Aivl prison diary 22 web

OUT

INSIDE i

Dedicated: This diary is dedicated to all people currently imprisoned throughout Australia who are unable to gain access the same standard of health services as is provided to the general community.

‘THE DEGREE OF CIVILISATION IN A SOCIETY CAN BE JUDGED

BY ENTERING ITS PRISONS’ -Dostoyevsky

Inside out is produced by the AIVL- Australian Injecting and Illicit Drug Users League. © AIVL 2009 ISBN GPO Box 1552 CANBERRA ACT 2601 NOT FOR GENERAL DISPLAY OR DISTRIBUTION This guide does not promote nor condone the use of illicit drugs; rather, it seeks to provide accurate information that will help drug users reduce risks and make safer choices. Nothing in this guide should be taken as recommending drug use.

The information provided has been assembled in consultation with drug user groups in each State and Territory, community organisations and state/territory government Corrections departments.

AIVL does not encourage anybody to break the law or use illicit drugs. AIVL takes no responsibility for any misfortunes which may result from any actions taken based on material within this book and does not indemnify readers against any harms incurred.

ii

ACKNOWLEDGEMENTS Thanks to all who made this diary possible: Firstly, all prisoners, ex and current, for their valuable input.

The assistance and input from the following is also greatly appreciated: State & Territory Government Corrections, Corrections Health & Community Corrections Departments.

Australian Drug User Groups, their staff, volunteers and members, particularly; the South Australian Voice of IV Education (SAVIVE), the NSW Users & AIDS Association (NUAA) and the Canberra Alliance for Harm Minimisation Advocacy (CAHMA). Others to be thanked for their hard work and persistence include: The Connection, Sisters Inside, Justice Action, Community Restorative Centre (CRC) Australian Hepatitis C Councils, Project Reference Group and AIVL staff.

iii

CONTENTS ACKNOWLEDGEMENTS

iii

WHO IS AIVL AND WHAT WE DO? 1

SAFER INJECTING/VEIN CARE

48

JULY

52

ABOUT THIS DIARY

1

OVERDOSE

55

PERSONAL INFO

3

AUGUST

58

ADDRESSES AND PHONE NUMBERS

4

HELP FOR PROBLEMS WITH DRUG USE

61

WHAT IS HEPATITIS?

8

SEPTEMBER

64

WHAT IS HEPATITIS C?

9

PLANNING FOR YOUR RELEASE: 67

9

OCTOBER

DIFFERENT STRAINS OF HEP C

72

WHAT DOES HEP C DO?

11

HEP C FRIENDLY RECIPES

75

JANUARY

12

NOVEMBER

80

HEP C TRANSMISSION

15

USEFUL CONTACTS

83

TRANSMISSION RISKS

15

DECEMBER

86

FEBRUARY

20

NOTES

88

HEP C TESTING

22

VACCINATION

25

MARCH

26

HEP C TREATMENT

29

APRIL

32

LIVING WITH HEP C

35

MAY

38

PROTECTING YOURSELF AGAINST HEPATITIS AND HIV/AIDS WHEN USING DRUGS

41

JUNE

44

CLEANING FITS

47

iv

WHO IS AIVL AND WHAT WE DO? The Australian Injecting & Illicit Drug Users League (AIVL), is the peak national body for State and Territory – based Drug User Organisations. AIVL’s staff are current and/or former drug users and/or on drug treatment. Along with representing illicit drug users on research and advisory bodies, AIVL provides information and educational materials and workshops to drug users about blood awareness, blood borne viruses and safer injecting practices.

Up to 90% of new hepatitis infections are due to drug use. AIVL performs the work it does in the hope of keeping drug users from being infected or re-infected by blood borne viruses like HIV/AIDS, hepatitis B and/or hepatitis C. If you’d like more information about anything in this book we encourage you to get in touch with your local users’ group (contacts in the back), ask your doctor or enquire with prisons health and program services. There are a number of useful contacts included.

ABOUT THIS DIARY All the information contained within this diary was developed with the assistance of recently released prisoners, the majority of who had hepatitis C and were injectors.

With so many people inside with hepatitis C, the main aim of this book is to educate prisoners about the virus, how to avoid infection or reinfection, treatment, and information for people living with the virus.

This booklet does not condemn or condone injecting drug use, nor does AIVL encourage people to use drugs. The information on 1

injecting contained within is aimed at people already injecting. The resource simply aims to reduce the harms associated with injecting (particularly hepatitis C). It is not designed as a ‘how to use drugs inside’ guide.

It is a fact that people do use drugs, and if they do choose to use, it is important to do so as safely as possible regardless of where they are. The information and cleaning methods shown in the book are based on the best available evidence at the time of production.

You may not have the power to use new fits for every hit, but you do have the power to make a choice to inject using the safest method available to you while in prison.

When not inside always use new equipment for every hit: new fits, water vials, tourniquet, your own spoon, swabs and filters. When inside, always try to use a fit that has been cleaned properly using the method shown.

We hope you find the info in this book helpful, that you learn something new and that you share this info with your mates.

2

PERSONAL INFO THIS DIARY BELONGS TO:

WHERE:

NUMBERS:

OTHER STUFF:

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ADDRESSES AND PHONE NUMBERS WHO:

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ADDRESSES AND PHONE NUMBERS WHO:

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ADDRESSES AND PHONE NUMBERS WHO:

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ADDRESSES AND PHONE NUMBERS WHO:

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1

ep you ha ve H e c n O . a ga in M yt h n ’t get it C, you ca nt of differe s se u a c e B iru Fa ct get the v n a c u o y a ga in. stra ins, a ga in a nd d n a , in a g a

what is

Hepatitis?

Onl y at a mag nification of O N you clearly se e the hep C E MILLION can vi ru s!

8

WHAT IS HEPATITIS? Hepatitis is a medical term that means ‘inflammation’ or ‘swelling’ of the liver. Inflammation is the body’s natural reaction to injury.

Hepatitis can be caused by: • a virus • drinking lots of alcohol • some chemicals Hepatitis can be caused by many viruses. In Australia the most common are Hepatitis A (Hep A), Hepatitis B (Hep B) & Hepatitis C (Hep C).

WHAT IS HEPATITIS C? Hep C is a blood borne virus which means you can get it if blood infected with Hep C gets into your blood stream. Invisible amounts of blood (in syringe, on someone’s hand or on tattooing needle) are enough to transmit the virus. Millions of the Hep C virus can live in a drop of blood the size of a pin head

DIFFERENT STRAINS OF HEP C There are different strains, called genotypes, of the hepatitis C virus. You can be re-infected with the same or a different strain.

The more times you get Hep C the more damage that is done to your liver. Some strains are harder to treat than others. Some strains need treatment for 6 months, others strains need treatment for 12 months. A polymerase chain reaction (PCR) test will tell you what strain you have.

9

Hepatitis A What is it

Hepatitis B

Virus that affects Virus that affects the liver the liver

Hepatitis C Virus that affects the liver

Passed on by Found in infected Blood to Blood (transmitted) persons faeces. If Sexual contact. a person doesn’t wash their hands after going to the toilet and they touch your food, drinks or stuff you eat with (i.e. fork or spoon etc).

Blood to blood.

Vaccination Available

Yes

Yes

No

Treatment Available

Only short term affects so no treatment given

Yes

Yes

Prevention

Vaccination, washing hands after going to toilet and before eating.

Vaccination.

Not sharing fits or other injecting stuff.

Not sharing fits or other injecting stuff.

Not sharing, razors, toothbrushes etc.

Safe sex (use condoms) 10

No other blood to blood contact, sharing razors, toothbrushes etc.

Fighting, rough sex etc.

WHAT DOES HEP C DO? The hepatitis C virus can damage your liver and cause scarring that affects how well the liver works. Short term effects can include making you feel tired and sick, experience aching muscles and joints. Over many years it can cause liver cancer or liver failure. Research into the effects of Hep C is still very new, but Hep C has been linked with many other conditions such as type 2 diabetes, thyroid diseases, different skin conditions and arthritis, to name just a few.

HEP C TRANSMISSION • The virus must be present in the blood.

• The virus leaves the body of a person who is infected.

• The virus must break through the skin barrier and enter the bloodstream of another person. There is no such thing as immunity to the Hep C virus.

• Even if you are one of the lucky 25% that naturally clear the virus in the first 6 months - you can still get the virus again.

• Having antibodies to Hep C doesn’t protect you from getting it.

• Having Hep A or Hep B doesn’t give you immunity to Hep C. • There is no such thing as Hep C that is ‘dormant’ or that can’t be passed on to others.

• Even if you have never felt sick from Hep C you can still pass it on.

11

JANUARY Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri 12

Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon 13

2

1990 Nelson a fter yea rs

Feb – – 11th freed Ma ndela28 serving n. in p riso

Basics of Hepatitis c “Live were yoeuver y da y a s if da y, you’l r la st. Becau se it l be righ on e t” 14

Chronic Hepatitis C outcomes chart (Natural History) On average, one of every four people who contract HCV will clear their infection naturally within 12 months. Three of every four people will develop chronic (ongoing) hep C. Of 100 people with chronic hep C who remain untreated After 20 years

45% won’t develop liver damage

47% will develop mild to moderate liver damage

After 40 years

45% won’t 31% will develop develop liver mild to moderate liver damage damage

7% will develop cirrhosis of the liver

1% will develop liver failure or liver cancer

20% will develop cirrhosis of the liver

4% will develop liver failure or liver cancer

TRANSMISSION RISKS HIGH RISK: Injecting Injecting is one of the easiest and high risk ways for getting or passing on Hep C. Injecting is the most common way that hepatitis C is transmitted, about 90% of new infections are through injecting.

Preventing Hep C when injecting Cleaning fits (see page 47) will reduce risk. On the outside always use new equipment.

Never share any other injecting equipment e.g. Spoons, filters, water, tourniquets. Wash hands before mixing up and before injecting yourself or helping others.

15

HIGH TO MEDIUM RISK: Tattooing Tattooing is also a high risk for contracting Hep C. If the tattooing equipment (including the ink) has been used by others and hasn’t been cleaned properly then there is a high risk of getting Hep C. Using new tattooing equipment is the only way to be sure you won’t get Hep C. This means using; new gun, new needle, new ink, new everything, every time.

If new equipment is not available then, wherever possible, soak used gear in bleach for as long as you can. Make sure everyone involved washes their hands. Have your own wipes or cotton. Make sure the area is clean.

Piercing and scarification Piercing and scarification equipment can transmit the virus if equipment is re-used (see above: tattooing equipment and cleaning).

MEDIUM RISK: Fights and Slash UpsWhen there is blood involved there is always a risk for Hep C to be transmitted. Clean up cuts and blood spills with bleach or antiseptic. Keep all wounds covered with clean bandages.

16

LOW RISK: Sex Hep C is not considered a sexually transmissible infection (STI), but if there is blood involved and open wounds etc (periods, rough sex, anal sex) then there is the possibility of getting or passing on Hep C. Always using condoms will help prevent Hep C (Hep B & HIV) and other STI’s.

House-hold Transmission Household transmission is low risk and rare. Household transmission is easy to avoid with simple precautions. It is important to not share items that can have blood on them; household items such as toothbrushes and razors almost always have blood on them. Always use your own razor and toothbrush and never let other people use them. Keep these separate and to be safe keep them out of reach of children.

Nail clippers, scissors, hair brushes and combs can have small amounts of blood. As with toothbrushes and razors, don’t share these household items.

Blood spills around the house are a low transmission risk. Clean up any blood spills straight away with bleach and/or detergent and if possible wear disposable gloves.

17

Blood transfusions are very low risk In Australia, since 1990 all blood is checked for hepatitis C and the risk is now very low.

NO RISK: • • • • • •

Hepatitis C is not transmitted through breast milk.

You can’t get Hep C from sharing cups, plates or cutlery.

You can’t get Hep C from hugging or kissing.

You can’t get Hep C from the air.

You can’t get Hep C from swimming pools, showers or toilets.

You can’t get Hep C from mosquitoes or other insects.

PARENTING ISSUES: Protecting your children from Hep C is easy by taking the precautions above in avoiding household transmission.

Pregnancy, testing babies and children There is a low risk of approx 5% that the baby will get Hep C from the mother during pregnancy (called vertical transmission). It is not recommended to test babies before 18 months old as they will carry the mother’s Hep C antibodies. This doesn’t mean the baby has Hep C. The decision to test children after 18 months should be discussed with a doctor or someone you trust and feel comfortable with.

Women with Hep C can have a normal birth and don’t need to have a Caesarian Section.

18

Breast feeding Women with Hep C can breast feed. Hep C is not transmitted through breast milk. There is a risk of transmission if the woman has bleeding or cracked nipples. Wait until nipples are healed before re-starting breast feeding.

Monthly Periods Even though the risk is low, to be safe, women who have their periods (menstruating) should use condoms and/or dental dams to prevent transmission.

19

FEBRUARY Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri 20

Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon 21

3

30 00 ca n exist0 000 hep viru the size in a d rop of b ses loo of a pin hea d. d

Hep c

testing M yt h of the- Some stra pa ssed vi ru s ca n ’ ins t be on. different Fa ct- All of thessed on. stra ins ca n be pa 22

HEP C TESTING How is a Hep C Test Done?

The test is done by taking a small amount of blood. Before this test you should be given a Pre-Test Discussion.

Pre-Test Discussion (this used to be called Pre-test Counselling) The pre-test discussion should give you information on: • What a positive result means - the virus has been detected in your blood.

• What a negative result means - the virus hasn’t been detected in your blood.

• Where and how to get health advice for a positive result.

• If you get a negative result, how to stay free from the virus.

The Pre-Test Discussion should: • • • •

Be private, Be explained in a way that you can understand, Have plenty of time for you to ask questions, Include the information in writing for you to take away and look at later.

What type of test should I have?

This will be worked out with the health care worker in the pre-test discussion. The first test that is usually done is the antibody test.

If the anti-body test is positive you can confirm if you have Hep C with a PCR test. To have treatment Hep C has to be confirmed with a PCR test.

23

Antibody tests The Antibody test looks for Hep C antibodies in the blood. Our bodies create antibodies in response to a virus entering the body. This test tells if you have come into contact with Hep C by looking for antibodies created in response to this contact. This test can’t tell if you have the virus. If you have naturally cleared the virus (see natural history page 15) you will still have antibodies. Even people who have had successful treatment will still have antibodies. Antibodies do not give you immunity to Hep C. They do not protect you from Hep C.

PCR (Polymerase Chain Reaction) tests After an antibody test, another test is needed to confirm that you have the virus. This test is called a Polymerase Chain Reaction (PCR) test. A PCR test looks for the actual virus rather than antibodies to the virus. There are different PCR tests that look for different things: • The PCR viral detection test looks for the presence of the virus. This test is used to confirm if a person has Hep C and is used before starting treatment.

• The PCR genotype (or strain) test tells what strain of the virus is present. This test is used in deciding the length of time on treatment. Different strains mean different amounts of time on treatment as some are easier to treat.

• The PCR viral load test looks for the amount of virus in the blood. This test is used during treatment and tells if the amount of virus in the blood is going up or down. It helps tell if the treatment is working.

24

Vaccination There are no vaccinations for Hep C or HIV. Prevention is the only method of staying free from both of these viruses.

There is a vaccination for both Hep A and Hep B. People with Hep C should get vaccinated against Hep A & Hep B to protect themselves from any more damage to their liver. Even if you don’t have Hep C, vaccinations for Hep A & Hep B are a good idea and worth asking about.

Most prisoners are able to get free vaccinations for Hep B while in prison from prison health clinics, Hep A vaccinations are also sometimes available.

25

MARCH Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri 26

Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon 27

4

st tion ’s fir a N il nry Ap r - 9th tra fficker, He r 1923 o f g u d dr hs ja il convicte does 6 mont m n iu M c E wa t h e d r u g o p in dea ling

Basics on treatment 1/3 of all ma le prisoner Hepatitis C Positive. 2/3s are of all fema le prisoners Hepatitis C positi ve. are

28

HEP C TREATMENT Before anyone has treatment they should try to: • • • •

Get lots of information on treatment and the side effects!

Get information on support services.

Weigh up the pros and cons on treatment.

Think about what else is going on in their life and will this fit in with treatment (Sometimes people have lots of things going on in their life so decide to wait).

Who can get Treatment?

• The prison health clinic staff will advise you of the conditions for treatment. These conditions include: • Repeated positive hepatitis C antibody tests or active hepatitis C (tested with PCR).

• Not pregnant or breast feeding.

• Use of contraception, with both partners taking precautions to prevent pregnancy both during treatment and up to 6 months after cessation of treatment.

• Must be 18 years or older.

• People who have had one previously unsuccessful attempt at treatment may be eligible • People with irreversible liver damage may not be eligible There are two drugs involved with Hep C treatment: • Pegylated Interferon. This drug is injected under the skin once a week.

• Ribavirin. This drug comes in tablets that are taken daily.

Depending on what strain of Hep C you have, treatment is for either 6 months or 12 months.

29

HepC

Hep C Treatment Side Effects

treatments

Before starting treatment you should get lots just took a of information on the for possible side effects and the better! ... ways to manage them. did you know, with treatment...

The doctor and nurse • Up to 80% of people clear the virus treating you for Hep C will • Liver biopsy no longer required help with management • Side effects are better managed and easier to deal with of any side effects. nt options by visiting: Everybody’s experience Learn more about new treatme nt www.aivl.org.au/hepctreatme with treatment is different.

Some people have no side ment HepC Treat get informed effects, others mild side effects, while others stop treatment because the side effects are so bad. Side effects can get better with time.

turn

AUSTRALIAN INJECTING & ILLICIT

DRUG USERS LEAGUE

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Some facts about current Hep C treatment: • Currently, with treatment and depending on the strain up to 80% of people now clear the virus.

• Before menopause women have a better chance of clearing the virus than men do.

• Women progress to liver scarring and liver cancer at a slower rate than men.

• Liver biopsies are not required anymore.

• Side effects are better managed and easier to deal with.

30

Support for Hep C Treatment There are support groups and services available to help people get through treatment and to help cope with side effects. If you know someone who has been through treatment you could talk with them or contact a support group or service that can put you in touch with someone who has completed treatment. Hep C treatment can cause depression so it’s important that you have lots of support to help you cope. Getting support will give you a better chance of finishing your treatment.

Hep C Treatment in Prison Some prisoners do have access to hepatitis C treatment while inside.

The health clinic staff can tell you if you can get treatment inside and how to do this.

If you can get treatment inside you might want to consider: • Privacy - will other prisoners and staff know you are on treatment (maybe you don’t care if others know).

• Coping with side effects while locked up.

• Is there support available at the prison.

• Maybe your time locked up is well spent by having Hep C treatment.

Even if you can’t get treatment inside: • • • •

You can find out more about it.

Start thinking about treatment for when you get out.

You may be able to get some of the pre treatment tests.

Get referred to a treatment clinic for when you get out.

31

APRIL Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri 32

Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon 33

5

th May – 2001 - 6st ical ly Austral ia’s firjectmined centre g supervised in ney op ens in Syd

Living

with hep c ay & orld Hepatitis D W – ay M th 9 1 eek is Awareness W it at ep H al on ti Na

The m of a ll isost wa sted da y we ha veone in which not laugh ed

34

LIVING WITH HEP C Many people have little or no symptoms of Hep C. This doesn’t mean that it has gone away or that it can’t be passed on. It just means that the virus is not causing serious effects on your body. For some people it can take 20 or more years for it to cause damage to your liver. This can also depend on how you live your life.

Living a healthy lifestyle can help to slow down the negative health effects.

Staying Healthy with Hep C Hep C causes damage to your liver and can make you feel tired and sick.

To protect your liver and help you feel better you should: • Avoid alcohol or at least cut down. Have breaks and alcohol free days. Alcohol speeds up damage to the liver. People with Hep C should drink much less than the recommended drinking levels.

• Avoid fatty foods. The liver has to work harder to break down fats.

• Eat plenty of fresh fruit and vegies.

• Get plenty of rest when you feel tired.

• Drink plenty of water.

• Get regular exercise.

• Try to avoid stress. Take up meditation or some other activity for controlling stress.

• Think about getting vaccinated against Hep A and B if you haven’t already.

35

• If still injecting drugs use the safest injecting methods you can.

• Consider alternative therapies (i.e. acupuncture, reflexology, yoga or tai chi, traditional Chinese medicine, homeopathy, reiki). Most Hepatitis Councils in your state will have resources about these.

Your Rights It is your right to be treated equally and without discrimination if you are Hep C positive. If you feel you have been treated unfairly or discriminated against there are many places you can go to for more information or advice regarding discrimination or complaints (please see contacts list located at the end of this diary). There are only a few exceptions where discrimination is allowed, for example: • People who are Hep C positive are not able to donate blood.

• In general you are not required to tell your employer, although in some cases health care workers or people whose work involves ‘exposure prone procedures’, i.e. the Australian Defense Forces, are sometimes required to notify their employer.

• If applying for health insurance sometimes disclosure maybe required.

The anti-discrimination laws and exceptions to these are different in every State and sometimes can be complex to understand.

Your State Hepatitis Council can best advise you of your rights in your state.

36

NOTES

37

MAY

Internationa l Hep atit Awareness Wee is k

Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri 38

Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon 39

6

Obstac les are necess ary for success because victory com es only afte r man y stru ggle s and cou ntle ss def eat s.

Protecting yourself “At a n y moment I could sta rt being a son better per h ic – but wh moment should I choose?”

40

PROTECTING YOURSELF AGAINST HEPATITIS AND HIV/AIDS The best way to not get Hep B, Hep C or HIV is to not inject.

The next best way is to use a new fit or a fit only used by you.

Rather than injecting your drugs you can also consider using them in different ways, such as: Swallowing drugs Smoking drugs Snorting Shafting (up your bum) As a last option (always choose one of the above where possible) Clean a fit that has been used previously.

See page 47 for example.

Bleach when trying to kill the Hep B, Hep C and HIV viruses is the best thing to use if new fits aren’t available. The longer the fit has come into contact with the bleach the better chance of killing Hep C. If you don’t have bleach, detergent is better than nothing at all. If none of these options are available rinse as many times as possible with cold water.

1 2

3

1 41

3

2

Hep B, Hep C and HIV can get onto other injecting equipment such as spoons, swabs, filters, tourniquets, water.

• Make sure used fits don’t go into a joint mix.

• If you only have dirty fits use separate spoons and separate water containers.

• Don’t put dirty used fits in shared water.

• Don’t mix up with water that has been used for rinsing fits.

• Get new water.

• Have a few water containers: a separate container for rinsing and a separate container for using in mix.

• If you don’t have enough containers throw out water and refill with new, clean water.

SEX Use a condom, dental dams, latex gloves etc for sex. These will help protect you from HIV.

INJECTING Don’t share fits or other injecting stuff like spoons, swabs, cotton wool, tourniquets or water. If being injected by others or helping someone to inject make sure hands are washed well with soap to make sure no blood gets on the injecting site.

It doesn’t matter what you are injecting, you can get HIV and hepatitis C and B if someone else’s blood gets into your blood stream.

STEROID INJECTING Steroid Injectors are also at risk for HIV (Hep B & Hep C) if new or clean equipment is not used.

42

TATTOOING & PIERCING Always use new, or well cleaned (with bleach if available) equipment for any tattoos or piercing. Try to have your own tattoo guns, needle and ink. Avoid dipping used needles into ink. Try to have piercing equipment used only by you. Encourage everybody to wash their hands before and after.

SKIN SCARRING (Scarification) SKIN PEELING BODY ALTERATIONS Anything that involves cutting, inserting or peeling the skin for decoration/ tribal markings will involve blood and therefore risk of HIV (Hep B & Hep C) transmission. Always use new or well cleaned (with bleach if possible) equipment (razors, knives etc) Again, make sure everybody washes their hands.

43

JUNE Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri 44

Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon 45

7

“Harm Minim isation is a sensation” li ving

Protecting yourself part 2

“I ha ve ow n--stroopinngions of my opinions-but I d ’t a lw a ys a gree with thoenm -George B.”u s h 46

CLEANING FITS The following method for cleaning fits is the most effective available at present to destroy the hepatitis C, hepatitis B and HIV viruses.

Use cold water, full-strength bleach and three different containers.

1. Cold Water 2. Bleach 3. Cold Water

3

1 2

1)

Draw up fit full of water from container 1. Rinse as many times as possible to remove visible traces of blood. Squirt down a sink, bin or drain.

2)

Draw up fit full of bleach from container 2. Shake for at least 30 seconds, counting slowly: one-one thousand, two-one thousand... Squirt bleach down a sink, bin or drain.

3)

Draw up fit full of cold water and rinse as many times as possible.

Don’t squirt water or bleach back into used containers.

No bleach?

Rinsing with cold water alone or detergent followed by water is better than doing nothing when trying to destroy hepatitis C, hepatitis B and HIV.

47

SAFER INJECTING/VEIN CARE – KEEP’ EM FIT Hand Washing Before injecting its worth taking a few extra seconds to wash your hands An effective washing practice is: • Remove all jewelry before washing.

• Wash your hands and the injecting site with warm running water and soap for at least 10-15 seconds (longer if visibly dirty). Remember to pay careful attention to your finger tips and between your fingers and hand creases; • Dry hands with paper towel (if not available give them a good shake).

Clean the injecting site.

If you don’t have swabs wash the injecting site with soap and water.

Take your time finding a vein • Warm up your arm or place where you are going to inject • Jump or run around to get the blood flowing.

• Try and drink at least a glass of water before finding a vein.

• Use a tourniquet as this makes finding a vein A LOT easier.

After finding the vein, slowly take the tourniquet off before you inject.

• It’s best to alternate veins as they take at least a couple of days to heal.

• Practice injecting with your other hand, in your other arm.

It may be awkward at first, but it gives you more options.

48

Inject Slowly Push the plunger down slowly, as this creates less pressure on the vein and is a good precaution in case you hit a nerve or artery. If the shot starts to hurt, pull out immediately.

After injecting, put clean tissue or toilet paper on the spot and hold firmly until bleeding stops. This will help stop blood leaking under the skin which causes bruising.

Never lick the tip of the needle or the blood from the injected site. Your mouth has tons of bacteria which can get into your blood stream and cause major problems.

Vein Care: looking after your veins.

Your veins are very important for circulating blood and oxygen around your body; they get oxygen to your arms, down to your fingertips, down your legs and to your toes. If the oxygen doesn’t get to these areas then they die. Everybody (injecting or not) needs good healthy, working veins.

Rotating your injecting spot • When you stick a needle in your vein, it leaves a hole that needs time to heal. Look after your vein by letting it heal before you hit on it again.

• If you don’t let your veins heal, you may get collapsed veins.

This means you may lose the vein permanently.

• Repeated injecting in the same site could cause infections.

• Unhealed veins can also leak which may result in a wasted shot.

49

• Sticking a needle through a hole that isn’t healed properly can push a blood clot into your blood stream. This clot could get stuck somewhere else in your body, including your brain. This is really dangerous.

Dirty Hits Dirty Hits can be caused by many different things like not washing your hands properly, not using clean injecting equipment, a dirty mix or not having a clean fit.

There are heaps of germs/bacteria inside people’s mouths. Injecting something that has been in the mouth (yours or some else’s) can also cause a dirty hit. This risk can be reduced, but not eliminated, by using appropriate filters. Once introduced into your body, bacteria can grow on your organs, build up and cause very serious health problems.

Think about things Do your best when in a hurry, if you are panicking about your shot, that’s when you could blow your vein! Steady! Take a deep breath and try not to rush it too much - Save the “easy” spots for when you KNOW you don’t have time.

The newer or sharper the fit is the less damage it will do to your veins.

Best to worst places to inject Arms are the best place to inject.

Legs are the next best but remember blood flow is slower here so there is more risk of blood clots and swelling.

Veins in hands and feet are more delicate and can blow out easily.

Feet take a long time to heal and the blood flow is very slow.

50

Groin injecting is very dangerous. The vein is very deep, hard to find, and close to the main artery and nerve.

Neck injecting is extremely dangerous.

Arteries Never inject into an artery. Arteries have a pulse that you can feel and the blood is bright red. If you do inject into an artery, pull out immediately and apply pressure until the bleeding stops. If the bleeding doesn’t stop or the area swells up and becomes red and painful - you need to seek medical help as soon as possible.

Electron microscope picture of needle used

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6 times

JULY Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri 52

Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon 53

8

Overdose

what to do the “Despite liv ing – cost of popu la r ” It ’s stil l

54

OVERDOSE When someone drops it’s important to do something quickly.

The first few minutes are very important.

Shout their name, gently shake their shoulders, or even pinch their earlobes. If no response, call for help (an officer inside, an ambulance outside) and then follow these steps: 1)

Check airway for food, vomit, dentures or anything else that might restrict breathing. Put your hand under their neck and lift gently so their head tilts back and you can see down their throat.

2)

Clear any blockage, gently with your fingers. Don’t take out false teeth unless they are blocking the airway.

3)

Keep your hand under their neck and put your ear to their mouth and nose to check their breathing. Watch for the rise and fall of their chest. If not breathing start CPR (cardiopulmonary resuscitation)

4)

Check on the side of their neck for a pulse. Use your fingers not your thumb. If no pulse start CPR.

5)

If they have a pulse and they are breathing, gently roll them on their side in the recovery position (see picture page 53).

6)

Maintain keeping their head tilted back to keep airway open.

7)

Keep watching their breathing and checking their pulse while they’re unconscious until help arrives.

55

Follow these steps whether you’re in prison or outside. We know you can’t call an ambulance in prison but prison officers must be told so they can call one. If needed buzz on the intercom from the overdosed person’s cell, that way you can save their life without putting your head on show.

Save your mate, their life’s at stake.

RECOVERY POSITION

56

CPR CPR breathes and compressions, 30 compressions, 2 breaths until ambulance arrives.

WARNING Overdoses are very common with newly released prisoners. The gear may be stronger and your tolerance decreased. Be careful when using outside – most overdose deaths happen when people use alone and/or when combining drugs. Pills+ alcohol + heroin DON’T MIX. 57

AUGUST Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri 58

Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon 59

9

rs, sp ell out numbe to re e w u o If yo you have to g how fa r would find the letter until you would ……… …

“A”? …………

One thousand.

Getting help

60

HELP FOR PROBLEMS WITH DRUG USE Drug use can cause all sorts of problems in people’s lives, affecting not just individuals but friends and families.

Lots of people are locked up for drug related offences. If you want to cut down or stop there are treatments available to help you do this.

For more information on these options speak with health clinic staff or contact the agencies listed towards the end of this diary.

Treatment Options Detox & Rehabs Detoxes are usually short term treatments where people can physically withdraw (generally with medical supervision) from the drug/drugs they are experiencing problems with.

Rehabs are longer term options, consisting of a few months or up to a year or longer.

Both provide a break from drug use, a chance to eat well, improve health and learn skills to help live drug free (or reduce drug use).

Support Groups There are lots of different support groups to choose from. The well known groups include NA (Narcotics Anonymous) & AA (Alcoholics Anonymous). These are abstinence based treatments.

61

Counselling This option is for any type of drug use and can be used on its own or combined with other treatment options. Some people find this option very helpful for drug use and other problems. Drug and Alcohol agencies can give you details of where to get counselling. Like all of the different options, you never know, unless you give it a go! It may work for you.

Replacement Drug Treatments (sometimes referred to as Pharmacotherapies) The following are replacement drug treatments for heroin use (or other opioids; morphine etc). Currently, there are no substitute drug treatments for speed, cocaine or marijuana use.

Methadone - treatment for heroin use. Taken daily as a drink.

Methadone has been shown to improve health and help leave behind the chaos of chasing money and drugs.

Subutex (Bupe or Buprenorphine) – Taken sublingually (under the tongue) daily or every second day.

Suboxone (Bupe or Buprenorphine with Naloxone) – Naloxone (also known as Narcan) is the drug ambos use to bring someone around from a heroin overdose. When taken orally the naloxone doesn’t have any effects. When injected it can cause withdrawal.

Naltrexone – this drug blocks the effects of heroin and can reduce carvings. It is taken in tablet form or as implants under the skin and is much longer acting than Narcan.

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NOTES

“If toast alw ay dow n, and c s la nds butter-side ats always la nd on their feet, w stra p toast on hat hap pens if you and d rop it? the ba ck of a cat ” – Ste ven Wright.

63

SEPTEMBER Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri 64

Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon 65

10

“ When I p ea cefull y die, I wa nt to g o like m did, in his y Gra ndfather s lee sc reaming , like th p, not e pa ssen in his ca r ” – Anon gers .

Your

Release “Try to bare light ly what needs mu st be”

66

PLANNING FOR RELEASE: Release Date: Have you contacted family and friends to tell them your release date? Y/N Do you have someone to help with release planning?

Y/N

Have you tried to get a support person to help you?

Y/N

(This could be a welfare officer, parole officer, family or friends.)

There are some support services listed at the back of this book. Ask your support person for contacts not provided. Most states/territories have prisoner assistance services. They can help with things you will need for your release.

Support Person Name: Contact details: Planning for your release - ID...

Do you have enough ID?

Y/N

To get Centrelink payments you will need 100 points.

The following forms of ID can be used: Birth certificate; Marriage certificates; children’s birth certificates; Divorce papers (available from Births, Deaths & Marriages registry office). Certificate of residence/citizenship (available from Immigration departments) Address of registry office and/or immigration department:

67

Do you have?

Birth certificate Passport Residency or Citizenship Marriage certificates Children’s birth certificates Divorce papers Drivers license/permit Bank statement with address ATM card or credit card School/Trade certificates.

70 points 70 points 70 points 40 points 40 points 40 points 40 points 40 points 40 points 40 points

Other

FINANCES Ask your support person about Centrelink forms so you can get paid as soon as possible.

Centrelink forms completed?

Y/N Do you have a tax file number?

Y/N Contacted the Tax Office?

Y/N Tax file number Tax Office address or phone number:

You will need a tax file number for work & for Centrelink. You have up to 28 days after signing for Centrelink to get this from the Tax Department.

Do you have a bank account?

Is your old bank account still open?

68

Y/N Y/N

Do you need to open a new account? (need 100 points ID) You will need a bank account for centrelink payments.

Y/N

Contact bank details:

Getting money for travel, clothes, and other immediate needs.

Some places give vouchers for travel back home.

Some prisoners can apply for money for clothes. Emergency money is available in some places for other needs.

Ask prison welfare, support staff or your parole officer if any of these are available.

Travel organised Y/N Getting a lift Y/N Travel vouchers available applied for?

Y/N Money for clothes available applied for?

Y/N Emergency money available applied for?

Y/N

HEALTH Do you have a Medicare card?

(You will need to mail copies of your ID to get a card)

Y/N

Medicare address:

Medicare form posted Y/N Have you spoken to health clinic staff about getting a health summary?

Y/N Got health summary Y/N (You will need this for management of health conditions such as 69

diabetes, high blood pressure, Hep C, HIV) Are you on Methadone or Bupe?

Methadone/Bupe transfer and/or script organised Are you planning on going to rehab or counselling?

Ask for referral and help to book in through the health clinic Referral organised / Booking organised

Y/N Y/N Y/N Y/N

Name & Address of rehab/counselling:

ACCOMMODATION Are you able to live where you were before?

Have you checked that this is still available?

Have you made enquires for government housing?

Do you have your name on the waiting list?

Y/N Y/N Y/N Y/N

Contact number\contact person:

Has your accommodation been approved by your parole officer? Y/N

OVER DOSE WARNING Overdoses are common with newly released prisoners. The gear may be much stronger and your tolerance may have decreased.

Be careful when using on the outside. Most overdose deaths happen when people are alone! Always try and use with a mate & don’t combine your drugs! Overdoses often happen when a few drugs are combined. Pills + alcohol + heroin = deadly cocktail!

70

NOTES

71

OCTOBER Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri 72

10th October – World Mental Hea lth Day

Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon 73

I pla yed a bla nk ta volume. The mim pe on full e who lives next door compla ined.” – Steven Wright

11

Healthy Recipes st , you’ve flo d le il k e o “If you’r importa nt pa rt ields a ver y e.” -Brooke Sh you r lif 74

HEALTHY RECIPES FOR EVERYONE BUT ESPECIALLY FOR PEOPLE WITH HEP C. Low fat food, fresh fruit and vegies are a great way to keep healthy while living with Hep C. Where possible, use low fat options for ingredients. Not all the ingredients will be available to prisoners or some of the cooking equipment. All of these recipes can use different main ingredients (meats and vegies). If you don’t have suggested flavourings like herbs, spices, sauces they can be replaced with what is available.

Experiment with others e.g. soy sauce, tomatoes, stock cubes etc. If you have different vegies add these instead or as well.

Bean Submarine

Method

2 Tablespoons of red kidney beans (can use other similar bean like baked beans) 2 tablespoons of Corn Kernels (fresh or tin) 1/2 spring onion (brown or white) 1/4 Carrot, grated (other vegies) 50 g reduced fat cheese (or other cheese) 2 teaspoons of taco sauce (BBQ, or tomato with added herb or spice) 2 Bread rolls

1) 2)

3)

75

Mix all ingredients together except rolls Split rolls along one side, pull out some bread and spoon in the mixture Wrap in foil and bake for 10 minutes at 180c. If no oven, put in pan on very low and cover

Hash Browns

Tuna & Corn Fritters 200g tin of tuna 2 spring onions, finely chopped (brown or white) 1/2 cup grated reduced fat cheese 300g can of cream corn (mashed corn) 2 eggs, lightly beaten Canola or olive oil spray (marg or butter)

1 cup grated potato 1 cup grated carrot 1/3 cup self raising flour, sifted (plain) 2 teaspoons of chives (other herbs) 4 eggs, lightly beaten 1/4 cup reduced fat milk Canola or olive oil spray (marg or butter)

Method Hash Browns - squeeze excess water from potatoes.

Then for the Tuna & Corn Fritters follow the same instructions.

Mix all [Fritter ingredients] or [hash brown ingredients] together except oil. Heat up fry pan; and add a little oil (marg or butter).

Put a spoonful of mixture to make the size/shape wanted. Fry on medium heat for approx 3 minutes on each side or until brown.

76

Biscuits - Oat Cakes

Apple Oat Bran Muffins

1 cup oat bran (or rolled oats) 1/2 cup wholemeal self-raising flour 1 tablespoon sugar 1 tablespoon butter 1/2 teaspoon cinnamon

1 1/4 cups whole wheat flour 1 cup oat bran 1/3 cup brown sugar 2 1/2 teaspoons baking powder 1/4 tsp baking soda 1/4 tsp salt, nutmeg and cinnamon 1 cup milk 2 tablespoons vegetable oil 1 egg or two egg whites 2/3 cup grated apple (do not peel) nuts and raisins are optional

Method 1) 2) 3)

4)

5)

Combine all ingredients and mix well.

Add enough boiling water to make a firm dough.

Knead the dough, roll out onto a floured board to ½ cm thickness and cut into triangles.

Place on non-stick baking trays. Bake at 160ºC/325ºF for 12 to 15 minutes, or until light brown.

Remove from oven and allow to cool while still on baking tray. When almost cool, carefully remove biscuits from the tray and store in an airtight container.

Method 1) 2) 3) 4)

5)

77

Mix dry ingredients in a bowl.

Mix wet ingredients in another bowl.

Mix the two together then fold in apple.

Spoon into muffin cups and bake 375 degrees about 20 minutes or until golden brown.

Batter keeps in refrigerator for up to 3 days.

Breakfast Pancakes

Pancakes plain 2 cups self raising flour (white) 2 cups reduced fat milk 2 eggs

1 1/2 cups of wholemeal self raising flour 1 cup untoasted muesli or rolled oats 2 eggs, beaten 1 tablespoon honey 2 cups reduced fat milk Extra milk if required

Method Combine all ingredients and mix well to make a thick batter. Let the breakfast pancakes mixture sit for approx 30min if possible, to soften flour and muesli. Heat the marg in frying pan on a medium to high heat. Make to desired size, cook 1 to 2 mins each side until golden brown.

78

NOTES

79

NOVEMBER Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri 80

ber 1st Novem a l n io – Inter nat a y D s Drug User

Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon 81

12

Obstac les are necess ary for success because victory com es only afte r man y stru ggle s and cou ntle ss def eat s.

Useful

contacts

82

USEFUL CONTACTS User groups AIVL (national) NSW (NUAA) ACT (CAHMA) QLD (QUIHN Brisbane) SA (SAVIVE WA (WASUA) TAS (TASCAHRD) VIC (Harm Reduction Victoria)

02 6279 1600 02 8354 7300 or 1800 644 413 02 6279 1670 07 3620 8111 or 1800 172 076 08 8334 1699 08 9321 2877 03 6234 1242 03 9329 1500

Hep C Councils National Info Line NSW ACT QLD VIC SA WA NT (Darwin) NT (Alice Springs) TAS

1300 HEP ABC (1300 437 222) 02 9332 1599 or 1800 803 990 1300 301 383 07 3236 0610 or 1800 648 491 03 9380 4644 or 1800 703 003 08 8362 8443 or 1800 021 133 08 9328 8538 or 1800 800 070 08 8941 1711 08 8953 3172 03 6243 1242

Prisoner support groups NSW (Prisoners Aid) NSW (CRC Justice Support) ACT (Prisoners AId) QLD (Prisoners Aid) VIC (VACRO) VIC (ACSO) SA (OARS) WA (OUTCARE)

02 9281 8863 02 9288 8700 02 6257 4866 07 4772 3330 03 9605 1900 or 1800 049 871 03 9413 7000 08 8210 1811 08 6263 8622 83

NT (Prisners Aid) NT (Alice Springs) NT (OARS) TAS (TAPSS)

08 8981 5928 08 8953 3054 08 8981 0487 03 6225 5042

Aboriginal support Groups NSW Redfern Aboriginal

Medical Service ACT The Connection ACT Winnunga Aboriginal

Medical Service QLD Aboriginal & Torres Strait

Islander Legal Service VIC Aboriginal Advancement

League SA Nunkuwarrin Yunti

Aboriginal Medical Centre SA Aboriginal Prisoners &

Offenders Support Service WA Derbarl Yerrigan Aboriginal

Medical Centre NT

02 9319 5823 02 6279 1671 02 6284 6222 1300 651 188 03 9480 6377 08 8223 5217 08 8231 0311 08 9421 3888 1800 131 350

Drug & Alcohol Information Services NSW ACT QLD VIC SA WA NT TAS

1800 422 599 02 6207 9977 1800 177 833 1300 858 584 1300 131 340 1800 198 024 1800 629 683 1800 811 994 84

Useful Websites Information; Support; Counselling websites www.aivl.org.au www.counsellingonline.org.au www.beyondblue.org.au www.adin.org.au www.adca.org.au www.ancd.org.au www.druginfo.adf.org.au Hepatitis C www.hepatitisaustralia.com www.hcvadvocate.org Indigenous www.healthinfonet.ecu.edu.au Prison Support & Other www.vacro.org.au www.bridgefoundation.com.au www.incorrections.org.au www.sistersinside.com.au email prisonsupportservices@aus.salvationarmy.org www.beyondbars.org.au

85

DECEMBER Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri 86

1st of December Wolrd AI DS Da y 10th December – Inter national Huma n Rights Da y

Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon 87

NOTES

88

NOTES

89

NOTES

90

NOTES

91

NOTES

92

NOTES

93

NOTES

94

95

96