the peer educator program. The hardest time is when people come in and they’ve been using, and they’re all happy and they look good. You think to yourself, ‘Maybe this time I could get away with it.’ But you know you’re kidding yourself. It wouldn’t work.

MEGAN: In prisons, the people really respect you—they don’t get a lot of chances in that environment.

And the changes you make happen while you’re there, but the continuity after you leave isn’t there. Prisons are the hardest place to make change happen.

YVONNE: My goals are to have a balance between my work and art—I do volunteering as well, so there are a lot of things to balance as well. You don’t want any one thing to take over—unless it’s the art! I wouldn’t mind that.

MARK: Life can just change really quickly. You can come back—it doesn’t matter how far down you are. There’s always hope!

For more information about the peer education program, call Maggie on 8362 8443 or email maggie@hepccouncilsa.asn.au.

One of the very successful parts of the program are the Love Your Liver Lunches: see page 15.

HBVaccine Why getting the hepatitis B vaccine is a good idea

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here is no vaccine against hepatitis C. However, there are vaccines for hepatitis A and hepatitis B. If you are living with hepatitis C, or have some other form of chronic liver disease, it is highly recommended that you get vaccinated for hepatitis B—it is even suggested that you get the combined hepatitis A/hepatitis B vaccine.

There is a simple reason for this: contracting another form of hepatitis when you already have hepatitis C can make you much sicker than either virus would on its own. Having two viruses at once is known as co-infection.

Different people will experience the effects of co-infection in different ways, but it can be very serious. If you are properly vaccinated, it will protect you for life.

Hepatitis B can be prevented with a safe and effective vaccine that has been available since 1982. In Australia, the hepatitis B vaccination program began in 1988, targeting groups at particularly high risk of infection.

It is now recommended that all babies and adolescents be vaccinated against hepatitis B. The program continues and ensures that babies and adolescents have access to free hepatitis B vaccine.

As well as individuals living with hepatitis C and/or chronic liver disease, the Australian Immunisation Handbook recommends that the following groups be vaccinated against hepatitis B: • babies and young children; • adolescents aged between 10 and 13 years; • sexual contacts of people with acute and chronic hepatitis B;

• household contacts of people with acute and chronic hepatitis B; • people on haemodialysis, individuals with HIV and other adults with weakened immune systems; • injecting drug users*; • recipients of certain blood products*; • residents and staff of facilities for persons with intellectual disabilities*; • individuals adopting children from overseas; • liver transplant recipients*; • inmates and staff from longterm correctional facilities*; and • healthcare workers, dentists, embalmers, tattooists and body-piercers.

(An asterisk (*) indicates those who might especially benefit from the combined hepatitis A/B vaccine.)

Babies receive hepatitis B vaccine shortly after birth while they are in hospital and further doses at 2, 4 and 12 months of age.

Children in Year 7 or adolescents aged between 11 and 15 years, who did not receive the infant vaccine, receive a two-dose course of adult hepatitis B vaccine, given 4 to 6 months apart.

In order to obtain maximum protection against hepatitis B,

adults should receive three doses of the vaccine at zero, 1 and 6 month intervals.

A post-vaccination blood test, to assess if the vaccine course has been effective in producing protection against hepatitis B infection, is recommended for the following groups: • people at significant occupational risk (e.g. healthcare workers whose work involves frequent exposure to blood and body fluids); • people at risk of severe or complicated disease (e.g. people with pre-existing liver disease not related to hepatitis B and adults with weakened immune systems); and • people in whom a poor response to the hepatitis B vaccination is expected.

Those who do not have antibodies will need to continue to have hepatitis B vaccines until the antibody test is positive.

Side effects of the hepatitis B vaccine are not common.

However, a small number of people report pain at the injection site and/or a mild fever after the injections.

Your doctor can get the hepatitis B vaccine free of charge for you if you have hepatitis C, are an injecting drug user, or for a number of other reasons. Make sure to ask your doctor about the vaccine, as they need to apply specially for the free vaccine.

Hepatitis C Community News December 2009 •

Great Liver Food What to eat and how to eat it

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here is no one food, or list of foods, that will magically protect your liver.

Maintaining a healthy liver is about maintaining a healthy body. There is definitely an association between some conditions and liver disease, such as high cholesterol, high blood pressure, insulin resistance, abdominal obesity, and diabetes.

It therefore makes sense to lead a lifestyle that prevents, and/or manages, these conditions.

Consume the right amount of kilojoules to maintain a healthy weight, have lots of fibre to keep your digestive tract healthy, reduce cholesterol levels and eat only a small amount of fat. Of the fat you do eat, try to have more unsaturated fats rather than saturated.

Image © .craig

Below is a list of foods that stand above the rest in their food group that will help you achieve these things. Living with liver disease, you may have specific dietary requirements for protein, salt and fluid intake. Speak to your doctor or dietitian.

1. Almonds (and other nuts, coconut, which contains saturated fat) Benefits: Almonds are packed with nutrients: fibre, riboflavin, magnesium, iron and calcium. In fact, almonds have more calcium than any other nut—75mg in one serving (about 23 almonds). Like all

Hepatitis C Community News • December 2009

nuts, almonds provide one of the best plant sources of protein, and nuts are also good for your heart, as they contain unsaturated fats—a healthier type of fat that helps to lower blood cholesterol levels.

Recommended intake: Aim for 1-2 tablespoons of raw, unsalted almonds (or other nuts) five times per week.

2. Oats (and brown rice, couscous) Benefits: Eating oats on a regular basis may lower cholesterol levels, reduce heart disease risk, and prevent type 2 diabetes. It is thought that this is because oats have a high soluble fibre content, a low Glycaemic Index, and they are a whole grain, meaning they contain many essential vitamins and minerals.

Recommended intake: Oats, brown rice and couscous fall into the ‘breads and cereals’ food group. Also in this group are foods like wholegrain bread, breakfast cereals and crackers, pasta, rice and noodles. You should have 4-8 serves of ‘breads and cereals’ per day, depending on how physically active you are. 1 serve is equal to 2 slices of bread, 1 cup of cooked pasta, rice, noodles or couscous, 1 cup of cooked porridge or 1 1/3 cups of breakfast cereal flakes. Aim for ½-1 serve of your 4-8 serves/day to be oats, brown rice or couscous.

3. Blueberries (and cranberries, boysenberries, strawberries, currants, blackberries and cherries) Benefits: Blueberries are high in plant compounds (phytonutrients).

As with cranberries, phytonutrients in blueberries may help prevent urinary tract infections. Blueberries may also improve short-term memory, promote healthy aging, and lower your risk of heart disease and cancer. They are a low-kilojoule source of fibre, potassium and vitamin C, and have been shown to have anti-inflammatory properties.

One cup of fresh blueberries has 350 kilojoules, 3.6 grams of fibre and 14mg of vitamin C. Vitamin C helps form the connective tissue collagen, keeps your capillaries and blood vessels healthy, and aids in the absorption of iron.

Recommended intake: All fruit is healthy for you, and you should aim to have two servings of fruit per day. One serve is equal to one medium piece of fresh fruit, 1 cup of diced fresh, or 2 tablespoons of dried. Of these serves, aim to have 4-5 serves per week of blueberries or other sources listed above.

4. Salmon (and other fish, predominantly oily (salmon, mackerel, tuna, marlin, swordfish, sardines, herring, trout), oysters, clams) Benefits: Omega 3 fatty acids, a type of unsaturated fat, lowers heart disease and stroke risk by decreasing cholesterol and triglyceride levels, slowing down the growth of artery-clogging plaques, and lowering blood pressure. Omega 3 has also been shown to help reduce inflammation associated with arthritis, and may possibly help with memory loss and Alzheimer’s disease. There is some evidence to show that it reduces depression as well. In addition to being an excellent source of omega3s, fish is low in saturated fat, and is a good source of protein. Omega 3s is most prevalent in fatty, cold-water

fish. Other forms are available in fortified eggs, flax seed (linseed), and walnuts.

Recommended intake: Aim to eat fish (fresh and/or canned) 2-4 times per week.

5. Soybeans (and soymilk, soy yoghurt, soy custard, soy ice cream, tofu, soy-based meat substitutes (soy bacon, soy sausages, etc)) Benefits: Soy is an extremely high quality protein that has no cholesterol or animal fat, is low in saturated fat and high in fibre. Soy is one of nature’s super-foods that can reduce your risk of heart disease and stroke, helps prevent osteoporosis, and may help protect against certain cancers like breast, prostate and bowel cancer. It also helps alleviate hot flushes during menopause.

There has been some controversy in recent times over the relationship between soy and cancer. There are now over 3000 scientific research papers on soy, and there is no sound evidence which demonstrates any negative health effects in humans from consuming soy foods as part of a balanced diet.

Recommended intake: 1-4 servings per day, such as soymilk on your cereal, tofu in your evening meal and/or soy ice-cream for dessert.

6. Tea Benefits: Tea is rich in antioxidants which help protect our body’s cells against damage and mutation.

The overall antioxidant power of black tea is the same as green tea, but green tea does have ECGC, a powerful antioxidant that may inhibit the growth of cancer cells. Black tea, in particular, may boost the immune system, lower the risk of stroke and may prevent osteoporosis.

Benefits: Dairy foods are the best sources of calcium. Calcium promotes strong bones and a healthy heart. Yoghurt in particular has additional benefits of pre- and probiotics, which promote a healthy digestive tract. Dairy is naturally high in saturated fat, and because the link between saturated fat and heart disease is clear, most people in the general population should be having reduced fat, low fat or no fat varieties. Also, be aware that ice-cream, cream and soft cheeses such as brie and camembert are relatively low in calcium and high in saturated fat.

Recommended intake: Aim to have 3 serves of reduced fat dairy per day. 1 serve is equal to 1 cup (250mL) milk, 1 tub (200g) yoghurt or 40g of hard cheese.

8. Broccoli (and brussels sprouts, cabbage, cauliflower) Benefits: Aside from having important nutrients such as calcium, potassium, folate and fibre, broccoli contains phytonutrients—a group of compounds that may help prevent chronic diseases, such as heart disease, diabetes and some cancers.

Broccoli is also a good source of vitamins A and C and antioxidants that protect your body’s cells from damage. These foods have also been linked with reducing the incidence of birth defects, boosting the immune system, and building/ maintaining strong healthy bones.

Recommended intake: All vegetables are healthy, and you should make an effort to eat a wide variety. Aim for 5 serves of vegetables per day, with only one serve being starchy vegetables (potato, sweet potato, corn). One serve of vegetables is equal to ½ cup of cooked, 1 cup of raw/salad or 1 medium potato. Of the 4 serves of non-starchy vegetables, aim for one serve each day to be broccoli, brussel sprouts, cabbage or cauliflower.

9. Kidney beans (and other legumes, e.g. chickpeas, cannellini beans, borlotti beans, baked beans, three-bean mix) Benefits: Kidney beans and other red beans are good sources of iron, magnesium, phosphorus, potassium, copper and thiamine.

Other legumes, such as chickpeas, cannellini beans and borlotti beans, are also great choices. All legumes are low in fat, low in kilojoules, and are high in dietary fibre. Red beans also contain phytonutrients that may help prevent chronic diseases, such as heart disease, high blood cholesterol, high blood pressure, and cancer. Legumes, although plant foods, are very high in protein, and thus serve as a meatalternative for vegetarians. Legumes are categorised into the vegetable group and also the meat group.

Recommended intake: 1 serve is ½ cup of canned/cooked legumes.

Aim to have 4 servings per week.

10. Spinach (and baby spinach, silver beet, turnips, dark lettuce) Benefits: Spinach is high in vitamins A and C and folate. It’s also a good source of riboflavin, vitamin B-6, calcium, iron and magnesium. The plant compounds in spinach may boost your immune system, and may help keep your hair and skin healthy.

Recommended intake: One serving is ½ cup of lightly steamed or 1 cup of raw. Aim to have 1 serving 2-3 times per week.

11. Pumpkin (and carrots, squash, sweet potatoes, capsicum) Benefits: These vegetables are high in the antioxidant beta carotene.

Food sources of beta carotene, which is converted to vitamin A in your body, may help slow the ageing process and reduce the risk of some cancers, such as cancers of the lung, colon, bladder and breast. Unlike true Vitamin A, beta-carotene is not toxic to the liver if consumed in large amountsexcesses are broken down and excreted through the kidneys.

Image © János Szüdi

Recommended portion: 1 cup per day.

7. Yoghurt (and milk, cheese, custard)

Continued on page 13 Hepatitis C Community News December 2009 •

A Strategy for Hepatitis B National strategy development draws near to finishing

R

ight now, a number of national strategies relevant to those living with hepatitis C in Australia are being developed.

The strategy development process is being overseen by the Ministerial Advisory Committee on Blood Borne Viruses and Sexually Transmitted Infections, which is chaired by Professor Michael Kidd AM. Among the five strategies being produced are those for hepatitis C, hepatitis B, and Aboriginal and Torres Strait Islander sexual health and bloodborne viruses.

The strategy for hepatitis B is significant because there has never been a national hepatitis B strategy before. The hepatitis C strategy, which already exists, is being redeveloped for the period 20092013.

Each of the national strategies is based on a fundamental commitment to partnership between the government, non-government, community, research and medical sectors. The partnership provides a basis for nonpartisan political support and building community understanding of the often controversial measures necessary to reduce sexually transmissible infections and bloodborne viruses.

Partnership requires a spirit of engagement and a capacity among

all partners to act as valued experts within their respective domains.

Partnerships take time to develop and mature, and are fostered where there is continuity and a depth of corporate knowledge among partners. Partnership is based on a commitment to consultation and joint decision-making.

Australia’s responses to date have been characterised by this partnership approach, and commitment to the importance of an enabling environment and the principles of harm reduction. The recent review of the 2005-2008 strategies found that commitment and leadership had diminished over time. The review has called for a reinvigoration of the strategic approach and reinvestment in these principles. The review found that national strategies were essential and indicated that the partnership approach was valuable but needed reinvigoration and renewal. It found that high-level strategies needed to be endorsed by state, territory and federal governments and implementation plans put into place, with a strengthened focus on performance and accountability.

to be delivered to the Department of Health and Ageing on schedule in mid-October.

The suite of five strategies will now go through a formal approval process. It is anticipated that this will culminate in each strategy being signed off by all of the federal, state and territory health ministers. This is seen as an essential step in the process of achieving a stronger commitment to implementation of the strategies at all levels of government.

It is hoped that the strategies will be released in early 2010. We will bring you more news with each issue of the Hepatitis C Community News.

The process required an intensive effort in a very short period of time to enable the drafts of the First National Hepatitis B Strategy and Third National Hepatitis C Strategy

For more information on the process and the strategies, visit www.ashm.org.au/default2.asp?active_page_id=350

Tuesday 19 Jan & Friday 22 Jan 2010 9:30am to 4:30pm HCCSA, 3 Hackney Rd, Hackney FREE 2-day course with lunch provided!

Certificate of attendance supplied Contact Maggie on 8362 8443 Hepatitis C Community News 10 • December 2009

Image Š Vernon Dutton & Jeppoirrier

MENTAL HEALTH FIRST AID TRAINING

Sharing Ideas in Beautiful Hobart Grass roots to national action A walking info stall from the conference

change the way we refer people for support,” said one HCCSA worker.

Fred, our telephone service debrief coordinator and peer educator, found the nuggets of information and experience presented by Nicky Newley-Guivarra from Hepatitis Queensland quite interesting. “It was useful to know that in some indigenous communities, one-onone education worked better than groups, and that flip charts were more effective than Power-Point presentations,” he said.

HCCSA peer educators Megan, Mark and Karan were impressed by the work done in prisons by other organisations, particularly Victoria and Tasmania. Both Mark and Megan were part of a presentation on HCCSA’s peer education project.

“For me, standing up in front of all those people to do my presentation was itself a highlight,” said Mark. “Meeting people from all around Australia who are doing the same work as we are was very interesting. The conference

Image © Kay Bazley, Hepatitis C Council NSW

Some HCCSA workers had the chance to attend a “share-fest” in Hobart recently—learning about what other groups like us have been doing, and telling others about our achievements.

Organised by Hepatitis Australia, the national hepatitis health promotion conference, ‘Grass Roots to National Action’, brought together presenters and participants from over 40 organisations throughout Australia, including community-based service providers, government agencies and community groups.

Presentations included the outcomes of academic research, innovative community projects, personal experiences and how-to workshops. However, as the name of the conference suggested, the emphasis was on community-based activities.

HCCSA participants were unanimous in the view that the only disappointing element was not being able to attend all the concurrent sessions. Suzanne, from SAVIVE, like many of the SA participants, found Tony Trimingham’s (from Family Drug Support) presentation, “The history of harm reduction, looking back – moving forward” engaging and enlightening. James Ward’s presentation on closing the gaps in life expectancy for Aboriginal and Torres Strait Islander communities, also made an impact on our participants.

Jacqui Richmond’s clear, informative presentation on hepatitis B treatment was also nominated by many of our participants as something to remember.

Another popular choice was Pam Wood’s story of how she moved from isolation to national action through the support of the online community Hepatitis C Australasia.

Pam is now one of the moderators of that forum.

“I came away from her presentation with a completely altered view of the role of online communities; thinking we can

also gave me an insight into the different roles and tasks within organisations, things that were not obvious to me as a peer educator.”

Seeing the work of other organisations in the prisons inspired Megan. “I don’t feel so alone knowing that other people have done the same thing, better.

It encourages me to keep going.”

This was endorsed by Karan who said the networking was invaluable.

In the spirit of further networking, TasCAHRD invited all participants to their office for an after-hours visit.

The hospitality of the TasCAHRD staff was much appreciated— especially the lovely cheese and apples that came with it.

For the HCCSA Information and Resources program, getting positive feedback (including requests for follow-up information) on our little poster presentation on the eBox project was very gratifying—a minihighlight of sorts.

Cecilia Lim Hepatitis C Community News December 2009 • 11

MAKE A NOISE!

Mascot Madness Oliver robbed of glory at Adelaide Oval

M

onday 28 September saw not only a great game of football between some Port Power and Adelaide Crows legends, but it was also the setting for a Guinness Book of World Records-breaking mascot race.

A total of 97 mascots, including HCCSA’s own Oliver, assembled on the ground at Adelaide Oval during half time to break a record set in the UK of 84 mascots running in a 100m race.

With some taking a little longer than others to make it across the finish line, others unable to see where they were going, and a few “tackles” between the characters, it was a lively spectacle.

The Man from Atlantis took out the trophy, whilst Nova Boy was lucky to make it across the line before the third quarter began.

As the carefully analysed footage displayed to the left shows, Oliver was hindered in his dash for glory by an oversized parrot on at least two occasions.

Unfortunately, less than 10m from the finish line, he chose to stop

TOP: Oliver, trapped between the Adelaide Zoo pandas and a cheap chip ABOVE: The triumphant race winner and argue with the interfering bird, rather than cross the line quickly and sort out the argument later.

Mascots had come from near and far to help create the new record.

“You’d be surprised what comes out of the woodworks,” said event organiser Tony McGuinness.

“There’s a lot of closet mascots out there.”

Guinness Book of World Records staff were on hand to witness the event and ensure it qualified for the title.

Where’s Oliver?: The 97 mascots assemble.

Hepatitis C Community News 12 • December 2009

Vending Machine Trial

Great Liver Food

CNP sites benefit from 12-month test

Continued from page 9

T

he importance of access to sterile injecting equipment cannot be overstated in the fight against the spread of hepatitis C. For injecting drug users who are at risk of contracting HCV, being able to get clean syringes at any time of the day or night, on any day of the week, is vital.

The Clean Needle Program, coordinated at a number of sites by Drug and Alcohol Services South Australia (DASSA), provides this vital service. The provision of sterile injecting equipment, waste and sharps disposal facilities, information, education and referrals to other services are central to preventing the spread of blood-borne viruses.

A new program at several CNP sites began on Monday, 30 November. Syringe vending machines are being trialled in South Australia, and can be found in three places as part of a 12month trial. For a cost of $2, the machines dispense a Fitpack, which contains eight 1mL syringes and 20 alcohol swabs.

The machines are located at: • Anglicare SA Salisbury (9 Mary St, Salisbury), • Murray Bridge Soldiers’ Memorial Hospital (Swanport Rd, Murray Bridge), and • Southern Primary Health Noarlunga Village (Alexander Kelly Dr, Noarlunga).

Vending machines will allow for more people to obtain sterile injecting equipment at these locations, at any time of the day or night. They have a choice between talking to the staff at the CNP site, or else using the machine with complete anonymity. Each machine also has a sharps disposal bin right next to it,

to promote the safe disposal of used injecting equipment.

It’s important to note that the vending machines will be an addition to, rather than a replacement for, the existing CNP services. Research has suggested that these machines increase access for hidden and marginalised populations who might not otherwise avail themselves of CNP services; this includes street youths, sex workers, homeless people and rural people. A Queensland trial of the machines found that they were most likely to be used by younger people, and by a greater proportion of women than those seen by the usual CNP services.

For further information regarding the vending machine trials or any other CNP related matters please contact the CNP Manager on 8274 3382. For any enquiries about drug- and alcohol-related information please call the Alcohol & Drug Information Service on 1300 13 1340. Counselling and information is available 24 hours a day.

Pumpkin is also a good source of fibre, vitamins B6, C and E, folate and potassium, and like all vegetables, they’re fat-free and low in kilojoules.

Recommended Portion: Like other vegetables, one serve equals ½ cup of cooked or 1 cup of raw/salad.

Aim for 5 serves of vegetables per day, with only one serve being starchy vegetables (potato, sweet potato, corn). Aim for one of your 5 serves of vegetables to be pumpkin or one of the ‘other sources’ listed above.

12. Vegetable juice Benefits: Vegetable juice contains the vitamins, minerals and other nutrients found in the original vegetables and it is an easy way to include vegetables in your diet. Tomato juice and vegetable juices that include tomatoes are good sources of lycopene, an antioxidant that may reduce the risk of heart attack, prostate cancer and possibly other types of cancer. Vegetables, unlike fruit, contain no (or very little) sugar, and hence vegetable juices are a low-kilojoule, nutrient-dense drink.

Carrot, celery, beetroot, cucumber, capsicum, tomato, and ginger can all be juiced. You can also buy commercial vegetable juices; however be sure to select the lowsodium varieties.

Recommended intake: If you regularly meet your recommended 5 serves of vegetables per day, aim to have one vegetable juice drink once per week. However, if you struggle to eat enough vegetables, use vegetable juices more often to help you meet your vitamin and mineral requirements. Keep in mind, however, that vegetable juices do not contain the fibre from whole vegetables, and hence you should make an effort to include vegetables in your daily diet.

Source: Hepatitis Australia (see www.loveyourliver.com.au for more) Hepatitis C Community News December 2009 • 13

Open Your Mind The postcards project

T

hanks to everyone who contributed to the postcards project that was organised by the Mental Health Coalition to commemorate Mental Health Week during October 4-10, 2009.

Mental health issues, like hepatitis C, are subject to stigmatisation that can hinder a person from seeking help and support. This can subsequently compound the effects of living with a chronic illness.

For many members of our community, being affected by hepatitis C and mental health are serious realities, and increasing awareness about people’s experiences is a way forward to improving health and quality of life.

We displayed the 18 postcards that we received back from our members on the HCCSA community notice board. The postcards depicted an array of differing perspectives and approaches to communicating views about mental health. Each postcard bought light to important mental health experiences, which I think was fun, creative and clever. Whilst we didn’t have an overwhelming response, it was always really exciting when we received another postcard from a member, embellished with their artwork and/or poetry.

In the meantime, we will be having fun building the Hep C Council’s float for the Adelaide Fringe Parade back—back again in February 2010!

Maggie McCabe

Hepatitis C Community News 14 • December 2009

Background photo © Jeff Weston

Overall, the idea was to raise awareness and reduce stigma about mental health, and learn more about the relationship between hep C and mental health. I think that the response we received from our members contributed to this idea and that we ought to do the whole thing again next year in October 2010 for Mental Health Week.

Love Your Liver Lunch

eBox Update

A review

A digital approach to prevention and treatment

T

he November Love Your Liver Lunch—now a monthly activity for the Peer Education group—was lovely: a big success.

The food, provided and cooked

by Mark and Yvonne, was mostly Lebanese. It was very refreshing, light and tasty—not heavy at all— low in fat and easy to digest.

The aim of the Love Your Liver Lunches, which were inspired by this year’s Hepatitis Awareness Week, are to raise awareness of good liver health, viral hepatitis and hepatitis services (see page 5 and 6 for more info). It was a perfect meal for this warm climate, given that we had just got through Adelaide’s 40-degree heatwave.

As one of the highlights of the meal, felafels are very wholesome, nutritional and high in protein, made from chickpeas (see pages 8-9 for more). Tabouli has great

amounts of vitamin C. The green goodies from the salads we had to choose from were excellent healthy liver food. It was enjoyed by all.

If you enjoy being surrounded by friends and family, why not invite yours to lunch, and cook liverfriendly food.

From those who took part: • “Absolutely delicious!”

• “Fresh, summery and zesty!”

• “Brilliant!”

• “De-lish!”

For recipes from this meal, or for information about (and pictures from) the last Love Your Liver Lunch in October, visit our website at www.hepccouncilsa. asn.au for more. For more general information, try www. loveyourliver.com.au.

Fred, Phil & Karan

Peer educators Yvonne and Mark showing off the new frying pan which Mark cycled all the way to Harris Scarfe to purchase on the morning of the lunch

L

ast issue we introduced the eBox project, a joint initiative of HCCSA and SAVIVE. Based in the Shopfront at Salisbury, the eBox is an electronic resource which offers movies, slides and step-through guides about hepatitis C risks and treatment.

The world is full of exciting technology which is often extremely well-suited to providing information in an appealing, straightforward way. However, the users of clean needle programs (CNPs) often have little or no access to these new technologies. If the internet is full of great information, that’s of no use if you don’t have access to a computer.

The initial 6-month eBox pilot program is intended to bring some of that audio-visual and internet-based information to CNP sites. This will raise awareness about hepatitis C transmission, testing and treatment, and promote the services available to CNP clients, particularly hepatitis C services.

The interactivity of some of the eBox content allows a client to get answers to their questions immediately. The audio-visual, dynamic and interactive nature of the presentation is attractive, and offers more opportunities for engagement. The information in the eBox is easily updated, modified and expanded. And finally, the eBox itself is a novelty and a talking point.

The Shopfront at Salisbury has a CNP site which sees 20-25 clients each day (operating Monday to Friday), so it’s an excellent location for a trial run of this project. Data is being collected on the number of contacts and the levels of engagement the clients have with the eBox. Clients are also providing feedback on cards, self-assessing any increase in their knowledge and any changes in attitude.

The great majority of the responses received after the first three months have indicated a positive change in attitude towards testing and treatment.

Hepatitis C Community News December 2009 • 15

Are you happy with your GP? If you are, we need to hear from you.*

Individual Membership will continue from year to year without the need for renewal, as long as contact details provided remain current. You are able to resign your membership at any time. To update contact details for continuing membership or to resign your membership, please phone HCCSA Administration on 8362 8443.

We are updating our Hep C-friendly GP list for metro and rural areas.

Please call Deborah on 1300 437 222. *We approach GPs for permission before putting their names on our list, and we do not reveal who nominated them.

Hepatitis C Community News 16 • December 2009

Useful Contacts & Community Links Hepatitis C Council of SA Provides information, education, support to people affected by hepatitis C, and workers in the sector. The Council provides information and education sessions, as well as free written information. The Calming the C Support Group is also run by the Council.

Call the Council’s Info and Support Line for information on 1300 437 222 (for the cost of a local call anywhere in SA).

MOSAIC & P.E.A.C.E. Relationships Australia (SA) provides support, education, information and referrals for people affected by hepatitis C through the MOSAIC and P.E.A.C.E. services. MOSAIC is for anyone whose life is affected by hepatitis C, and P.E.A.C.E. is for people from non-Englishspeaking backgrounds.

(08) 8223 4566 Nunkuwarrin Yunti An Aboriginal-controlled community health service with a clean needle program and liver clinic.

(08) 8223 5011

Clean Needle Programs To find out about programs operating in SA, contact the Alcohol and Drug Information Service.

1300 131 340 Partners of Prisoners (POP) Facilitates access to and delivery of relevant support services and programs which promote the health, wellbeing and family life of partners of prisoners who are at risk of hepatitis C, HIV/AIDS or are people living with hepatitis C or HIV. (08) 8210 0809 SAVIVE Provides peer-based support, information and education for drug users, and is a Clean Needle Program outlet.

(08) 8334 1699 Hepatitis Helpline This hotline operated by Drug and Alcohol Services South Australia provides 24-hour information, referral and support.

Freecall: 1800 621 780 SA Sex Industry Network (SA-SIN) Promotes the health, rights and wellbeing of sex workers.

(08) 8334 1666

Vietnamese Community in Australia (SA Chapter) Provides social services and support to the Vietnamese community, including alcohol and drug education, and a clean needle program.

(08) 8447 8821 The Adelaide Dental Hospital has a specially-funded clinic where people with hepatitis C who also have a Health Care Card can receive priority dental care. Call the Hepatitis C Council for a referral on (08) 8362 8443.

Aboriginal Drug and Alcohol Council of SA (ADAC) Ensures the development of effective programs to reduce harm related to substance misuse in Aboriginal communities.

(08) 8362 0395 AIDS Council of SA (ACSA) Aims to improve the health and wellbeing of gay/homosexually active people, people who inject drugs, sex workers and people living with HIV/AIDS in order to contribute to the overall wellbeing of the community.

(08) 8334 1611

Are you interested in volunteering with the Hepatitis C Council of SA? Please give us a call on (08) 8362 8443 or drop us a line at admin@hepccouncilsa.asn.au and let us know. We rely on volunteers for many of our vital services.

The Council offers a meeting room suitable for workshops, presentations, formal and informal meetings. It is a spacious area suitable for up to 30 participants.

Meeting Room Hire at the

The room has modern, self-contained kitchen and bathroom facilities.

It also contains an electronic whiteboard, and the Council offers the use of an overhead projector, data projector, TV and video (subject to availability).

Fees for room hire are $33 per hour (inc GST). Bookings over three hours will be charged at $110 (inc GST). Fees will be directed into programs for people living with or affected by hepatitis C. Organisations that receive funding through the HHPP of the Department of Health will be exempt from payment.

Community members affected by hepatitis C are encouraged to use the room at no cost.

Contact us at 3 Hackney Road, Hackney PO Box 782, Kent Town SA 5071 Phone: (08) 8362 8443 Fax: (08) 8362 8559 Web: www.hepccouncilsa.asn.au Email: admin@hepccouncilsa.asn.au

Jack makes his first visit to the hepatitis C Council of SA offices...

well, i’m supposed to be meeting a peer educator called mark here. i guess this is the place.

HELLO?

! ! ! ! ! !

W W O P P A KKA O

Hi! I’m MARK.

? ?? what the..?

to be continued!