Hep Review 53

For 14 years, travelling together down your hep C road Virus busters Prison hepatitis C infections Ring of truth - advice on body piercing Drug users hard lessons tools to teach doctors Dependence may be combatted by single treatment The Hep C Review

Edition 53

June 2006

1

editor’s intro

Council keyhole

H

ello readers and welcome to Edition 53 which comes to you following a reasonably busy period here in the Hep C Council office. This busyness seemed in part due to the previous edition being a month late - making this edition seem rather early - but also due to the volume of work on our hands.

We don’t make a big effort to highlight the level of work we carry out here at the Council but recent discussion in the online forum Hep C Australasia (see p38) about the place and role of Hep C Councils has emphasised the importance of updating readers about our work.

You may not be overly interested in, or support, each particular type of project work we undertake - this is understandable as no group of people totally agree on all things at all times.

As an organisation, we have always taken a partnership approach and simply by reading this magazine we become partners. As in any relationship, good communicaiton and a bigger-picture awareness of the scope of our work will improve the partnership.

From this edition onwards, you will find articles describing our project work: Council Keyhole (right), a regular column drawn from one of our activity reporting mechanisms. In this case, it takes the slant of how we work with ‘self management’ Connecting with Young People (p31), a full page article that overviews our work aimed towards younger people and specifically, those who are at greater risk of HCV infection.

As is our ongoing aim, we have tried to provide an interesting hepatitis C read. We hope that you will find it so.

SELF MANAGEMENT Taking a particular slant - in this case, self management - this new column provides a keyhole view of some of the Council’s work over the past few months. In no way does it represent the scope of our week-to-week work.

Hep C Helpline workers discuss the importance of self management with the vast majority of callers. There is a particular focus on healthy eating, alcohol management, exercise, rest, stress management, herbal and complementary therapies, suggestions for managing symptoms, promotion of regular GP check ups and discussion of management/ treatment options with GP/ Specialist, and the usefulness of staying abreast of new developments. An important aspect of self management is mental health, and where appropriate, Helpline staff will have a supportive discussion with callers about ways to improve and maintain their emotional health and wellbeing, as well as how to access support from family, friends or professionals.

The Education and Development Team routinely delivers information on self management issues within our standard education sessions which are run primarily with health care, AOD, and community workers. Information is provided on complementary therapies, treatment, diet and exercise, alcohol, harm reduction and safer injecting, the psychosocial effects of HCV and general lifestyle factors. We also cover aspects of hep C symptoms management and the management of treatment side effects.

Self management has always been a popular topic amongst HepLink members. The March 2006 HepLink Forum was dedicated specifically to the topic of self management and quality of life issues for people living with hepatitis C. Presenters included a naturopath, gastroenterologist and a social researcher, who each presented about self management related issues from their own specialty perspective.

Articles related to self management are regular inclusions in The Hep C Review. Recent articles have included articles about diet and exercise, alcohol, diabetes, complementary therapies, and symptoms and side effects management.

Paul Harvey Editor

An example of self managament promotion within our resources is our recent booklet, I Have Hep C what might happen to me?

HAVE YOU BEEN DIAGNOSED WITH LIVER/HEPATIC DISEASE? ARE YOU:

• • • •

Male Female Aged 18 – 65 years Willing to participate in clinical research trials?

You will be paid for your time and inconvenience Please contact: James Lance, GSK Medicines Research Unit Prince of Wales Hospital, Randwick Ph: 1800 475 475 (1800 GSK GSK) email: volunteers.4.trials@gsk.com

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The Hep C Review

Edition 53

June 2006

This 2005 resource is targeted at people with hepatitis C and includes a strong emphasis on the importance of teamwork between the individual and her/his health care providers. The resource also highlights the importance of the individual ‘owning’ their health issues and taking a proactive, positive and informed approach to dealing with those issues. It provides people with a general guide to the sorts of self management approaches they could give consideration to based upon an estimation of their illness progression.

Hep C and Food – Developed in collaboration with dieticians from the Albion Street Centre and the Royal Prince Alfred Hospital (part of the HepNut project).

We produce a range of Fact Sheets covering such topics as complementary therapies, side effect management etc., with our latest factshee, Hep C Symptoms, due for imminent release.

HCCNSW

Calling all members

The Hepatitis C Council of NSW is an independent, community-based, non-profit, membership organisation.

We are funded by the NSW Health Department.

Hep C Review editor: Editorial Committee:

Tim Baxter Teresa Clonan Paul Harvey Louise Houtzager Stuart Loveday Yvonne Preston Lisa Waller

Look for your special Membership Page inside (page 40).

Our 2006 membership year began on 1 March we look forward to continuing to receive your renewals.

It’s now easier than ever join or renew online www.hepatitisc.org.au or use the enclosed form.

Paul Harvey

HCR medical & research advisors:

Dr David Baker Prof Bob Batey Prof Yvonne Cossart Prof Greg Dore Prof Geoff Farrell Prof Sue Kippax Prof Geoff McCaughan Dr Cathy Pell Dr Ingrid van Beek Dr Alex Wodak

S100 treatment advisor:

Mick Turner (AGDHA)

Proof reading: Prue Astill Glenda Clementson Thuy Van Hoang Liz Roberts Emma Ward MARLTON comic by Andrew Marlton

Seeking your personal story Personal stories provide a very valuable balance to the many information articles that we carry in each edition.

Overwhelmingly, they are written by people with hepatitis C but can be just as interesting when telling the story of family members or friends - the lived experience of health care workers would be equally interesting.

email:

Published articles attract a $50 ‘prize’

•

Author’s name and contact details must be supplied (for editorial purposes but need not be included in the printed article)

•

Articles should be between 400-800 words

•

Whether a submitted article is published or not is at the discretion of the Editorial Committee.

•

We seek diverse viewpoints, although articles considered unnecessarily inflammatory or vilifying will not be published

•

The deadline for contributions to the ED54 article writing competition is 24 July 2006.

We’re really looking forward to receiving your articles.

ED

02 9332 1853

fax:

02 9332 1730

hccnsw@hepatitisc.org.au

website:

www.hepatitisc.org.au

postal address:

PO Box 432

DARLINGHURST NSW 1300 AUSTRALIA

Please consider writing in with your story..

•

phone:

Hep C Helpline:

1800 803 990 (NSW) 9332 1599 (Sydney)

Aside from HCCNSW editorial comment, views expressed in this magazine or within flyers enclosed with it are not necessarily those of the Hepatitis C Council of NSW. Neither are such views necessarily those of our funding body.

Contributions to The Hep C Review are welcomed and are subject to editing for spacing and clarity. Contributors should supply their contact details - although we do not publish such details unless asked. We’re happy for people to reprint information from this magazine provided that The Hep C Review and any particular author/s where such exist are credited, and the edition number and date are highlighted.

This permission does not apply to graphics or cartoons. Many of these are not subject to public domain and must not be reprinted without permission of original artists/publishers. If you have any doubts, please contact us.

ISSN 1440 - 7884

The Hep C Review

Edition 53

June 2006

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contents News Drug Action Week

5

Black Cohosh reactions spark warnings

5

Needle exchange stoush

6

Fast track for oral protease inhibitor

6

Waffle House to pay ex-cook $50k

Restrictive criteria may deny treatment to US drug users

43

Hepatitis C treatment difficult in older people

43

Albumin prevents liver complications in cirrhosis 44 Saliva-based HCV test developed

44

7

Thalidomide’s possible role with chronic hepatitis C

45

Disgraced doctor practicing in NSW

7

Lighter patients with liver cancer fare better

45

Indian health care workers have more hep C

7

Lack of evidence of sexual transmission

46

ACT gets grant for treatment support

7

Tattooing and piercing resources available again

8

Hepatitis C virus load and survival among US injecting drug users

46

Increased blood-borne illnesses in Iran

8

Immune restoration disease

46

Hep C not an issue for most Maitland tattooists

8

$10m for survivors of tainted transfusions

9

Extrahepatic immunologic manifestations in chronic hepatitis C

47

Australia’s drug policy has failed

9

Transmission of HCV to several organ and tissue recipients from an antibody-negative donor

47

Motor rally world mourns Great Mehta

10

Lords debate blood inquiry calls

10

US inquiry into body-snatchers

10

Spontaneous HCV clearance more common than previously thought 48

Hep C harm minimisation posters now available 11

Liver fibrosis serum panel markers evaluated in chronic hepatitis C

Features

Hepatitis C among injecting drug users on opioid replacement therapy 49

Community & stakeholder consultations – strategic directions for your Council 12

Interferon protein predicts hepatitis C treatment response

Ring of Truth

13

Hello Hep C Helpline

14

Domestic medical injections threaten millions of world’s poorest

15

Infectious diseases in prisons in Central and Eastern Europe

18

Methadone for prisoners ‘saves money’

19

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49

My story Blood blues

21

Heal thyself

34

Access and quality of hep C treatment

37

Promotion

Dental health report is a big opportunity for Premier

20

Hep C Australasia

38

Virus busters

22

Hep C Review online index

39

Drug users’ hard lessons become tools to teach doctors

24

Volunteering at the Hepatitis C Council NSW

39

Connecting with young people

31

The Australian Hep C Lounge

39

Addiction may be combatted by single treatment strategy

The Australian Trial in Acute Hepatitis C

39

33

Nothing changes if nothing changes - the 7th Rural Victorian Alcohol & Drug Conference

41

NSW Northern Rivers liver clinic support group

41

Opinion The silent infection: Should we be testing for perinatal hepatitis C?

16

Prison hepatitis C infections: A time bomb for all 17 A radical Canadian concept

26

Harm reduction: dispelling the myths

30

Research updates Description of a hepatitis C outbreak in a cancer clinic

23

45-year follow-up of people who contracted HCV as young adults 32

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The Hep C Review

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Regular pages Council keyhole - self management

2

Letters

5

Membership news

40

A Council profile - Emma Ward

42

Interferon-based therapy

50

Complementary therapies

51

Support / info services

52

Noticeboard

54

Membership form

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letters

SOUTH COAST GREETINGS I relocated to far south NSW over two years ago to attempt a lifestyle change to assist in ‘control’ of my liver degeneration rate.

By the time you read this, I will have made my way off to Canberra, liver ready, to begin Interferon treatment.

One note I wanted to raise is that with the numerous blood tests, it seems the primary form of diagnosis and treatment monitoring, could an article providing a biochemical explanation of the activity of ALTs etc. be too much to ask?

Perhaps there is a website that stores this information but I don’t have a computer, no funds to pay for connections and for me, finding info takes a long time.

If you can be of assistance, it may assist others as well as yours truly.

news DRUG ACTION WEEK 2006 Australia - Drug Action Week, an initiative of the Alcohol and other Drugs Council of Australia (ADCA), is a national week of activities to raise awareness about alcohol and other drug issues and to promote the achievements of those who work to reduce drug related harm. The week also aims to promote public debate about good practice strategies for reducing drug related harm.

The momentum behind Drug Action Week is the hundreds of people who volunteer their time and energy to hold events. It is their involvement that makes it such a successful and important week on the national landscape.

Drug Action Week includes activities that inform and involve communities, educators, individuals, the media and politicians to reduce drug related harm in Australia.

Sun 18 June

launch day

Mon 19 June harm minimisation Tues 20 June treatment

Trev, NSW

Wed 21 June prevention Thur 22 June Indigenous Peoples Fri 23 June

workforce

Thanks for your letter, Trev.

Sat 24 June

closing day

We have an article that you would find helpful and we will run it in the upcoming edition. In the meanwhile, I suggest you call the NSW Hep C Helpline (p3) and they will explain the different parts of a liver function test result form.

Regarding internet access, we carried a promo article in the last edition about a community scheme that aims to provide discounted exgovernment computers and cheap internet access to people who’s household budget can’t stretch that far (ED52, p38).

For more information, visit www.drugactionweek.org.au

BLACK COHOSH REACTIONS SPARK WARNINGS Australia - Warnings that black cohosh may cause liver damage will soon appear on products containing the herb, which is widely used to treat menopause symptoms.

The Therapeutic Goods Administration plan to add package warnings about the risk follows 47 international reports - including nine Australian cases - of serious hepatic reactions to the herb, a Federal Health Department spokesman said.

Four patients required liver transplantation, and serious cases had occurred in people after less than a month's use of the product and did not appear to be doserelated, he said.

The warnings come as German research confirmed a combination of black cohosh (Remifemin) and St John's wort led to a 50% reduction in reported menopause symptoms compared with 20% for placebo, and a reduction in depression scores by 42% compared with 13% for placebo.

Associate Professor John Eden, director of the Sydney Menopause Centre and head of the natural therapies unit at the Royal Hospital for Women, said the warnings were an over-reaction because millions of women took black cohosh - and liver problems occurred in less than one in a million.

Abridged from Australian Doctor, 10 February 2006.

Hope this helps and good luck with the treatment.

ED

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June 2006

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news NEEDLE EXCHANGE STOUSH

FAST TRACK FOR ORAL PROTEASE INHIBITOR

Australia - A needle and syringe program in Manly, Sydney, has been described as ‘‘hideous’’ by Cr Pat Daley, who wants it moved to Manly Hospital.

USA - Schering-Plough recently reported that the US Food and Drug Administration (FDA) has granted Fast Track designation to its investigational oral hepatitis C protease inhibitor (SCH 503034), currently in Phase II clinical development for the treatment of chronic hepatitis C virus (HCV) infection.

He told a Manly Council meeting he wanted to see a special unit formed at the hospital to tackle drug issues and mental health.

He said Manly RUSH on Pittwater Rd, a centre which provides injecting equipment and other public health initiatives, should also be moved to the hospital. ‘‘We should take the opportunity to have a wide ranging review of all services on the peninsula, including the hideous facility RUSH,’’ Cr Daley said.

But Cr Brad Pedersen described Cr Daley’s views as ‘‘extremely paranoid’’. ‘‘It’s a very good facility which provides a good service.

There is no doubt the spread of serious diseases including AIDS and hepatitis C would increase without this,’’ Cr Pedersen said. ‘‘Are we simply keeping people on methadone, on drugs and exacerbating the mental health problem on the peninsula?" he asked.

Cr Daley said RUSH could be relocated at the hospital under structured supervision and users could be taken there on the council run ‘Hop, Skip and Jump’ bus.

But Mayor Peter Macdonald said Cr- Daley should be ashamed of himself for constantly attacking drug programs in Manly. ‘‘It is so important to have these in our community,’’ Mr Macdonald said. ‘‘It is proven that needle exchange programs and methadone clinics are best located discretely in the community.’’

A Northern Sydney Central Coast Health Service spokeswoman said RUSH did assess and refer clients to drug treatment programs and ran education projects in addition to the needle and syringe program.

Abridged from The Manly Daily, 21 April 2006

Fast Track designation allows FDA to expedite review of drugs and biologics for serious or life-threatening conditions and which demonstrate the potential to address unmet medical needs.

The proposed first indication for SCH 503034 is for treatment of HCV in people with HCV genotype 1 virus who have not responded to combination therapy with pegylated Interferon and Ribavirin.

SCH 503034 is an active inhibitor of the hepatitis C virus serine protease. This mechanism is distinct from those of current therapies, thus SCH 503034 represents a novel class of HCV inhibitor.

SCH 503034 has demonstrated potent antiviral activity and was well tolerated, both as monotherapy and in combination with PEG-INTRON® (PegInterferon alfa-2b), in Phase I clinical studies in people chronically infected with HCV genotype 1 who were nonresponders to previous therapy, including PegInterferon and Ribavirin combination therapy.

Results of Phase I clinical studies with SCH 503034 were presented at the 56th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) in November 2005.

Based on the results of the Phase I clinical program and extensive preclinical safety and pharmacology studies, Schering-Plough is conducting a large, randomized Phase II dose-finding study involving 300 people worldwide.

This study evaluates the safety and efficacy of SCH 503034 in combination with PEG-INTRON, with and without added Ribavirin, for 24 or 48 weeks in people with chronic HCV genotype 1 who were non-responders to previous PegInterferon and Ribavirin combination therapy.

The primary objective of this study is to determine the safe and effective dose range of SCH 503034 in combination with PEG-INTRON in this population. A secondary objective is to explore whether or not Ribavirin provides an additional benefit when combined with SCH 503034 plus PEG-INTRON.

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Abridged from http://biz.yahoo.com via www.hcvadvocate.org

news ACT GETS GRANT FOR TREATMENT SUPPORT

WAFFLE HOUSE TO PAY EXCOOK $50K

Australia - The ACT Hepatitis C Council has been awarded $75,000 towards a pilot program offering treatment support for people with hepatitis C.

USA - Waffle House owners have agreed to pay $50,000 to settle a lawsuit stemming from the 2004 firing of a cook. The restaurant was accused of unlawful employment policies and practices, violating the Americans with Disabilities Act of 1990 and the Civil Rights Act of 1964 when it fired the cook because of his hepatitis C, according to court documents filed in the US District Court in Jackson.

Feedback from people with the hepatitis C virus (HCV), health professionals and community workers in the ACT highlighted the need for a comprehensive counselling and support service for people seeking HCV treatment.

Treatment is often lengthy and isolating and treatment specific information is confusing and difficult to access. Because of the stigma and discrimination of having HCV, people may be reluctant to disclose and often cannot share their experiences with family or friends until the later stages of the disease which then has enormous economic and social consequences.

Research shows that treatment support programs for other blood borne viruses, where people have early access to counselling and peer support, decrease the long term economic impact for the healthcare system.

The ACT Hepatitis C Council proposes that a pilot program that will be trialled over a three year period and will explore evidence for a sustainable treatment support program for people with HCV and be a model for other states and client groups. People with HCV will have access to peer support through a confidential mentoring service coordinated and staffed by peers.

ACT Hep C Council

While in this case the hepatitis C was not disabling, the law protects those "who are actually disabled, have a record of being disabled or are regarded as disabled as defined by the act," said the Equal Employment Opportunity Commission, which sued on behalf of the cook.

In court documents, the commission said the restaurant regarded the cook as disabled when the franchise fired him. The company denied the allegations, but settled to avoid "the additional expense and delay in the litigation of this case," according to court records.

"It would be fair to say that the restaurant ownership took what they felt was appropriate action (when firing the cook)," said Joe Manuel, attorney for Waffle House. "The government disagreed, and we resolved (the case)."

INDIAN HEALTH CARE WORKERS HAVE MORE HEP C India - Health care workers may get infected by the hepatitis C virus if precautions are not taken in disposing needles and other contaminated materials, according to a new study which found that prevalence of virus was almost double in health care workers in comparison to general population.

Seventy to eighty per cent of the people infected by HCV are likely to develop chronic hepatitis C, which may lead to liver damage and cancer if not properly treated, experts said.

"In our study, the seroprevalence (presence of factors in blood which indicate presence of hepatitis C virus) in health workers was found to be considerably higher than in the general population," scientists from the Department of Medicine, Maulana Azad Medical College, who carried out the study, said.

Health officials determined it was unnecessary for anyone working with the cook at the restaurant to be tested for hepatitis C, Manuel said, nor has any customer "ever reported (being) sick from eating at the restaurant."

Abridged from www.indiadaily.com via www.hcvadvocate.org HCV Advocate note: This report is from India. In the US the prevalence of HCV among Healthcare workers is around 2% which is the same as the general US population.

Abridged from www.jacksonsun.com via www.hcvadvocate.org Similar legislation exists in NSW and the rest of Australia and would apply if the same events happened here. ED.

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news TATTOOING AND PIERCING INFO RESOURCES AVAILABLE AGAIN

HEP C NOT AN ISSUE FOR MOST MAITLAND TATTOOISTS

Australia - The Commonwealth Department of Health and Ageing has recently funded the reprinting of three key resources: the brochures Healthy Body Art, Healthy Procedures for Body Piercers, Healthy Procedures for Tattooists.

Australia - Everyone who visits Maitland’s State of the Art Tattoos shop is treated the same - whether they suffer from the liver infection hepatitis C or not.

With the current and growing popularity of tattoos and piercing, the new supplies of these resources is timely and welcomed.

The resources can be viewed on the website: www.hepatitisc.org/resources/inforesources.html and in NSW are available via the NSW Hep C Helpline: 9332 1599 (Sydney callers) or 1800 803 990 (other NSW callers).

Supplies of the resources are also available directly from the Commonwealth. Phone 1800 020 103, extension 8654 to place your order.

HCCNSW

Iran - The growing number of injecting drug users in Iran is fuelling an increase in transmission of blood-borne viruses, Mohammed Mehdi Gooya, head of the Ministry of Health and Medical Education's disease management office recently reported.

The country is taking steps to address injecting drug use.

Under Iranian government-sponsored programs, health workers distribute clean syringes and provide methadone treatment to heroin users. In Tehran, the local administration is providing needles to hundreds of inmates who formerly shared syringes.

According to the ministry, there are 137,000 injecting drug users. The ministry previously had said about 20,000 people in Iran were HIV-positive. Gooya also said about 64% of HIV cases occurred through injecting drug use, and the rate of drug use is increasing by about 8% annually.

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Abridged from AFP/YahooNews, 19 April 2006 via www.dailydose.net

The Hep C Review

However, not everyone feels this way.

A Victorian anti-discrimination case has ruled that it was reasonable for a tattooist to refuse a job because the customer admitted he or she had hepatitis C. Lee Little is one of a number of tattooists who said tattooing a person with hepatitis C was no longer a problem.

“Basically we treat everyone who walks through this door as if they have hepatitis C,” Mr Little said.

“Of course we follow health regulations to the letter and no-one ever leaves our business with an infection because we are so careful.

INCREASED BLOOD-BORNE ILLNESSES IN IRAN

With health regulations stricter than ever before, Maitland tattooists are confident of tattooing most people regardless of their hepatitis C status.

Edition 53

June 2006

“We are also right up on sterilisation procedures so really there is no problem for us to tattoo someone with hepatitis C. “These days there are more infections from body piercing.”

Mr Little, who has been a tattoo artist for the past 20 years and now works at Maitland’s State of the Art Tattoos, said health regulations had changed dramatically during recent years.

He said most tattooists were extremely diligent when it came to health and skin care.

“Everything is really strict now, compared to say 15 years ago, and a lot of tattooists have cleaned up their acts which is good,” he said.

Abridged from The Maitland Mercury, 28 April 2006 The Victorian case, mentioned above, involved an apprentice tattoo artist and a prospective customer who disclosed he was HCV and HIV positive. For more information on the fuller issues around tattooing in Australia, see ED52, p13 and ED50, p22.

Ed

news $10M FOR SURVIVORS OF TAINTED TRANSFUSIONS NZ - The New Zealand government is about to make a $10 million back down in the bad blood scandal.

It will include Prime Minister Helen Clark making a public apology and a payout to 170 people with haemophilia who were infected with hepatitis C from contaminated blood products in the 1980s and 1990s.

An outline of the proposed compensation package was signed a few days before last year's election, after the Haemophilia Foundation threatened an embarrassing leaflet-drop to thousands of voters in key electorates, highlighting the government's broken promises.

It contained a letter by then opposition health spokeswoman Annette King in 1999, promising a "fair and speedy settlement" if Labour was elected.

AUSTRALIA'S DRUG POLICY HAS FAILED Australia - Our national policy on illicit drugs has failed and the emphasis should be shifted from law enforcement to treatment and prevention, an Australia Institute study has found.

Institute deputy director Andrew Macintosh said the report he authored had concluded Australia's Tough on Drugs policy had failed to significantly reduce domestic drug markets or confront drug-related mental health disorders.

The report called on governments to shift the emphasis in dealing with illicit drugs from law enforcement to treatment and prevention strategies.

"The issue of drug dependency needs to be confronted as a health rather than a legal problem," Mr McIntosh said in a statement.

"Four out of every five state and federal dollars allocated to dealing with illicit drug issues are going to law enforcement.

In 2000, the government set aside $7m in compensation, but the tight criteria meant only three of the 172 affected people with haemophilia were eligible.

"This hugely disproportionate spending of funds has not been accompanied by significant reductions in drug use and drug-related harm but it has been accompanied by increased mental health and other social problems.

A foundation spokesman warned King at a public meeting of the planned leaflet drop targeting her electorate and those of Finance Minister Michael Cullen and Prime Minister Helen Clark.

"Treatment, on the other hand, has been shown to substantially reduce drug and mental health problems and drug-related crime and corruption."

Urgent meetings ensued and within days, a basic settlement package was hammered out, and the Foundation withdrew its threat.

On the eve of World Haemophilia Day tomorrow, the foundation has revealed the proposal's details, which the Ministry of Health said this month would be finalised by October but would then need to be passed by cabinet.

It will include a formal apology from Clark, who was health minister during much of the period of the scandal, compensation of up to about $60,000 a person, improved treatment and welfare, a one-stop shop at Accident Compensation Corporation for claims, financial help with legal fees and funding for the foundation.

Haemophilia Foundation president Dave McCone said the government had at last acted fairly and compassionately.

Abridged from www.stuff.co.nz/

Mr McIntosh said studies had shown treatment was extremely cost effective, yielding savings of up to $12 for every dollar invested.

He said the Council of Australian Governments strategy to address mental health issues should adopt a treatmentoriented approach to drug dependency rather than the counterproductive stance currently espoused by the federal and several state governments.

"We are coming at the problem from the wrong way.

Eighty per cent of drug arrests in 2003-04 involved consumption offences and 60 per cent were for using or possessing cannabis.

"This is back-to-front thinking. Users are at the end of the line.

"Moreover, the statistics show that legal threats are not deterring them. Prevention and treatment programs within a health context hold far more promise."

The report found strict drug law enforcement policies had failed to dent illicit drug markets and had exacerbated the social cost of illicit drug use.

Abridged from The Age, 5 March 2006, via www.dailydose.net

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news LORDS DEBATE BLOOD INQUIRY CALLS UK - Hundreds of victims of one of the worst medical disasters in the history of the NHS are taking their fight for a public inquiry to the House of Lords.

Many who contracted HIV and hepatitis C through contaminated blood transfusions in the 80s are struggling financially.

Andrew Evans, from Birmingham, was born with haemophilia and became HIV positive from a contaminated blood product at five-years-old.

He and others are demanding millions of pounds in government compensation.

Mr Evans said he developed AIDS at 16 and was frequently in hospital for four years undergoing a hip replacement and treatment for pneumonia and a stroke.

"The side effects of taking HIV medication every day is akin to taking low-dose chemotherapy for the rest of your life. You can imagine that can have a devastating effect," he said.

A one-off payment of £20,000 (AUD$49,940) was made to Mr Evans by the government and then when court action was threatened in 1991 he said he and other patients were advised to settle as they were not expected to live until the end of the trial. He received £21,000 (AUD$52,430).

Margaret Unwin, chief executive of The Haemophilia Society, said 4,800 people had contracted either hepatitis C or HIV through blood supplies bought by the NHS from US companies.

She said 1,250 had HIV and only 300 of those people are still living.

"The compensation is not adequate for people's needs and there has never been a public inquiry into what happened," she said.

The Department of Health released a statement earlier this year which said: "the government of the day acted in good faith, relying on the technology available at that time ... therefore we don't feel a public inquiry would provide any real benefit to those affected."

The House of Lords is to debate a renewed call for a public inquiry.

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Abridged from http://news.bbc.co.uk via www.hcvadvocate.org

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June 2006

US INQUIRY INTO BODY-SNATCHERS USA - Long time Tampa residents Jeffrey King and his wife Nancy are living a nightmare. Jeffrey is getting a blood test next week to find out if he has HIV, hepatitis, or syphilis.

"Of course I'm nervous," he told Action News. "I mean, we're talking about a disease that I could possibly transmit to my wife."

"It's emotional for me to see what he's going through, and it's emotional for me if I allow myself to think really long and hard about what does this hold for our future?"

Nancy offered.

Jeffrey King, a 46 year-old businessman, is the first potential bay area victim of a nationwide scandal. Four men are charged in New York with cutting up corpses, stealing body parts without checking for disease, then selling them to tissue and bone processing plants, two of which are near Gainesville.

In October, Jeffrey had a cadaver bone implanted in his jaw because a rotted tooth had damaged his jawbone. A month later, his dentist told him the bone was among those stolen.

And, his dentist said, three other bay area patients also have stolen parts implanted.

"There are potential victims right here in the Tampa Bay area, and God only knows how many more victims there are in the Tampa Bay area," Jeffrey continued.

Jeffrey King is among hundreds of people nationwide who could be walking around with a potentially deadly disease. He came forward after seeing Matthew Schwartz's report Tuesday night.

"I wanted to come forward because it totally upset me. I know there's a lot of people out there. There may be a lot of people out there that have no idea that they have these bones," Jeffrey said.

Jeffrey has a blood test kit, but has been afraid to use it.

"It's been sitting on my dresser for a month. And I'd look at it every day and I'd think, 'Do I really wanna know?'

And then my mind says, 'You need to know.' " Now, Jeffrey says, his blood test is scheduled for next week.

Abridged from www.abcactionnews.com via www.hcvadvocate.org

news MOTOR RALLY WORLD MOURNS GREAT MEHTA Africa - THE East African motor sport fraternity is mourning the death of Ugandan-born rally driver Shekhar Mehta who died in London on Wednesday.

Mehta who was born in Lugazi 62 years ago died of hepatitis 'C'.

Shekhar Mehta is famed for winning the Kenya Safari rally a record five times, four of them consecutively. He won the world's toughest rally in 1973, one year after his family shifted to Kenya to flee Idi Amin's murderous regime. But, when Mehta won his first Safari, Amin wrote him a congratulatory message saying "as far as I am concerned, Mehta's victory was for Uganda and not Kenya."

Mehta went on to win from 1979 to 1982. His other biggest achievement was finishing second in the ParisDakar rally with Mike Doughty in a Peugeot T16.

Mehta has been FIA (Sport) vice president and FIA rally commission chairman.

"It is a big blow for Africa," former FMU president Jack Wavamunno said yesterday.

"The last time I spoke to him, he told me to call him again on his Nairobi phone number but when I called his phone was off. I later learnt that he fell sick," the Ugandan rally ace said.

HEP C HARM MINIMISATION POSTERS NOW AVAILABLE Australia - The Hep C Review magazine centrespread poster set, aimed for targeted use by NSP, AOD and youth workers across NSW, were recently launched by the Hepatitis C Council of NSW. The posters target people who use illicit drugs in the hope that if they begin injecting - or are already injecting their drugs - they will become aware of the dangers and be better placed to avoid those dangers.

The glossy A2 posters convey health promotion messages that are drawn, with thanks, from existing AIVL resources.

Tim Baxter, a graphics and design artist who has considerable experience working with at-risk youth has created the colourful and vibrant designs that carry the messages and deliver them in an eye-catching and effective manner.

The posters are available free to health care, AOD, NSP and youth services in NSW only. For more information about the posters, or to discuss ordering them, please contact the NSW Hep C Helpline (see p2).

HCCNSW

Abridged from http://allafrica.com/ via www.hcvadvocate.org

Our resident cartoonist MARLTON “tells-it-like-it-shouldn’t-be” in the lead-up to October’s national hep C awareness campaign; focusing in 2006 on self-management.

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COMMUNITY & STAKEHOLDER CONSULTATIONS – STRATEGIC DIRECTIONS FOR YOUR COUNCIL We report back on the lead up work towards the Council’s strategic planning, and our recent Quality Improvement accreditation review. ery many thanks to those of you who contributed to our recent survey, interviews and focus groups where the Hepatitis C Council of NSW sought your views on our activities and future directions in our advocacy and services approaches over the coming four years to 2010.

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a continued focus on prevention and skilling up of the health workforce

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raising the profile of hepatitis C as a chronic disease and re-positioning hepatitis C so that possible funding sources are expanding

The Council engaged RPR Consulting to carry out this detailed consultation process and we are delighted that the Council has got a resounding “thumbs up” from both our affected communities and stakeholders regarding our methods of operation and the work that we do.

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using an evidence-based approach to the development of policy and working to develop coordinated approaches between agencies on key policy questions

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possibly broadening the role of the Council to encompass all forms of hepatitis.

The written survey was sent directly to people on our mailing list and participants were given four weeks to reply. By the cut-off date of early April, 280 responses had been received. Additionally five in-depth telephone interviews were conducted with service providers who are key stakeholders both with the Council and our affected communities. An in-depth face-to-face meeting took place with representatives of our primary funders, NSW Health and two focus groups of service users and with service providers were held.

The findings of this consultation will contribute extensively towards the revision of the Council’s current strategic plan and they will form the basis of both our strategic direction for the next four years 2006-2007 to 2009-2010 and to our two-year business plans within that period.

The feedback from both the stakeholder and community interviews and the survey was very positive, indicating a high level of support for the Hepatitis C Council of NSW and our work. Resources, such as the NSW Hep C Helpline, The Hep C Review and the website were highly regarded and research collaboration and education initiatives were well received.

The Hepatitis C Council is generally considered to be committed, responsive and organised, which allowed an excellent level of advocacy and engagement with the community.

Opportunities for the future development of The Hepatitis C Council of NSW and its activities centred on:

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shifting community perceptions of hepatitis C

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more work with Aboriginal communities and with people from culturally and linguistically diverse backgrounds

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increasing access to and uptake of treatment, including redefining service delivery models

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We shall be placing the detailed report on these consultations on our website: www.hepatitisc.org.au Management Committee, staff, volunteers and C-een & Heard speakers will join in a planning day in June 2006 that will take account of the findings of this consultation process and a new strategic plan will emerge soon after that time.

Once again, our sincere thanks to those Council members, healthcare workers and other members of the affected communities who gave their time to contribute to our planning review.

Continuous quality improvement – the recommendation to remain accredited Alongside the Hepatitis C Council’s strategic consultation exercise, we have recently gone through a very detailed external examination by reviewers working on behalf of Quality Management Services, the agency charged with overseeing continuous quality improvement (CQI) which ensures the Council’s internal and external processes and operations are sufficient to meet the national standards that lead to accreditation.

We are pleased that the reviewers report that the Council has met all national standards and are recommending commendations in five areas.

Accordingly we are pleased to report that the reviewers will be recommending ongoing accreditation of the Hepatitis C Council of NSW using the Australian Health and Community Service standards, first achieved in July 2003.

HCCNSW

feature

Are you considering getting your body pierced? Helen Wellings provides advice on how to do it as safely as apossible.

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Body piercing is a booming industry - all sorts of people are showing off rings, studs or bars that have been inserted in upper ears, eyebrows, necks, lips, tongues, nipples or navels.

Expect bleeding, bruising, discolouration and/or swelling after a piercing. Alarm bells should ring if swelling, bleeding, weeping, redness or tenderness worsens or lasts for more than a few days.

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Infections are often due to piercing done in unhygenic conditions or poor follow-up care.

Before you take the plunge, consider these points.

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Make sure your piercing studio is licensed to operate.

Check it meets minimum health requirements and has passed a health inspection.

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Make sure that sterilised needles are used. It’s important that the studio has a sterilising unit. This guarantees the removal of all bacteria and bloodborne viruses from piercing tools.

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Piercers should be qualified and experienced. Look for certificates or plaques on the wall and ask to see a photo portfolio of previous work.

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You should be given an after-care sheet with instructions to prevent infection.

Don’t be shy to ask questions and do as many checks as you need. After all, it’s your money and - more importantly - your health that is at stake.

iercing used to be confined to the earlobes, with the piercing of any other body part frowned upon. How things have changed!

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Prices vary enormously, depending on where you go and the difficulty of the job.

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For ear piercing, expect to pay from $20 to $50, including standard studs. You’ll need to buy antiseptic spray - about $12. The sky’s the limit for the price of earrings.

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Piercing other body parts generally costs more. Expect to pay from $45 to $130. Studs are usually extra so ‘buyer beware’. Many body parts are sensitive and can be prone to infection.

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Tongue, lip and cheek piercing have been blamed for speech impediments, breathing problems, increased tooth decay and broken teeth.

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Scar tissue has been known to form around nipple piercing causing breastfeeding problems.

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Overseas research has linked ear tissue loss with infected ear cartilage piercing.

Image courtesy of google or yahoo images

By Helen Wellings (abridged from New Idea, 28 Jan 2006) For additional information and advice, contact the NSW Hep C Helpline (p14), or download body piercing and tattooing brochures from www.hepatitisc.org.au/resources/ inforesources.html

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“Hello Hep C Helpline” is brought to you by the Hep C Helpline team. The questions are based on genuine calls however some details have been changed to ensure caller anonymity.

I’ve had hep C for 15 years now and I am exhausted most of the time. I work from home. I try to keep myself alert with coca cola and I drink 3 to 4 cans a day. The fatigue is affecting my work and I don’t even have enough energy to walk the dog. How can I improve my energy levels?

Fatigue is a common symptom that is experienced by more than 50% of people who have hepatitis C. Many people find that if they make some changes to lifestyle and diet they are able to reduce their fatigue. Different things work for different people so it may be worth experimenting with some changes to see what helps and what doesn’t.

It’s recommended that people with hep C eat a well balanced healthy diet that is low in fat, to drink only low amounts of alcohol, if any at all, maintain a healthy body weight and have regular mild exercise (such as a brisk 30 minute walk every day). Reducing sugar intake and eating smaller regular meals may help to maintain more even energy levels. Speaking with your GP about the symptoms is worthwhile and consulting a dietician or nutritionist may help.

Some other things that might reduce fatigue include: •

Cutting down the amount of soft drinks you have, preferably replacing them with water, juice or herbal tea. Soft drinks usually contain a large amount of sugar. Some research has shown that high amounts of sugar could actually deplete the immune system. Everyone should try to drink at least 2 litres of water a day. Reducing drinks that contain caffeine can also help.

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Some herbal products such as milk thistle may help to reduce the symptoms of fatigue. Before taking complementary therapies, it’s advisable that you consult a naturopath and you could let them know you have a liver specific condition (this may be enough to tell them if you want to avoid disclosing about your hep C). The important thing is to ensure that any herbal products you take are not potentially harmful to the liver. It can be useful to tell your GP about any complementary therapies you are taking.

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Short naps during the day may help, but excessive sleep can make people feel worse. It can help to set specific sleep times to try to regulate the body clock.

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Try to plan the day’s activities around times when tiredness and fatigue normally appear. When energy is higher, complete extra tasks like cooking food in batches then freezing to eat later.

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Regular light to moderate exercise has been shown to be one of the best strategies for reducing fatigue. This might sound like a contradiction, but many people find it helps a lot.

It might be worth considering combination therapy if you haven’t already. The chance of cure where the virus becomes permanently undetected is 50-80%, depending on what genotype you have, so over half of people can be cured of hep C with treatment. If a person is cured then the symptoms caused by hep C, including fatigue, usually disappear in the months following treatment completion. The current hep C treatment is a combination of the drugs pegylated Interferon and Ribavirin. This medication has been around for many years but cure rates have improved recently and the sideeffects are less severe than they used to be. If you would like to discuss the treatment process further, then you could speak with your GP about a referral to a liver specialist.

Hep C Helpline

feature

In 1954, Becton, Dickinson and Company created the first mass-produced disposable needle & syringe for Dr Jonas Salk’s mass administration of one million American children with his new polio vaccine. Disposable syringes are now available across the world - although their misuse is causing concern about spread of blood-borne viruses and disease. illions of people in poor countries get sick and die from a common tool for getting well: the hypodermic syringe. In some countries, most injections are done with needles that are reused without sterilization. Twenty-one million people each year get hepatitis B this way, two million get hepatitis C and 650,000 get infected with HIV.

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the percentage of injections with reused needles declined in Burkina Faso from 55 per cent to four per cent.

As third-world health problems go, this one seems solvable. Single-use syringes, whose plungers break or are blocked after first use, cost about 6 cents apiece.

Countries could simply follow the lead of Botswana and Uganda and ban all other kinds of syringes.

The Safe Injection Global Network, backed partly by the World Health Organization, is trying to help countries develop educational programs for health care workers and doctors. The Bush administration also works on injection safety as part of its AIDS efforts overseas. But more needs to be done, particularly since such a small amount of money can save so many lives.

But nothing is ever simple in places where health care is disorganized and threadbare. The biggest problem is that many poor countries are injection-crazy. For every injection given as a vaccination, 20 are given as cures.

Many injected medicines are snake oil, and even effective injections are mostly unnecessary, as a pill would work just as well. But patients demand injections because they think the medicine is stronger, and health care workers like to give them because they can charge more.

The most direct course is to ban reusable needles. But in countries spending $10 a year per capita on health care, 6 cents a shot is a lot when a traditional syringe can be reused some 200 times.

Abridged from www.nytimes.com via www.hcvadvocate.org

It is hard for governments to change dearly held beliefs about medicine. Dirty needles kill many years after a shot. In some places, it took a health crisis to bring progress. In Romania, people became aware of the problem of unsafe injection after children in orphanages had been given contaminated blood and vaccinated with dirty needles, resulting in the infamous wave of AIDS infection.

In Burkina Faso, a severe meningitis outbreak helped, paradoxically, by producing an extreme shortage of medicines and syringes. This led the government to reform its medical-supply system.

Small pharmacies stocked with essentials including single-shot syringes now exist in health posts throughout the country. From 1995 to 2000,

Image courtesy of google or yahoo images

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By Winita Hardikar, Elizabeth J Elliott and Cheryl A Jones

screening for HCV. However, other national bodies recommend selective testing for HCV infection in pregnant woman with identifiable risk factors (eg, intravenous drug use, tattooing, body piercing, needle sharing, or receipt of blood products or invasive procedures overseas or before 1990 in Australia).

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erinatal transmission of hepatitis C virus (HCV) is the main source of newly diagnosed paediatric HCV infections in Australia. About 5% of infants born to women who are positive for both HCV antibody and HCV RNA during pregnancy will acquire HCV infection.

It is estimated that 1%–2% of women of childbearing age in Australia are infected with HCV. Assuming that 75% of these have chronic hepatitis and viraemia in the third trimester of pregnancy, we would expect about 75–100 new cases of vertically acquired childhood HCV infection in Australia per year.

However, rates reported from national laboratory data and from the Australian Paediatric Surveillance Unit are much lower, suggesting that paediatric HCV infection may be under-recognised in Australia. We thus recommend a more standardised approach to identification and follow-up of infants exposed perinatally to HCV. Why identify infants with HCV infection? Although most HCV-infected children have good health for at least the first two decades of life, HCV-induced chronic liver disease and liver failure have both been reported in childhood. As it is not possible to predict which children will develop severe liver disease, long-term monitoring of HCV-infected children is needed.

In addition, children identified as HCV-positive should be offered vaccination against both hepatitis A (after two years of age) and hepatitis B. Superinfection of HCV-infected individuals with hepatitis A virus increases the risk of fulminant hepatitis and death, while coinfection with HCV and hepatitis B virus is associated with a higher risk of cirrhosis and hepatocellular carcinoma.

HCV-infected children with severe hepatic involvement should be offered antiviral therapy. Current treatment (pegylated Interferon-alfa & Ribavirin) successfully clear HCV in 40%–80% of HCV-infected adults, depending on the HCV genotype. Although data about efficacy in childhood is limited, treatment has been used safely and effectively in children. Identifying Australian children with HCV infection could also allow them access to novel therapies and ongoing international multicentre randomised controlled trials.

Why is HCV infection under-diagnosed in childhood?

Children with HCV infection may not be identified for several reasons:

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They are unlikely to attract medical attention, as most have no symptoms or signs of liver disease.

Consequently, their identification relies on careful follow-up of offspring from at-risk pregnancies.

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Antenatal HCV screening practices vary widely around the country, and therefore many HCVexposed infants are missed. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommends universal antenatal

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Appropriate methods of testing HCV-exposed infants and children are not widely understood, and national guidelines for testing and follow-up of offspring of HCV-infected mothers are not detailed or widely known to child health care providers. In children aged under 18 months, persistence of maternal antibody complicates the interpretation of HCV antibody tests, while in infants aged under about 2 months qualitative HCV RNA polymerase chain reaction (PCR) testing is insensitive.

How should we screen for vertically transmitted HCV infection? For diagnosing perinatal HCV infection, the most cost-effective strategy may be to screen offspring of HCV RNA-positive women. However, as HCV RNA levels can fluctuate in pregnancy, and as antenatal HCV screening practices vary, we recommend: Screening all infants born to women who are HCV antibodypositive, using HCV antibody and liver function tests, at 18 months of age or older. If results are negative, then the infant can be safely assumed not to have HCV infection. If antibody results are positive or liver function is abnormal, then the child should be referred to a paediatric gastroenterologist.

Testing infants who are considered unlikely to attend for 18month follow-up, using HCV RNA and liver function tests at three months of age, when they are more likely to be receiving local medical care. Those with positive HCV RNA results or abnormal liver function should be referred to a paediatric gastroenterologist. If both tests give negative results, we recommend repeating HCV antibody testing at age 18 months, as both viraemia and liver function indicators can be intermittent in HCV infection. HCV RNA testing for the diagnosis of vertically transmitted HCV infection (in isolation) is not an approved item on the current Medicare Benefits Schedule11 and costs about $90 (ie, six times the cost of HCV antibody testing).

Testing for HCV should be performed only after pre-test family counselling and with the consent of the infant’s parent(s) or guardians.

There is an urgent need to disseminate clinical practice guidelines in Australia for the screening, diagnosis and management of children born to women with HCV infection during pregnancy. Ongoing collection of national data on HCV infection in children is needed to document the scale of this emerging disease in the paediatric population, and the groups of children at risk of infection. Identification and referral of HCV-infected children will allow early initiation of therapy and monitoring of outcomes.

Abridged from Medical Journal of Australia, 2006; 184 (2): 54-55

opinion

Andrew Lloyd

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here’s a hidden danger lurking in Australia's prisons waiting for the chance to break out — and we're not talking about unreformed prisoners. The hepatitis C virus is incubating in our prisons at alarming rates, and poses a major health risk to all of us.

While it is of significant concern that one in 100 in the general community carries the hepatitis C virus, this pales in comparison to the situation in prisons where about one in three is infected with the virus.

The rate is highest among female prisoners and those who have injected drugs. They show infection rates of 50-70 per cent. Of those individuals who enter prison free of hepatitis C, about 10 per cent will become infected during each year of imprisonment. Prisons are crowded and often violent places where the virus is transmitted by blood-to-blood contact, including via injecting drug use, tattooing and fighting. Untreated, hepatitis C leads to slowly progressive liver disease which may ultimately lead to fatal liver failure and liver cancer.

Last year saw our highest-ever rates of incarceration, with over 25,000 people in prison at any one time (including almost 2,000 women) — meaning that between 7,500 and 10,000 prisoners are currently infected with hepatitis C. And the reality is that most of them will be released back into the community within approximately six months, with the potential for a slowly accumulating health care burden due to chronic liver disease. The economic and social cost to the Australian community of this silent epidemic incubating in the prison system is vast.

So what is being done about it?

Despite the best intentions by some in the health and prison sectors, the answer has got to be "not nearly enough".

While the National Hepatitis C Strategy released last year acknowledges the additional problems associated with providing diagnostic and treatment services within prisons, a nationally co-ordinated response to dealing with hepatitis C in prisons is long overdue. This issue was a major theme of the 5th Australasian Viral Hepatitis Conference held in Sydney in February 2006.

Currently, each state and territory has its own rules and approaches, varying from very limited prevention or surveillance activities and no treatment services in most states, to the reasonably developed and integrated hepatitis C service provided by Justice Health in NSW. The positive outcomes of treatment for inmates with hepatitis C provided in NSW prisons by this service were also presented at the conference — this may well provide a benchmark for the other states.

One of the most controversial suggestions to minimise the ongoing spread of hepatitis C in prisons is piloting needle and syringe exchange programs for injecting drug users in prisons. Successful trials in Europe have shown that these don't automatically lead to increased injecting drug use or added safety risks to prison staff. Similar trials deserve to be given a go here. However, there is fierce opposition from many quarters.

Other proposals include better health education and counselling for prisoners, and improved access to screening and treatment services. Whatever approaches are taken, the basic goals need to incorporate both prevention and treatment components.

The Australian National Council on Drugs has said that "failure to reduce the risk of hepatitis C and other bloodborne viral infection transmission in prisons severely undermines the work being conducted in the community with injecting drug users."

With the death rate from hepatitis C-related illnesses predicted to more than treble by 2020, there is a strong case for our prisons to be transformed immediately from incubators of the disease to model settings for effective prevention and treatment.

Failure to do so will continue to put the health of the whole community at risk.

Andrew Lloyd AM is professor of infectious disease at the University of NSW and a visiting medical officer for Justice Health NSW. Abridged from www.-theaustralian.news.com. via www.hcvadvocate.org

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Part one of an ongoing series of articles from the Canadian HIV/AIDS Legal Network that provide a perspective on what is happening in Central/Eastern European prison systems.

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Hepatitis C seroprevalence Hepatitis C (HCV) prevalence rates in prisons are even higher than HIV prevalence rates. A 2004 review of prevalence and incidence in incarcerated populations worldwide found HCV seroprevalence rates ranging from 4.8 percent in an Indian jail to 92 percent in two prisons in northern Spain. In prisons in Ukraine, rates of up to 95 percent were found in early 2005.

Most HCV-positive prisoners come to prison already infected, but the potential for further spread is high. HCV is much more easily transmitted than HIV, and transmission has been documented in prisons in several countries.

Worldwide Many other countries report high rates of injecting drug use behind bars. Typically, injecting drug use decreases in prisons among prisoners who were users on the outside.

However, prisoners are more likely to inject in an unsafe manner when they do inject. Studies have therefore concluded that imprisonment increases the risk of contracting HIV infection. The following are data from some recent studies:

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A 2002 report prepared for the European Union found that between 0.3 and 34 percent of prisoners in the European Union and Norway injected while incarcerated; that between 0.4 and 21 percent of injecting drug users started injecting in prison; and that a high proportion of injecting drug users in prison share injecting equipment.

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In Canada, 11 percent of 4285 federal prisoners participating in a survey of prisoners reported having injected since arriving in their current penal institution. In some regions, up to 23 percent of prisoners reported injecting drug use.

Drug use Despite the sustained efforts of prison systems to prevent drug use by prisoners - by doing what they can to prevent the entry of drugs into prisons - the reality is that drugs can and do enter. Many prisoners come to prison with established drug habits and often find a way to continue drug use on the inside. Some prisoners start using drugs inside. No country has been able to stop drug use, including injecting drug use, in prisons.

Central and Eastern Europe and former Soviet Union A number of studies have provided evidence of the extent of injecting and other drug use in prisons in the region.

The following are some examples:

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In a study performed in 2000 at 10 penitentiary institutions in the Russian Federation, 10 per cent of the surveyed prisoners reported at least one injection of illegal drugs during imprisonment, with nearly two per cent of the total prison population injecting on a regular basis. Two thirds of those who injected drugs in prison also admitted needle-sharing.

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In a study undertaken in a number of prisons in Ukraine in early 2005, a significant number of prisoners admitted to injecting and to sharing injecting equipment in prison.

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In Tajikistan, one third of the prisoners who reported ever having injected also reported injecting drugs in prison.

Tattooing In prison, tattooing is a social activity and involves sharing needles, which makes it risky. In a study conducted in the Russian Federation, tattooing in prison was reported by 26 per cent of prisoners with 62 percent sharing tattooing equipment. In Canada, 45 percent of federal prisoners reported having had a tattoo done in prison.

This ongoing article is abridged from a series of factsheets from the Canadian HIV/AIDS Legal Network - www.aidslaw.ca

Image courtesy of yahoo or google images

feature

Methadone programs in the nation's jails save taxpayers much more money than they cost and should be dramatically expanded in every state, experts say.

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study by drug researchers found that giving strictly controlled doses of methadone to inmates addicted to heroin not only cut re-offending rates but also cost a fraction of the considerable expense of locking up prisoners for a year.

According to the analysis, said to be the world's first costefficiency study of a prison methadone program, treating one inmate with methadone for one year costs $3,234.

As the cost of locking up an inmate is about $176 for just one day - or about $64,000 a year - methadone programs in jail pay their costs for a whole year if they cut a prisoner's subsequent jail time by just 20 days.

The study was conducted by the National Drug and Alcohol Research Centre and the Centre for Health Economics Research and Evaluation.

Co-author Kate Dolan said a previous NDARC study had found that if inmates were in methadone treatment for at least eight months, the proportion sent back to jail within a year of release was 23 per cent. The proportion was 97 per cent among prisoners who had not been given access to methadone while in jail.

Most states already have methadone programs in jails, but some are extremely restricted. Ms Dolan said none were big enough to meet demand and called for their urgent expansion. Of the 8,000 inmates in NSW, about 4,000 had a heroin problem at the time of sentencing, she said. Of those in jail, 2,000 inmates injected heroin, but just 1,000 were on a methadone program.

"Ideally, (methadone programs) should be available for everyone who needs them, but I'm being realistic - I know how hard it is (to increase them)," she said. "If we could get to 2,000 ... that would be fantastic."

A spokesman for NSW Health Minister John Hatzistergos said there was "nothing to suggest there is significant unmet need" for methadone programs in the state's jails.

Statistics compiled in 2004 by the Australian National Council on Drugs, the Prime Minister's official advisory body on drug policy, showed some other states, particularly Queensland, had far lower rates of methadone treatment in jails than NSW. Just 45 prisoners out of a total Queensland jail population of 4,721 had methadone treatment in 2003-04; less than one per cent.

ANCD executive officer Gino Vumbaca backed the NDARC call for methadone programs to be expanded, but said other therapies, such as counselling and drugfree rehabilitation, should be made available.

"We would assume there's more than one per cent of Queensland's prisoners who have a drug problem," he said.

"If you are going to spend $60,000 a year to put someone in jail, you might as well spend a couple of extra grand to treat their drug problem."

Abridged from The Australian, 17 April 06, via www.dailydose.net

Ms Dolan called for the NSW jail methadone program to be expanded from 1,000 inmates to at least 1,500.

Artwork above by Soudabeh Ardavan, downloaded with thanks from http://www.iranian.com/Arts/2002/September/Ardavan/9.html

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Having hepatitis C can affect our dental health - which heightens the importance of this current opportunity for dental health care reform.

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he Council of Social Service of NSW (NCOSS) has suggested that the May/April release of the NSW Upper House Inquiry into oral health could herald major improvements across NSW. "This inquiry is an opportunity for NSW Premier Morris Iemma to show strong and decisive leadership by helping to extend dental care to all the people of NSW," said NCOSS Director, Gary Moore.

“For ten years, the health care of NSW citizens has had a vital part missing. By addressing the glaring inequity in dental care, Premier Iemma could dramatically improve the health of our state.”

“The Iemma Government can no longer pass the buck to the Commonwealth Government. One of the worst examples of poor health policy today is the ongoing separation of the oral health of individuals from all other aspects of their health care.

“Those who are ineligible to use public dental treatment are seeking pain relief and antibiotics from GPs, which places a further financial strain on people who are already struggling to make ends meet.”

“During a recent consultation with rural communities a dentist informed NCOSS about one of his patients who had an abscess on his gum. The decay has gone all the way to the root of his tooth. He could not get an appointment at a public clinic because it wasn’t swollen and it didn’t bleed. He had to have his tooth removed.”

“Many public dental patients are faced with a broad range of issues that impact on their oral health. This includes poor education, large housing stress, access to healthy food, and other chronic conditions”

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In addition, according to Dr Chris Wilson, of the Australian Dental Association of NSW, ”chronic underfunding has resulted in a system rapidly losing the capacity, infrastructure and staff to deliver critical dental services.”

“National research demonstrates that the oral health problems experienced by people living on low incomes are worsening. The inequality between those that can afford to go to the dentist and those that can’t is getting far worse.”

Burnside’s Chief Executive Officer, Jane Woodruff also believes that poor access to adequate dental service leads to ever-worsening dental health.

“In the research for our submission to the NSW Upper House Inquiry into Dental Services, we came across people who had undergone numerous extractions and young people in their 20s who were missing teeth and needing dentures.

“Abscesses, chronic pain, ulcers, chipped teeth, bleeding gums and migraines resulting from poor dental health were reported by many of the respondents.”

“Some of the people we spoke with were concerned that having poor teeth would make it hard for them to get jobs. Who would employ someone with missing teeth?” asked Ms Woodruff.

“By providing dental health care to all NSW citizens, I’m sure Premier Iemma would see many more smiles,” added Mr Moore.

NCOSS press release

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article writing competition

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y name is Julie and I am a 43 year old woman who contracted hep C 18 years ago through a blood transfusion.

It happened when giving birth to my daughter, Sarah. I had suffered a haemorrhage and was given contaminated blood from Wollongong Hospital.

I chose Bulli Hospital to give birth as it was smaller and more personal but after 18 hours of labour, delayed placenta and an eight and a half pound baby girl, I began to bleed. As the blood was in the main hospital (Wollongong) I received the transfused blood from there.

A few days later I was sent home. Two or three days after that, I haemorrhaged again and was rushed directly to Wollongong Hospital. My situation was serious and my family were called in as I was not expected to last the night. A priest was summoned in the case that my last rites would need to be administered. After many attempts to stop the bleeding, a hormone therapy finally worked.

Weeks later I received a letter from Wollongong Hospital telling me that the blood I'd received had been contaminated with hepatitis C. Being totally ignorant about hep C, I ignored the news and carried on breastfeeding and caring for my newborn daughter.

I lapsed into ignorance of my hep C and my rights for six years when I collapsed. After tests, my doctor found hep C was the cause but I remained in the dark about treatments, the Hep C Council, compensation, my rights, etc. as my doctor failed to inform me about them.

Now in my 40s, I am feeling the full effects of the disease. I have lately found out that I was entitled to compensation but left it too late - even though I explained that I had been unaware of my rights.

I have been left on sickness benefits. I approached two doctors here in my local town asking for advice about treatment and alternative therapies. I spoke to a local dietitian but she said because I did not live in the city (Sydney), I may not have any access to help.

Adding salt to the wound, when I did become aware of my rights, I contacted a local solicitor who carried out some preliminary work on my case. I was of the belief that it was a "No gain, No payment" arrangement but a bill arrived in the post for $700, two hundred of which was a charge from my doctor for 'services provided' and I haven't even got copies of my medical records yet.

Julie, NSW

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Last century viruses killed more people than both world wars combined. Viruses are still a challenge for medicine, and this century is starting out to be no different. The good news? We might have finally found a way to fight back.

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here’s an absolutely amazing system that’s just come to light in the last three or four years. The system is called RNA interference, or RNAi for short. It’s the most important breakthrough in science since the discovery of the structure of DNA. RNA interference is a way that cells can switch off the genes that cause disease. It’s a natural process and is happening right now inside just about every cell in our bodies.

Researchers worldwide have been trying to harness this natural defence system to target the genes of viruses like HIV and hepatitis C with pinpoint accuracy - and shut them down.

The mice were genetically modified with a combination of genes that basically allow them to emit light, it’s basically the same thing as a firefly.

Placing the mice in a special light emitting chamber then lets you scan and track where the hep C virus is going in the body of the mouse? It basically shows where it is in the body of the mouse, and how much virus is still left in the liver.

One mouse that had no RNAi treatment showed up with its liver-full of hep C virus glowing.

The mouse that had the RNAi treatment showed that the glow from its liver disappeared completely.

It was only a few years ago that scientists believed this builtin ability to switch off genes only happened in plants. That all changed when Australian biologist Mick Graham saw something that others hadn’t seen before - he showed that RNA interference worked in animals as well.

Prof Mark Kay, genetic therapist at Stanford University, explained this shows that the RNAi is knocking out a specific gene that potentially could be detrimental if it was in humans.

“I could see ... how it could be manipulated but more importantly if this was going to exist in animals I could see ... this would be so powerful.

It starts with the DNA inside our cells, the double spiral molecule that stores genetic information. DNA in each of our cells makes RNA, a single-stranded message that carries its instructions to different parts of the cell. But sometimes those RNA messages are faulty. RNA interference is a natural defence system, like floating shredding machines that check the RNA messages and destroy the faulty ones, in effect switching off bad genes.

As an example of the RNAi in play, researchers infected five laboratory mice with the hepatitis C virus and tracked the progress of the virus with a tag that makes the mouse livers glow in the dark.

So we know it could work - but how would it work?

When viruses hijack a cell, they force it to make genetic messages from their own RNA, which can get past the cell’s checking system.

Now here’s the clever bit: if scientists can introduce harmless pieces of faulty RNA that actually mimic parts of the virus RNA, the cell will recognize both as something to get rid of.

So the next time a virus invades, RNAi swings into action.

Enzymes chop up the dangerous virus genes and disable the invader.

When scientists first realised that this was going on in a cell, it was just without precedent, said Mick Graham. The insight opened up a new frontier in medical research.

His company Benitec, founded in Brisbane in 1998, is now based on the other side of the world. Its sights are set on nothing less than curing hepatitis C and HIV-AIDS. But to road test RNAi and make sure it’s safe will take at least another decade.

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Abridged from a transcript from the ABC TV series, Catalyst. Full transcript of the episode can be found at: www.abc.net.au/catalyst/stories/s1619353.htm

Image courtesy of yahoo or google images

research summary DESCRIPTION OF A HEPATITIS C OUTBREAK IN A CANCER CLINIC Summaries for Patients are a service provided by Annals of Internal Medicine to help people better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician.

The summary below is from the full report titled "An Outbreak of Hepatitis C Virus Infections among Outpatients at a Haematology/Oncology Clinic." It is in the 7 June 2005 issue of Annals of Internal Medicine (volume 142, pages 898-902). The authors are A. Macedo de Oliveira, K.L. White, D.P. Leschinsky, B.D. Beecham, T.M. Vogt, R.L. Moolenaar, J.F. Perz, and T.J. Safranek.

What is the problem and what is known about it so far?

Hepatitis C virus (HCV) causes liver inflammation. The virus is most commonly transmitted when a person comes in close contact with infected blood, usually by being stuck with a needle, as in injecting drug use, body piercing, or tattooing. Outbreaks of HCV infection are unusual, especially in health care settings. In 2002, officials in Nebraska learned of a possible HCV outbreak involving 4 patients. The only common factor among these patients was treatment at the same cancer clinic.

The officials suspected that the patients somehow became infected from the treatment they received in the clinic.

Why did the researchers do this particular study?

To confirm that HCV was transmitted in the clinic, to determine how many people were affected, and to identify how it was transmitted.

Who was studied?

367 patients seen at the clinic between March 2000 and July 2001.

How was the study done?

What did the researchers find?

Slightly more than one quarter of patients became infected from treatment they received in the cancer clinic. All were treated on days when another patient who already had hepatitis C was also treated. The researchers discovered that a nurse often took blood from intravenous catheters using a disposable syringe. The nurse reused this syringe to take saline solution out of bags to flush the catheters. The nurse probably contaminated the syringe and saline solution with HCV from the patient who already had the infection and spread it to subsequent patients by flushing their catheters with contaminated saline. The outbreak ended when the nurse was dismissed and this practice was stopped.

What are the limitations of the study?

More than 200 patients had died of cancer before the study began, so the researchers could not identify all of the patients who were probably infected. Because the researchers did not take blood from clinic staff, they could not exclude the possibility that the infection was spread from workers to patients.

What are the implications of the study?

Reuse of disposable syringes in a cancer clinic caused a hepatitis C outbreak. The outbreak could have been prevented by using sterile syringes for each patient and not reusing contaminated syringes in saline bags. Careful adherence to simple infection-control standards can prevent many infection outbreaks. When those standards are violated, prompt recognition and correction of the violations are necessary to limit the spread of infection.

Annals of Internal Medicine (www.annals.org)

The researchers took blood from each of the patients for HCV testing. They interviewed the patients and clinic staff and looked closely at the patients' medical charts to identify possible causes of infection.

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feature

Marlana Reed and Geraldine Westcott were huddled in the corridor of a hospital in the Bronx, wrangling over who would be in charge of heroin and who should cover crack. After agreeing, they entered the conference room.

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t the head of a long table five first-year doctors on the other side focused the attentive stares they seemed to have honed in medical school.

"I know you all know about drugs through the books," said Ms Reed, whose face, prone to girlish grins, belies her 48 years. "But we're here to tell you the real deal from the street."

So began the seminar.

In the Albert Einstein College of Medicine's residency program at Montefiore Medical Centre, substance dependency training may include lessons from those with firsthand experience. Since January, three pairs of patients, called Peer Educators, have come monthly from among five methadone clinics in the Bronx to lead 90minute courses for internal medicine interns through a program called Project GROW (Giving Resources and Options to Women).

"In med school, we get the chemical mechanisms of what drugs do to the body and how to treat it," said an intern, Dr Svetlana Korenfeld. "You can read about drug dependency, but if you've never seen it the way it really is, you won't recognise it."

Dr Hillary Kunins, GROW's founder, and Dr Melissa Stein, who coordinates the interns' substance dependency education, also attend the sessions to add information from a physician's standpoint. But the Peer Educators provide nuances that statistics and medical jargon miss. For instance, in a recent seminar, Dr Kunins mentioned that crack smokers face an increased risk of hepatitis C from sharing pipes.

Ms Westcott explained: "Say if you're in a hurry to get that hit. The glass might pop and you cut the skin, or you burn your mouth because the stem is too short."

A crack binge, she added, often results in scorches on smokers' thumbs, from use of cheap lighters.

One intern, Dr Alexander Han, said he was clueless about such things — despite having treated many people with substance dependency in his first months of practice. "When I look back, they definitely did have a lot of skin chafing," he said. "I wasn't too sure what it was, and so I let it be. Burn marks in the mouth? I'd never thought to look for that."

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In 2000, Dr Kunins began directing a methadone clinic in the Bronx and fretted that though her patients were at risk for health problems like HIV, they often avoided medical care besides their once-a-day methadone stop. A few years later, she founded GROW, offering HIV riskreduction education, counselling and escorts to doctor's appointments. She knew, however, that the patients still faced a medical culture that speaks a different language than they do and is not well equipped to serve them.

With Dr Stein's help, she began organizing seminars to bring women from GROW to instruct interns so they can better understand drug-related health issues.

The course material strays from the curriculum the doctors have seen before. The Peer Educators lecture and field questions on street lingo, how to find and use drugs, and what being high and withdrawal are like. "How long does crack last?" asked Dr Christina Tseng, an intern.

"That first hit is tremendous," Ms Westcott said. "After that, you just chasing it until the money is gone."

Dr Tseng wondered what a doctor could have done to help them stop using.

"Don't be judgmental, because a drug user figures everybody's watching anyway," Ms Reed said, adding that users are not likely to ask for help outright. "You gotta kind of read in between."

In many of Ms Reed's seminars, she explains how heroin can be bought in abandoned buildings. "There are these holes in the wall, and you put your hand in the hole and they put the stuff in your hand," she said. "The last time I put my hand in that wall, somebody put cuffs on it from the other side."

In more than 20 years of using drugs, Ms Reed said she experienced incredible highs. But memories of the lows — including being arrested and fearing for her baby after using drugs during pregnancy — will not go away even though she has not used heroin for more than a decade.

Now, she gains satisfaction from her tumultuous history by sharing valuable information with doctors who have spent many of their years in classrooms.

"It makes me feel good to know something they don't," Ms Reed said. "Today, that is my high."

According to Dr Kunins, GROW's main purpose is to give these women the tools to care for their own health. "But they have this expertise, and if they can transmit that to the doctors," she said, "then we can improve the system."

feature

e corridor of a hospital in the Bronx, wrangling over who k. After agreeing, they entered the conference room.

Dr Kunins and Dr Stein say what distinguishes their program from similar ones that connect drug users with clinicians is that these women assume the role of expert.

"We don't present the participants as patients, we present them as teachers," Dr Stein said. "They often don't share personal experience very much. It's a different dynamic than the testimonial model."

GROW provides its Peer Educators with a $20 stipend and transportation to seminars. The interns are getting a deal, too, said Dr Richard Saitz, the president of the Association for Medical Education and Research in Substance Abuse.

"Learning factual information from someone who is an expert on their own disease would be something that they will remember for a long time," Dr Saitz said from his office at Boston University, where he works to raise substance abuse awareness among health professionals.

Not only is this kind of training rare, Dr Saitz said, but substance dependency training for residents is also lacking overall. He cited a broad, government-financed survey, published in 2000, with more than 1,200 residency program directors responding. Only 56 percent required substance dependency training of any kind, he said.

Dr Saitz believes that number is too low.

"There's no word for educational malpractice," he said, "but to not train people in drug dependency when you're training them for HIV or hep C reduction is ridiculous."

And that is where Ms Reed and Ms Westcott are making a mark. "Unless the patient was specifically admitted for overdose or withdrawal," Dr Han said after the seminar, "I would usually just ask routinely, 'Do you smoke, use alcohol or drugs?' and then move on. Now I think we know a lot more questions to ask."

Ms Reed said that she hoped her students would use their new skills with care. After all, she said with a grin, "If I go to a doctor and they have more street knowledge than I do, I might feel a little shaky about that doctor."

www.nytimes.com via www.hcvadvocate.org

Image courtesy of yahoo or google images

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opinion

Here in Canada, we have a national wheat board and several provincial egg and milk marketing boards. They, in effect, try and stabili So, why not a marketing board for opium in Afghanistan, not to sustain the crop but to eventually abolish it, even while supporting th his is John Ralston Saul's idea. It is not as wacky as it sounds. In fact, it makes a whole lot more sense than the failed Anglo-American-Canadian drugeradication effort in Afghanistan.

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The Americans are in a bind. They are told by the Hamid Karzai government that cracking down too hard on farmers will only increase hardship and make them more anti-American.

Canadians know Saul as a contrarian, a man of big ideas.

Author of such acclaimed works as Voltaire's Bastards and his current best-seller, The Collapse of Globalism, he went to Afghanistan twice, accompanying his wife, then governor-general Adrienne Clarkson.

In a way, this has already happened. The Taliban are getting stronger because farmers do not want to cooperate with the foreign troops who would only deprive them of their livelihood.

Like anyone who goes there, he was seized with how opium permeates the Afghan legal, economic and social infrastructure.

Afghans took to the cash crop in the 1990s when the economy had crashed after the United States and other allies abandoned Afghanistan once the Soviet occupation had been overturned.

It was the Taliban which, using their draconian methods, eliminated the poppy crop, winning kudos from the United Nations and the United States.

Once they were toppled, however, the poppies bloomed again. In a further irony, the current crop is being sustained by the Taliban to finance their insurgency.

Production is up 40 per cent over last year. The expected yield of 4,000 tonnes would constitute about 87 per cent of the world's supply. The cash yield may be about $3 billion U.S., representing nearly half the Afghan GDP. The narcotics trade employs one in 10 Afghans (2.3 million people).

Since most of the consumption is in Europe and North America, where governments can no longer control consumption, they have aimed their eradication strategy at the source.

But for having spent $1 billion in Afghanistan, the Americans and the British have managed to reduce production by less than four per cent.

"The US spent more than the entire national budget of Afghanistan to accomplish essentially nothing," writes Richard Holbrooke, the former US ambassador to the United Nations.

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The Taliban are not the only culprits. Some of the warlords who are allies of the Americans also benefit handsomely from the trade.

Caught in the middle of this maddening muddle are the Canadian troops in Kandahar, which is the centre of the drug trade. Are they part of the US anti-drug drive?

Last fall, the Canadian defence minister Bill Graham said: "We do not see the military role as involved in the eradication of drugs. That's very much a police function.

We create the conditions of stability that enable them to do their jobs. If troops were to get involved in that, it raises a lot of other concerns about operations that would not be appropriate."

Yet Gen Rick Hillier has been singing a different tune.

Drug eradication is part of what our soldiers do because, he said, poppies are "a weapon of mass destruction."

Is that just his usual US-style bombast or does it represent a clear shift in policy?

Meanwhile, a Vienna-based think-tank, Senlis Council, has proposed that the Afghan farmers be allowed to grow opium under licence for painkillers. Even if that were to happen, it would entail a small acreage.

At the other end are those who advocate the decriminalising of drugs, arguing that it is the illegality of opium etc. that drives up the prices and introduces all the criminality.

Enter Saul, without taking political sides.

In the 1970s, he supported the idea of buying up the entire world crop and just burning it. But the flaw in that solution was that farmers would have to be paid in perpetuity for not planting.

opinion

eral provincial egg and milk marketing boards. They, in effect, try and stabilise farmers' incomes. not to sustain the crop but to eventually abolish it, even while supporting the farmers?

A better Canadian idea, he said in an interview, would be to explore "realistic alternative crops," and have an Afghan marketing board set a price at double the price of poppies, and also guarantee the farmers that you would buy their entire production.

"You are not talking about a gigantic sum of money," given that farmers don't get paid much for the poppies.

Most of the drug money is made downstream in turning poppies into heroin.

You would start off with a small area of Afghanistan and expand to the entire poppy-growing regions.

Image Original courtesy image courtesy of www.google.com/images of google or yahoo images

Such an experiment would be far cheaper than the cost of fighting the production of opium there and the distribution of heroin in the West.

It would also be "ethically and morally sound," he said, both for the West and for the Afghans, who "would be put on the road to self-dignity and, ultimately, selfsustainability."

Abridged from The Toronto Star, 20 April 2006 via www.dailydose.net

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By Dr Richard Di Natale

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concrete evidence. Needle and syringe programs have been shown in a number of studies to decrease the transmission of HIV, hepatitis C and other blood-borne viruses.

It has been an enormous year for illicit drugs. A rise in opium production in Afghanistan, a global methamphetamine epidemic, a debate over the dangers of chronic cannabis consumption, and a number of Australians arrested overseas in high profile cases. Schapelle Corby, the Bali Nine, Michelle Leslie and most recently the tragic hanging of Van Nguyen mean that the issue of illicit drug use has continued to dominate the national agenda.

The evidence is also clear that drug substitution treatment (such as methadone and buprenorphine) to heroin-dependent individuals reduces the risk of overdose and has beneficial impacts upon health, employment and general well-being.

The evidence is also mounting that safe injecting rooms and heroin trials have produced positive outcomes for individuals and the broader community. The common retort that such measures "send the wrong message" or encourage drug use is simply not accurate. The published literature is clear and unambiguous on this point.

egal and illegal drugs cause harm. Responses that focus exclusively on reducing drug use have failed. On the other hand, harm reduction strategies can and do work.

There is no doubt that all drug use, both legal and illegal, has the potential for harm. There is the potential for overdose with illicit opiates such as heroin due to the unpredictable nature of the dose.

There is the risk of idiosyncratic and toxic reactions that, although rare compared with the frequency of drug use, can cause harm in some individuals. The sharing of needles, sadly still common among some injecting drug users, is associated with the transmission of blood-borne viruses such as HIV and hepatitis C. More recently the possibility of an association between chronic cannabis abuse and psychosis has been described, although this potential link requires further research. Finally, substance dependence can develop after frequent drug use (not after first time injection, as is sometimes assumed), which impacts negatively upon the lives of many people.

As a community we have a responsibility to implement measures that have been proven to reduce these harms and are based on the best available evidence. The harm reduction approach, which is a central tenet of Australia's response to illicit drug use, is just such a method. Harm reduction evolved in response to the rapid spread of HIV/AIDS among injecting drug users during the 1980s. It includes a range of strategies that aim to reduce harms to both injecting drug users and the wider community.

These harms include the social and economic costs of illicit drug use and HIV/AIDS, the legal costs associated with the justice system and the impact upon basic rights such as access to health care and social services. Harm reduction recognises that despite the risks associated with drug use and despite our best efforts, some people will not stop using drugs. Given this undeniable reality the primary objective of harm reduction is to reduce the harmful consequences of drug use, rather than focusing solely on reducing drug consumption and supply. The harm reduction approach includes a number of complementary strategies.

These include the provision of information and counselling to injecting drug users, the provision of drug treatment and drug substitution services, peer outreach programs and the provision, distribution and disposal of clean needles and syringes. More recently it has included access to safe injecting rooms and medically prescribed heroin to registered users. All of these approaches are supported by

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The introduction of harm reduction measures such as needle and syringe programs and safe injecting facilities is not associated with an increase in drug use. In the same way that we do not deny smokers access to treatment simply on the grounds that this would send the wrong message, we cannot and should not deny drug users access to interventions that save lives.

Some governments have replaced criminal penalties for cannabis consumption with a system of civil penalties. Their critics argue that such changes send the wrong message.

Again such arguments are unsupported by the facts.

Evaluation of similar models has shown that the adoption of civil penalties for personal cannabis use is not associated with increased use of the drug.

Another popular perception among critics of harm reduction is that these initiatives are extremely unpopular among Australians. Again the facts speak for themselves. Federal and state governments currently fund a number of harm reduction interventions (needle and syringe exchange, drug substitution etc.) throughout Australia and these have strong bipartisan support.

Interestingly, there was also significant public support in Australia for a heroin trial in the ACT in 1996, which did not go ahead only due to direct intervention from the Prime Minister. Harm reduction is an effective, pragmatic response to drug use. It reduces the harms associated with drug use, both to drug users and the broader community. Harm reduction does not increase drug use and it has the support of a significant segment of the Australian community.

To argue against harm reduction initiatives on the grounds of lack of effectiveness or that it sends the wrong message is simply to argue against some fundamental facts.

Dr Richard Di Natale is a public health specialist at the Australian International Health Institute (AIHI).

This article was abridged from Issues, 21 March 2006 http://issues.control.com.au/

Image courtesy of google or yahoo images

feature

The Hepatitis C Council of NSW recognises that young people at risk of contracting hepatitis C make up a critical part of the community and are a key target group for the focus of our prevention and harm minimisation efforts. In addition to our general liaison, support, education, and advocacy work and collaboration with peer agencies across the health sector, we currently have some vital initiatives specifically targeting young people.

What is Hep C? In 2001 the HCCNSW produced a cartoon-style low literacy prevention resource called What is Hep C and the Australian Hepatitis Council (AHC) based their 2005 booklet of the same name on this version. Unfortunately the AHC version is not approved for distribution in schools. The HCCNSW is in the process of updating and reprinting the NSW version for a targeted distribution project to schools. The resource will be promoted specifically to teachers who are responsible for teaching the sexual health, bloodborne virus (BBV) and alcohol and other drugs (AoD) curriculum.

Hep C bookmarks HCCNSW produces a series of bookmarks aimed at delivering short and simple HCV-related health promotion messages and promoting awareness of the Council. The initial print run of 85,000 have been distributed through local libraries, TAFE and university libraries and retail bookstores.

They have also been distributed to NSW public high school students. The first version focused on sexual transmission of HCV. The upcoming second version (which will also be promoted to NSW non-government schools) has a focus on tattooing and body piercing.

State wide hep C prevention stickers This 2005 hepatitis C prevention and early intervention resource, targeted at marginalised people who inject drugs, is a result of an ongoing partnership between the Eastern Zone of Sydney South West Area Health Service, the Youth Accommodation Association of NSW and the Hepatitis C Council of NSW.

The education resource - a series of stickers - is based on a 60 metre long mural in the Sydney suburb of Marrickville.

The mural was designed by young people from the local youth resource centre and local aerosol artists.

In consultation with young people, the images from the mural were adapted into a series of six stickers, and were extensively focus tested with youth to refine the messages and imagery and ensure the stickers were relevant and interesting. These stickers have been distributed state wide through youth health services, youth accommodation services, youth alcohol & other drug services, alternative education programs for young people, Youth Week events, the Hep C Helpline, as well as NSW needle syringe programs and sexual health clinics.

At risk youth Over the last two years we have developed a series of eight HCV harm minimisation posters aimed at young people at risk or already injecting drugs. Text in the posters is taken with permission and thanks from existing AIVL publications and the design work is contracted to Tim Baxter who works with young people in his work at the Kirketon Road Centre, a primary health care and NSP in Sydney's Kings Cross district.

The posters have formed the centre spread within our magazine, The Hep C Review, and are now being printed A2 size, full colour gloss, and being promoted and distributed to AOD, NSP, youth and sexual health workers across NSW. It is hoped that the posters will increase people's awareness of the harms involved in injecting drug use and help people to learn and adopt the behaviours that would lessen such harm. Funding limitations mean that the impact of the posters will not be evaluated but distribution will be monitored with a view to ensuring thorough and effective promotion and distribution to all relevant workers, agencies and communities.

Representation The HCCNSW is represented on advisory committees for three separate BBV prevention projects targeting young people: two research projects that are investigating interventions for people injecting drugs or at risk of injecting, and one youth service education project.

HCCNSW

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research summary 45-YEAR FOLLOW-UP OF PEOPLE WHO CONTRACTED HCV AS YOUNG ADULTS Summaries for Patients are a service provided by Annals of Internal Medicine to help people better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician.

This summary below is from the full report titled "45-Year Follow-up of Hepatitis C Virus Infection in Healthy Young Adults." It is in the 18 January 1999 issue of Annals of Internal Medicine (volume 131, pages 105-111). The authors are L.B. Seeff, R.N. Miller, C.S. Rabkin, Z. Buskell-Bales, K.D. Straley-Eason, B.L. Smoak, L.D. Johnson, S.R. Lee, and E.L. Kaplan.

What is the problem and what is known about it so far?

Infection of the liver with the hepatitis C virus can, in some cases, lead to severe liver disease. Little is known, however, about the outcome of hepatitis C infection over the long term. The drugs used to treat hepatitis C can cause side effects, are only partly effective, and are very expensive. Knowing how often serious liver disease actually results from hepatitis C infection would help in deciding whether widespread screening and treatment for hepatitis C is reasonable.

Why did the researchers do this particular study?

The researchers wanted to learn the long-term liverrelated medical histories of patients who had become infected with hepatitis C virus when they were young adults.

Who was studied?

8,568 military recruits at a Wyoming Air Force base who had had blood drawn between 1948 and 1954. The samples were kept frozen thereafter for almost 50 years.

How was the study done?

The researchers first tested the thawed blood samples for evidence of hepatitis C infection. Using computerised information from the Veterans Affairs Administration, the Health Care Financing Administration, and the National Death Index, they then tracked the medical condition of the recruits with and without hepatitis C infection between the time the initial blood samples were drawn, and December 1996.

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What did the researchers find?

Seventeen of the original blood samples from the 8,568 recruits tested positive for hepatitis C infection. Over the 45 years of follow-up, 2 of these 17 recruits (11.8%) with hepatitis C developed liver disease compared with 205 of the 8,551 (2.4%) without hepatitis C. Seven (41%) of the 17 recruits with hepatitis C had died by December 1996.

One died of liver disease, 5 of causes other than liver disease, and 1 of an unknown cause. Of the 8,551 recruits without infection, 2,226 (26%) had died by this time, 119 from liver disease.

What were the limitations of the study?

The accuracy of the hepatitis C test results in blood stored this long is uncertain. It is also possible that some study subjects who were free of the infection at the time the blood was drawn developed it sometime during the next 45 years. With only 17 persons identified with infection, the study had limited ability to say definitely whether liver problems were more common in people with hepatitis C infection than in people without it.

What are the implications of the study?

Serious liver problems may not develop very frequently over the years as a result of hepatitis C infection acquired at a young age. Liver problems do, however, appear to be detectable more commonly over time in persons who have hepatitis C than in those who do not.

Annals of Internal Medicine (www.annals.org)

feature

An international research team led by the University of Saskatchewan, Canada, has discovered a signalling pathway in the brain involved in drug dependence, together with a method for blocking its action, that may point to a single treatment strategy for most addictions.

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heir findings appear in the March issue of the prestigious journal Nature Medicine.

The team, led by Dr Xia Zhang, associate professor in the University of Saskatchewan (UofS) department of psychiatry, found that a naturally occurring enzyme known as PTEN acts on the part of the brain where many illicit drugs exert their rewarding effects - the ventral tegmental area (VTA).

"Our results suggest a potential universal strategy for treating drug dependency," Zhang says. "Most illicit drugs act on the neurons in this area."

He cautions that much work remains to be done before a treatment based on the discovery could be developed to help drug dependent people. This includes several years of further testing, including animal and, finally, human trials.

The team discovered that PTEN acts on these serotonin receptors, increasing brain cell activity. This is the same "reward" process sparked by drugs of dependency.

Armed with this knowledge, the team designed a molecule called a peptide, tailored to fit the serotonin receptors and block PTEN. When rats were treated with this PTEN-blocker, it shut down the drug reward process – including the process that induces craving and withdrawal.

The study, funded by the Canadian Institutes of Health Research and the Natural Sciences and Engineering Research Council, looked at nicotine and THC (the active ingredient in

marijuana). However, Zhang says the results could also hold true for other drugs such as cocaine, heroin, and even methamphetamine.

Zhang's UofS research team is part of the Neural Systems and Plasticity Research Group, one of several interdisciplinary health sciences research groups at the University.

The group, dedicated to the study of brain systems and how they change with experience, draws expertise from numerous departments across six colleges on campus.

Abridged from www.medicalnewstoday.com via www.dailydose.net

"We have our peptide, but there's a long way to go before a clinical application," he says.

"Dr Zhang's research is important to our understanding of drug dependency.

His work epitomizes how health research holds the key to improved health and quality of life for Canadians and people throughout the world," said Dr Rémi Quirion, Scientific Director of the Canadian Institutes of Health Research Institute of Neurosciences, Mental Health and Addiction.

Zhang, who worked with colleagues at the UofS, University of Toronto, and Vanderbilt University in Tennessee on the project, explains that VTA brain cells are sensitive to serotonin, a hormone associated with learning, sleep and mood.

Image courtesy of google or yahoo images

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article writing competition

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hrough my experience I would like to relay information that could benefit others.

Around two years ago I was diagnosed with hep C and, as one, who in the past has been a user and advocate of herbal medicine and alternate therapies I decided to go down this treatment path. With many stories regarding Interferon and Ribavirin therapy and its side effects I did not feel that this pharmacological treatment was right for me.

I visited a couple of naturopaths who prescribed standard anti-viral, liver cleansing and protecting herbs. No noticeable results. No reduction in liver enzymes.

Doctors were telling me to have a liver biopsy and seriously consider combination treatment. Naturopaths were telling me a biopsy was an invasive and quite dangerous procedure and that drug therapies were toxic.

Confusion struck an already distressed person.

I then found a naturopath who was doing research on hep C virus. With this background I thought I had found someone whose knowledge of treating my disease would be superior to the other practitioners. (Anyone who has been down a similar path to myself will understand the trials and challenges of weaving through the labyrinth of information about treatments and treatment methods.)

Anyway, I gave the practitioner copies of recent blood tests, including viral load, and advised how long I thought I had been carrying the virus. I was prescribed the same sort of liquid herbal tonic that had been given to me before by the other naturopaths, together with, large doses of antioxidant tablets and very high doses of milk thistle tablets. My liver enzymes were not coming down and after what I thought to be a reasonable length of time, around 12 weeks I asked if I should reduce the herbs and antioxidants. I voiced my concern at the still elevated liver enzymes and what may be happening to my liver.

I was advised not to stop this, that the elevated liver enzymes were indicative of a "healing crisis" and that these herbs and tablets were protecting my liver. I felt like a jigsaw puzzle and the pieces just weren't fitting together. Something just didn't feel right about loading my body with these tablets and tinctures and I was once again struck with a bolt of confusion.

Through the information gathering and experiential process of my journey with HCV, I now know that my already scarred liver was working far too hard to process the herbs and supplements and that the inflammation the "healing crisis" continued to produce was in fact leading to further fibrosis. The term healing crisis seems to be bandied around quite a bit by naturopaths.

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I think it means "things getting worse before they get better" but for how long does the practitioner allow the "worse" to continue!

We put our health in the hands of others with the hope that they will give relief to our suffering and trust they have the appropriate training, experience and diagnostic tools to assist in our healing process. I discovered one of these tools, not through a naturopathic practitioner nor by a medical physician, but through an email from America. It described a simple non-invasive caffeine breath test, which it said, gave similar findings to that of a liver biopsy. This email could not have come at a more appropriate time as I was truly losing faith in western naturopathic medicine.

The caffeine breath test takes about an hour and involves blowing into a tube, drinking a caffeine solution and then, blowing into another tube. The residue of the breath is then analysed and the information provides knowledge as to how well the liver is functioning. I had this performed at Concord Hospital, in Sydney.

My test revealed quite impaired liver function so I made the decision to have a liver biopsy. My need to know the exact status of my liver far outweighed my fear of the procedure. I had no problem at all with the biopsy in fact I took myself home by public transport four hours after it was performed!

The most important tool that any health care practitioner can have is that of diagnostics. Iridology can be used and the tongue can be assessed and there are others that complimentary therapists use but these techniques do not give accurate diagnosis.

Treatment decisions based on fact are far wiser than those based on assumption.

I changed the course of my direction and decided to go down a path that I previously declared I would never tread! I was equipped with information that allowed me to make an informed decision regarding my treatment The caffeine breath test confirmed what my inner wisdom was attempting to tell me and the biopsy confirmed the findings of the breath test. My liver was scarred and functioning well below normal. It was simply unable to process all the herbal extracts and vitamins without great effort. It was being taxed to the limit.

I had no idea that I had severely impaired liver function, nor in fairness, did the naturopaths who prescribed the herbs. It still, however, begs the question; should someone with chronic HCV be prescribed herbs and large amounts of other supplements without prior knowledge of the overall health of the liver?

article writing competition

Naturopathic practitioners treating liver problems would do their profession, and those seeking their help, a tremendous and maybe even life-saving service by providing information on the caffeine breath test. I'm sure there are many, many people who seek naturopathic help for symptoms of a "sluggish" liver when in fact the liver may be far worse than the naturopath or the person seeking an herbal remedy is aware of. Providing information on safe non-invasive medical procedures should be a part of a naturopath's strategy in preventing and fighting disease.

A person with advanced fibrosis or cirrhosis cannot afford to go through the naturopathic 'healing crisis" that leads to further liver inflammation!

I do not wish to offend those practicing herbal medicine.

I serve to enlighten not to disparage. The need to communicate my experience and express my personal opinions comes from a place of goodwill and genuine concern for others. I believe I raise some important issues that the universe is calling on me to deliver.

Image courtesy of Julie Parker: http://artbyjparker.com/index.html

I am now 16 weeks into a 48 week combination therapy program. Yes I have side effects. I am fatigued, headachy and dizzy. I have heart palpitations and dry mouth and eyes. I am also going through menopause. I get down at times and I'm never quite sure when I'll feel OK or when I'll feel yucky. It's the strangest thing the way the energies fluctuate and it makes it hard to plan ahead but I am now learning that it is important for me not to let my social life deteriorate.

The down feelings are not severe and it's alleviated when I am fully focused on a task or when I'm out with others.

My meditation practices help keep me balanced and give me understanding of my life journey.

Things are how they are at this point in my life. It's all just a temporary journey anyway. Clearance of this virus is what I seek to attain and if at times I allow myself to think only of what's best for me then that's quite OK! Doing what is best for the self is the wisest thing to do when going down this treatment path. I have used this time to cut from my life all that is not beneficial to my healing. It

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article writing competition

has included friendships that were based more on the occasional smokes of pot and glasses of red wine than on any real life interests. The act of cutting these ties liberated me from a past that was well beyond its use by date.

I suspect HCV invaded my body back in the experimental hippie days of my youth. It's been there for far too long nurtured by both an unbalanced and for a long time unhealthy lifestyle. It became active when my menopause started. My liver no longer cares to host this unwelcome parasite so I shoot it with guns of Interferon and bullets of Ribavirin. Chemical warfare is in progress and I can feel the battle within. It leaves me feeling exhausted and some days I just lay and rest. I will, however, emerge the triumphant warrior scarred yet transformed by the battle. My kind of hep C genotype is quite responsive to the treatment so I keep faith that the virus will be eradicated.

There's a karmic irony to all this. The treatment has me injecting myself. Syringe out weekly for a subcutaneous jab! It's the very damned thing that got me into this mess so many years ago. And the place where I had my first injection of the Interferon, well, it's that very same place where I first experimented with drugs! It was the weirdest feeling to inject myself again. Long forgotten visions emerged with the forces of karma returning to transmute the syringe of destruction into the syringe of restoration.

In ending I would like to give all of you on this journey my love, compassion, respect and understanding for the unique and individual way you all handle this disease.

Have faith that all in life is as it should be and use it to serve not only your own best interests but also that of others who suffer and are in need.

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Sharon, NSW

Image courtesy of Julie Parker: http://artbyjparker.com/index.html

writing competition

M

y hep C was caused by a contaminated blood transfusion. I didn't know straight away and it was discovered four years after my operation when a blood test showed my liver function test results were too high.

That helped explained my fatigue, I had more tests during the year and in the end was declared the proud owner of chronic hep C. I was diagnosed in 1992 and there was not much known about hep C and there definitely was no treatment that would get rid of the virus. I was of course upset. I felt contaminated, but then said "Oh well, I have to die of something".

I changed my way of eating as I discovered that fat didn't agree with me, neither very sweet things, red meat I didn't eat for a long time. I was lethargic and tired.

My GP referred me to a gastroenterologist who told me to have a biopsy. The verdict: mild chronic hep C. I think I was his first patient with hep C and also my GP's first.

They were both pretty excited and worried. Now, of course we know, that in most cases it is not life threatening .

Many years went by and I decided to have the PCR test done (at my own expense), result genotype 3A. I and my GP were pretty excited about it, as I had the type of hep C that was supposed to react favourably to the treatment.

Again a referral to see the specialist.

Hurray I thought. Now I might be cured and won't feel soooo tired any more. I know the treatment wouldn't be a picnic, but with the chance of a cure I was prepared to go through all the misery. But no, the specialist said the treatment would probably not work for me as I was too old.

Image courtesy of yahoo or google images

I suppose he saw I was disappointed and we discussed further my treatment options but at my age, overall, the treatment might have involved more inconvenience than benefit for me so I decided to forget about it.

The GP was also very disappointed and now I have decided to have no ultra sounds and blood tests anymore, what will be, will be! As I had no access to treatment I don't know how the treatment would have been, but when I had the biopsy the nurses and radiologist were all very friendly and caring. The next day a nurse rang to ask how I was feeling.

With my changes to food and eating, I feel better although I still feel a bit of fatigue. But I don’t have aches and pain and feel pretty lucky for a septuagenarian.

Margaret, NSW

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promotion

HEP C AUSTRALASIA an online support group for people affected by hepatitis C

H

ep C Australasia is a community-based internet discussion forum which aims to empower people affected by hepatitis C and provides a place to share ideas, opinions, support, tears and laughter.

Membership of Hep C Australasia is not associated with membership of the various Hepatitis C Councils and organisations in Australia or New Zealand.

Together, we seek to nurture and support each other emotionally through the difficulties and challenges associated with hepatitis C. We are committed to expanding our knowledge and awareness of hepatitis C through sharing of views, comment and experiences.

We respect the diversity and dignity of every person’s individual choices, beliefs, stories, problems, and successes.

We do not promote any mode of treatment. We recognise that different treatments are appropriate for the different needs, wishes, and situations of different people.

We are Australasian-based and our primary focus is on those people affected by hepatitis C and living in Australia and New Zealand. People from other countries are welcome and enable valuable linkages to what is happening with hepatitis C in other cultures.

Some interesting stats from Hep C Australasia What part of the world do members live?

Australia New Zealand

77% 5%

Nth America Western Europe

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4%

Age breakdown of members over 50 31-40 under 21

22% 27%

41-50 21-30

38% 13%

male

33%

1%

Gender breakdown of members female transgender

65% 2%

Where members come from (geographically) a State capital city 53%

regional city

large town

15%

small town

farms, etc.

8%

http://hepatitisc.communityzero.com/ 38

10%

15% 9%

promotion THE HEP C REVIEW ONLINE INDEX We have recently developed an online index of Hep C Review articles. Searchable, the PDF file covers over 1,300 news, feature and research articles, and personal stories from the eight year period June 1998 to June 2006.

The index is accessible at.. www.hepatitisc.org.au/resources/documents/HCRIndex.pdf

HCCNSW

THE AUSTRALIAN HEP C LOUNGE

VOLUNTEERING AT HCCNSW The Council relies heavily on the involvement of volunteers, mostly here at our office in Surry Hills, Sydney. If you are interested in dropping in on an occasional or regular basis, please give us a call.

Many of our volunteers have different desires: some tie volunteering in with workplace training plans; others want to fill spare time; others simply have a desire to help and all enjoy the company and friendly atmosphere. All motives are absolutely valid and we welcome everyone.

This site is dedicated to the many individuals with this often debilitating virus, and to increasing public awareness of hepatitis C through sharing music and art, and the public voicing of their very valid opinions.

The main focus for the Lounge is to promote awareness that life does not stop because of hep C and that none of us should feel embarrassed about our pasts - when we were, and are, part of an historical time of social experimentation and experiences. To feel shame at having experimented with such things not only creates guilt and sickness but takes away a huge part of our lives.

It covers up who we are and what we have all survived and disregards our great abilities in overcoming personal adversity.

For more information, contact Paul on 9332 1853 or paulh@hepatitisc.org.au

We hope the information, artists and musicians you are able to view or to link to through this site will assist in helping to dispel the stigma that individuals and their families face while living with HCV.

HCCNSW

This independent and valuable project is an initiative of people from the online hep C community. Visit the Lounge today: www.hiphepcats.com/

HAVE YOU RECENTLY CONTRACTED HEPATITIS C? Would you like to help with hep C treatment research?

The Australian Trial in Acute Hepatitis C (ATAHC)* The National Centre in HIV Epidemiology and Clinical Research is running a national study to look at outcomes of people who have recently contracted hepatitis C, and the possible benefits of treatment at this time.

If you have been recently diagnosed with hep C (in the last 6 months) and believe that you might have contracted hep C within the last year or two, and you would like to know more about this study, please contact the study coordinator Barbara Yeung on (02) 9385 0879. If you live in NSW, you can also phone the NSW Hep C Helpline on 1800 803 990 *This has been approved by the St. Vincent’s Hospital Human Research Ethics Committee. Ref #H03/074

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membership news

membership

Here we highlight items of particular interest for members and the exclusive benefits of financial membership.

In Member News, our bulletin which is mailed under separate cover to all financial members, you’ll get the scoop on recent and upcoming happenings, and learn how to make the most of your Council membership.

MEMBER NEWS . . . .

In your Winter edition of Member News, please watch for: >

Living with Hepatitis C - Stigma, Disclosure and Support - a transcript of personal presentations by Magdalena Harris and others at the 9th Social Research Conference on HIV, Hepatitis C and Related Diseases, held in Sydney in April, and themed “Stigma, Pleasure & Practice”.

>

The second MC profile in our new series “Getting to Know Your Management Committee”. This time the spotlight is on Magdalena Harris.

>

Treatment Success Stories - Robert, a long standing Council member, MC member and Council Treasurer for 10 years, and “Kath”, also a Council member for 10 years and dedicated volunteer, share their experiences with us.

What’s that ? You haven’t renewed your membership yet ? Why not ?

The 2006 membership year began on 1 March and some members are still dragging their feet. Come on . . . you know who you are and you know you want to !

So easy and convenient online !

It’s now easier than ever to join or renew, with our secure online facility.

Just go to our website www.hepatitisc.org.au and click on the membership link.

We’re still happy to receive hard copy applications or renewals, but PLEASE ensure you complete the relevant sections on BOTH sides of the membership form and sign the declaration on the back. Cheques and money orders need to be made out to . . .

HEPATITIS C COUNCIL OF NSW - MEMBERSHIP

Fancy a night at the movies?

You could be enjoying the latest blockbuster free! All members financial on 30 June will go into the draw for a double cinema pass.

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If you’ve always wanted to tackle the Harbour Bridge Climb . . . watch this space

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promotion

NOTHING CHANGES IF NOTHING CHANGES

NSW NORTHERN RIVERS LIVER CLINIC SUPPORT GROUP

7th Rural Victorian Alcohol & Drug Conference - Warrnambool, Victoria, 10 & 11 August 2006 The only Australian event with a rural and regional Alcohol & Other Drugs (AOD) focus, this year's Conference explores the commonalities and disparities between Indigenous and non-Indigenous alcohol and other drug issues and services.

Speakers with rural/regional expertise will utilise this theme while exploring topics like AOD and young people, professional development/access, service ethics, consumer rights and clinical support.

Following on from the success of initiatives trialled at last year's Conference ('Time for Change'), we will again have the specialised support of our Futurist-in-Residence, Dr Sohail Inayatullah, and Key Recommendations will again be solicited from the delegates.

Two conference satellites are also scheduled: On 9 July, experts will discuss 'Bringing Pharmacotherapies to the Bush - enhancing the relationship for pharmacy and general practice', and on 9 August, Dr Inayatullah will provide a one-day intensive 'Introduction to Futures Studies how to bring 'foresight' to your practice, policy and planning'. (Both in Warrnambool.)

Registrations open late May, but if you would like to get onto the mailing list to take advantage of early-bird rates and preferences, send an e-mail with your contact details soon to grant@ienmanagement.com

Enquiries regarding program content should be directed to the Conference Chair at wyldbor1@vic.chariot.net.au

•

Are you contemplating treatment and want to hear from others how they experienced it?

•

Are you undergoing treatment and would like to compare your experience with others?

•

Have you completed treatment and are prepared to share your experience and lend your support to others?

The Northern Rivers Liver Clinic welcomes you to come and participate in a facilitated, relaxed, informal discussion and to join us for a light lunch afterwards.

12 midday - 1.30pm 23 June

21 July

18 August

15 September

Images courtesy of yahoo or google images

For more information, please phone the Liver Clinic in Lismore on 6620 7539

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a Council profile

How did you come to work for the council?

I originally come from Perth but have been living in London for the past seven years and for the last two years I was working on a Helpline for sole parents, giving information and advice on welfare issues. On relocating to Sydney I was on the lookout for a similar position and when I saw the word Helpline it jumped out at me. It meant I could utilise my communication skills and learn about a new topic, so I was very pleased when I was offered the job.

What’s your professional background?

I have worked in the non government sector for about five years, and before that I did lots of different jobs, including being a croupier in a casino. That position certainly taught me about people and crisis management!

What are you currently working on?

A variety of projects, I have recently just completed an awareness mailout to employment services, and have been involved in writing a Helpline evaluation report, based on surveys that were sent out to our callers.

What are your interests outside of work?

I like going to the beach, yoga, gardening, reading and hanging out with friends. After living in Britain for seven years I am enjoying the sunshine..

What are your favourite books?

My all time favourite is Grapes of Wrath by John Steinbeck, what a heart wrencher. I cried about six times, in public, the first time I ever read that book!

Any wise thoughts?

Try and stay happy, a positive mental attitude and smiling certainly helps!

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research update RESTRICTIVE CRITERIA MAY DENY TREATMENT TO US DRUG USERS

HEPATITIS C TREATMENT DIFFICULT IN OLDER PEOPLE

USA - The application of multiple exclusion criteria for hepatitis C virus (HCV) treatment may mean that the majority of young injecting drug users would be denied treatment, warn a group of clinicians in the March 1st issue of Clinical Infectious Diseases.

Japan - Because of side effects, patients over the age of 60 with hepatitis C find it more difficult to stick with standard treatments than do their younger counterparts, according to a study in Japan.

Hepatitis C is highly prevalent in injecting drug users, but they face difficulties in adhering to treatment, Dr Holly Hagan from the Centre for Drug Use and HIV Research in New York and colleagues point out. Recent guidelines recommend that practitioners determine on an individual basis whether drug users should be offered HCV treatment, but the researchers say many physicians "still choose to apply restrictive criteria."

Dr Hagan's team found that among a sample of 404 HCV+ injecting drug users between 18 and 35 years of age, 96% had conditions that represent "potentially unwarranted" contraindications to HCV treatment.

These contraindications included problem drinking or moderate-to-severe depression (63%) and recent drug injection (89%).

Given that younger patients are more likely to respond to HCV treatment, "factors used in screening for treatment eligibility in this group should be limited to those that clearly reduce the effectiveness of treatment or increase toxicity," Dr Hagan and colleagues assert.

Two researchers from the Centre for the Study of Hepatitis C at Weill Medical College of Cornell in New York agree, adding in an editorial that "a growing number of studies" suggest that drug users treated for HCV infection can achieve sustained virologic response rates similar to other populations, even if they have psychiatric co-morbidities or continuing to use drugs during treatment, Drs Brian Edlin and Michael Carden write.

Injecting drug users make up the core of HCV epidemic in the developed world, they point out. This "is the battleground on which efforts to control HCV infection in the developed world will be won or lost."

Impaired heart, lung and kidney function can make older patients more susceptible to anaemia induced by Ribavirin, one of the drugs used for treating hepatitis C, explain Dr Yoshiaki Iwasaki, from Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, and colleagues.

Iwasaki's group analysed outcomes among 208 patients with chronic hepatitis C. The treatment involved injections of Interferon daily for 2 weeks then three times weekly for 22 weeks, and daily Ribavirin.

The researchers report in the medical journal Hepatology that only 92 (44 percent) continued without dose reductions until the end of treatment.

Rates of discontinuation or dose reduction were 38 percent in those younger than 50 years old, 48 percent in those between 50 and 59, and 77 percent in patients 60 or older.

Overall, the treatment was successful in eliminating the hepatitis C virus in 37 percent of the patients, with age being associated with a poorer response rate.

"Treatment schedule should be modified, or other therapeutic modalities should be considered for older patients with chronic hepatitis C," Iwasaki's group concludes.

Hepatology, January 2006.

Abridged from http://today.reuters.co.uk via www.hcvadvocate.org

Clin Infect Dis 2006;42:669-675.

Abridged from Reuters Health via www.hcvadvocate.org

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research update ALBUMIN PREVENTS LIVER COMPLICATIONS IN CIRRHOSIS France - In patients with cirrhosis and ascites, human albumin appears more effective in preventing liverrelated complications than synthetic colloid, and is also associated with decreased hospital costs, finds the latest Liver International.

Dr Richard Moreau and colleagues from France assessed which colloid, either albumin or synthetic colloids, can be used for plasma expansion.

Following paracentesis or other complications requiring fluid loading in patients with cirrhosis remains controversial.

The research team compared outcome and hospitalrelated cost in 68 patients with cirrhosis.

The team included 63 patients with ascites removal by paracentesis and five patients with ascites removal by paracentesis and renal impairment.

The primary end point was occurrence of a first liverrelated complication.

The researchers team reported that the trial was prematurely discontinued because of safety concerns.

Of the included patients, 30 were assigned to receive albumin and 38 were assigned to receive a synthetic colloid.

The patients were treated with either 20% human albumin or with a synthetic colloid of 4% polygeline.

The researchers found that the median time to first liverrelated complication was not significantly longer in the albumin group.

However, the total number of liver-related complications adjusted to a 100-day period was significantly lower in the albumin group.

The team noted that median hospital cost for a 30-day period was significantly lower in the albumin group.

Dr Moreau's team commented, "In patients with cirrhosis and ascites, human albumin appears to be more effective in preventing liver-related complications than synthetic colloid."

"This may be associated with decreased hospital costs."

Liver Int 2006: 26(1): 46 Abridged from www.gastrohep.com via www.hcvadvocate.org

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SALIVA-BASED HCV TEST DEVELOPED Israel - Scientists have developed a saliva-based test to detect the hepatitis C virus, and say it could be appropriate for mass screening programmes in developing countries.

Hepatitis C is common in the developing world, but the conventional method of detecting the virus in a blood sample is often inaccessible to poorer nations.

Current tests use a sample of the patient's serum, the liquid part of blood in which blood cells are suspended, and detect antibodies that the body produces in reaction to the virus.

But such tests are costly, complicated and rely on an array of medical equipment and skilled personnel.

Now researchers led by Arieh Yaari of Soroka University Medical Centre, Israel, have shown that saliva can be used instead of serum to detect the virus.

They carried out their study on 37 dialysis patients, people without kidney function whose blood must be passed through a machine to filter out waste products.

Such patients have a high incidence of hepatitis C and may resemble ill people in developing countries in their immune response levels.

Yaari and colleagues report 100 per cent success at detecting hepatitis C in the saliva of patients who had symptoms of the disease. This is comparable to the results of testing serum.

In patients who had the virus but had yet to develop symptoms, the saliva test was accurate in 94 per cent of cases, while the conventional serum test detected only 63 per cent of infections.

Yaari's team say that as it is cheap and easy to obtain saliva samples, detecting hepatitis C infections using this technique might be economically and clinically important in developing nations.

They add that as the research involved only 37 patients, a larger study is needed to confirm the results. This could focus on a different high-risk population, for example people in developing countries, say the researchers.

Journal of Virological Methods doi: 10.1016/ j.viromet.2005.09.009 Abridged from www.scidev.net via www.hcvadvocate.org

research update THALIDOMIDE’S POSSIBLE ROLE WITH CHRONIC HEPATITIS C

LIGHTER PATIENTS WITH LIVER CANCER FARE BETTER

Italy - Researchers have reported that the administration of thalidomide to patients with hepatitis C unresponsive to Interferon alfa and Ribavirin is well tolerated and reduced liver enzymes elevations in 6 of the 8 people studied. The details of this study appeared in the February 2006 issue of The American Journal of Gastroenterology.

Japan - Include liver cancer on the list of conditions exacerbated by excess poundage. That's the conclusion of Japanese researchers, who found that people who are obese and have HCV-associated hepatocellular carcinoma have significantly shorter survival than leaner people with liver cancer.

Approximately 20% of people with hepatitis C who develop cirrhosis will get cancer. It takes approximately 20 years to develop cirrhosis and 25-30 years to develop cancer. It is rare to develop hepatocellular carcinoma without cirrhosis. The US is witnessing an increase in hepatitis C infection similar to the increase observed in Japan 50 years ago. Hepatitis C associated hepatocellular cancer is increasing in incidence, while cancers related to alcohol and hepatitis B are remaining constant. There will be an expected three-fold increase in hepatitis C associated liver cancer over the next 20 years.

"Obesity may worsen the prognosis of people with hepatocellular carcinoma, and reduction of body weight may improve the clinical course and prognosis of people with HCV by delaying the development of hepatocellular carcinoma," Dr Toshihiko Mazuta and colleagues at Saga Medical School reported at the 2005 American Association for the Study of Liver Diseases meeting.

Currently, a large trial is being carried out in people with cirrhosis to determine if eight years of therapy with Interferon alfa plus Ribavirin prevents liver cancer. A recent study has suggested that Neumega®, interleukin11, may be effective in treating refractory hepatitis C. Vaccine development is promising but is still a futuristic program and other treatment modalities are needed to control hepatitis C and to prevent future cases of hepatocellular carcinoma.

Because obesity has been implicated as a risk factor for hepatocellular carcinoma and has been associated with a worse clinical course of HCV, Dr Mizuta and colleagues decided to look at the influence of body mass index (BMI) on HCV related liver cancer.

The current study evaluated the effect of a 24 week course of thalidomide in eight people with chronic hepatitis C who had failed therapy with Interferon and Ribavirin. These authors reported significant decreases in liver enzymes. This effect was associated with a decrease in tumour necrosis factor alfa in six of eight treated people. Decrease in enzymes were correlated with in vitro immunologic studies.

The authors suggest that this is a promising new approach to the treatment of chronic hepatitis C infection and prevention of hepatocellular cancer, especially in patients who do not clear virus with antiviral therapy.

Milazzo LM, Biasin M, Gatti N, et al. Thalidomide in the treatment of chronic hepatitis C unresponsive to Alfa-Interferon and Ribavirin.

American Journal of Gastroenterology.

2006;101:399-402.

Abridged from http:// professional.cancerconsultants.com via www.hcvadvocate.org

A study involving eight persons would have to be considered as exploratory and certainly not conclusive. We publish this article not because of its immediate relevance to people living with hepatitis C, but to show the breadth of HCV research currently occurring: ED

An estimated 1.5 million people in Japan have HCV and approximately 30,000 Japanese die from hepatocellular carcinoma annually. More than 80% of the deaths are due to HCV-associated liver cancer, Dr Mizuta said.

They conducted a retrospective study of 150 people with hepatocellular carcinoma and who were positive for HCV antibodies. The patients were classified into four groups according to their BMI at time of hepatocellular carcinoma diagnosis.

They looked at differences of age, gender, alcohol consumption, smoking (packs/year), diabetes, and hepatic function, as measured by ALT and albumin levels, prothrombin activity, and Child-Pugh Class disease.

They found that lean people had lower liver enzyme (serum ALT) levels compared with the normal group, but not compared with the overweight or obese groups.

When they looked at serum albumin concentration and prothrombin activity, however, they found that levels gradually decreased as BMI increased. In addition, the severity of disease as measured by the ratio of Child-Pugh C class in each group increased in association with BMI. Only 5% of lean people had Child-Pugh C class disease compared with 38% of obese people.

There were no differences in gender, alcohol, smoking, and diabetes among the four groups. Analysis showed a BMI less than 28 proved to be the only independent factor associated with poor prognosis, they found.

"BMI influences the onset age of hepatocellular carcinoma and hepatic function; further, obesity is a poor prognostic factor in people with HCV-related hepatocellular carcinoma," they wrote.

Abridged from 2005 AASLD Meeting via www.hcvadvocate.org

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research update LACK OF EVIDENCE OF SEXUAL TRANSMISSION USA - The risk of sexual transmission of HCV was evaluated among 895 monogamous heterosexual partners of individuals with chronic HCV in a long-term prospective study, which provided a follow-up period of 8,060 person-years.

Seven hundred and seventy-six (86.7%) spouses were followed for 10 yrs, corresponding to 7,760 person-years of observation. one hundred and nineteen (13.3%) spouses (69 whose HCV-positive partners cleared the virus following treatment and 50 who ended their relationship or were lost at follow-up) contributed an additional 300 person-years.

All couples denied practicing anal intercourse or sex during menstruation, as well as condom use.

The average weekly rate of sexual intercourse was 1.8. Three HCV infections were observed during follow-up corresponding to an incidence rate of 0.37 per 1,000 person-years.

However, the infecting HCV genotype in one spouse (2a) was different from that of the partner (1b), clearly excluding sexual transmission. The remaining two couples had concordant genotypes, but analysis of the HCV genome showed that the corresponding partners carried different viral isolates, again excluding the possibility of intra-spousal transmission of HCV. Data indicated that the risk of sexual transmission of HCV within heterosexual monogamous couples is extremely low or even nil. No general recommendations for condom use seem required for people in monogamous partnerships with HCV-infected partners.

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HEPATITIS C IMMUNE VIRUS LOAD AND RESTORATION SURVIVAL DISEASE AMONG USA Australia - Immune-restoration disease, first described by Martyn INJECTING French from WA in 1992, occurs when clinical disease develops early DRUG USERS in the course of antiretroviral therapy, USA - People chronically infected with hepatitis C virus (HCV) are at higher risk for end-stage liver disease (ESLD). We evaluated whether ESLD death was associated with pre-illness HCV RNA level or specific HCV protein antibodies among persons in a cohort of 6,570 injecting drug users who enrolled in nine US cities between 1987 and 1991.

We compared 84 ESLD descendents and 305 randomly selected cohort participants with detectable HCV RNA, stratified by sex, race, HIV, and HTLV-II strata.

Risk of ESLD death was unrelated to the intensity of antibodies against the HCV and NS5 proteins, individually or combined, but it increased with HCV RNA level.

The association between HCV RNA level and ESLD death remained significant after adjustment for alcohol consumption.

In conclusion, HCV RNA level is a predictor of ESLD death among persons with chronic HCV infection.

Hepatitis C Virus Load and Survival Among Injection Drug Users in the United States. Michie Hisada, Nilanjan Chatterjee, et al, Hepatology 2005;42:14461452

Lack of evidence of sexual transmission of hepatitis C among monogamous couples: results of a 10-year prospective follow-up study.

Vandelli C, Renzo F, et al. Am J Gastro The Hep C Review

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because of restored immune responses.

This phenomenon can be potentially serious for conditions in which it is the inflammatory response, rather than the infecting organism, that causes tissue damage. These include hepatitis C, in which a serious flare of clinical hepatitis can be seen in some people who were asymptomatic while immunosuppressed.

The explanation that the body is responding to and attacking organisms that it previously was unable to, will need to be reinforced repeatedly.

Attention should be paid to symptomatic treatment and emotional support so that the person can be aided through this phase to the better health that will almost always follow.

Abridged from Australian Doctor, 10 Feb 2006, p28.

research update EXTRAHEPATIC IMMUNOLOGIC MANIFESTATIONS IN CHRONIC HEPATITIS C AND HEPATITIS C VIRUS SEROTYPES

TRANSMISSION OF HEPATITIS C VIRUS TO SEVERAL ORGAN AND TISSUE RECIPIENTS FROM AN ANTIBODYNEGATIVE DONOR

France/UK - The objective of this study was to determine, using a serotyping assay, whether the occurrence of extrahepatic immunologic disorders in people with chronic hepatitis C is dependent on hepatitis C virus serotype (genotype).

USA - Although hepatitis C virus (HCV) transmission through tissue transplantation has been rarely reported, a donor with undetected viremia may infect several recipients. A patient developed acute hepatitis C shortly after tissue transplantation. Ninety-one tissues or organs had been recovered from the donor.

Design: Prospective study.

Setting: Liver unit and virology laboratory of a university hospital.

Patients: 59 consecutive patients with chronic hepatitis C. Measurements: Hepatitis C virus serotype was determined using a recently developed immunoenzymatic assay that detects antibodies directed to serotype-specific immunodominant epitopes. Cryoglobulin, rheumatoid factor, and numerous antitissue antibodies were sought.

Biopsies of labial salivary glands were done in 49 of the 59 patients.

Results: Prevalence was 59% for serotype 1, 10% for serotype 2, 12% for serotype 3, and 3% for mixed infection. Fifteen percent of patients could not be serotyped. Cryoglobulinemia was found in 36% of patients and rheumatoid factor was found in the serum of 71%. At least one antitissue antibody was found in the serum of 41% of patients; salivary gland biopsy showed lymphocytic capillaritis in 49% of patients. These immunologic abnormalities were seen in patients infected with any of the three serotypes, and prevalenceof the abnormalities did not differ significantly among patients infected with different serotypes.

Conclusions: We confirm that the prevalence of extrahepatic immunologic abnormalities is high in patients with chronic hepatitis C. These abnormalities may occur in patients infected with any of the three major hepatitis C virus serotypes now present in developed countries.

Pawlotsky J-M, Roudot-Thoraval F, Simmonds P, et al. Annals of Internal Medicine. 1 February 1995, Volume 122, Issue 3: Pages 169-173.

Objective: To determine whether the donor was the source of infection and the extent of transmission to other organ and tissue recipients.

Design: Descriptive epidemiologic study; serum testing for HCV infection.

Setting: Donor and graft recipients were located in 16 states and two other countries.

Measurements: Hepatitis C virus infection was defined as the presence of anti-HCV or HCV RNA. The authors determined the genetic relatedness of viral isolates from the donor and recipients by genotype comparison and quasi-species analysis.

Results: The donor was anti-HCV–negative but was HCV RNA–positive (genotype 1a). Forty persons received transplants during 22 months. Five persons were HCVinfected before transplantation or had a genotype other than 1a, and 5 persons had no post-transplantation serum specimens available. Of the remaining 30 recipients, HCV infection occurred in 8 recipients: 3 of 3 organ recipients, 1 of 2 saphenous vein recipients, 1 of 3 tendon recipients, and 3 of 3 tendon with bone recipients. These 8 recipients had viral isolates genetically related to those of the donor. No cases occurred in recipients of skin (n = 2), cornea (n = 1), or irradiated bone (n = 16).

Limitations: Post-transplantation serum specimens were unavailable for 5 recipients.

Conclusions: An anti-HCV–negative donor was the source of HCV infection for 8 recipients of organs or tissues.

Although HCV transmission from anti-HCV–negative donors is probably uncommon, changes in donor screening to include routine testing for HCV RNA merit further consideration to improve the safety of transplantation.

Tugwell B, Patel P, et al. Annals of Internal Medicine. 1 November 2005, Volume 143, Issue 9: Pages 648-654

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research update SPONTANEOUS HCV CLEARANCE MORE COMMON THAN PREVIOUSLY THOUGHT

LIVER FIBROSIS SERUM PANEL MARKERS EVALUATED IN CHRONIC HEPATITIS C

USA - Spontaneous clearance of hepatitis C virus (HCV) after chronic infection is thought to be a rare event, but new research suggests that clearance rates as high as eight per cent may occur.

France - Recent research from France has chronicled the evaluation of liver fibrosis serum panel markers in chronic hepatitis C (CHC).

Roughly 15% to 30% of people who contracted HCV will clear the virus during the acute phase. Until recently, it was believed that the remaining patients with chronic infection seldom, if ever, clear the virus.

In a Japanese study reported in 2003, an HCV clearance rate of 3.7% was described in patients with chronic infection. The present findings, which appear in Clinical Infectious Diseases for April 1, suggest that the rate may be higher still.

The study involved 139 Alaskan natives who had tested positive for HCV RNA on three separate occasions and were followed on a regular basis for a mean period of seven years.

Eleven of the patients (8%) had at least one test with undetectable HCV RNA during follow-up. Seven of these patients were considered to have probable or possible HCV clearance, yielding an annual clearance rate of 0.74% per person year.

Follow-up testing of nine of the seronegative patients identified five that still appeared to be virus-free, the report indicates. A low HCV RNA titer predicted spontaneous non-detectability of HCV RNA. In a related editorial, Dr Georg Lauer and Dr Arthur Kim, from Harvard Medical School in Boston, point out that "more studies are needed before we can feel confident about the incidence of spontaneous viral clearance in chronic HCV infection or before we start investigating the genetic disposition of Alaska Natives and its relevance to viral control."

"Meanwhile, clinicians should stay alert to this rare outcome of HCV infection, and further investigations of this phenomenon should be strongly encouraged," the editorialists add.

Clin Infect Dis 2006;42:945-954.

Abridged from Reuters via www.medscape.com

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"CHC is characterised by hepatic fibrosis, used as a proxy measure of prognosis. Liver biopsy is a flawed reference standard and serum markers of fibrosis offer an attractive alternative," wrote J. Parkes and colleagues, Hopital St. Antoine. "A systematic review was conducted to assess the performance of panels of serum markers of hepatic fibrosis in CHC, incorporating analyses placing markers in a clinical context."

"Fourteen studies were included with 10 different panels.

Median AUC in validation populations was 0.77 and training populations 0.81. Likelihood ratios (LR) ranged from -LR 0.1 to 0.9, + LR 1.2 to 33.1, diagnostic odds ratios (DOR) were 9.0 (median) with a range of 5 to 27 mostly below values of robust tests.

"Tests performed with either high sensitivity with low specificity or vice versa. Cut-off levels that gave clinically relevant predictive values for the presence/absence of significant fibrosis were applicable to 35% of the population," wrote the researchers.

The investigators concluded, "Serum markers can rule-in or rule-out fibrosis in up to 35% of patients, but cannot differentiate stages of fibrosis reliably. Improvement of index and reference test in needed including evaluation of clinical outcomes as reference. Improved test reporting is needed to derive LR and DOR as performance indicators."

Parkes and colleagues published their study in the Journal of Hepatology (Performance of serum marker panels for liver fibrosis in chronic hepatitis C. J Hepatol, 2006;44(3):462-474).

Abridged from www.therapeuticsdaily.com via www.hcvadvocate.org

research update HEPATITIS C AMONG INJECTING DRUG USERS ON OPIOID REPLACEMENT THERAPY Australia - This item from our own surgery shows that of 178 injectors on methadone/buprenorphine maintenance treatment, 75% tested positive for hepatitis C (HCV) antibodies. Of 130 untreated HCV cases, 53% had normal ALT enzyme levels and half of these were HCVRNA negative, indicating probable viral clearance.

Older patients on methadone/buprenorphine were significantly more likely to have normal ALT levels and to be HCV-RNA negative. This might be explained by low levels of injecting and hepatitis C re-infection in this group.

Younger patients were less likely to have hepatitis B (HBV) immunity through vaccination or exposure, pointing to the need to target this at-risk group effectively for catch-up vaccination.

Of 58 active hepatitis cases meeting pre-liver biopsy criteria for subsidised HCV treatment, 34 had relative contraindications to antiviral treatment, including drug and alcohol/psychiatric reasons. There were 11 whose only contraindication was continuing to inject. Recent studies show that patients with active injecting drug use can still be successfully treated with HCV antivirals.

At the time of this clinical audit only 6 patients had ever been referred for specialist HCV assessment, however since the end of the study the rate of referral has increased considerably and several patients have completed or commenced HCV treatment, some in the primary care Interferon prescribers project of the Australasian Society for HIV Medicine (ASHM).

This study emphasises a unique public health opportunity. The emerging epidemic of hepatitis C is occurring predominantly in the drug using population, thus detection and referral should be possible at methadone clinics, GPs, pharmacies, needle services and injecting facilities frequented by this population. Hence, despite the enormous looming problem of active hepatitis, liver failure and cancer, it is possible that early detection and treatment could avert many of the consequences and save health funds in the long term.

We believe that it is incumbent on all those who treat drug addicts to ensure that their patients have HIV and HCV testing at least annually, and recommend HBV vaccination where appropriate. This is as fundamental as doctors doing cervical cancer smears or prostate tests at certain intervals in the course of normal medical practice.

Hepatitis C virus prevalence and outcomes among injecting drug users on opioid replacement therapy. Hallinan R, Byrne A, Amin J, Dore GJ. J Gastro Hepatology 2005 20;7:1082-1086

INTERFERON PROTEIN PREDICTS HEPATITIS C TREATMENT RESPONSE Spain - Pre-treatment levels of Interferon gamma inducible protein 10 (IP-10) are associated with sustained virological response of hepatitis C to treatment with PegInterferon and Ribavirin, according to a report in the March issue of Gut. People with genotype 1 and low serum IP-10 levels before therapy have a higher probability of response to antiviral therapy than those with elevated IP-10 concentrations, reported Dr Carmelo Garcia-Monzon from University Hospital Santa Cristina, Madrid.

Dr Garcia-Monzon and colleagues evaluated the relationship between pre-treatment serum IP-10 levels and the virological response to PegInterferon plus Ribavirin therapy in 137 people with chronic hepatitis C. Seventy-nine people (57.7%) achieved a sustained response, and 58 (42.3%) were nonresponders.

Analysis of results showed that only non-1 genotype and low baseline viral load were independent predictors of a sustained virological response.

When just those people with genotype 1 were considered, pre-treatment IP-10 levels and baseline viral load were independent predictors of a sustained virological response.

"Based on our results, IP-10 may have a role in failure of antiviral therapy in patients with chronic HCV infection," the investigators suggest. "However, the mechanism by which IP-10 modulates the efficacy of PegInterferon plus Ribavirin therapy remains elusive, but it is conceivable that it is related to its biological functions."

"Our clinical results suggest that IP-10 might interfere with antiviral activity of Interferon alpha in the liver," Dr Garcia-Monzon said. "We are planning to carry out studies on cultured hepatocytes in order to determine whether IP-10 modulates Interferon-mediated antiviral response. Understanding the molecular basis of IP-10 effects on target cells could provide strategies for improving the antiviral therapy in chronic HCV infection."

"Predicting response to antiviral therapy is a crucial point in the management of people with chronic HCV infection," Dr Garcia-Monzon concluded. "We have shown that IP-10 could be important for optimizing therapy in genotype 1 patients who are the most difficult to cure. Definitive conclusions on this issue, however, must await validation studies worldwide."

Gut 2006;55:374-379.

Abridged from Reuters via www.hcvadvocate.org

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interferon-based therapy PEG INTERFERON ALPHA & RIBAVIRIN

PEGINTERFERON ALPHA-2A OR 2B

Subsidised ‘peg combo’ treatment for people with chronic hepatitis C is available to those who satisfy all of the following criteria:

Australian Government-funded PegInterferon Alpha-2a or 2b involves a course of weekly pegylated Interferon injections for up to 52 weeks. People are asked to visit their GP or specialist for follow-up visits during and after treatment.

Aside from modest Pharmaceutical Benefits Scheme charges, there should be no additional costs levied by treatment centres.

1

Blood tests: people must have documented chronic hepatitis C infection (repeatedly antibody positive or PCR positive).

2

Contraception: women of childbearing age undergoing treatment must not already be pregnant nor breastfeeding, and both a woman and her male partner must use effective forms of contraception (one for each person). Men undergoing treatment and their female partners must use effective forms of contraception (one for each person). Female partners of men undergoing treatment must not already be pregnant.

3

Age: people must be 18 years or older.

4

Treatment history: people must not have had prior Interferon or peg Interferon treatment.

DURATION & GENOTYPES For people with genotype 2 or 3 without cirrhosis or bridging fibrosis, treatment is limited to 24 weeks. For people with genotype 1, 4, 5 or 6 and those genotype 2 or 3 people with cirrhosis or bridging fibrosis, treatment lasts 48 weeks.

MONITORING POINTS People with genotype 1, 4, 5 or 6 who are eligible for 48 weeks of treatment may only continue treatment after the first 12 weeks if the result of a PCR quantitative test shows that HCV has become undetectable or the viral load has decreased by at least a 2 log drop. The baseline and 12-week tests must be performed at the same laboratory using the same type of test kit. PCR quantitative tests at week 12 are unnecessary for people with genotype 2 and 3 because of their higher likelihood of early viral response.

People with genotype 1, 4, 5 or 6 who are PCR positive at week 12 but have attained at least a 2 log drop in viral load may only continue treatment after 24 weeks if HCV is not detectable by a PCR qualitative test at week 24. Similarly, genotype 2 or 3 people with cirrhosis or bridging fibrosis may only continue treatment after 24 weeks if HCV is not detectable by a PCR qualitative test at week 24. PCR qualitative tests at week 24 are unnecessary for people with genotype 1, 4, 5 or 6 who test PCR negative at week 12.

When Interferon molecules are pegylated, the drug lasts longer in the body. It is injected once a week and ensures a more consistent therapeutic dose rather than the peaks and troughs of thrice-weekly injections.

PegInterferon Alpha-2a or 2b monotherapy leads to a sustained response in around 25% of those who try it, basically doubling the sustained response rate of basic Interferon monotherapy.

Government-funded treatment is offered to people 18 years or older who have chronic hepatitis C and compensated liver disease, and who have received no prior Interferon therapy, and who have a contraindication to Ribavirin (can’t tolerate it) and who satisfy all of the following criteria: 1

Blood tests: people must have abnormal ALT levels in conjunction with documented chronic hepatitis C infection, i.e. repeatedly antibody positive and/or HCV RNA (PCR) positive.

3

Other liver damage: people must not have other forms of chronic liver disease.

4

Contraception: women of childbearing age must not be pregnant, not breast-feeding, and must be using an effective form of contraception.

5a

Duration: with Alpha 2a, the treatment course is limited to 48 weeks. People may only continue treatment after the first 12 weeks if PCR viral load testing shows that the plasma HCV RNA has become undetectable or the viral load has decreased by at least a 2 log drop.

5b

Duration: with Alpha 2b, the treatment course is limited to 48 weeks at 0.5 to 1 microgram per kilogram weekly. People may only continue treatment after the first 12 weeks if PCR viral load testing shows that the plasma HCV RNA has become undetectable or the viral load has decreased by at least a 2 log drop.

CAUTION Treatment with Interferon alpha has been associated with depression and suicide in some people. Those people with a history of suicide ideation or depressive illness should be warned of the risks. Psychiatric status during therapy should be monitored.

A potentially serious side effect of Ribavirin is anaemia caused by haemolysis (destruction of red blood cells and resultant release of haemoglobin). People’s blood counts are monitored closely, especially in the first few weeks, and doctors may lower the Ribavirin dose if necessary. Adults who can’t tolerate Ribavirin and have had no prior Interferon treatment may be offered subsidised PegInterferon Alpha-2b if they meet certain criteria.

Ribavirin is a category X drug and must not be taken by pregnant women. Pregnancy in women undergoing treatment or in the female partners of men undergoing treatment must be avoided during therapy and for 6 months after cessation of treatment.

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complementary therapies LIVER BIOPSY NO LONGER A GENERAL REQUIREMENT FOR TREATMENT

COMPLEMENTARY THERAPIES

From 1 April 2006, a biopsy examination is no longer a mandatory pre-treatment test for people wanting to access government subsidised S100 hepatitis C pharmaceutical treatment.

A previous Australian trial of one particular Chinese herbal preparation has shown some positive benefits and few side-effects (see Ed 15, p 6). A similar trial but on a larger scale was carried out in the NSW Northern Rivers region (see Ed 24, p 8).

Currently, a trial of particular herbs and vitamins is being carried out by researchers at John Hunter Hospital, Newcastle, and Royal Prince Alfred and Westmead hospitals, Sydney (see Ed 45, p 9).

Note that some people with genotype 2 or 3 may still require biopsy to determine whether they have cirrhosis or bridging fibrosis - which would have an impact on treatment monitoring. See ‘Monitoring Points’, previous page.

Some people choose complementary therapies as a first or a last resort. Others may not use them at all. Some may use them in conjunction with pharmaceutical drug treatments. Whichever way you choose, you should be fully informed. Ask searching questions of whichever practitioner you go to:

•

Has the practitioner considered all relevant diagnostic testing?

For further information on this issue, please speak to your treatment specialist.

•

Has your practitioner consulted about your hepatitis C condition with your GP or other health care providers?

•

Is the treatment dangerous if you get the prescription wrong?

ALTERNATIVE ACCESS

•

How has their complementary therapy helped people with hep C?

People wanting to access Interferonbased therapy outside of the government subsidised S100 scheme can purchase treatment drugs at full price or seek access through industrysponsored special access programs.

•

What are the side-effects?

•

Is the practitioner a member of a recognised natural therapy organisation?

•

How much experience do they have working with people with hepatitis C?

•

How have they measured the health outcomes of their therapy?

For more information, people should contact their nearest treatment centre.

For telephone numbers, please call the Hep C Helpline (see p52).

•

How do they aim to help you?

Good results have been reported by some people using complementary therapies while others have found no observable benefits. As with any treatment, it’s important to remember that wrongly-prescribed medicines can be harmful.

Remember, you have the right to ask any reasonable question of any health practitioner and expect a satisfactory answer. If you are not satisfied, shop around until you feel comfortable with your practitioner.

NSW TREATMENT CENTRES

You cannot claim a rebate from Medicare when you attend a natural therapist.

Some private health insurance schemes cover some complementary therapies. It may help to ask your natural therapist about money before you visit them. Many will come to arrangements about payment; perhaps a discounted fee?

Treatment centres are required to have access to the following specialist facilities for the provision of clinical support services for hepatitis C:

It is also important to continue seeing your regular doctor and/or specialist. Talk to them and your natural therapist about the treatment options that you are considering and continue to have your liver function tests done.

•

a nurse educator/counsellor for patients

•

24 hour access to medical advice for patients

• •

an established liver clinic facilities for safe liver biopsy.

Treatment centres exist in most parts of NSW. Phone the Hep C Helpline for the contact details of your nearest centre.

It is best if your doctor, specialist and natural therapist are able to consult directly with one another. If a natural therapist suggests that you stop seeing your medical specialist or doctor, or stop a course of pharmaceutical medicine, you should consider changing your natural therapist.

If you decide to use complementary therapies, it is vital that you see a practitioner who is properly qualified, knowledgeable and well experienced in working with people who have hepatitis C. Additionally, they should be members of a relevant professional association.

Phone the NSW Hep C Helpline (see p52) for more information and the contact details of relevant professional associations.

NSW Justice Health has nine treatment assessment centres (two within jails for women) and various clinics for monitoring ongoing treatment.

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support / info services NSW Hep C Helpline

Sexual health clinics

For free, confidential and non-judgmental information and emotional support you can phone the NSW Hep C Helpline.

The service gives you the opportunity to talk with trained phone workers and discuss those issues important to you. It also provides referral to local health care and support services:

Although hepatitis C is not classified as a sexually transmissible disease, staff at these clinics can offer a range of services including pre- and post-test discussion and HCV blood tests. They are listed in your local phone book under ‘sexual health clinics’.

•

9332 1599 (Sydney callers)

•

1800 803 990 (NSW regional callers)

If you are concerned about confidentiality, these clinics do not need your surname or Medicare card and keep all medical records private.

Prisons Hep C Helpline

Other support & counselling

A special phone service provided through the NSW Hep C Helpline that can be accessed by NSW inmates and prison staff. Call this free and confidential service by using the jail phone, or by calling the numbers above.

Traids is a state-wide counselling, support and advocacy service for people with medically acquired hepatitis C or HIV. They offer short and long-term counselling, information, support and advocacy to affected people and their families and/or carers. Traids services are free and confidential, and on either a face-to-face or telephone basis. They also run support groups and have a regular newsletter. Current hepatitis C information is available. For more information, phone 02 9843 3143 (Traids have a call-back policy for NSW regional callers).

Community health centres Community Health and Neighbourhood Centres exist in most towns and suburbs. They provide services, including counselling, crisis support and information on local health and welfare agencies. Some Neighbourhood Centres run a range of support and discussion groups and activities that may range from archery to yoga. Look in your White Pages under Community Health Centres. Neighbourhood Centres can be found by phoning your local town Council.

General Practitioners It is important that people find a well-informed GP who can support all long-term health care needs. Ideally, a doctor should be able to review and monitor a person’s health on a regular basis and provide psychological and social support if needed. GPs should also be able to act as advocates to help with difficulties in other parts of the health care system. GPs should be able to advise when it is necessary to seek specialist advice or further investigations or about research trial options. The NSW Hep C Helpline may be able to refer people to doctors and other health care workers in their area who have been involved in hepatitis C training.

Alcohol & other drug services People who inject drugs and want to access peer-based information and support should phone NUAA (the NSW Users and AIDS Association) on 8354 7300 (Sydney callers) or 1800 644 413 (NSW regional callers).

NSW health services have a number of Drug and Alcohol clinics set up around the state. These centres offer confidential advice, assessment, treatment and referral for people who have a drug/alcohol problem or who have concerns about the use of these substances. The services are free and the staff are experienced in all aspects of drug and alcohol use and associated conditions. If you are worried about your own or someone else’s drug and alcohol problem, phone the Alcohol & Drug Information Service (ADIS) on 9361 8000 (Syd) or 1800 422 599 (NSW), or contact your local hospital or community health centre who will also be able to advise you on your nearest clinic.

Family Drug Support An organisation that provides assistance to families to deal with drug issues in a way that strengthens relationships and achieves positive outcomes. Phone FDS on 1300 368 186.

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Family & relationship counselling If hepatitis C is impacting on your family relationships, it may be wise to seek family or relationship counselling. To find out more, contact Relationships Australia on 9418 8800 or 1800 801 578.

Advice on food & nutrition Accredited Practicing Dietitians (APD) are qualified dietitians engaged in a formalised system of ongoing professional updating. Dietitians work in hospitals and community health centres, where there is usually no charge for their services.

Alternatively, private practitioners are listed in the Yellow Pages. For information on healthy eating and referral to local dietitians, call the Dietitians Association of Australia: 02 6282 9798 or 1300 658 196 or www.daa.asn.au

Cultural and linguistically diverse communities The Multicultural HIV/AIDS and hepatitis C Service (MHAHS) works with culturally and linguistically diverse individuals and communities to achieve better health and wellbeing in relation to HIV/AIDS and hepatitis C, and to encourage and support health services working in these areas to respond appropriately and equitably. MHAHS targets 20 different language groups, but is also available to other individuals and communities from culturally diverse backgrounds seeking assistance. For more details, phone 9515 5053 or 1800 108 098 or just visit www.multiculturalhivhepc.net/ to access hepatitis C information in languages other than English.

NSW Health hepatitis C regional coordinators Phone the NSW Hep C Helpline (above) for information about possible local services in your area and/or contact details for your hepatitis C regional coordinator.

support / info services Hep C Australasia This Australasia-wide online internet community has over two hundred members. You can start your own conversation thread or take part in existing threads, offer your point of view or share your experiences. Just visit http:// hepatitisc.communityzero.com/

Port Macquarie Hepatitis C Support Group Peer support available for people living with or affected by hep C. For information, please contact Lynelle Wood on 6588 2750 or Alison Mears on 0418 207 939.

Central Coast HOTS group

St Vincent’s Support Group Darlinghurst

HOTS: HCV and Offering Togetherness and Support. We are a Central Coast hep C support group who meet twice a month on the 1st Wednesday evening of the month from 7.30 to 9.00 pm, and the 3rd Tuesday morning of the month from 10.30 am to 12 midday.

This treatment-related support group kicked off the new year on 20 Jan and meets on the first Tuesday of each month. St Vincent’s Hospital, Darlinghurst

These different times allow people who work or study to attend as well. We meet at the PSN House at North Gosford.

We also have guest speakers, general discussion and outings.

You will always get a cuppa.

For information, please contact Leslie on 4323 2905.

Hunter Hepatitis C Support Services A service that is open to all people of the Hunter living with HCV and is linked to a team of health care professionals specialising in hepatitis C treatment & care. Based at John Hunter Hospital, Lookout Rd, New Lambton.

For information, please contact Margaret Croft on 4922 3429 or Tracey Jones on 4921 4789.

Nepean Hepatitis C Support Group Guest speakers keeping you informed about hep C. Family and friends are more than welcome. Light refreshments and supper are provided.

Held in the Nurse Education Dept. Lecture Room (Somerset Street entrance), Nepean Hospital.

For further information, please contact Jo or Vince on 4734 3466.

Northern Rivers Liver Clinic Support Group An opportunity for people contemplating treatment, undergoing treatment and for those who have completed treatment to get know each other.

The Liver Clinic invites you to come and join in a facilitated, relaxed and informal monthly discussion and to join us for a light lunch afterwards.

For more information, please phone 6620 7539.

For information, please contact Zoe Potgieter 8382 2887.

St George Support Group Group meets intermittently at the Waratah Clinic. For information, please contact Philip on 9350 2961.

Westmead Support Group A support group for people living with hepatitis C, including those on treatment. People from any area are welcome.

From 7pm to 8.30pm, every 1st Thursday of each month (except Dec & Jan) at Room 2, Level 2, Parramatta Health Service, 158 Marsden St, Parramatta. There is free parking, with entry via George Street. Otherwise, it is a 10 min walk from Parramatta station.

For information, please contact Seng Kee on 9845 7706, Maria on 9843 3143, Susan on 9840 4110 or Jasmin 9845 6034.

Westmead Hepatitis C Information Nights Our Information Nights are aimed for people with hep C, families, friends and interested others. Our speakers talk about various aspects of hepatitis C such as: research about the virus, transmission, treatment and symptom relief. People who have hepatitis C or who have successfully undergone treatment often speak of their experiences and we also allow time for questions and answers.

Supper is generally provided as we know this can be an awkward time for some people. Parking is available at the hospital but you will need five dollars in coins. Alternatively, it is about a ten-minute walk from Westmead station. Go to the main entrance of the hospital and ask for directions at Reception, or look for our signs. There is no charge for the Information Night and people from any area are most welcome.

For information, please contact Seng Kee on 9845 7706, Maria on 9843 3143, or Susan on 9840 4110.

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noticeboard Our loan library Library loans are available for up to 4 weeks. Please call the Hep C Helpline on (02) 9332 1599 (Sydney callers) or 1800 803 990 (other NSW callers) to request the item you require. Items are loaned free of charge but borrowers are required to pay return postage. Please enquire about postage rates when you call the Helpline.

Videos The Big Combo (HCCNSW, 2002): Approx 20 mins; two people consider pharmaceutical treatment for hepatitis C in very different ways; information on current treatment and interviews with treatment specialists. Available with subtitles for people with hearing difficulties. English.

Everybody’s Business (MHAHS/ANCAHRD, 2004): Covering hepatitis C and HIV; suitable for health workers working with groups. Comes with a facilitator’s workbook. Available in English, Khmer, Somali, Indonesian and Thai.

Look Back Look Forward (Kathy Sport/Ronin Films, 1998): Approx 30 mins; real-life stories of people’s experiences with hepatitis C and interviews with health specialists. Suitable for individuals and health workers.

English. (Council members only)

The most precious gift Until recently, people living with hepatitis C have been advised not to donate body organs - because HCV would be carried across to the recipient. This advice has now changed and it is suggested that people with hepatitis C do consider the act of organ donation.

Transplanting a hepatitis C infected liver into someone who already has hepatitis C makes good sense - if the newly transplanted liver is in a reasonably healthy condition (i.e. non-cirrhotic) and non-HCV livers are not available for that person at the time.

People seeking more information about donating their liver should contact Lifelink, the NSW/ACT network that coordinates organ donation. Phone 02 9229 4003.

HCCNSW

Books Hepatitis C: An Australian Perspective (Crofts, Dore, Locarnini, 2001): Covers all aspects of hepatitis C clinical management, treatment and prognosis. Suitable for health workers. (Council financial members only) Hepatitis C, other liver disorders and liver health: A Practical Guide (Farrell, 2002): Covers all aspects of hepatitis C management, treatment and lifestyle issues, as well as other liver disorders. Suitable for individuals and health workers. (Council financial members only)

Cassette Tapes Hepatitis C: A Brief Introduction (HCCNSW, 2000): The Council’s comprehensive brochure on audiotape for people with reading difficulties. NB: treatment information has changed slightly since 2000. English.

HCCNSW

Volunteers sought for Hep C Review mail out We want to recruit volunteers from the readership to help with the ED54 mail out in early September and hope you might consider coming along.

We offer free training on the job, bottomless coffee, biscuits and air conditioning. Our mail out mascot Rusty will be here (and he is great with kids).

For more information, phone Paul on 9332 1853.

Conference update 14th National Symposium on hepatitis B and C Saturday, 18 November 2006 St Vincent’s Hospital Melbourne Vic Email eleanor.belot@svhm.org.au

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Complaints If you wish to make a complaint concerning our products or services, please visit our website or telephone the office for more information: www.hepatitisc.org.au

02 9332 1853

membership form / renewal / tax invoice An invitation to join / rejoin the Council Hepatitis C Council of NSW PO Box 432 DARLINGHURST NSW 1300 Or fax: 02 9332 1730 About the Council We are a community-based, non-government, membership organisation and a health promotion charity. Our role is to represent and provide services to people affected by hepatitis C throughout NSW. The Council is overseen by a voluntary Management Committee, primarily made up of people elected by the membership. Although primarily funded by NSW Health, we rely heavily on the involvement and support of our members.

1. Please complete A or B or C, then complete other side

A. For people affected by HCV, or other interested people Name Postal address

Suburb/town State

Postcode

Home phone

Email:

B. For individual healthcare or related professionals Name Occupation Postal address

Privacy policy The Hepatitis C Council of NSW respects and upholds your rights to privacy protection. In accordance with National Privacy Principles, we have a detailed policy and set of procedures regulating how we collect, use, disclose and hold your personal information.

For a copy of the policy, please contact the Council office on 02 9332 1853 (Sydney and non-NSW callers), or 1800 803 990 (NSW regional callers), or visit our website: www.hepatitisc.org.au

Membership Our membership year begins on 1 March and runs to the end of February the following year. All members (including Zero Fee members) must renew their memberships on an annual basis.

Membership income assists the Council greatly in its work throughout the year.

For NSW health care workers One of our services is the NSW Hep C Helpline, an information and support phone line that is able to refer callers to a range of services and health care workers in their local area (within NSW only).

If you want to be listed on our database as a referral option, please indicate on this form and return to us by fax or post. We will provide posted regular HCV update information. Please note that we encourage services on our referral database to become members of the Council.

Suburb/town State

Postcode

Work phone

Work fax

Mobile

Email:

May we list you on our referral database?

Copies of The Hep C Review required

1

2 5 10 20 50 100

1

2 5 10 20 50 100

C. For agencies, organisations and companies Name of agency Contact person Position Postal address

Suburb/town

As the most widely-read hepatitis C publication in NSW, targeting both people affected by hepatitis C and health care workers, The Hep C Review is provided free to all members of the Council.

State

Postcode

Work phone

Work fax

In NSW, if your service has clients/patients who may be interested in The Hep C Review, please indicate the number of extra copies you would like to receive on this form.

Mobile

Email:

May we list you on our referral database?

Copies of The Hep C Review required

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membership form / renewal / tax invoice 2. Are you a new or existing member?

5. Separate donations are gratefully accepted by the Council.

Donations of $2 and over are tax deductible.

This is the first time I've applied to become a financial member

If you would like to make a separate donation, please record the amount here:

I'm already a financial member and this is a membership renewal

$.....................................

I currently receive your magazine and I want to become a financial member

6. If paying by credit card, please provide all information in this section.

I'm not sure - please check your database

Card number:

3. Our membership year begins on 1 March and finishes on the last day of February.

To become a financial member, please tick one membership fee box, below:

Card type

Waged: for people in paid employment

$25

Cardholder signature:

Concession: for people on government benefits

$10

Zero Fee membership: for people in NSW experiencing severe financial hardship (NSW prison inmates)

$0

Individual health or allied professionals

$40

7. Payment, GST and postage instructions

Community-based agency (Management Committee run)

$50

All Council membership fees are GST exempt but for most people, our membership fees are not tax deductible.

Public/private sector agency

$70

MasterCard

Expiry date:

Visa

month:

Bankcard

year:

Please print cardholder name:

If paying by cheque or money order, please make payments out to:

NB: Above are Australian rates only. Overseas applicants please contact the office or consult our website for additional surcharge information.

Hepatitis C Council of NSW - Membership Please post payments to Hepatitis C Council of NSW PO Box 432 DARLINGHURST NSW 1300 Our ABN is 96 964 460 285

8. Would you like us to post you a receipt?

4. Contact with the Council office.

We post our magazine out every three months in plain unmarked envelopes. Occasionally, we contact members (especially those living in Sydney) by phone or mail, seeking volunteer assistance here in the office.

If you would like a receipt for your payment, please tick the box (right)

9. Declaration - I accept the objects and rules of the Hepatitis C Council of NSW and apply for membership of the Council.

I agree to my personal contact details being held by the Council and used in accordance with the Council's privacy policy.

I'd like to assist. Please contact me regarding volunteer work Please do not contact me regarding volunteer work for the Council

Signed:

Dated:

If you would like to obtain a copy of our constitution or privacy policy, please contact the office (02 9332 1853) or visit our website: www.hepatitisc.org.au

This section office use only staff initials 56 The Hep C Review

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date entered

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info pack sent?