#103 HepSA Community News

Community News #103 • November 2024

Hepatitis & Pollution Plus Hep B & Migration and more

IN THIS ISSUE

About the Cover: Artwork by James Morrison, using textures and elements from Freepik, Vecteezy and Textures.com

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International Overdose Awareness Day

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Gary’s Story

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Reflex Testing

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Pollution & Hepatitis

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Migration & Hep B

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SAPOL Training

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In Our Library

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Contacts

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

Editor: James Morrison Regular Contributors: Cecilia Lim, Joy Sims Some photos in this publication may have been altered to disguise identifying details of members of the public.

This resource was prepared and printed on Kaurna Country.

Disclaimer: Views expressed in this newsletter are not necessarily those of Hepatitis SA. 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 Hepatitis SA members and the general public.

SA Health has contributed funds towards this program.

ISSN 2651-9011 (Online)

International Overdose Awareness Day International Overdose Awareness Day (IOAD) is held on August 31 every year. It is the world’s largest annual campaign to end overdose, remember without stigma those who have died, and acknowledge the grief of family and friends left behind. The theme for 2024 was ‘Together we can’, which highlights the power of community when we all stand together.

Hepatitis SA’s NSP Peer Project workers were invited to Community Access and Services SA’s (CAaSSA) community barbecue so on a cold windy Friday, we set up a table with naloxone information and another table so people could make ‘leaves’ with heartfelt messages to loved ones they have lost or who have been affected by overdose. We had made a ‘Tribute tree’, painted it purple and that’s where people hung their ‘leaves’. It was a test run for the BBQ too, as it was brand spanking new.

The weather was terrible to say the least. The wind blew through the area like a hurricane.

Luckily, we brought rocks to weigh naloxone resources and leaves down. It was a private barbecue with only NSP service users attending.

Everyone loved the idea of the tribute tree and spent most of their time talking about a person they had lost and how it would have been great if naloxone was around, as the ambulance didn’t make it or whoever was with that person didn’t have the knowledge to know how to help. The couple of people who hadn’t lost anybody didn’t want to miss out on adding to the tree. They wrote quotes like ‘look after your mates’ and ‘naloxone saves lives’.

and where to get them locally. That was a better way than showing them in a group, where they might have felt too shy to ask any questions. It also gave me a chance to dispel any myths. Two of them had used naloxone before and were most proud to wear their “I Carry Naloxone’ wristbands. Although they were going put them higher up their arm, under their sleeves, in public due to fear of discrimination.

The community acknowledged how important it was to have naloxone on hand: in the medicine cabinet at home, or in the car, for instance.

An hour in the rain came pouring down.

Nothing could be saved except for the tree.

It has a bit of water damage, and the leaves just have a bit more character.

Considering the weather, we were happy to see seven people turn up and not only stay for the whole time but also learn about naloxone, and put their feelings on the tree.

Hopefully, these will be seven people who will educate their friends about naloxone and where to get it.

We would like to say a big thank you to Dusty for cooking sausages and onions in galeforce winds; it’s not for the faint-hearted. He also made a big effort to talk to everyone and make them feel welcome.

Margie Randle & Fiona Poeder Peer Educators

While people were eating their snags, we showed each of them the Nyxoid nasal spray naloxone and Prenoxad intramuscular injectable naloxone; how to use each one HEPATITIS SA COMMUNITY NEWS 103

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Full Circle: Gary’s Story Gary Spence began his adult working life in the police. He moved on to community services and came full circle with a unique achievement: successfully lobbying for the inclusion of blood borne virus education into the standard training program of the South Australia Police (SAPOL).

Sitting down for a chat with Community News just before his retirement (to a lovely life of peace and quiet in the country), Gary said successfully negotiating with the SAPOL’s Training and Development Branch to deliver that program gave him a great feeling of completion.

Up until then, training and education that the Hepatitis SA Education Team delivered to

SAPOL had always been a little ad hoc, with no set times, locations, time frames or even standard length.

That all changed with the new ‘Blood Safety & Viral Hepatitis’ on-going education program. The SAPOL-compliant program was given a SAPOL Health Safety and Welfare training code which means it is now a SA Police requirement for all operational personnel to have received this training. All personnel have a five-year period in which to compete their training.

“It was quite a challenge and a bit touch and go at one stage,” he recalled. Negotiations took a year, delayed by staff changes at the SAPOL end. What clinched it was the fact that Gary had worked with SA Police for 20 years before moving to the community sector.

Hepatitis SA Education Coordinator, Jenny Grant, said much of the success in getting the ‘Blood Safety & Viral Hepatitis’ program incorporated as required training for their operational personnel was due to the trust that Gary had built with the SA Police training department.

“They knew that he understood how SAPOL works, what their operational staff training needs were, and how to provide content which was useful and relevant,” she said.

Gary started working when he was 11. “After school, in the afternoons, I’d earn pocket money by helping out at the local deli,” he said. At 16 he graduated to selling white goods at Harris Scarfe, before applying to join the SA Police Academy at age 17.

Gary back in the day in SAPOL (photo provided by Gary Spence)

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“I had to live in the Police Academy for two years and hated everything about it,” he recalled. “I started on a Thursday and by the

TOP: Gary (far left) at a rally, in his capacity as Manager of Gay Men’s Health (photo provided by Gary Spence) BOTTOM: Gary (centre, in blue) at a HIV PEP rally (photo provided by Gary Spence)

second day I was ready to quit.” His parents convinced him to stay on and keep it up. And so, two years of training turned into 20 years of policing.

His policing career was diverse, from general patrols in Port Augusta from 1985 to 1990, to communications back in Adelaide, taking calls and dispatching jobs. What gave him a new direction was a domestic violence course which he attended – it motivated him to go into that area of policing, helping the victims of DV. That’s when policing for him clearly became more of a service than a force.

“It was quite harrowing to see what the victims suffered,” he said. “Many of the perpetrators looked so respectable from the outside.” In time, the role expanded to include sexual assault, and in that process extended to the gay and lesbian community as well.

Gary remembered one week in particular, where two male victims approached him for help, and he couldn’t find any services for them. “We got shunted around from one desk to another, one service to another. It was very bad,” he said. That experience prompted him to push for the role of a gay and lesbian liaison officer in SAPOL – a role he filled from 1998 until it was abolished in 2001. The position was never officially formalised, and that allowed it to be done away with easily.

In his capacity as the liaison officer, Gary provided training to police officers with support via the AIDS Council, and Gay Men’s Health. “There were other changes happening in the police department as well.

A female non-Police person commenced as head of HR, and she was very supportive of

this position. The culture was shifting,” he said.

Nonetheless, there was still a lot of opposition to the change and despite the inevitable cultural shift, the liaison officer’s position was done away with quite swiftly by a very senior police officer at the time, with no discussions entered into.

Ironically, the abolition of the role had the unexpected consequence of every officer needing to be aware of the issues and needs of the community, and to be able to do the job previously done by the gay and lesbian liaison officer. The training package which Gary had developed for SAPOL operational personnel became all the more important. It is still in use today.

In 2002, Gary decided it was time to move on. “Otherwise, it clouds your view,” he said.

“Gay Men’s Health at the AIDS Council had a position open, they asked me if I would apply, and I decided to go for it. It was time for a change.

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“During the seven to eight years with Gay Men’s Health, I was a project worker and then manager.” He was also Acting CEO of the AIDS Council for a year.

Gary left the AIDS Council in 2009 and purchased a trendy little environmentallyfriendly gift shop, The Waste Not Want Not Shop in Goodwood (which he later moved to Blackwood), with his partner Jayson Smart, a school teacher who also ran a dance studio.

Gary had met Jayson in 1993 through the now SA Police Commissioner, Grant Stevens.

“One highlight of having the shop was the opportunity of working at some stage with all three of my grown-up children,” he said.

While the shop was a nice challenge, it wasn’t quite enough, so in 2016 Gary sold the shop and joined Hepatitis SA as an educator where his experience in education,

Gary (left) and Jayson (photo provided by Gary Spence)

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and understanding of community needs could be applied to another good cause.

Gary’s journey took him from a young person who “hated everything” about the Police Academy, through 20 years in policing, helping to shift the culture, and on to another 20 years as organiser and educator in the HIV and hepatitis sectors. His 41-year career was rounded off with that final feather in his cap: successfully getting blood safety and hepatitis education built into standard South Australian Police training – tying it up nicely, like a bow.

“It’s a nice feeling – coming full circle,” he admitted as he walked out the door with a smile.

SEE MORE: instagram.com/p/CgtL8Y7MMvH

Reflex Testing What is Reflex Testing? SA has started doing it for hepatitis C. Should it also be considered for hepatitis D? There is a true story about a woman who for 12 years, lived with hep C without hep C. She lived with the feeling of guilt, isolation and anxiety until she discovered inadvertently that she didn’t have hep C. Her doctor had failed to order the second test required to confirm her hepatitis C status. (See her full story at youtube.com/ watch?v=MnxH8qn7xSc.) On the flip side, another person told of how he’d thought he was safe and protected from hepatitis C because he had hepatitis C antibodies. It was only later when another healthcare provider ordered the second test, that he found out he in fact had hepatitis C, and needed further medical care.

“A woman who, for 12 years, lived with hep C without hep C.”

Hepatitis C testing is usually in two steps: an antibody test to see if the person had been exposed to the hepatitis C virus, followed by an RNA test to confirm that the virus is still present. The second is conducted only if the first test returns a positive result, and until recently, needed to be specifically requested by the healthcare provider, even if the first test showed that the person had been exposed to the hepatitis C virus.

This has resulted in people with chronic hepatitis C not being properly diagnosed. In some cases, doctors did not recall patients for the second test, while in others the patient just didn’t show up and became lost to follow-up.

Reflex it To address this problem, from June this year, SA Pathology has taken the very logical (and common-sense) decision to automatically carry out that second test, should the first test indicate a need for it.

This automatic further testing is known as ‘reflex testing’. South Australia is an early adopter of this approach, which has been recommended for quite a while, by clinicians, pathologists, epidemiologists, researchers, community organisations in the viral hepatitis sector, and people affected by hepatitis C across Australia. It is also a priority action in the National Hepatitis C Strategy.

According to the SA Health webpage, “SA Pathology has commenced reflexive NAT (nucleic acid test) testing on all samples that are HCV antibody-reactive or indeterminate, if specimen volume is sufficient.” This means if samples test positive for hepatitis C antibodies or the results are not clearly negative, the laboratory will go on to test for hepatitis C RNA in those samples, if there is enough sample left for carrying out that next HEPATITIS SA COMMUNITY NEWS 103

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test. Reflex testing, it says, decreases the burden on medical practitioners and patients and minimises delays between initial testing and treatment commencement.

It will also reduce mis- and missed diagnoses like the examples discussed earlier.

Reflex testing is part of a concerted push to eliminate hepatitis C in South Australia by 2030. Untreated chronic hepatitis C infection is a major cause of liver disease, cancer, and premature death. South Australia could be the first jurisdiction in Australia, and among the first in the world, to eliminate hepatitis C as a public health threat.

Key to this campaign is accurate and efficient diagnosis to find people who have been living with hepatitis C without knowing it, and to find re-infections among those who had been cured but are exposed to ongoing

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risks. Reflex testing is just another tool to make the process easier and faster for medical practitioners and patients.

The SA Health website (https:/bit.ly/ sahcreflex) provides clear advice to medical practitioners on routine and repeat testing, serology requests and notifications, among other useful tips such as identification of high-risk settings and clinical indicators.

What about D? As we celebrate the introduction of reflex testing for hepatitis C, it’s worth noting that there are advocates for reflex testing of another viral hepatitis infection – hepatitis D. Hepatitis D is a viral infection that occurs only in people living with hepatitis B. It is the most severe form of viral hepatitis, with a 70 per cent risk of cirrhosis in five to ten years, and liver cancer within ten years. People at

Infographics from ‘The Case for Hepatitis D (HCV) Reflex Testing‘ ‘by Dr Razavi-Shearer via Hep B Foundation (with permission).

greatest risk of hepatitis D are those living with hepatitis B who are also from global regions of high prevalence.

There is not enough data to establish the true prevalence of hepatitis D globally or within Australia but—as can be seen from the numbers—for individuals with hepatitis D, the outcomes can be devastating.

Identification of hepatitis D is a complex process involving many visits, beginning with the identification of chronic hepatitis B infection, followed by testing for hepatitis D antibodies, which is then followed by hepatitis D RNA testing.

This can be reduced to two visits where a sample tested for hepatitis B is automatically tested for hepatitis D antibodies and hepatitis D RNA when test results indicate the possibility of infection. Reflex testing of hepatitis D for people with chronic hepatitis

B will not only identify people who are at real risk of serious disease and death and get them into care, but also provide a better understanding of the prevalence of hepatitis D and the associated burden of care.

With the rising rate of hepatitis B in Australia, it is time for hepatitis D reflex testing to be put on the agenda.

READ MORE: The Case for Hepatitis D (HDV) Reflex Testing, D. Razavi-Shearer: hepb.org/ assets/Uploads/Razavi-Shearer-HDVReflex-230914-1-2.pdf Increase in routine hepatitis C RNA testing required to achieve elimination, SA Health: bit.ly/sahcvreflex

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Does Pollution Make Hepatitis Worse?

A new study, published in Nature‘s Scientific Reports, has looked at how air pollution specifically affects people living with hepatitis, and the results are both concerning and also more evidence for why we need to take strong measures to curb pollution and anthropogenic climate change.

In the study, by Shengfei Pei and his team at the School of Public Health at the North China University of Science and Technology, 15 years’ worth of the monthly incidence

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rates of viral hepatitis (from 2005 to 2020) were sourced from the Chinese Center for Disease Control and Prevention. Pollution data spanning 2014–2020 was obtained from the US’s National Oceanic and Atmospheric Administration (NOAA), encompassing pollutants such as carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone (O3).

Carbon monoxide is usually produced by burning fossil fuels, and is extremely toxic when inhaled. Nitrogen dioxide, often produced by burning natural gas, causes a range of respiratory diseases and can also be lethal if inhaled at higher levels. Sulphur dioxide, also created through burning fossil fuels and through volcanic activity, is poisonous in high amounts. Ozone, while vital in the upper atmosphere for the UV-deflecting ozone layer, is extremely poisonous to humans at sea level, attacking

Image by US Environmental Protection Agency [www.epa.gov/pm-pollution/particulate-matter-pm-basics, Public Domain, commons.wikimedia.org/w/index.php?curid=94168146]

Man-made environmental pollution is known as a significant danger to human health.

Globally, air pollution kills more than 8 million people annually, and the particulate matter caused by Australia’s climate changefuelled Black Summer bushfires in 2019-20 is estimated to have killed more than 400 people in the years since.

the respiratory, cardiovascular, central nervous and reproductive systems.

The study also looked at particulate matter, which are microscopic objects floating in the air and which, when inhaled, can cause damage to the lungs and other internal organs. Particulate matter is often referred to by its size, such as PM10 (particles with a diameter of 10 micrometres or less, which can damage the lungs and heart) or PM2.5 (particles with a diameter of 2.5 micrometres (0.0025 mm) or smaller, often found in smoke).

A series of analyses was done to evaluate the singular and combined impacts of pollutants on viral hepatitis cases across different demographics, age groups, and environmental conditions.

carcinoma, although studies on the synergistic effects of pollutants and hepatitis infection remain limited (Chen et al 2024) In general, raised pollutant exposures of all types were found to affect the development of viral hepatitis, highlighting the need for sustained monitoring of pollutants in relation to viral hepatitis to implement effective public health strategies.

For more information on air quality and monitoring in South Australia, visit the Environment Protection Authority website.

READ MORE: nature.com/articles/s41598-024-72047-1 epa.sa.gov.au/environmental_info/air_quality

Among different groups, PM10 and Carbon dioxide emerged as the most significant risk factor, notably impacting patients with hepatitis A and E, while Sulphur dioxide and PM2.5 impacted other types, particularly damaging for people aged from 35 to 64.

Long-term exposure to mixed pollutants and lower levels of PM2.5 and PM10 influences hepatitis development with a lag of 5 to 6 months, highlighting the need for sustained monitoring of pollutants to implement effective public health strategies. Additionally, research indicates a correlation between PM2.5 exposure and the progression of hepatitis to hepatocellular

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Migration: Improved Prospects for People Living with Hepatitis B Changes to Australia’s migration laws have lowered the barriers to permanent residency for people living with hepatitis B. These changes come after years of lobbying by advocacy groups.

The Australian migration system is set up to make it more difficult for people living with chronic illnesses to get permanent visas, using the justification that the financial cost of meeting those people’s health needs is prohibitive. However, over the past five years, there have been incremental changes to migration law and policy that have improved the prospects of people living with chronic hepatitis B becoming permanent residents in Australia.

The Department of Home Affairs, who control Australia’s immigration system, has what they call a ‘significant cost threshold’, which is the cut-off amount beyond which the government has decided that a potential migrant will be too expensive to support (or, as they put it, a visa applicant’s estimated health and community service costs’ are ‘significant’ and therefore do not meet the ‘Migration Health Requirement’). Three main factors

have changed the way this affects people living with hepatitis B. The first change is in time. Previously the Department of Home Affairs would estimate the potential costs that would accrue over an applicant’s entire lifespan. Now the rules have changed to mean that the costs are now estimated for a 10-year period for those whose health condition has a ‘reasonably predictable course’, something which applies to chronic hepatitis B infections.

(For temporary visa applicants, the relevant period of time for the estimate of cost is the length of the particular visa subclass.)

The second change is in cost. The price of medication used for hepatitis B treatment has decreased significantly. This decrease in medication cost means that the estimated costs of a person’s healthcare each year for the purposes of migration will, in most cases, also decrease significantly. Ten years of medication at a lower rate is much better than a lifetime of higher prices.

The third change is that the ‘significant cost threshold’ level has itself been raised, meaning that the cut-off point is now higher.

Together, these three changes now mean that applicants living with hepatitis B, including those on treatment, are unlikely to exceed the significant cost threshold based on their treatment alone. This is welcome news for many people living with chronic infection who are seeking to migrate to Australia. Previously, applicants may have been limited to applying for visas that had provision for a waiver of this health

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requirement to be granted. Most visas do not have these provisions. This meant there were few visa pathways available to people living with hepatitis B for obtaining permanent residency.

applying for a permanent visa. The resource identifies three significant policy changes that have improved the prospects for people living with chronic hepatitis B applying for permanent residency.

These changes to migration law and healthcare costs are good news for many people living with hepatitis B seeking permanent residency in Australia. However, changes to a complex system like migration mean it can be even more difficult to navigate. The Health+Law Research Partnership (healthpluslaw.org), which was created to identify and eliminate legal barriers to testing and treatment for people living with hepatitis B or HIV in Australia, has interviewed a number of people as part of their Legal Needs Study, highlighting the difficulty that people living with hepatitis B face locating clear, up-to-date information on migration law and processes.

People living with hepatitis B who have not received migration advice over the past couple of years may wish to obtain updated advice as these – and other – changes to law and policy may have improved or changed visa pathway options for them. They should contact a registered migration agent or lawyer to discuss these changes and their own circumstances.

The Health+Law team has assisted AHSM Health, Australia’s peak professional body representing healthcare professionals in HIV, BBV, and sexual and reproductive health, to update their ‘Hepatitis B and Immigration‘ resource, which outlines how clinicians can support patients living with hepatitis B

The information contained in this article is general in nature and based on provisional information supplied by Health+Law. It should not be relied on as legal advice. You should talk to a registered migration agent or lawyer to obtain tailored legal advice.

The information is correct at the time of publication but may be subject to change.

The HIV/AIDS Legal Centre (HALC: halc. org.au) is a specialist legal centre, which provides free advice and assistance to people living with HIV or hepatitis. Subject to eligibility requirements, HALC may be able to provide legal assistance.

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Training Breakthrough with SAPOL Blood safety and viral hepatitis education and training are now a requirement for all South Australian Police operational personnel. After a year of negotiations with SA Police Training and Development Branch, Hepatitis SA has successfully implemented blood safety and viral hepatitis training and education sessions to all operational SA Police personnel in an ongoing arrangement.

The Blood Safety & Viral Hepatitis education package has been given its own SA Police Health Safety and Welfare code. This is significant as it means all operational personnel are required to undertake this training. Officers have a five-year period in which to complete the full list required training.

Police officers come into contact with people living with blood borne viruses. Knowing what risks are real, what are myths and how to be blood safe, is important for them to handle situations with understanding and without fear.

People with a lived experience of a blood borne virus often face stigma and discrimination in a range of settings, including with the criminal justice system.

In the past Hepatitis SA’s Education Team have delivered training and education to SA Police, but it had always been a little ad hoc without any structured co-ordination. With the incorporation of the new Blood Safety & Viral Hepatitis education package developed

by Hepatitis SA in collaboration with SA Police, this has now changed.

The training discusses all things bloodborne virus, including transmission and treatment, as well as the laws relating to stigma and discrimination, including the amendments made to the Criminal Law

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(Forensic Procedures) Act 2007 (via the Criminal Law (Forensic Procedures) (Blood Testing for Diseases) Amendment Bill 2015), which has been in place in South Australia since 2016. The package has an operational focus to make it relevant and engaging for participants.

Training is delivered face-to-face as part of each Local Service Areas training cycle.

While the training may be provided by Hepatitis SA online, face-to-face is preferred so robust discussions can take place.

Education session run for about 40 minutes. Although this is shorter than the usual Hepatitis SA education session, our Education Team welcome the opportunity to strengthen partnership with SA Police and provide their operational personnel with best practice blood safety and viral hepatitis education.

Evaluations are conducted at the beginning and end of each session to gauge participants’ increase in general blood borne virus knowledge as well as attitudinal change to stigma questions. There is also a space for attendees to leave a comment at the completion of the training.

Outcomes Sessions conducted thus far have shown participants have gained a strong understanding of blood borne viruses.

Over 98 per cent gave correct answers to knowledge-based questions such as, ‘Is there a vaccination for hepatitis B?’ and ‘Is there a treatment to cure hepatitis C?’.

Participants also showed a strong understanding of potential stigma and discrimination with over 80 per cent answering “no” to the question ‘Should you

BLOOD SAFETY & VIRAL HEPATITIS EDUCATION

S.A. POLICE IN TRAINING

WHAT

otiations with SA • After a year of neg Development Police Training and has successfully SA Branch, Hepatitis safety & viral od implemented blo education and hepatitis training rational SA Police sessions to all ope oing capacity. personnel in an ong all ice requirement for • It is now a SA Pol al to have received son per l ona rati ope n been given its ow this training, it has personal have a all training code and the e pet com to ich 5-year period in wh training.

WHERE AND WHEN

as part of each • Training is delivered face-to-face Local Service Areas training cycle. itis SA • The training can be provided by Hepat red so online, however face-to-face is prefer . robust discussions can take place

HOW

for about 40 minutes.

• Education sessions run ideal for our educational than less is this h oug Alth education team have had sessions, Hepatitis SA to roll with it. ted at the beginning • Evaluations are conduc to gauge participants’ and end of each session d-borne virus knowledge increase in general bloo nge to stigma questions. as well as attitudinal cha attendees to leave a There is also a space for ion of the training. comment at the complet

WHY • People with a live d experience of a blood-borne virus often face stigma and discrimination in settings, including a range of with the criminal justice system.

• In the past Hepat itis SA Education Team have delive red education to SA Pol training and always been a littl ice, but this has e any structured coo ad hoc without rdination.

• With the new SA Pol Safery & Viral Hepat ice Blood package developed itis education in collaboration wit by Hepatitis SA h SAPOL, this has now changed.

• The training pac kag things blood-borne e discusses all transmission and viruses including trea well as the laws rela tment as and discrimination ting to stigma , Mandatory Testing including the Bill which has been in place in SA since 2016.

• These sessions hav Health Safety & We e a SA Police lfare code attached, with the sessions having an operational foc us to engage the officers.

SO FAR… • Hepatitis SA are booked to service area training cycl attend two local es 2024, equating to 12 sess before the end of ions to more than 500 officers.

• Sessions conducted thus participants have gained far have shown that a strong understanding of blood-borne viruses by 98% or higher on knowled answering on average ge based questions such as, ‘Is there a vacc ination for hepatitis B?’ and ‘Is there a treatme nt to cure hepatitis C?’.

• Participants have also shown a strong understa nding of potential stigma and disc 80% answering “no” to ‘Sho rimination, with over they are living with a bloo uld you ask someone if d-borne virus’, and “yes” to ‘Is it illegal to discriminate against someone living with a blood-borne virus ?’

• Some comments from part ‘Very well presented and icipants include gave information relevant to our field’, ‘Ver y factual information’, and thorough, good ‘The presenter was very conversant with the sub ject matter’.

Authors: Jenny Grant & Gary Spence Organisation: Hepatitis SA Contact: education@hepsa.asn.au • 08 8362 8443 / 1800 437 222 • PO Box 782 Kent Town SA 5071 Publication Date: July 2024

ask someone if they are living with a blood borne virus?’ and “yes” to ‘It is Illegal to discriminate against someone living with a blood borne virus?’

Some comments from participants include ‘Very well presented and gave information relevant to our field’, ‘Very thorough, good factual information’, and ‘The presenter was very conversant with the subject matter’.

So far, Hepatitis SA are booked to attend two Local Service Area training cycles before the end of 2024. This is equivalent to 12 sessions to a total of over 500 officers.

Hepatitis SA’s work on the Blood Safety & Viral Hepatitis training package was part of the poster presentation at the 14th Viral Hepatitis Conference in Darwin. You can see the poster on this page, above.

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In Our Library Staying well over the holidays There are a number of cultural/seasonal celebrations coming up over the summer months – most of which could involve some serious eating, drinking and socialising!

This can be a demanding time especially when dealing with significant health issues. Trying to maintain a (relatively) healthy diet and controlling alcohol intake can be physically and mentally challenging.

Managing social gatherings (or the lack of) at this time of year can also be quite stressful, with increased pressure on being cheerful and sociable. It’s a good time to give yourself some extra attention and put in place strategies to help you to feel calm and rested.

Here’s some information that could help in having a more relaxed and healthy time in the coming months.

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Keeping track of healthy eating and drinking New LiverWELL app LiverWELL, Melbourne, 2024.

Phone app info and links.

As well as comprehensive features for tracking appointment reminders and tracking tests and medications - this new version of the app contains links to self management guides on eating, drinking, exercising and feeling well. Available in Arabic, Burmese, Chinese, English, Thai and Vietnamese. liverwell.org.au/get-the-app

Eat well for your liver Hepatitis SA, Adelaide, 2023.

42p booklet.

Contains general principles about eating well to care for your liver plus a range of simple, affordable and delicious recipes - and ideas for liver friendly drinks for those avoiding alcohol.

Also contains useful information about reading food labels.

Contact admin@hepsa.asn.au for a free hard copy. bit.ly/eatwellforyourliver

Healthier Lunar New Year eating Diabetes Victoria, Melbourne. 2p.

Dietician Ivan Chan has some tips for how to enjoy healthy versions of special Lunar New Year treats – with information about the cultural significance of each. Also contains links to more articles about healthy food choices, healthy cooking and meal ideas. bit.ly/lunarnewyear_eating

Alcohol and hepatitis Queensland Health, Brisbane, 2022. 2p.

Information about how alcohol affects the liver, especially for those with hepatitis. Includes a standard drinks chart, the signs that you might need to cut down on alcohol, drinking and treatment, and hints about managing your alcohol intake. bit.ly/alcoholandhepatitis

Tips for low salt eating this Christmas Hepatitis SA, Adelaide, 2017. 5p.

Discusses the challenges of keeping to a modified diet at a time of indulgence! Contains a chart of common Christmas food with low salt alternatives, links to low salt recipe collections, and really useful tips for hosting, or being a guest, with special dietary needs. bit.ly/christmas_lowsalt

Healthy eating out and take away guide Queensland Govt and Nutrition and Education Materials Online, Brisbane, 2016. 2p.

A comprehensive list developed by nutritionists, showing different types of takeaway food (Asian, Indian, delis and burger shops, Italian, bakery, salads, chicken, fish etc) with lists of preferred choices for each - and what to avoid. bit.ly/healthyeatingout

Alcohol-free socializing Hello Sunday Morning, Sydney.

2p.

Outlines strategies for enjoying social events without relying on alcohol - with ideas for alcohol free drinks (and the fancy names for ones that you can order at the bar!) Also has advice for ‘successful sober socialising’ and hints for self care during what can often be a stressful time. bit.ly/alcoholfreesocialising

Taking care of mental health Managing stress through the festive season Healthdirect, Canberra, 2019. 2p.

Acknowledging that the festive season isn’t necessarily happy or healthy for some, this article presents 8 tips for anyone facing challenges during this time.

Includes advice about finances, social media, family connections, alcohol, medications, and a search engine to find health services. Also available as an audio file. bit.ly/festiveseasonstress

Loneliness and isolation over the holidays Mental Health First Aid Australia, Melbourne. 7p.

This time of the year can be a time of celebrations with family and friends but it can also bring difficulties in dealing with family dynamics, grief, and financial pressure. This article talks about some of the more common stressors you may be experiencing, together with some practical tips on how to care for yourself and others. bit.ly/holidayloneliness

For more information about diet and nutrition in general see the list at bit.ly/hepsalib-dietnutrition.

HEPATITIS SA COMMUNITY NEWS 103

15

Hepatitis SA provides free information and education on viral hepatitis, and support to people living with viral hepatitis.

HEPATITIS SA BOARD

Postal Address: Kaurna Country PO Box 782 Kent Town 5071

Vice Chair Bill Gaston

(08) 8362 8443 1800 437 222

Treasurer Michael Larkin

www.hepsa.asn.au Community News: hepsa.asn.au/ communitynews Library: hepsa.asn.au/library

Ordinary Members Lindy Brinkworth Bernie McGinnes Janice Scott Lucy Ralton Joshua Riessen Kerry Paterson (CEO)

@HepatitisSA @hep_sa Resources: issuu.com/hepccsa Email: admin@hepatitissa.asn.au

Chair Arieta Papadelos

Secretary Sharon Eves

How Do I Love My Liver?

Once you’re comfortable with this, you can Gum Infections Staying Motivated tattooing and other procedures

Hepatitis C

exercise more often or for longer if you want,

Dentures should fit well to help maintain oral health.

Remember to rinse dentures after each meal, and clean them daily with a soft brush and mild soap. Don’t use toothpaste, Living with as this will wear the dentures away.

Advanced Dentures should be removed at night and left to soak in cold water while not in Liver Disease the mouth. If the dentures are developing Protect your liver against 3 main a stain, add a small amount of vinegar or threats: viral hepatitis, fatty liver dilute bleach to the water.

Information for Family & Friends

§

and alcohol.

Helpful Hints

 Maintain a healthy weight with

fruits and vegetables. standard drink a day.

 Avoid binge drinking - don’t drink

Hepatitis C Treatment more than 4 standard drinks in one sitting.

There are highly effective cures for hepatitis C with over 99% success rate and little SAThese drugs, known as or noHepatitis side effects.

Street address: 3 Hackney Road, HACKNEY direct acting antivirals, are available on the Postal address PO Box 782, KENT TOWN SA 5071 Pharmaceutical Benefits Scheme (PBS).

Telephone: 08 8362 8443

Facsimile: 08 8362 8559 Email: admin@hepsa.asn.au Hepatitis SA www. | www.K3myLiver.org.au | www.hepccheck.info Phhepsa.asn.au 1800 437 222 or (08) 8362 8443

An information booklet from

Kaurna Country 3 Hackney Rd Hackney SA 5069 PO Box 782 Kent Town SA 5071 www.hepsa.asn.au

1 Living with Advanced Liver Disease - Helpful Hints.indd 1

achieved so far.

teeth and bad alsohealthy symptoms • breath Promise are yourself rewardsof (perhaps gum infection.high-quality healthy treats, or some new running gear) for achieving your goals.

Causes: • Exercise with a partner or a group. Having other people involved makes it harder for Infectionsyou of to the gums are usually drop out, and you can encourage each caused by plaque on the teeth (see Tooth other.

Decay, above) • SetMotivated a regular time for your exercise, so that it Staying Using interferon used as becomes (occasionally a normal part of your routine.

Keeping up your exercise regime can a treatment for hepatitis C) or smoking can sometimes be challenging. It’s easy to put lower your resistance to gum things off, but then you disease run the risk of giving

Protect your liver against 3 main up altogether.

Cartoon © The Divine Harvester

Cartoon © r8r

regular exercise.

 Eat a balanced diet with lots of  Reduce alcohol intake - keep to 1

Keeping upDo your exercise regime can sometimes be where equipment is not fully How I to Love My Liver? but remember not overdo it.

If you exercise If your gums are you healthy, willfeeling be challenging.

It’smight easy tothey put things off, butovertired then you run sterilised. too hard, end up therun-down, risk ofwon’t givingwhich up altogether. pink, firm bleed when brushed. or can make you more likely  and Do not share injecting equipment. injure yourself, toget give up exercising How Do I orLove My Liver?

Infectedtogums may bleed when brushed, or • Don’t let yourself bored—try different altogether and undo alltothe good work you’ve Call 437 222 to find out more. forms of exercise keep things interesting. may swell or1300 redden.

Receding gums, loose

Care: threats: viral hepatitis, fatty liver Protect your liver against 3 main • Don’t let yourself get bored—try Maintain good oralforms hygiene by using different of exercise to keep threats: viral hepatitis, fatty liver and alcohol. things a soft toothbrush andinteresting. a fluoride toothpaste, and alcohol. holdingtheMaintain ata45° to theweight gum line • brush Promise yourself healthy rewards healthy with high-quality healthy and moving the(perhaps brush in smallweight circles  regular Maintain a healthy with treats, or exercise. some new for achieving www.K3MyLiver.org.au Use dental on running the gapsgear) between regular exercise.  Eat a floss balanced your goals. diet with lots of Eat balancedofdiet with lots of teeth andon theawww.hepsa.asn.au surfaces teeth fruits and vegetables.

Exercise with a partner or a group. and vegetables.

Use an• fruits antibacterial mouthwash,  Reduce alcohol keep tomakes 1 Having otherintake people--involved it Reduce alcohol intake keep to 1 preferably standard alcohol-free harderdrink for(like you PerioGard) to drop out, and you can day. standard drink a a day.

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1300 437 222

SA Health has contributed funds towards that it becomes a normal part of your this Program. one sitting. one sitting. routine.

Warning: People with cirrhosis or blood/

more than 4 standard drinks in

bleeding disorders, or who are taking Last updated Octoberabout 2012 Hepatitis SA Hepatitis SA interferon, should talk to a dentist Hepatitis SA Street address: Hackney Road,437 HACKNEY Phwhich 1800 222be or (08) 8362 8443 any special precautions may Street address: 33Hackney Road, HACKNEY Postal address PO Box 782, KENT TOWN SAKaurna 5071 Postal address PO Box 782, KENT TOWN SA 5071 Country needed.

Telephone: 08 8362 8443

C

38443 Hackney Rd Hackney SA 5069 Telephone: 08 Facsimile: 088362 8362 8559 Last 08 update: AugBox 2021 Facsimile: 8362PO 8559 782 Kent Town SA 5071 Email: admin@hepsa.asn.au SA Healthadmin@hepsa.asn.au has contributed funds www.hepsa.asn.au Email: www. hepsa.asn.au | www.K3myLiver.org.au | www.hepccheck.info towards this Program. www. hepsa.asn.au | www.K3myLiver.org.au | www.hepccheck.info

What are the risks?

Why Love

Exercise Exercise for for Healthy Healthy Livers Why Love Why Livers MyLove Liver?

My Liver?

There are no adverse risks or side effects from a Hepatitis C fibroscan.

My Liver? & Dental Care  Get vaccinated for hepatitis A and B.  Practise safe sex.  Avoid cosmetic, body piercing,

 Get vaccinated for hepatitis A and B. tattooing and other procedures  Practise safe sex. where equipment is not fully  Avoid cosmetic, body piercing,

All artwork by Hana Jang, used under Creative Commons license: [flickr.com/photos/from_drawing]

 Get vaccinated for hepatitis A and B.  Practise safe sex.  Avoid cosmetic, body piercing,

Denture Care

sterilised. tattooing and other procedures  Doequipment not shareisinjecting where not fully equipment.

(Above) The ultrasound probe, and (below) how it is applied sterilised.

Call 1300 437 222 to find out more.  Do not share injecting equipment.

Call 1300 437 222 to find out more.

Because it is the only one

Moreyou Information have and you can’t

health and community workers.

1300 437 222222 1300 437

pubhlth-strateg-phys-act-guidelines#guidelines_adults.

The Heart Foundation has a number of helpful resources at bit.ly/heartfoundation-physact.

The Heart Foundation has a number of helpful

Last updated May 2022

Last updated October 2012 Last updated August 2013

Last updated October 2012

Information Support

hepsa.asn.au

or visit hepsa.asn.au.

Hepatitis SA has lots of useful about Fibroscan scores are ainformation very useful tool,health but and hepatitis. the Hepatitisabout SA Helpline 1300 More generalCall information your on liver can they arek3myliver.org.au. not the whole picture.

Your doctor or 437found 222 or at visit Hepatitis SA online at hepatitissa.asn. be au. Come andwill explore our library at 3 Hackney Rd, nurse take into all the information Visit our library online ataccount hepsa.asn.au/ Hackney, for the latest health research findings, or library. they have about yourat health when they make explore the catalogue online hepsa.asn.au/library. www.K3MyLiver.org.au www.K3MyLiver.org.au Formore more information on see recommendations toexercise yousee about your treatment For information on exercise, the Australian Hepatitis SA provides information, support and the Australian National PhysicalforActivity www.hepsa.asn.au www.hepsa.asn.au National Physical Activity Guidelines Adults atand www. options, justaffected the scanby results. education to not people hepatitis, Guidelines for Adults at bit.ly/oznat-x-guide. health.gov.au/internet/main/publishing.nsf/content/health-

SA Health has contributed funds towards resources at www.heartfoundation.org.au/active-living/ SA Health has contributed funds towards this Program.

Pages/default.aspx. this Program.

SA Health has contributed funds towards this Program.

We can help. Talk to us.

Call or web chat 9am–5pm, Mon–Fri

1800 437 222

Hepatitis SAlive has lots of useful information without it! about health and hepatitis.

What happens next?

More Information Call the Hepatitis SA Helpline on 1800 437 222

Fibroscan

What is it, and how will it help me?

Free hepatitis A, B and C information, confidential and non-judgemental support, referrals and printed resources.

Because it is the only one

Because it is the only one youand have you have you and can’tyou can’t live without it! live without it!

Hepatitis SA Ph 1800 437 222 or (08) 8362 8443 Kaurna Country 3 Hackney Rd Hackney SA 5069 PO Box 782 Kent Town SA 5071 www.hepatitissa.asn.au

SA Health has contributed funds Hepatitis SA provides information, support towards thisand Program.

SA provides information, educationHepatitis to people affected by hepatitis, and support and Last update:by April 2022 and education to people affected hepatitis, health and community workers.

health and community workers.

21/08/2014 12:55:25 PM

Hepatitis SA has a wide range of hepatitis B and hepatitis C publications which are distributed free of charge to anyone in South Australia.

Free hepatitis A, B and C information, confidential and non-judgemental support, referrals and printed resources.

We can help. Talk to us.

Call or web chat 9am–5pm, Mon–Fri

Information Support

1800 437 222 hepsa.asn.au

16

HEPATITIS SA COMMUNITY NEWS 103

To browse our collection and place your orders, go to hepsa.asn.au/orders or scan the QR code below:

Viral Hepatitis Community Nurses Viral Hepatitis Nurses are nurse consultants who work with patients in the community, general practice or hospital setting. They provide a link between public hospital specialist services and general practice, and give specialised support to general practitioners (GPs) to assist in the management of patients with hepatitis B or hepatitis C. With advanced knowledge and skills in testing, management, and treatment of viral hepatitis, they assist with the management of patients on antiviral medications and work in shared care arrangements with GPs who are experienced in prescribing medications for hepatitis C or accredited to prescribe section 100 medications for hepatitis B. They can be contacted directly by patients or their GPs: Central Adelaide Local Health Network Queen Elizabeth Hospital Phone: 0423 782 415, 0466 851 759 or 0401 717 953 Royal Adelaide Hospital Phone: 0401 125 361 or (08) 7074 2194

Northern Adelaide Local Health Network Phone: 0401 717 971 or 0413 285 476 Southern Adelaide Local Health Network Phone: 0466 777 876 or 0466 777 873 Office: (08) 8204 6324

Specialist Treatment Clinics Subsidised treatment for hepatitis B and C are provided by specialists at the major hospitals.

You will need a referral from your GP. However, you can call the hospitals and speak to the nurses to get information about treatment and what you need for your referral.

• Flinders Medical Centre Gastroenterology & Hepatology Unit: call 8204 6324 • Queen Elizabeth Hospital: call 8222 6000 and ask to speak a viral hepatitis nurse • Royal Adelaide Hospital Viral Hepatitis Unit: call Anton on 0401 125 361 • Lyell McEwin Hospital: call Bin on 0401 717 971

Don’t like Talking?

NSP

No Problem.

Visit hepsa.asn.au - no need to log in, lots of info & updates Follow the HepSAY blog - hepsa.asn.au/blog Order print resources - hepsa.asn.au/orders/ Follow us on Twi er @hep_sa or Facebook @Hepa sSA

ALL services & resources FREE

Full range of syringes and needles. Water and filters also available in limited quantities for free.

FUNDED BY SA HEALTH, BROUGHT TO YOU BY HEPAT

Viral Hepatitis & Blood Safety Education

Cartoon by theAwkwardYeti.com, used with permission

FREE ONLINE

Feel safer around blood, and better able to as patients living with viral hepatitis.

Session includes: Overview of hepatitis A, B & C (some HIV Overview of testing and treatment Transmission risks & myths Best practice after blood exposure Post-Exposure Prophylaxis Available Come to Hep SA’sservices Lunch & Learn: •

Stuck for a Lunch Date?

LastFree session for 2024 lunch time session MON 29 JULY 2024 • 12.30-1.30PM FREE lunch-time session

TFeel U E Ssafer 1 7 Saround EPT 20 24 • 12.30-1.30PM ( blood R I 1 others NOV 2 0 2 4with • 1 2viral . 3 0 -hepatitis 1.30PM (A and learn how toFhelp living WED 11 DEC 2024 • 12.30-1.30PM (A Wed, 11 Dec: 12.30–1.30pm (ACDT)

bookings via https://www.trybooking.com/CRLCC or the Q

Bookings via trybooking.com/CRLCC or scan the Qr code: 2

HEPATITIS SA COMMUNITY NEWS 103