Hep Review ED89 by HepatitisNSW

HEP REVIEW November 2015 -February 2016 Edition #89

NEW DRUG TREATMENTS Whatâ&#x20AC;&#x2122;s the latest word?

A YEAR OF BETTER LIVING Part 3 of your step-by-step guide to better health HEPATITIS & ABORIGINAL PEOPLE Disproportionately affected... and we know why.

ALSO INSIDE...

HEPATITIS MATTERS THE CUPID PROJECT PERSONAL STORIES HEALTHY RECIPES & MORE!

HEP REVIEW

Published every four months by Hepatitis NSW (HNSW) - an independent community-based, non-profit membership organisation and health promotion charity. We are primarily funded by the NSW Ministry of Health. Level 4, 414 Elizabeth St, Surry Hills NSW 2010

Editor/Design/Production Grace Crowley

Hep Review is mailed free to HNSW members – membership is free for people living with viral hepatitis in NSW.

Editorial Committee Tim Baxter Miriam Chin Denise Voros Paul Harvey Alastair Lawrie Stuart Loveday Rhea Shortus Contribut0rs Carla Treloar, Heather McCormack, Dr Ses Salmond, Rhoslyn Humphreys, Peter, BJ Hep Review advisors Dr David Baker, Prof Bob Batey, Ms Christine Berle, Rhoslyn Humphreys, Prof Greg Dore, Jenny Douglas, Prof Geoff Farrell, Prof Jacob George, Prof Geoff McCaughan, Dr Cathy Pell, Dr Ses Salmond, Prof Carla Treloar, Dr Ingrid van Beek, Dr Alex Wodak Proofreading/Sub-Editing Cindy Tucker Samantha Edmonds Contact phone 02 9332 1853 fax 02 9332 1730 email hepreview@hep.org.au post PO Box 432, Darlinghurst NSW 1300 office Level 4, 414 Elizabeth St, Surry Hills, Sydney Cover Image Exposition by RAF expositionbyraf.com

Hepatitis Infoline 1800 803 990 2 Hep Review #89 | Nov-Feb 2016

2 / HEP REVIEW /

We accept contribution of articles about health and personal aspects of hep C or hep B. Contributions to Hep Review are subject to editing for consistency and accuracy. Contributors should supply their contact details and indicate whether they want their name published. We’re happy for people to reprint information from this magazine, provided Hep Review and authors are acknowledged and that the edition number and date are clearly visible. This permission does not apply to images, graphics or cartoons. Reprint permission: hepreview@hep.org.au Although Hep Review takes great care to ensure the accuracy of all the information it presents, Hep Review staff and volunteers, HNSW, or the organisations and people who supply us with information cannot be held responsible for any damages, direct or consequential, that arise from use of the material or due to errors contained herein. The views expressed in this magazine and in any flyers enclosed with it are not necessarily those of Hepatitis NSW or our funding body. Information, resources and advertising in Hep Review do not constitute endorsement or recommendation of any medical treatment or product. HNSW recommends that all treatments or products be discussed thoroughly and openly with a qualified and fully HCV-informed medical practitioner. A model, photographer or author’s hep C or hep B status should not be assumed based on their appearance in Hep Review, association with HNSW or contributions to this magazine.

Hepatitis NSW would like to acknowledge and show respect for the Gadigal people as the traditional custodians of the land on which Hep Review is published. We’d also like to extend that acknowledgement and respect to all Aboriginal nations in NSW and across Australia.

NOVEMBER 2015 Edition #89

Contents

HEP REVIEW

Features 6

What’s the word on new treatment drugs?

Aboriginal people are disproportionately affected by hepatitis

A year of living better!

The latest info on sofosbuvir, ledipasvir, viekira pak, etc!

Regulars Letters.......................................... 3 Editorial........................................ 4 Local news.................................. 11 World news................................. 12 Going Viral................................. 38 Discover: research into viral hepatitis............................. 47 Horrorscope.............................. 52 Crossword & Comics................. 53 Clinic listings.............................. 54 Your feeback wanted................ 59 Hello Hepatitis Infoline: Let’s talk about positive psychology......61

The toll of incarceration.

Extras The Cupid Project: Couples who inject drugs.........................19 The Silent Disease...................... 21 5 Minute Guide to Chronic Hepatitis B in NSW.....................22 Healthy Recipies........................ 30 Living Well................................. 36 Hepatitis Matters.......................41 Time for Action on World Hepatitis Day............................. 43 Hep Art....................................... 45 NSW Hepatitis Awareness Week Wrap................................ 47

Part three in our guide to improving your health and vitality one step at a time.

My Story BJ’s Story On the inside, BJ reflects on the issues facing inmates who inject, and the desperate need for better access to treatment and needle exchanges in prison. ....................................................19 Peter’s Story Peter made the slog through treatment and emerged from his experience healthier and with some new insights. .................................................... 21

Our cover features Shaline from regional NSW. Shaline volunteered to be part of Hepatitis NSW’s Photocall Project. Thank you! hep.org.au | Hep Review 3

letters Dear Hep Review, I think Hep Review is great. I have always enjoyed reading the issues. I consider myself so lucky because I’m cured of hep C now for one year. I was so very sick on the treatment it somehow helped reading the issues of Hep Review and even now that part of my life is past and I only look forward to a wonderful and healthy life with my two year old boy. I still really enjoyed finding this issue of Hep Review in my letterbox! Thank you everybody involved! Yours, M Thanks for your great feedback, M. It’s always wonderful to hear from readers and to know that we’re hitting the mark when it comes to the magazine. Dear Hep Review, This magazine is very informative however it seems to address issues directed towards users. I’ve met people who have contracted the virus through other means. It would be good if some of these stories were shared to educate others on ways people are infected other than AOD users. Regards, Kim Thanks so much, Kim. While there is a variety of transmission mechanisms - including blood transfusion, medical procedures done with unsterile equipment, sexual transmission between HIV positive gay men - over 80% of Australians with hep C acquired it through sharing equipment to inject drugs, even if that was once, more than 30 years ago. We believe it is important not to shy away from that fact. Sadly, most people with hepatitis C experience stigma and discrimination, regardless of the means of transmission. Several of our community advocates are people who acquired hep C through medical procedures will often choose to answer that question by saying “the means of transmission should have no bearing on how I am treated as patient”. Thankfully the blood supply is now screened and universal precautions in Australia now prevent transmission via medical procedures. Dear Hep Review, I realised how important it is for other people close to me to know about my hep C status. As I am currently an inmate in jail I believe that my cell mate deserved the right to know I have hep C. If there were an accident and blood spill this could potentially lead to her becoming infected. I informed her I was positive. This was the first time I have disclosed my status. Staff should also be made aware. Sincerely, KA Good on you for being concerned and confident enough to disclose your status, but please be aware that you aren’t obliged to disclose your status to anyone unless you are - for example - working in an exposure prone procedure (such as an operating theatre or dental surgery), are applying for insurance, joining the armed forces or competing in martial arts. The risk of someone being infected by touching your blood is very low unless they also have an open wound. People who disclose their status often feel like the burden of a dirty secret has been lifted off them and the conversations that follow are often, life affirming and lead to closer friendships. Who you tell is up to you and be aware that there is still a great deal of stigma and discrimination among the informed.

4 Hep Review #89 | Nov-Feb 2016

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1800 803 990

editorial GRACE CROWLEY

epatitis NSW has warmly welcomed recommendations by the Pharmaceutical Benefits Advisory Committee (PBAC) that interferon-free options to treat hepatitis C should be listed on the Pharmaceutical Benefits Scheme (PBS). An August recommendation in favour of Viekira Pak (which includes ombitasvir, paritaprevir, ritonavir and dasabuvir), brings to four the number of interferon-free drugs, or drug combinations, which have been recommended by the PBAC but not yet funded by the Australian Government. While PBAC recommendations are welcome, what people living with hepatitis C really need is access to these new drugs via the PBS. We hope to hear positive news from Canberra before the end of the year.

“More people have already been cured using sofosbuvirbased combinations in the USA than the entire number of Australians living with hepatitis C.”

More people have already been cured using sofosbuvir-based combinations in the USA than the entire number of Australians living with hepatitis C. It is not reasonable that Australians continue to wait and so the new hep C treatments ball is most decidedly now in the Australian Government’s court. This issue of Hep Review takes an indepth look at the new treatment drugs - access, effectiveness, length of treatment, the appoval process and how to pronounce them!

There are also heaps of articles featuring news and other developments around viral hepatitis, prevention, advocacy, good living and much, much more. And don’t forget you could be in the running to win a $100 Coles/Myer gift card by sending in your valuable feedback (please see page 59 for details and last issue’s winner). This is my first issue as editor, having replaced the wonderful Bruce Cherry who has headed off overseas to make movies. All the best Bruce, and thanks for your great work on the publication over the last year.... hopefully I can live up to it! My thanks also to Hepatitis NSW for the opportunity to be involved in their work towards a world free from viral hepatitis. Cheers Grace Editor

hep.org.au | Hep Review 5

FEATURE FEATURE

2015 and 2016

are particularly exciting times for the treatment opportunities for all people in Australia living with hep C, with a range of different drugs and drug combinations already recommended by the Pharmaceutical Benefits Advisory Committee (PBAC). Other pharmaceutical companies have additional, different treatment drug combinations in the pipeline that are likely to be considered by the PBAC in the next few years. This article was developed following the respective March and July 2015 PBAC recommendations, and relate to these specific drug combinations: n Sofosbuvir & Ledipasvir n Sofosbuvir & Daclatasvir n Sofosbuvir & Ribavirin n Sofosbuvir & Peg Interferon & Ribavirin n Viekira Pak [Paritaprevir/Ritonavir/ Ombitasvir & Dasabuvir] n Viekera Pak & Ribavirin

Image by The Javorac | flikr [modified]

66 H Hep ep R Review eview #89 #89 || Nov-Feb Nov-Feb 2016 2016

Please note: the information in this article cannot be confirmed until the drugs are listed on the Pharmaceutical Benefits Scheme (PBS) and there are no guarantees this will happen. Until then, this is a general guide of what medical experts believe might happen. Professional bodies such as the Australasian Society for HIV Medicine, the Australian Liver Association and the Australasian Society for Infectious Diseases will most likely develop Australian guidelines for how the treatments would be delivered. Also, please be aware that other new drugs for treating hep C are being developed. Over time, these will also likely become approved for use in Australia, and hopefully be PBS listed and funded.

FEATURE

The new drug names are quite the mouthful... so how do you say them?

Sofosbuvir – so-FOS-buh-vir Ledipasvir – le-DIP-as-vir Daclatasvir – da-KLAT-as-vir Viekera Pak – vi-KEERA-pak If you still can’t get your tongue around them, check out these short Vines from David and Ruth at the Hepatitis NSW office giving it a go! bit.ly/1FTwCU7 | bit.ly/1NhBuVM bit.ly/1j1BsUO | bit.ly/1KX3PNt

How are new treatment drugs approved and funded in Australia? The methods used to approve and subsidise pharmaceutical drugs which treat the broad range of diseases that people in Australia have is a tried and tested process that successive Australian governments have refined and improved over the years. There are three basic steps involved (the first and second can happen at the same time): First, the Therapeutic Goods Authority (TGA), Australia’s regulatory authority for therapeutic goods needs to authorise a drug’s supply, import, export, manufacturing and advertising. Second, the PBAC needs to recommend a treatment drug for listing under the PBS. The PBAC is an independent expert body appointed by the Australian Government. When recommending a medicine for listing, the PBAC takes into account the medical conditions for which the medicine was registered for use in Australia, its clinical effectiveness, safety and cost-effectiveness (‘value for money’) compared with other treatments. Third, once a recommendation for listing under the PBS has been made by the PBAC for medicines that will cost the Australian Government over a certain amount of money, the Australian Government’s cabinet needs to approve the level of expenditure that the new treatment drugs will involve for the government. Only then can a new treatment drug be listed under the PBS.

How will the above treatments be accessed outside major metro areas especially smaller regional and rural areas that might not have a gastroenterologist or hepatologist? Initially, it will be much the same as for current treatments: provided by doctors and specialists working at hospital liver clinics and some specially trained GPs (doctors). But, if there is an s85 prescribing and accreditation program for GPs and other prescribers (instead of the current s100 program), this will expand access points, including in rural and regional areas. The potential GP training and roll-out will take some time, so we imagine things will be much the same until late 2016 or 2017.

When can we expect news about the progress through PBS, and assuming that’s successful, when might they be available? Clinicians say they hope that price negotiations (between drug companies and the federal government) will be finalised soon. Ultimately, the decision to list the drugs on the PBS and fund them will be made by Federal Cabinet and there is no set timeframe for when this decision may be made.

Continued next page...

hep.org.au | Hep Review 7

FEATURE Continued from previous page...

Will there be restrictions based on severity of illness? It looks very unlikely, based on the recommendations of the PBAC following its March 2015 meeting and July 2015 meeting.

TGA (Therapeutic Goods Administration) advises to PBAC on

drugs that are tested as safe to use in Australia.

PBAC (Pharmaceutical Benefits Advisory Committee)

makes recommendations to the Federal Minister for Health regarding new medication and whether it should be available to all or only some people.

The Minister (currently the Hon. Sussan Ley MP) then

takes the recommendations to Federal Cabinet.

Cabinet decides if the medication will be added to the Schedule of Pharmaceutical Benefits and the level of restriction if any. The PBS (Pharmaceutical Benefits Scheme) provides

subsidised prescription drugs to residents of Australia, ensuring affordable and reliable access to a wide range of necessary medicines. n Unrestricted: available for general use (eg paracetamol). n Restricted (all hepatitis C drugs fall in this category): PBS subsidised drugs are available only to patients meeting specific criteria. Determinations include whether the subsidised treatments will be be available to all with hepatitis C or only those at defined stages of liver disease.

edited from: en.wikipedia.org/wiki/ Pharmaceutical_Benefits_Scheme

8 Hep Review #89 | Nov-Feb 2016

Which of these combinations are for which genotypes? Hep C genotype 1 n Sofosbuvir & ledipasvir n Sofosbuvir & daclatasvir n Sofosbuvir & peg interferon & ribavirin (unlikely to be used as a first-line therapy) n Viekira Pak n Viekira Pak & ribavirin

Hep C genotype 2 n Sofosbuvir & ribavirin

Hep C genotype 3 n Sofosbuvir & daclatasvir n Sofosbuvir & peg interferon & ribavirin (unlikely to be used as a first-line therapy)

How long would these treatments last? Sofosbuvir & ledipasvir n 8 weeks for people with fibrosis score of 0-3 and viral load less than 6 million n 12 weeks for people with cirrhosis and no prior treatment n 24 weeks for people with cirrhosis and prior treatment.

Sofosbuvir & daclatasvir n 12 weeks (although likely longer for people with cirrhosis).

Sofosbuvir & ribavirin n 12 weeks

Sofosbuvir, peg interferon & ribavirin n 12 weeks

Viekira Pak n 12 weeks

Viekira Pak & ribavirin n 12-24 weeks depending on treatment history and/ or cirrhosis

FEATURE PEG-I/ RBV/SOF SOF/LDV VP SOF/DCV

PEG-I/ RBV/SMV

Efficacy

PEG-I/ RBV/TVR PEG-I/ RBV/BOC PEG-I/ RBV

SOF - sofosbuvir LDV - ledipasvir VP - viekira pak DCV - daclatasvir PEG-I - peg interferon RBV - ribavirin

Interferon/ RBV 48 Weeks 28-48 Weeks 24 Weeks 12 Weeks

Interferon

Tolerability

Dore GJ & Feld J. CID 2015

Chart: Effectiveness vs tolerability of Interferon & new hepatitis C medications

Are these treatments taken with ribavirin? Several treatment combinations include ribavirin, and one includes peg interferon (this last treatment is unlikely to be used as a first-line therapy and may likely be used only with people who have a resistance to other, newer treatments). Additionally, sofosbuvir & daclatasvir may be taken with ribavirin for those people who have genotype 3 and cirrhosis. The viekira pak combination includes ribavirin for people with genotype 1a and for some other people (eg. with genotype 1b who also have cirrhosis).

What side effects are there and what might be done about them? n Sofosbuvir & ledipasvir is well tolerated with only minor side effects. n Sofosbuvir & daclatasvir is well tolerated with only minor side effects. n Sofosbuvir & ribavirin is well tolerated. The most common adverse events are fatigue, headache, skin irritation, and insomnia (ribavirin side effects). n Sofosbuvir, peg interferon & ribavirin is well tolerated for most people. The most common adverse events are fatigue, headache, mood swings, depression, nausea, insomnia and anaemia (peg interferon & ribavirin side effects). However these side effects should be more tolerable due to shorter treatment durations. n Viekira Pak is well tolerated with only minor side effects.

Courtesy: Greg Dore

n Viekira Pak & ribavirin is well tolerated for most people. The most common adverse events are nausea, insomnia and itching (ribavirin side effects).

Will there be contraindications (that is, where treatment should not be used in particular circumstances)? There are some drug-drug interaction issues, but most will be able to be handled with change of accompanying medications, or through careful monitoring. Pregnancy is contraindicated with some of these treatments (eg. ribavirin) and is listed as a “Precaution” for others. Treating doctors will advise which treatments would be suitable (or not suitable) for particular treatments depending on a person’s past and present medical conditions and medications.

How would you go about getting access to these treatments? When the treatments are approved, get your doctor to give you a referral letter and then make an appointment to see a current HCV prescriber. Contact details in NSW can be found by calling the Hepatitis Infoline (1800 803 990) or visiting hep.org.au/services-directory

Who will have access to these treatments? The vast majority of people with chronic hep C will likely have access.

Continued next page...

hep.org.au | Hep Review 9

FEATURE

Continued from previous page...

What success rates do these treatments offer? Sofosbuvir & ledipasvir n Around 95% of people (with genotype 1) treated, achieve cure (see below for an explanation of “cure”).

Sofosbuvir & daclatasvir n Around 95% of people (with genotypes 1 or precirrhosis 3) treated, achieve cure. (People with genotype 3 and cirrhosis have lower cure rates and may require longer duration and addition of ribavirin)

Sofosbuvir & ribavirin n Around 95% of people (with genotype 2) treated, achieve cure.

Sofosbuvir, peg interferon & ribavirin n Around 90% of people treated achieve cure, although this treatment (for people with genotypes 1 or 3) is unlikely to be used as a firstline treatment option.

Viekira Pak n At least 95% of people (with genotype 1b and no cirrhosis) treated achieve cure.

Viekira Pak & ribavirin n Around 96% of people (with genotype 1) treated achieve cure. The above cure rates relate to people’s hepatitis C genotype and treatment history. They are from clinical trials (and therefore may not apply to reallife populations). Treating doctors will advise which treatment options are suitable for you.

How often will people need to attend a hospital for follow up and what types of healthcare workers are seen for these appointments? Clinics may have different protocols. One major Sydney treatment clinic is considering developing different schedules based on whether people have other illnesses and the complexity of their hep C disease. Some people may need to have only one on-treatment visit (e.g. at week 4). All people will have at least one post-treatment visit, generally 12 weeks after treatment ends.

10 Hep Review #89 | Nov-Feb 2016

What blood tests will I need and how often? Again this will probably differ from clinic to clinic, and in regards to the complexity of a patient’s hep C disease, but it could be very simple (week 4 Full Blood Count, Urea & Electrolytes Test, LFTs, PCR) for many people, while others will require more intensive follow-up/ monitoring. All people will require a PCR test following treatment (12 or 24 weeks afterwards) to check for SVR (cure).

At what stage do people need to have the virus undetectable to stay on treatment? It doesn’t seem to matter. Doctors will probably use a week 4 PCR test to assess adherence as opposed to speed of viral load decline. By then, all people should be <1,000 viral load and generally <100 viral load, if they are taking therapy.

When can people consider themselves cured? “Cure” or “SVR” (Sustained Virological Response) means that someone has cleared hep C virus from their body. If someone is PCR virus undetectable at 12 weeks post-treatment they are generally considered to be cured. Some clinics will still do an additional PCR test at 24 weeks. Depending on the extent of liver damage caused by hepatitis C, and despite clearing the virus, some people may still require regular liver health check-ups. Talk to your treating doctor about what “cure” might mean for you, and how to manage your long-term liver health

Will these treatments be accessed from a hospital or can they be monitored by primary care physician? Contact details in NSW can be found by calling the Hepatitis Infoline (1800 803 990) or visiting hep.org.au/services-directory

To talk about anything in this article: Hepatitis Infoline (NSW): 1800 803 990 website: hep.org.au This article was developed by Hepatitis NSW. It was reviewed by the Hepatitis NSW Medical and Research Advisory Panel. It will be reviewed as soon as these treatments are given PBS listing and Medicare funding, or when any additional new treatments are recommended by the PBAC.

news

LOCAL NEWS news | new south wales | australia

New Data Shows Metropolitan Sydney Disproportionately Affected by Hepatitis B

Hepatitis B virus

New data released in August shows that 85% of hepatitis B notifications in NSW occurred in just five Local Health Districts (LHDs), all based in metropolitan Sydney. According to the NSW Hepatitis B and C Strategies 2014-2020: 2014 Annual Data Report the following five LHDs were disproportionately affected by hepatitis B notifications: n Western Sydney, with 572 notifications in 2014; n South Western Sydney, with 438; n Sydney, 393; n South Eastern Sydney, 392; and n Northern Sydney, with 357. These five HDs also had the highest hepatitis B notification rates, adjusted for population. “With an estimated 60% of people living with hepatitis B in NSW born overseas, it is not surprising that hep B notifications predominantly occur in areas with higher migrant populations,” Hepatitis NSW Acting CEO, Mr Robert Wisniewski, said. “However, with a significant number of people living with hepatitis B still undiagnosed, we need to ensure that testing remains a priority.

“The good news is that current treatments for hepatitis B are effective in preventing progression to serious liver disease,” Mr Wisniewski added.

medications, which are based on an immune-system modifying agent called Interferon, all of them unsuccessful at clearing the hepatitis C from his system.

In 2014, an estimated 3,135 people diagnosed with hepatitis B in NSW were dispensed antiviral therapy at least once.

Instead of getting better, in 2012 his liver started failing. It was only then that he was able to access the new medication under a compassionate release program run by a pharmaceutical company. It cured his hepatitis but was too late to save his liver.

The NSW Hepatitis B Strategy 20142020 aims to increase the number of people living with hepatitis B receiving antiviral treatment (when clinically indicated) by 300%. To download the report visit the NSW Health website: health.nsw.gov.au/hepatitis Hepatitis C drugs wait for Medicare funding A few years ago Steve Gribbin, a 51-year-old from Tamworth, was a successful local government manager who taught photography on the side. “Now we literally don’t even leave the house unless it’s to go to the chemist, the supermarket or the doctor,” he said. Steve is one of many people with hepatitis C who could not access the new treatments doctors expect will revolutionise the treatment of the condition, until it was too late. Patient advocates and doctors fear more people will suffer as Steve has while the government and pharmaceutical companies figure out how much money will be paid for the new drugs, which are expected to cost billions of dollars over the next four or five years. Mr Gribbin tried three rounds of treatment with the old-style

“I look like an old man … my muscles are wasting away,” he said. “I can’t walk more than 100 metres or I’m out of breath, and I get really bad cramps.” Steve said he just wants the new treatments to be available so no one else gets sick while waiting.

Steve Gribbin & wife Faye image: smh.com.au | Barry Smith

Hepatitis Australia chief executive Helen Tyrrell said the delay in getting the drugs to patients was “completely unacceptable”. She said it was believed about 230,000 Australians are living with hepatitis C but only 1% are treated each year. A spokeswoman said the Department of Health was progressing the listing of the medicines “as swiftly as possible”. Abridged from smh.com.au Read at: bit.ly/1KqiALJ

hep.org.au | Hep Review 11

news

WORLD NEWS news - international

RAPPER Okyeame Kwame says fighting Hep B is his joy

Rural USA doctors want looser rules for Hep C treatment A doctor at the centre of an HIV outbreak in rural Indiana cannot prescribe the latest treatments for patients also infected with the hepatitis C virus. State Medicaid rules forbid Dr. William Cooke from prescribing new treatments to his HIV patients with hep C.

Okyeame Kwame

Rapper Okyeame Kwame, via his foundation and MDS Lancet Laboratories, conducts a yearly hepatitis B screening and vaccination project in a bid to kick the disease out of Ghana. Since its inception six years ago, the project has screened and vaccinated almost 7,000 people across the length and breadth of the country. This year marks the seventh time and it took place in late July. Kwame said “Fighting hepatitis is my biggest joy because I think preventing it is the responsibility of all Ghanaians. In all of my endeavors, nothing fulfills me more than when I’m on this noble cause and I believe I’ve still got more to do in the society that brought me up.” “Will we be able to screen 1,000 people again? Are we able to reduce the prevalence rate from 15 per cent? Will our actions compel people to seek clarity about hepatitis B from their doctors?” Kwame asks. Expectations for this year’s project - themed “Let’s kick hepatitis out of Ghana” - are high as the last few years have chalked up a massive success. Abridged from: ghanaweb.com Read in full: bit.ly/1EZ5Ppi

12 Hep Review #89 | Nov-Feb 2016

The rules put tight limits on treatments paid for with taxpayer dollars. The only doctors who can prescribe the expensive drugs are gastroenterologists and infectious disease specialists. But neither exist in Dr. Cooke’s poor rural community of Scott County - nor in many other rural areas where cases of hep C are on the rise.

Cost is a major factor. While hep C is treatable, drugs are expensive. A 12-week regimen of the latest medicine can cost as much as $US84,000. But those drugs have higher cure rates, and involve less complications, than treatments used in the past. There are signals that Indiana may soon review its policies. Abridged from: cnhinews.com Read in full: bit.ly/1Kj31z1 20 million Nigerians are infected with VIRAL Hepatitis About 20 million Nigerians are infected with the hepatitis B or C virus in Nigeria, Community Health physician Dr Chukwuma Anyaike has said. Dr Anyaike who is the Head Prevention, Department of Public Health at the Federal Ministry of Health was speaking at a stakeholders’ advocacy workshop on Viral Hepatitis awareness organised by the Yakubu Gowon Foundation in Abuja.

Dr WIlliam Cooke

“All that does is increase barriers to care,” said Cooke. Citing public health experts, Cooke said most hep C treatments can be delivered in a family doctor’s office or clinic. The Indiana Rural Health Association is concerned too, especially as the number of hep C patients rises. State officials have identified about 11,500 cases in Indiana. More than 4,000 new cases of hep C were identified last year. “The rule creates a burden for people who live in rural communities that are already facing problems with access to medical care,” said Don Kelso, the Association’s president.

“This means one in every 12 Nigerians is infected with hepatitis B or C,” he said. Viral hepatitis is a very big public health issue in Nigeria. The Nigerians living with hepatitis B and/or C are at the risk of developing cirrhosis of the liver and

Dr Chukwuma Anyaike

news

WORLD NEWS news - international

cancer of the liver. Dr Anyaike said they “are living in the community and they are not aware of it and in the same process, they are transferring the infection to other people in the community.” Workshop chair, retired General Yakubu Gowon, said Nigeria should consider the spread of the virus a national emergency, “seeing that the prevalence rate of this disease is about double the national HIV prevalence rate. The nation and the world should take note.”

“It’s just a matter of time before someone picks up HIV or hepatitis over there because things such as sterilisation, re-use of needles, changing gloves between patients and even proper draping of surgical sheets just isn’t happening there,” Mr Greensmith said.

“What we should do is to create the awareness and to sensitise people on the burden of viral hepatitis in Nigeria, and for the various strata of the government to commit some funds to fight viral hepatitis in the country,” Dr Anyaike said.

image: flikr.com | philandpam

Hepatitis C affects about 3 million people in the U.S. and claims more lives there than AIDS. With the new drugs, patients finally have a choice among highly effective cures with minimal side effects.

“Some of the hospitals over there say they have proper accreditation but it may have been passed in 2006. There aren’t the proper checks. Here, accreditation is redone every year but it’s not like that in Thailand.”

Abridged from: dailytrust.com.ng Read in full: bit.ly/1Lv2Hy8

Mr Greensmith admitted that plastic surgery had become too expensive in Australia, explaining the popularity of travelling to Thailand to have the work carried out.

fears shortcuts in Thai surgery standards will lead to HIV, hepatitis

He said the latest research showed that 40% of Australians are travelling overseas to have plastic surgery procedures.

Andrew Greensmith, a leading plastic surgeon from the Melbourne Institute of Plastic Surgery believes it is only a matter of time before a patient contracts HIV or hepatitis at a hospital in Thailand. He warns that the increased popularity in medical tourism is leaving Australians prone to suffering a range of blood borne diseases.

The $US1,000 pill for hepatitis C that made headlines last year no longer is the favorite of patients and doctors. The new leading pill is more expensive, and the number of patients seeking a cure has surged. Sovaldi, last year’s wonder drug, has been pushed aside by a successor called Harvoni, made by the same company. The sticker price for Harvoni is $US1,350 a pill.

He further explained that of those infected with viral hepatitis, 25% go on to develop chronic liver disease resulting in between 500,000 to 700,000 deaths annually. From the survey, Kano has the highest number of people infected with the B variant of the virus while Kwara state has the highest number of people with hepatitis C.

Pricier hepatitis C drug overtakes $US1,000 pill

“The other issue is that this medical tourism is advertised as a holiday and all you should be doing after a breast augmentation is resting at home for a few days.” Abridged from: heraldsun.com.au Read in full: bit.ly/1iKHQQC

image: flikr.com | carbonnyc | modified

Previous treatments were hit and miss, and many patients couldn’t tolerate the side effects. But newfound choice doesn’t seem to have led to widespread price competition. The number of prescriptions filled for hep C drugs has more than doubled. A big part of the reason is simplicity, patients on Harvoni need only take a single pill daily, for 12 weeks in most cases. Previously, patients took combinations of drugs. Abridged from: dispatch.com Read in full: bit.ly/1QdGZSR

hep.org.au | Hep Review 13

Aboriginal people ar

When we talk

about closing the gap between indigenous and non-indigenous Australians, we often talk about very siloed ideas of what that means: there’s overincarceration, the health gap and the education gap, for example. But viral hepatitis, and particularly hepatitis C, is one of those areas where it all links together in a horrible cycle that ends up disproportionately affecting Aboriginal people’s health.

The over-incarceration of Aboriginal people means that more of us are in an environment where there are very high rates of hepatitis C. We’re more likely to inject drugs and share equipment when we do inject drugs, and our historic disconnection from the health sector means that people aren’t getting treatment and they aren’t being monitored. We’re also often disconnected from health messages that educate drug users to inject safely due to educational disparity and geographical distance. Colonialism and racism play a big role, too. Even today people claim that over-incarceration occurs because Aboriginal people commit more crimes. That is wrong. The evidence suggests Aboriginal 14 14 H Hep ep R Review eview #89 #89 || Nov-Feb Nov-Feb 2016 2016

people are more likely to be searched for drugs, more likely to be arrested if they do have drugs on them and more likely to be sent to prison if they are arrested. Conservative estimates state that 30%-50% of people in the criminal justice system at any one time have, or have had, hepatitis C. Ex-prisoners tell stories of one needle being shared between 10 to 20 people again and again and again. If you were trying to design the ideal environment for hepatitis C transmission, you would come up with something that looks a lot like our prison system – a high number of people incarcerated for drug-related

re disproportionately affected by hepatitis We know why This aricle, written by Hepatitis NSW Project Officer Heather McCormack, was originally published in partnership with @IndigenousX in The Guardian on July 27 as part of Hepatitis Awareness Week Heather is a Wiradjuri woman of Wiradjuri, Darug and Scottish descent who lives and works on Gadigal land.

crimes, who currently inject drugs but who are then denied access to sterile injecting equipment. About 90% of new hepatitis C infections come from shared injecting equipment. A lot of people now understand not to share needles, but hepatitis C is a startlingly infectious disease and can be passed on by traces of blood on things like tourniquets and swabs. So if people don’t know not to share absolutely anything related to injecting, they can still transmit the disease. In that remaining 10%, things like backyard tattooing and piercing and prison tattooing – which we know happens frequently in the Aboriginal community – are a big risk factor.

There is a persistent myth that Aboriginal people share injecting equipment because of the culture of sharing. That is just not the case. The real reason is a combination of access to sterile equipment and low health literacy. We know when people are given the information and capacity to look after their own health they do, and Aboriginal people aren’t any different to that. Anecdotal evidence suggests that Aboriginal people using drugs are more heavily policed than Continued next page...

“If you were trying to design the ideal environment for hepatitis C transmission, you would come up with something that looks a lot like our prison system...” hep.org.au hep.org.au || H Hep ep R Review eview 15 15

Continued from previous page...

non-Aboriginal drug users. We have heard of people accessing needle syringe programs (NSPs) and being targeted by police doing that, even though that’s not supposed to be a thing that police do. We also know that a lot of Aboriginal people are reluctant to access NSPs where they may be recognised by members of their communities as someone who uses drugs. There are some places, especially regional and remote areas, where there just aren’t NSPs. Aboriginal medical services that have implemented NSPs find that some people don’t access it because that’s where they get all their healthcare needs met and they don’t want their healthcare providers to know they use drugs. Some of the services are countering this by putting

“We know when people are given the information and capacity to look after their own health they do, and Aboriginal people aren’t any different to that.”

vending machines in places where they can’t be seen but there is still more work to be done. It cannot be any clearer that the single easiest way to reduce hepatitis C transmission would be to introduce needle and syringe programs in prisons. The statistics for hepatitis C in prisons are staggering. People don’t stop injecting when they go into prison and they don’t stop injecting when they come out of prison. We know that some people actually start injecting when they go into prison. While prisoners are no more or less valuable than any other member of the community, it is also a way of passing that infection into the general population. Owing to myriad complex factors, we tend to cycle people through prison in repeated short sentences, and that includes a number of marginalised people not being offered bail . Drug treatment programs, however, are only available to prisoners who are incarcerated for a minimum of six months. In practice, this means we are effectively imprisoning many people for using substances illicitly, but telling them they’re not in prison long enough to be treated for dependency on those substances. With no NSPs in prisons, this puts inmates at huge risk of hepatitis C transmission. Read in full: bit.ly/1EBd5ri See also: twitter.com/@IndigenousX

C-EEN & HEARD Our positive speaker service program, C-een & Heard, let’s you share first-hand in someone’s personal account of living with hepatitis C.

The power of a personal story is universal and a C-een & Heard speaker will enhance your existing training and education initiatives with a personal perspective.

To book a speaker please call the Hepatitis Infoline: 1800 803 990 Contact Aisling Dowling: adowling@hep.org.au | 02 8217 7716

16 Hep Review #89 | Nov-Feb 2016

“I like being able to help people who are going through what I’ve been through, I wish HepConnect was around back when I was on treatment.” “HepConnect definitely helped me, and I am motivated by other people who have been through the treatment.”

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

Hepatitis NSW PHOTOCALL PROJECT

Your photos, your stories Help us to share your stories and/or photos with your communities.

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

Images by Exposition by RAF

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

Hep Connect treatment peer support

1800 803 990 hep.org.au | Hep Review 17

Y R O T S BJ’s

y name is BJ, I’m currently in jail for another stint – I’ve spent a lot of my adult life in the system on and off for about nine years.

Corrective Services has changed the bleach to FINCOL which kills hep C but only if you rinse the fit with cold tap water 3 times, soak the fit for 5 minutes in FINCOL, and rinse with cold tap water 3 times and usually there is only one fit being used by 30 inmates a day. There is little time to be going through that cleaning procedure when you not only have to be discreet but are mostly locked in the yards and only out of your cell for about six hours a day. Now the FINCOL is here everyone just cleans the fits with hot water because no one has the time to clean them and, as a result, the hep C rate is getting out of control. Wouldn’t the jails prefer a disease free system? Corrective Services would be better off having a needle exchange program. Also, now that they’ve banned smokes and matches no one will have matches to smoke the Bupe (buprenorphine) with so many more people are going to start shooting up instead and catch hep C. A lot of people come into jail for maybe three months on minor offences who are leaving with hep C so more needs to be done to keep prisoners busy and active, getting treatment for hep C faster, and definitely a needle exchange. Getting treatment inside is another matter. Like I said, I’ve spent nearly nine years in jail and I’m only 34, I

18 18 H Hep ep R Review eview #89 #89 || Nov-Feb Nov-Feb 2016 2016

caught hep C in 2003 by using a jail fit but my body got rid of it naturally. However I caught it again, on the outside this time, and during my previous 18 months stint in jail, I kept trying to get treatment for hep C but couldn’t because I kept getting moved around all the time. Now I’m trying for treatment again and hope all goes well this time around. I’m on methadone now so I don’t use jail fits anymore but it’s very sad seeing these young 18 year old kids coming into jail drug free and disease free and then leaving with hep C and a habit on the Bupe. This is a very hot topic of discussion on the inside at the moment. To the people reading this, do you want your sons, your daughters, your brothers, your sisters, cousins, even your parents coming into jail disease free and potentially leaving with hep C or other viruses? I’m asking all readers to help our goal to get a needle exchange in jails and better, faster treatment for all prisoners.

Many thanks for your story, BJ (not pictured). Hepatitis NSW and many other organisations have lobbied long and hard for needle exchanges in prisons and continue to do so - we believe the evidence in favour of prison NSPs is clear, and we hope the Government finally agrees.

by Professor Carla Treloar Deputy Director of the Centre for Social Research in Health, University of NSW

he Cupid Project focuses on hepatitis C risk and prevention in couples who inject drugs. Couples are important to think about for a number of reasons.

Transmission of hepatitis C occurs when more than one person is present. Surveys of people who inject drugs show that about half report sharing of injecting equipment with a sexual partner. Relationships between couples have unique qualities - love, trust, intimacy - that typically aren't present between friends or acquaintances but may make sharing more likely

Another factor to consider for this project is how couples who inject are usually talked about. Couples who inject can be seen as not as "authentic" as other couples. That is, stereotypes of couples as more in love with a drug than each other may influence how workers or services perceive them. This was a very important stereotype for our research to avoid.

We also know that hepatitis C health promotion and prevention materials are typically written for individuals. The social environments and relationships of people who inject are not acknowledged in these materials. Our research provides a great opportunity to understand how couples negotiate injecting and hepatitis C risk in their relationships.

We made these arguments to the National Health and Medical Research Council who funded this research into heterosexual couples who inject. We recognise the importance of hep c for other couples and the need for specific research in this area too. Continued next page...

Couples who inject drugs

The Cupid Project hep.org.au | Hep Review 19

Continued from previous page... In this project, we interviewed couples and harm reduction workers in Sydney and Melbourne. We asked them questions about injecting drug use, hepatitis C and partnerships. Was hepatitis C relevant to their relationship, for example; or how was injecting with their partner different from using with friends? We wanted to focus on participants’ lived experiences of relationships. We particularly wanted to better understand the role of couples, as not only crucial sources of care, support and stability but as influential sources of practice, including those negotiated around injecting drug use. For many participants, trust was the important feature of their relationship, including their drug use. Trust was also related to safety and security generally as well as a part of how couples negotiated hepatitis C risk. Nearly all participants described rules they had negotiated with their partner around injecting drugs with others. Following these ‘rules’ was central to creating and maintaining trust and intimacy within the relationship. For some couples this meant agreeing not to inject with anyone outside the relationship. Many of our participants reported doing ‘everything together’. Being together (physically and emotionally) meant that couples knew ‘everything’ about each other. That is, couples came to know about the details of each other’s injecting practices, blood test results, and medical check-ups. This knowledge helped build trust between partners and influenced how couples managed hepatitis C risk. Importantly, participants’ perceptions of risk (and safety) were not fixed but changed over time. Couples’ sense of which injecting-related practices were risky evolved over their relationship. For some couples, a growing sense of emotional closeness led to a ‘relaxation’ of attitudes towards hepatitis C. In these cases, efforts to keep injecting equipment separate decreased as the relationship

20 Hep Review #89 | Nov-Feb 2016

became more ‘serious’. For others, however, their injecting practices became ‘stricter’ over time – after gaining a clearer understanding of ‘genotypes’, for example, or after beginning hepatitis C treatment. Decision making about managing risk was a complex, confusing and at times contradictory process for these couples. Most saw their relationship as a safe and trustworthy space. Sharing needle-syringes with one’s partner was almost always described by participants as a ‘last resort’ and not something to be considered with anyone else. Our study challenges the stereotypes of couples who inject drugs as ‘drug-driven’ and ‘unhealthy’. Participants commonly talked about love, care and commitment when describing their relationship. The priority for participants was to keep themselves, their partner and their relationship healthy and safe. For many, their relationship was an emotional refuge or safe haven. Couples relied on their relationship as a protection in a world that participants saw as hostile and stigmatising. If we want to do better in hepatitis C prevention, we need to recognise and work with the strengths that are to be found in the relationships between couples who inject drugs. This also means that we need to change how we do hepatitis C prevention to include messages and strategies that are relevant and meaningful for couples. Cupid Project Website: bit.ly/cupid-project Acknowledgements We would like to thank all the participants who so generously shared their time and insights. The chief investigators of this project are Carla Treloar, Suzanne Fraser, Joanne Bryant and Tim Rhodes, along with the associate investigators, Nicky Bath and Mary Ellen Harrod and researcher, Jake Rance.

June 2015

saw the release of the final report of the Commonwealth Parliamentary Inquiry into Hepatitis C. Called The Silent Disease, the Report looked at a wide range of issues surrounding hepatitis C in Australia, and makes 10 recommendations for change, including that: n The Australian Government work with states and territories to develop well-informed hepatitis C awareness campaigns, aimed at the general community, people at risk of contracting hep C, people living with hep C and also against stigma and discrimination. n The Commonwealth Department of Health work with states and territories to develop strategies to address the high prevalence of hepatitis C in the Aboriginal and Torres Strait Islander population. n A national strategy for blood-borne viruses and sexually transmissible infections in prisons be developed, to complement the existing national strategies on hepatitis C, hepatitis B and HIV, among others. n Enhance reporting on the National Hepatitis C Strategy 2014-2017 by including a comprehensive reporting and review framework, with annual reporting against key performance indicators. n Devise a specific target(s) for hepatitis C testing and report on progress towards reaching the target(s) annually, as well as considering how

“Disappointingly, the Report did not recommend the introduction of NSPs into prisons – which is, as Hepatitis NSW has consistently advocated, essential to prevent hepatitis C transmission.”

rapid point of care testing might assist in meeting this goal, and n Work with the Royal Australian College of General Practitioners and liver clinics to examine appropriate information provision, treatment processes, and patient counselling for people diagnosed with hepatitis C. Disappointingly, the Report did not recommend the introduction of NSPs into prisons – which is, as Hepatitis NSW has consistently advocated, essential to prevent hepatitis C transmission. The Silent Disease also failed to recommend that new hepatitis C treatments be approved as quickly as possible, and made accessible to as many people as possible. Despite these obvious shortcomings, the Report nevertheless points the way forward on a range of issues which we hope the Australian, and New South Wales, Governments take action on as a matter of priority. Finally, Hepatitis NSW would like to say a big thank you to all those people from the community who made submissions to the inquiry, including the five community members who appeared before the Committee to give evidence in Sydney earlier this year. You have made your voices loud and clear – and helped Australia take another step forward on the long road to ending the hep C epidemic. Download The Silent Disease: bit.ly/1UQPsly

Image: Development of Cirrhosis of the Liver

hep.org.au | Hep Review 21

22 22 H Hep ep R Review eview #89 #89 || Nov-Feb Nov-Feb 2016 2016

CREATED BY

(02) 9515 1234

131 450

Infographic excerpt courtesy Multicultural HIV and Hepatitis Service (MHAHS) Full graphic: bit.ly/mhahs-CHB

hep.org.au hep.org.au || H Hep ep R Review eview 23 23

A year of living better

A year of

Living Better!

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

24 24 H Hep ep R Review eview #89 #89 || Nov-Feb Nov-Feb 2016 2016

Imagine making and sustaining 12 healthy habits in a year that last a lifetime! A year of living better is a step-by-step series designed to help you achieve better health, in manageable chunks. This is the third and last issue in our guide to improving your health and vitality one step at time. So far we have looked at improving your digestion by eating mindfully, followed by how to make healthy food choices, with some specific examples of liver friendly foods to help support your digestion and liver function. We also looked at sleep, and the importance of a good bed time routine. In this issue we look at stress, exercise, good hydration and finally putting it all together to optimise your health and vitality. In the centre spread you’ll find a “My action” chart which you can place on your wall or fridge for inspiration. Feel free to add your own actions.

AUTHORS Ses Salmond has been in practice as a naturopath, herbalist and homoeopath for over 20 years Ses was awarded her PhD from the School of Medicine and Public Health at the University of Newcastle in 2013 on the Hep573 Study, a clinical trial of silymarin alone and silymarin combined with antioxidants in the treatment of chronic hepatitis C. She was awarded the Douglas Piper Young Investigator Award in Clinical Sciences by the Gastroenterological Society of Australia in 2010. She has been published widely in medical and naturopathic textbooks. Rhoslyn Humphreys is a naturopath and medical nutritionist as well as a yoga and meditation teacher. Rhoslyn holds a Bachelor of Naturopathy, an Advanced Diploma of Nutrition Medicine and an Advanced Diploma of Yoga. Like to see the referenced version of this article? hepreview@hep.org.au hep.org.au hep.org.au || H Hep ep R Review eview 25 25

1 20

1 2 3 4 5

8 9 1

A year of living better

9 30 28 2 NO

NOV

12 13 14 1 5

2015

Reduce Stress with coping strategies

20 21 22 23

>>> getselfhelp.co.uk/stress.htm >>> Beyond Blue - Reducing stress: bit.ly/1O5bltq 26 Hep Review #89 | Nov-Feb 2016

Activating the ‘relaxation response’ helps the body recover and helps stop the increasing effects of stress. Some ideas to help relax and reduce stress are – mindful eating, exercise, meditation, yoga, Tai chi, deep breathing techniques, relaxation/visualisation CDs and time management.

The effect of stress increases with time, the person becomes less able to cope, which increases the feeling of anxiety. The suppression of the immune system can lead to illness and increased alertness can cause disturbed sleep patterns which all make the problem worse. Stressed people may also adopt a less healthy life style as they do not have the time or motivation to exercise or eat properly, two important factors that can help in reducing stress.

The initial, “alarm” response to stressful events turns on the body’s fight or flight response, resulting in increased blood pressure and blood sugar levels. Increased muscle tension, potentially causing headaches and muscular pain. Cortisol levels increase which suppresses growth, wound healing and the immune system. Whilst the body is in fight or flight mode, all non-essential bodily functions are postponed. Digestion is not seen as an essential function resulting in digestive discomfort, poor absorption of nutrients and constipation or diarrhoea. People can react to stress by eating more, leading to weight problems and more stress or losing their appetite completely.

Everyone suffers from stress at some point and some stress is good, it can be a natural, necessary and appropriate response to a situation. It helps us be more alert and helps us perform better up to a point. Stress is not associated with just the unpleasant things in life, all change causes stress even pleasurable change. However, when stress gets too much, we feel we cannot cope.

Time management can help regain the feeling of control and the ability to cope. Try to anticipate stressful events and identify triggers and form coping strategies and create a support network. Make time to do something you enjoy, regularly and to spend time with people with whom you can laugh and relax.

People suffering from stress can be overwhelmed by negative emotions, anger, frustration, helplessness, fear, and depression, becoming emotionally more fragile.

A year of living better

1 2 3 4 5 6

8 9

29 30 31 D EC

DEC

3 14 15 12 1

2015

21 22 23

Too much sitting is extremely bad for our health. If you have a desk job, try and stand up every half an hour and stretch and move about. Answer the phone standing up. The same is true for sitting at home in front of the television (or computer), move every 30 minutes, try leaving the remote by the TV.

Experiment, visit your local library and borrow some exercise DVDs, such as Zumba, Yoga or Pilates to try at home. Try 5 minutes of skipping a day, which will get your heart going. Other possible activities could include dancing, swimming, a team sport or even joing a gym.

Start with walking - use your smartphone as a pedometer and increase your steps every day, aim for 10,000 steps a day. Walk with a friend or join a local walking group.

Exercise reduces stress, increases the number of mitochondria in muscles (the power houses of the body), improves energy, reduces weight and makes you feel good.

Get up and get moving

Increase incidental exercise â&#x20AC;&#x201C; for example, you can take the stairs instead of the lift or escalator, get off the bus one stop earlier so you can get in a bit more walking, park the car further from the shops... all these small incidents add up and make a big difference.

Zumba: an aerobic fitness program featuring movements inspired by various styles of Latin American dance and performed primarily to Latin American dance music. Yoga: breath control, simple meditation, and the adoption of specific bodily postures practised for health and relaxation. Pilates: a system of exercises using special apparatus, designed to improve physical strength, flexibility, and posture, and enhance mental awareness. If you have concerns about your health and fitness, consult your doctor before starting a vigorous exercise program. hep.org.au | Hep Review 27

A year of living better

2 3 4 16 1 5

12 13 14 15

29 30 31

JAN

Soothing and digestive mint, relaxing chamomile, digestive fennel, uplifting rooibos. Try mixtures such as: a sleep mixture with passion flower, lemon grass and chamomile; a digestive mixture with mint, fennel and chamomile; a detox mixture with dandelion leaf, calendula, nettle; an invigorating, anti-inflammatory tea with fresh grated ginger; an immune tea with yarrow, elder and peppermint. Fennel and mint tea can be great to satisfy sweet cravings. Try drinking herbal teas over ice or cold on hot days

Avoid Fruit juice, alcohol or soft drinks which can be harmful to the liver. Fruit juice is very high in fructose. The liver responds to fruit juice and soft drinks by converting the excess sugar into fat droplets and storing them in the liver, contributing to nonalcoholic fatty liver disease (NAFLD), increasing â&#x20AC;&#x153;badâ&#x20AC;? cholesterol, blood pressure and contributing to diabetes.

28 Hep Review #89 | Nov-Feb 2016

20 21 22 23

Herbal teas

Water, dandelion coffee, small amount of lemon juice in water. Swill the mouth out with plain water before cleaning teeth to protect the enamel on your teeth.

Great examples

Adequate hydration will improve your energy levels, reduce headaches, cramps and constipation and improve your complexion.

Aim to drink 2 litres of water a day, including herbal teas. You may need a bit more or a bit less depending on your body size, and definitely more on hot days or when exercising. Use a handy measure so that you can ensure you are drinking enough. If it is not easy to remember how many glasses of water you have had in day, use a jug or drinking bottle.

2016

Hydrate for health

Water with a slice of anything is the best way to rehydrate. A jug of water with ice, mint leaves and lime slices. Also try these ideas: Cold herbal teas: peppermint and green tea Iced teas: green tea with mint leaves; earl grey tea with lemon slices, black tea/ or your favourite tea, with orange slices. For ice cubes you could place unsweetened cranberry juice into ice trays and freeze. This could become the ice cubes you add to your iced tea or summer drinks. Sparkling mineral water with lemon or lime slices and cranberry juice ice cubes.

1 2 3 4 5

8 1

FE 29

12 13 14 15

FEB 5

n Increase healthy foods:- veggies, high in antioxidants; protein for repair and good fats to reduce inflammation. n Reduce stress with adequate sleep and exercise, use time management to ensure a good work, rest and play balance.

If you’ve missed either of the first two A Year of Living Better articles you can find them in Hep Review back issues #87 & #88 online at: issuu.com/hepatitisnsw

20 21 22 23

n Increase the elimination of toxins (fibre, prebiotics, probiotics, water and exercise).

n Reduce the intake of toxins (alcohol, nicotine, sugar).

Key points

Reread the three A Year of Living Better articles, play with the ideas and research recipes and tools to help you make the changes your own. A friend or group to keep you company and inspired along the way is a great idea.

Remember the 20:80 rule, be good 80% of the time and forgive yourself the 20% of the time when you might not be quite so good, so that you don’t feel that you are missing out or feel guilty for being a little naughty.

2016

Energy and vitality – reaping the beneFIts

6 01

A year of living better

To maximise your vitality you need to provide your body with the right fuel, with plenty of fresh fruit and vegetables, adequate protein, good fats and at least 2 litres of water per day. Look after your mind by using planning techniques and coping strategies to reduce stress and ensure that you allocate time to work, rest, play and sleep. Ask yourself – am I trying to do too much, am I being effective with my time, can I delegate some tasks. Have I done something today that gave me joy?

Or you can call Hepatitis NSW to request Hep Review back issues #87 & #88: 02 9332 1853

hep.org.au | Hep Review 29

liver loving recipes

HEALTHY HYDRATING SALAD Watermelon, fetta, olives, Spanish onion and mint salad Cut watermelon into cubes, crumble or cube fetta, dice the onion, add pitted olives, and mint leaves and combine all these ingredients into your salad.

Wholemeal Savoury Muffins with Spinach and Sunflower Seeds Preparation time: 20 minutes Cooking time: 35 minutes Makes: 24 Storage: Air-tight container

Ingredients • • • • • • • • • •

1 egg 185g wholemeal self-raising flour 250ml soy milk 70g firm tofu, diced 3 tbsp shallots, chopped 5 button mushrooms, finely chopped 100ml olive oil 50g cooked spinach, chopped 2 tbsp sunflower seeds 1 tsp salt

Method 1. Preheat oven to 190°C. 2. Beat egg, add to flour, then stir in other ingredients 3. Spoon mix into greased muffin tins 4. Bake for 35 minutes, until golden brown 5. Serve hot with homemade pumpkin, carrot and potato soup. 6. Read more about the health benefits of spinach for your liver.

30 Hep Review #89 | Nov-Feb 2016

liver loving recipes

green power

Broccoli and Leek Soup Preparation time: 10 minutes Cooking time: 25 Serves: 4 Storage: Store covered in glad-wrap in the fridge – do not freeze

½ avocado + 3 handfuls of baby spinach or 2 kale leaves + 3 celery stalks + handful of mint or sprigs of parsley + ½ to 1 inch piece of ginger + 1 tablespoon of coconut flakes + ¼ cup of water Mix in a blender, add ice cubes if you wish and then drink

Ingredients • • • • • • • • • • •

2 thick slices wholemeal bread, crusts removed, cut into 1cm pieces Olive oil spray 1 leek, pale section only, halved lengthways, thinly sliced 2 garlic cloves, crushed 1 large potato, peeled, finely chopped 1L (4 cups) water 1 salt-reduced vegetable stock cube, crumbled 600g broccoli, cut into florets 1/4 cup fresh parsley leaves 1/4 cup fresh basil leaves 75g (1/4 cup) low-fat sour cream

Method 1. Preheat oven to 200°C. Place bread on baking tray and spray lightly with olive oil. Bake, turning once, for 10 minutes or until golden. 2. Meanwhile, heat a large saucepan over medium heat. Spray with olive oil spray. Add the leek. Cook, stirring occasionally, for 5 mins or until soft. Add the garlic and cook for 30 seconds or until aromatic. 3. Add the potato, water and stock cube to the leek mixture. Bring to the boil. Reduce heat to low and simmer for 10 minutes. Add the broccoli. Simmer for 5 minutes or until the broccoli is tender. Set aside to cool slightly. 4. Place the broccoli mixture, parsley and basil in the jug of a blender and blend until smooth. Transfer the soup to a clean saucepan. Stir over medium-low heat until heated through. 5. Ladle the soup among serving bowls. Top with sour cream and croutons. Season with pepper to serve. hep.org.au | Hep Review 31

R P A

28 29 27 30

5 2

21 22 23

2 E 7

26 AU 29 30 31

20 21 22 19 23

28 29 30 27 31

28 C

29 30 31 D E

3 14 1 12 1 5

(EXERCISE, MOVE, WALK, STRETCH)

Get up and get moving 1

20 21 22 2 19 3

20 21 22

12 13 14 1 5

1 2 3 4 5 6

20 21 2 19 2

9 30 28 2 NO

12 13 14 15

11 16

9 1

20 21 22 23

32 Hep Review #89 | Nov-Feb 2016

12 13 14 11 15

(USE NATURAL coping strategies TO CHILL OUT)

HEP REVIEW

Eat breakfast

Reduce Stress

(the most important meal of the day)

1 2 3 4 5

1 20

1 2 3 4 5

(7-8 hours a night keeps you healthy & happy)

sleep well

12 13 14 11

(NUTS AND SEEDS, LEAN MEAT, TOFU, OATS, LENTILS)

EAT ENOUGH PROTEIN

12 13 14 15 11

28 29 30 31 27

1 2 3 4 5

eat mindfully + chew more

15 20

1 2 3 4 5

15 20

1 2 3 4 5

8 J

1 3

27 28 29 26 30

a welloiled machine

20 21 2 19 2

O T C

29 30 31

28 R A

FEB RU 9 28 2

27 6

20 21 22 23

20 21 22

29 30 SE PT E

(reap the benefIts OF YOUR HEALTHIER LIFESTYLE) 1

20 21 22 23

Energy and vitality

12 13 14 1 5

12 13 14 15 16

8 0

29 30 31

1 2 3 4 5

12 13 14 16

(dRINK 2 litres of water/ HERBAL TEAS A DAY)

(good bacteria improves gut health & digestion)

Hydrate for health

12 13 14 15

fermented foods

11 16

1 2 3 4 5

(bitter & sprouted foods boost digestion)

19 20 21 2 2 18 23

1 2 3 4 5

(more omega 3, less omega 6 & avoid trans fats)

liver support

12 13 1 4 11

28 29 27 30

12 13 14 11 15

EAT A RAINBOW a day (seasonally fresh fruits and vegetables)

1 2 3 4 5

15 20

N 9

1 2 3 4 5

15 20

20 21 22 23

A year of

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

living better

hep.org.au | Hep Review 33

liver loving recipes

Iced Ginger Tea with Lemon Boil 4 cups of water and pour over large bowl with 4 bags of ginger tea. Steep for 15-20 minutes, then remove the bags and transfer to a pitcher. Pour the tea into glasses full of ice and add a squeeze of lemon.

Vegetable curry Serves: 4

Ingredients • • • • • • • • • • • • •

150g brushed potatoes, cut into small cubes 150g sweet potato 1 onion 1/2 cauliflower, cut into small florets 1 carrot, cut into thin slices 1 large handful of baby spinach 2 garlic cloves 2 teaspoons fresh ginger, finely grated 1 1/2 cups salt-reduced vegetable stock 125mls of passata (pasta sauce) 1 cup of frozen baby peas 1/2 to 1 tablespoon of madras curry paste 1/2 cup reduced-fat Greek/natural yoghurt with 2 teaspoons cornflour mixed through • 1/2 cup reduced-fat Greek/natural yoghurt with 2 teaspoons chopped mint stirred through to serve • Cooked basmati rice to serve

Method 1. Use a frying pan that has a lid (you will put the lid on when simmering the curry) to heat the oil 2. Add the onions and cook til soft 3. Add the garlic and the ginger and cook, stirring for one minute 4. Add the curry paste, potatoes, carrot and cauliflower 5. Stir to heat through before adding the passata and vegetable stock 6. Simmer for 15 minutes with the lid on, or until the vegetables are tender 7. Stir the yoghurt/cornflour mixture into the curry, then add the peas and baby spinach 8. Simmer for a few minutes until they are cooked through 9. Serve in a bowl with the cooked basmati rice and a dollop of the minted yoghurt 34 Hep Review #89 | Nov-Feb 2016

liver loving recipes

Salmon and Dill Macaroni

Apple crumble

Preparation time: 10 minutes Cooking time: 10 minutes Serves: 4

Preparation time: 20 minutes Cooking time: 20 minutes Serves: 6 Storage: Covered in the fridge, not suitable for freezing

Ingredients • 1 1/3 cups dried macaroni • cooking oil spray • 2 x 150g salmon steaks (300g in total), skin removed • 375mL can 98.5% fat-free evaporated milk • 2 garlic cloves, crushed • 40g baby spinach leaves • 4 green onions, finely chopped • 2 tbs dill, chopped

Method 1. Cook pasta following packet instructions or until tender. Drain and return to saucepan. 2. Meanwhile, spray salmon with cooking oil. Heat a large non-stick frying pan over medium-high heat. Add salmon and cook for 3 minutes on each side, or until cooked to your liking. Transfer to a plate. Use a fork to flake salmon into large pieces. 3. Add milk and garlic to frying pan and simmer over low heat. Add macaroni and cook, stirring, for one minute or until hot. Remove from heat. Stir in the spinach, onions, dill and salmon until spinach just wilts. Divide between four bowls and serve.

Ingredients • 6 apples, peeled, cored and diced

• • • • • • • •

1 tablespoon sugar 2 tablespoons water 2 teaspoons margarine 2 tablespoons honey 1 cup rolled oats 1 teaspoon cinnamon 1/4 cup sultanas 1/2 cup wholemeal plain flour

Method 1. Preheat oven to 180°C 2. Place apples, sugar and water in a saucepan, cover and cook for 8 to 10 minutes until softened, or microwave, covered for about 5 minutes 3. Spoon the apple mix into an ovenproof dish 4. Combine the honey and margarine and heat in the microwave until melted 5. Add to the oats, flour and cinnamon and stir until combined 6. Spread the crumble mix over the apple and bake for about 20 minutes until golden 7. Serve hot

Recipies sourced from LoveYourLiver.com.au hep.org.au | Hep Review 35

Our free course for people living with hepatitis C looking for ways to improve their health

Here

in Australia there are a lot of people eagerly waiting for brand new hep C treatments, hopefully coming in December. Part of deferring treatment until that date is making sure that your liver is in good shape and you’re keeping yourself informed with everything that’s going on. That’s where the Living Well program comes in. Here at Hepatitis NSW we have a four or six week course all about living healthy, living smart and living well with hepatitis C. With the Living Well program we’re interested in a holistic approach to health, not just eating a bit better and doing some exercise. Your health is so much more than that. That’s why we talk about our emotional wellbeing; we look at what foods can give your more energy; we discuss how to improve your sleep and we cover how exercise and diet can boost your mood. We look at how all the things in our lives can contribute to our health and work out how to make positive changes. Living Well is not one of those courses full of presentations with sessions that make you feel like you’re back at school. Living Well is about practical skills, real people and stories, and offers a non-judgemental, confidential space where everyone can discuss all things hepatitis and health. Our course is run by a mix of people with lived experience of hep C and viral hepatitis expertise but the real strength of the program is that we take the position that the experts on living with hep C are, in fact, the people living with hep C. We’re just here to

Continued next page... 36 H 36 Hep ep R Review eview #89 #89 || Nov-Feb Nov-Feb 2016 2016

draw on that knowledge and build your confidence to take control of your health. We also bring in guest speakers such as dieticians, healthcare workers and counsellors to add their expertise to the group, all in a laid-back atmosphere. This program focuses on strengthening five keys things: n Knowledge: The more you know the more you can make informed decisions. n Skills: Giving you the tools to better manage your own health. n Support: Having backup and assistance at your fingertips. n Confidence: Feel empowered to take control of your hepatitis and health. n Motivation: Make positive changes in your health and be active around your hepatitis. Some of our Living Well participants already have a level of understanding about hep C and the importance of looking after your health as a whole but the course is useful for all levels of knowledge. While we might know what’s good and what’s bad for our overall health it’s often getting detailed, practical information that helps us make better decisions. How often are we told to “eat healthier,” “exercise regularly” or “this or that is bad for you?” Part of what we do during the Living Well sessions is to give you real-world knowledge on improving physical health. Without knowing how important an organ our liver is we don’t often appreciate why it’s important to look after it. Without practical ways to get better sleep, more energy or lift our mood we can’t take steps to improve our overall health. We cover exactly what alcohol does to your liver, for instance, or we talk about how exercise stimulates the production of endorphins which can make you feel good. So often we get told things without anyone explaining why and that can be really frustrating. At Hepatitis NSW we appreciate that knowledge is power and the more information you’re given the easier it is to make informed decisions around your health. We want to put the power back in your hands.

“With the Living Well program we’re interested in a holistic approach to health, not just eating a bit better and doing some exercise.”

Living with hep C and accessing the health system can often seem like a confusing jumble of technical words like interferon, antibody test, Fibroscan, liver function test and sustained virological response. Sometimes it can feel like we’re not being told what’s going on and we’re not in control of our own health but the best way to get the most out of the health system is to understand how it all works. A key part of the Living Well program is breaking down all this complexity and making it easier for you to know what tests to get and what your treatment options are. Being able to walk into your GP’s office knowing what you want and need can be incredibly empowering and we’re all about giving you the confidence to get the most out of the health system. At the end of the day Living Well is a selfmanagement course so we’re really interested in giving anyone who attends the tools and the confidence to wrestle back control of their own health. If you’re looking for ways to improve your health while living with hep C, we’re going to be running a Living Well course in Surry Hills before the end of the year which is open to anyone and everyone. With the new treatments seemingly just on the horizon, we want to make sure everyone is aware of their liver health, living as healthily and informed as they can and, if they want to, ready for treatment. So if this sounds like something you would be interested in please get in contact, we’d love to have you get involved and start living healthier, living smarter and living well.

When: Evenings, weekends or day sessions How often: 4 or 6 week courses Who: You & other people with hep C Where: Hepatitis NSW, Lvl 4, 414 Elizabeth St (near corner Elizabeth & Devonshire Sts) Surry Hills Contact Kyle: p: 02 8217 7707 e: kleadbeatter@hep.org.au

livingwell HEPATITIS INFOLINE

1800 803 990 hep.org.au | Hep Review 37

AMAZING Committees

are not famous for being fertile grounds for inspiring ideas. There is the old adage: “What’s a camel? A horse built by a committee.” But several years ago, in a small committee that had been put together to plan the inception of Going Viral NSW, The Amazing Race was born. Its premise was simple. Workers, with a client base of at risk young people, who were attending training on BBVs, hepatitis C and NSPs, would spend a day in the shoes of their clients and access services asking for injecting equipment. The catch: they had to do it at several stops along the way, while completing a series of set tasks. And they had to do it faster than the other groups. And they were filmed. After some refining, the final model was complete. During the second day of training at Going Viral NSW, attendees split into groups small enough to fit into a sedan. They are supported by a facilitator who leads them on a route with pre-arranged stops, including a primary NSP, a secondary NSP, a pharmacy and a dispensing machine. Participants enter the service, prepped. They need to get injecting equipment, maybe a 3 pack or a 10 pack with swabs and a spoon. Then they ask for information “Could you please tell me where the nearest disposal bin is?” or “Do you have contact details for a methadone program?” Once those tasks have been completed the facilitator starts the camera rolling and asks a number of debrief style questions; “how was that for you?” and “how do you think it would have been if you

“...participants consistently fedback that the most profound aspect of The Amazing Race is the opportunity to ‘walk a mile in someone’s shoes’.”

38 Hep Review #89 | Nov-Feb 2016

were a young person?” and “after having that firsthand experience, what messages would you pass on to young people who need to access the NSP?” then finally “After that experience, what can we do to overcome barriers and increase access to NSPs for young people?” The exercise always elicits a range of responses and feelings yet participants consistently fedback that the most profound aspect of The Amazing Race is the opportunity to ‘walk a mile in someone’s shoes’. Especially those belonging to the clients they engage with daily. One participant said “I was able to experience the emotions such as nervousness and anxiety the same way a young person accessing the NSP would feel.” By giving the workforce an opportunity to live this experience, The Amazing Race is able to open the door

for those participants to start addressing the barriers to accessing services like stigma and discrimination.

Although reviewing the service provided by NSPs is not an aim of the activity, unsurprisingly, how participants were treated tended to impact their feedback. What was surprising though was how moved many of them were when they experienced kindness and NSP staff who went out of their way to provide exceptional service. Staff who took the time to look up phone numbers or write down addresses for Methadone clinics, some who photocopied maps and highlighted disposal bins, the touching story of a NSP worker who showed genuine concern when a participant asked for nearby rehab details. “She even asked me if I had recently overdosed. And when I answered no, she told me to keep up the good work!” When these issues were later explored by participants and facilitators it was agreed that one of the most effective ways to help young people feel more comfortable in accessing NSP services is treating them with warmth and kindness. To make sure they know that it is their right to access these services and that NSPs are there to meet their needs and provide support. As one participant said “It made me really think of what people who are injecting go through and feel like when they enter these locations.”

So far The Amazing Race has been delivered across five local health districts, 15 times, to more than 120 youth workers. The feedback is, well, amazing. Overwhelmingly, participants comment that having had this firsthand experience will profoundly impact and improve the way that they engage with young people accessing their service, especially around hepatitis C and safe injecting practices. Workers reported an increase in knowledge of NSP services and an increase in confidence in talking to young people about NSPs and how to access their services. Beautifully captured in one participant’s comment, “Going to the places we went to has opened my eyes up in a good way. I feel educated enough to help young people in need.” We aim to continue delivering this unique experience to youth workers across NSW for a long time to come.

O hep.org.au | Hep Review 39

LOCAL NEWS news | TASMANIA | australia Anger at Tasmanian hepatitis C trial with call for money to be spent on cures A Tasmanian medical trial to teach people with hepatitis C how to avoid infecting their children with the virus has been criticised as fearmongering and a waste of desperately needed health funding. The Tasmanian State Government will partly fund the trial, called Families Living Healthily with hepatitis C, which aims to teach people with hep C how to better prevent transmission of the bloodborne virus. More than 5,000 Tasmanians have been diagnosed with hep C, but medical experts believe many more people unknowingly carry the liver-destroying virus in their blood.

edition #20

Hep C campaigner Greg Jefferys said the stigma of illicit drug use associated with the illness already prevented many sufferers from seeking treatment, and the new trial will only exacerbate the problem.

“I don’t know of one single case of a child being infected with hep C by Greg Jefferys their parents. Instead image: themercury.com.au of this nonsense, the Government should be curing people of hep C, not running a scare campaign about almost non-existent risks,” Mr Jefferys said. “This will simply make people fearful of those with hep C and add to the stigma associated with having hep C.” Health Minister Michael Ferguson said he believed people with hep C would want to know about potential risks to other family members. Mr Jefferys says scarce Tasmanian health funds would be better spent on helping to cure others by sourcing generic Indian drugs. Abridged from: themercury.com.au Read in full: bit.ly/1QdSIB1

MAGAZINE

In the latest issue four good friends play together and party together. When one is confronted with a possible hep C exposure, will they stick together? Or will their little group fall apart in the face of stigma...? Transmission Magazine is an easy-read Hepatitis NSW publication featuring a comic developed by community, puzzles and basic info about hep C!

Read it online hep.org.au/news-stand

subscribe Call 1800 803 990

40 Hep Review #89 | Nov-Feb 2016

Hepatitis Matters H

epatitis NSWâ&#x20AC;&#x2122;s advocacy publication Our 20 Asks is now four years old, and expires this year. Which means it is time to review the existing document and determine whether the organisation needs a new advocacy document and if so what form it might take.

n A web-based format provides scope for updating issues and their respective priority over time, linking to relevant campaigns, sharing on social media and highlighting specific issues for specific audiences and purposes like World Hepatitis Day.

We have undertaken a short, two-step consultation looking at these questions and came up with some recommendations for next steps, to allow a new advocacy document to be launched in late 2015 or early 2016.

n Some issues require more emphasis or different approaches. We need to keep fighting for equal access to new treatments, harm reduction initiatives within prisons, increased access to needle and syringe programs at the same time as sharpening our focus on addressing stigma and discrimination, prioritising hepatitis B, and responding to the challenge of viral hepatitis among Aboriginal people.

An online survey sent was to selected individuals between 5th and 15th May 2015 and a face to face meeting with several stakeholders was held on 13 May 2015. Follow up consultations were held in October. This is what we found out: n The concept of an advocacy document is well supported and has been used effectively in a number of circumstances, in particular to reposition Hepatitis NSW as an organisation that consistently engages in advocacy on behalf of the community. n 20 is too many issues and as a result the current document became overly long and wordy. As the number is less important than the concept, it should not be part of the title. n The use of names and faces to support advocacy issues is very helpful in engaging community and personalising/humanising the issues. Each advocacy issue could be supported by a quote/photo from an affected community member, where available.

n Emphasise actionable items within the remit of a state-based organisation. However, some national issues such as access to new treatments will continue to be included because it affects everyone, and is central to eliminating viral hepatitis. n Link it with strategic planning and campaigning to ensure that our advocacy goals are captured within it and become the business of the whole organisation. n Distribution via multimedia and social media to reduce cost and improve access. It needs to be visually interesting, catchy and engaging. Hepatitis Matters is our new way to frame the important issues we will be working on engaging with you through our campaigns. Watch out for further developments in this space in coming months.

hep.org.au hep.org.au || H Hep ep R Review eview 41 41

discover

DISCOVER

Research into viral hepatitis

Advanced liver damage in hepatitis C patients grossly underestimated and underdiagnosed The number of hepatitis C patients suffering from advanced liver damage may be grossly underestimated and underdiagnosed, according to a study led by researchers at Henry Ford Health System and the U.S. Centers for Disease Control and Prevention.

“It is not unusual for patients with hepatitis C to come in and they have liver cancer, and they didn’t even know that they had cirrhosis that led to their cancer.”

42 Hep Review #89 | Nov-Feb 2016

Clinicians typically rely on liver biopsies to diagnose cirrhosis. But in the hepatitis C patients studied, only 661 patients were diagnosed with cirrhosis through a liver biopsy.

Illustration: Sara Andreasson

The findings were the result of a study of nearly 10,000 patients suffering from hepatitis C. The records analysed by the researchers indicated evidence of liver damage, or cirrhosis, in 29% or 2,788 of the hepatitis C patients included in the study. But surprisingly, 1,727 of those 2,788 patients, or 62% of those suffering from liver damage, had no formal documentation in their medical records that they had cirrhosis. The results suggest cirrhosis may be underdiagnosed in a large segment of the population.

“Our results suggest a fourfold higher prevalence of cirrhosis than is indicated by biopsy alone,” says Stuart Gordon, M.D., lead researcher and Director of Hepatology at Henry Ford Hospital. “A lot of patients in our study had cirrhosis and probably didn’t know they had cirrhosis. “Sometimes the clues of liver damage or cirrhosis are very subtle,” says Dr. Gordon. “It is not unusual for patients with hepatitis C to come in and they have liver cancer, and they didn’t even know that they had cirrhosis that led to their cancer.” sciencenewsline.com/ articles/2015081815540015.html

Time for Action

discover

on World Hepatitis Day

n World Hepatitis Day, 28 July 2015, Hepatitis NSW hosted a morning tea for members of the community, members, staff and board of Hepatitis NSW, NGOs, healthcare workers, researchers and Ministry of Health representatives to help promote the #TimeForAction message.

“Less than 5% of people living with chronic hepatitis B – and only 1% of people living with chronic hepatitis C – receive treatment each year.”

While the NSW Health Minister was unavailable (with Ms Nicky Bath, Manager of the Harm Reduction & Viral Hepatitis Branch, presenting on her behalf), Labor’s Shadow Health Minister the Hon Walt Secord MLC and the Greens’ Mr David Shoebridge MLC both attended. Mr Stuart Loveday, CEO, spoke on behalf of Hepatitis NSW, while C me community advocate, Mary Sherwood, gave a community perspective about hepatitis C, the need for testing, liver checks and most of all access to treatment.

Continued next page... hep.org.au | Hep Review 43

Continued from previous page... Together with Hepatitis Australia, and state and territory hepatitis organisations from across the country, Hepatitis NSW used World Hepatitis Day – and NSW Hepatitis Awareness Week, which ran from Monday 27 July to Sunday 2 August – to put forward five key messages.

TIME FOR ACTION TO EXPAND HEPATITIS PREVENTION PROGRAMS n Needle and syringe programs provide a cost-effective way to prevent transmission. Governments need to ensure that prevention programs, including those in correctional settings, are increased and fully funded. n While childhood hepatitis B vaccination rates are good, governments need to support consistent access to free hepatitis B vaccination for all adolescents and adults at risk.

TIME FOR ACTION TO INCREASE HEPATITIS TESTING “More GPs are needed with a greater knowledge of chronic hepatitis who can provide regular surveillance rather than having to go to a specialist service.” n Doctors need to offer hepatitis B tests to anyone born overseas in a country where hepatitis B is prevalent (or who have parents from these countries) or who are of Aboriginal or Torres Strait Islander descent. n Doctors should offer hepatitis C testing to anyone potentially exposed to the virus.

TIME FOR ACTION TO IMPROVE ACCESS TO REGULAR LIVER CHECK-UPS “We need access to specialists without long waiting times. I was referred to a specialist in March and can’t get an appointment until November. That causes more stress and worry.” n Everyone living with chronic hepatitis B or C should have regular liver check-ups, which are easy to carry out, don’t hurt and are the simplest way to monitor liver health and ensure treatment starts before it is too late n Governments need to ensure that liver scans are available to all people living with chronic hepatitis B and C.

TIME FOR ACTION TO INCREASE HEPATITIS TREATMENT RATES “My physical, mental and emotional health is badly affected by living with this illness. I obsess about whether I will see my grandchildren grow up and what my current life expectancy is. I feel very alone, frightened and ill.” n Less than 5% of people living with chronic hepatitis B – and only 1% of people living with chronic hepatitis C – receive treatment each year. n Hepatitis B medicines can now be collected from any pharmacy. It is vital that communities and healthcare providers are aware of, and benefit from, this change. n New interferon-free therapies are becoming available for hepatitis C around the world, making it possible to cure hepatitis C without the terrible side-effects of the older treatments. It is vital that all Australians have affordable access to the new medicines at the earliest opportunity

TIME FOR ACTION TO END STIGMA AND DISCRIMINATION “Discrimination in the health care setting prevents people like me from accessing treatment, care and support.” n Stigma and discrimination continue to prevent people living with chronic hepatitis B and C from accessing vital health services. Government funding for anti-discrimination campaigns is vital to create a culture of non-discrimination, which encourages good prevention practices, increased testing, greater use of liver check-ups and access to treatment. n Governments, communities and healthcare providers have a role to play in ensuring that hepatitis is regarded as a treatable liver health condition. Addressing all five of these priorities – prevention, testing, liver checks, treatment and addressing stigma and discrimination – are essential to dealing effectively with the hepatitis B and C epidemics in Australia, and above all of meeting the needs of people living with viral hepatitis.

Lend your voice to our new project!

Computers can now be found in nearly all Correctional centres. Corrective Services wants Hepatitis NSW to promote our work to prisoners via these computers. We’re looking for volunteers who can provide voice overs or video filming for several of our resources.

More info please call Paul: 0412 885 201 44 Hep Review #89 | Nov-Feb 2016

by :G len n

Ar t

Art by: Gle nn S

These winning health promotion messages were created by men in custody at Long Bay Correctional Centre. The competition idea started when Darren called from Long Bay Correctional Centre saying he wanted to do something to get the word out about hepatitis C for NSW Hepatitis Awareness Week. With the okeydokey of Corrective Services NSW and a supportive program officer, their successful grant application was written and a hepatitis awareness campaign kicked off at Long Bay. The campaign included workshops, a nutritious lunch, an art competition and consultation to revamp harm reduction posters.

y: tb

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ae l ich

Ar tb

Congratulations to all the guys who were involved in the campaign!

an Dyl y: b t

â&#x20AC;&#x153;LOVE AND LET LIVERâ&#x20AC;?

hep.org.au | Hep Review 45

NSW Hepatitis Awa

here was a bustle of activity between July 27 and August 2 as organisations across NSW held various events and outreach to programs to educate the community on all things hepatitis... hereâ&#x20AC;&#x2122;s a quick wrap of just a few activities.

St George Hospital Liver Clinic It was a busy but exciting Hepatitis Awareness Week for the St George Hospital Liver Clinic team. We kicked off by having a health promotion stall in the foyer of the hospital where patients, visitors and staff were equally challenged by the viral hepatitis quiz, taking away the facts and having their myths dispelled. This was also an opportunity to raise dollars for our Good Samaritan Fund by selling protein balls and protein drinks, which helps provide for some of our needier patients. A presentation on Reactivation of Hepatitis B in the Immunosuppressed was well received by the Haematology department at their Journal Club meeting, with requests for further in-services to the oncology team and ward staff now scheduled for later in the year. Our outreach community program extended Scan and Scone mornings to those who attended the Mission

Australia Centre and St. George Drug and Alcohol Services. A total of 40 fibroscans were done and clients of the services put their name down for viral hepatitis screening the following week. The scones were a great draw card, providing an opportunity to discuss liver health and new treatments for hepatitis C just around the corner.

Mt Druitt Community Health & Auburn Hospital Arabic Multicultural Health Workers - Hanaa Nosir from Mt. Druitt Community Health and Manal Hanna from Auburn Hospital - organised three hepatitis C awareness sessions in Auburn, Blacktown and Mt.Druitt as part of Hepatitis Awareness Week. This was a collaborative project in partnership with The Health Promotion Officers Mohamed Keynan and Murad Hussain from Blacktown/Mt. Druitt Community Health Centres.

46 Hep Review #89 | Nov-Feb 2016

More than one hundred Arabic speaking people from the community attended the three awareness sessions. The aim of this project was to increase community awareness about hepatitis C, including symptoms, treatment, screening, prevention and where to seek help. Show bags with information on hepatitis C were given to all participants. They were very satisfied overall and gave positive feedback about the program. It is expected that the participants will disseminate the information to other members of their community.

areness Week Wrap Kyogle Youth Action Hip to Hep! Kyogle Youth Action provides Advocacy & Referral, Skills Based Activities, Case Management and Drug & Alcohol free recreational activities to Kyogle Youth aged 12 to 18 years. The Youth centre is open from 9:30am– 5:30pm on Wednesday, Thursday and Friday’s till 8pm. Young people can access the centre from 3:305:30pm to use the computers, internet, kitchen facilities and access youth workers. In Hepatitis Awareness Week we ran a short information session with a Clinical Nurse from Lismore Liver Clinic followed by an info session on safe tattoo/piercing practises with the only ‘legal’ tattoo artist in Kyogle and finished off with a workshop where the young people picked an image or statement with Hepatitis awareness and prevention message to screen print onto a t-shirt or calico bag.

women booked herself in for a blood test because she has a ‘backyard piercing’ and doesn’t know if the correct sterilisation procedures occurred. We will engage with the Liver Clinic and arrange for another information session in the future since there seemed to be a real lack of knowledge and a thirst for knowledge. Thanks to Hepatitis NSW for funding the project and enabling it to happen.

Attendance was low although the young people that did participate gained a lot of insight into Hepatitis and one young

Thirroul Neighbourhood Centre On Wednesday July 29, Northern Illawarra Youth Project ran their Hepatitis Awareness workshop. The youth centre welcomes young people of the community aged between 11-18. The current range of young people that attend are between 12-14, which gave interesting insight for the Hepatitis workshop, Love Your Liver.

The event sought to educate young people about certain ways hepatitis can be contracted, and how to keep healthy, and seek treatment if it occurs. The workshop focused on keeping it fun, by running a mock tattooing session, as well as showing episodes of Miami Ink that focused on needle and ink safety. This provided workers the opportunity to talk to young people about a serious issue, but kept it a light and safe area. This gave the young people a chance to have fun with our airbrushing tattoo kits, and focus on safety measures surrounding tattooing, and the young people loved trying out the kit, creating fabulous designs, and were happy to ask questions and listen to workers explaining the issue of hepatitis. We also provided a super healthy and super yummy afternoon spread of leafy greens, nuts and fruits that also focused on liver health, as part of hepatitis management. Overall, we had a wonderful and educational workshop, and the youth went absolutely nuts for it!

hep.org.au | Hep Review 47

NSW Hepatitis Awareness Week Wrap North Coast Primary Health Network & Mid North Coast Local Health District North Coast Primary Health Network and Mid North Coast Local Health District staff partnered to host a Hepatitis and Healthy liver awareness day at Bowraville, a small rural community situated west of Macksville. Community members and students from the local school were educated about hepatitis C using a local NSW Hepatitis Champion and were then invited to design a logo for printing onto T-shirts. The T shirt design task was led by Abbey Mitchell who specialises in design and working with young people. The design process which involved drawing and colouring, encouraged both mindfulness and discussion amongst participants. Carol Hart submitted the winning design. The prize of a watch was awarded to signify the Hepatitis Day theme of “Time to Act”.

Nimbin NSP On Hepatitis Awareness Day The Nimbin NSP shared a stall set up outside the Nimbin community centre, Sabina a senior team member, spoke to an estimated 30 people handing out information and engaging them in conversation, ranging from basic hep C awareness through to testing and treatment options. The Client feedback was very positive, showing a fairly high level of knowledge around all issues regarding Hep C and needle & syringe services.

Lismore - Mid North Coast Local Health District They all knew that there were heaps and heaps and HEAPS of people “The Northern Rivers has in Australia living with hepatitis C the highest percentage of (they all circled “over 230,000”); they all knew that Hepatitis C people with hep C in NSW was transmitted through blood; outside of metropolitan the majority of them knew the Sydney.” symptoms of liver disease, and that if untreated hepatitis C can lead to serious liver disease; but some people didn’t know about the availability of treatment, and 25% thought that there was a vaccination for hepatitis C. This is the information gleaned from our World Hepatitis Day stall in the CBD of Lismore. We attracted people to the stall by BBQing some delicious sweet corn and encouraged them to enter the raffle for the food hamper that was brimming with fruit and veg, other liver friendly foods, and a $50 Coles voucher. All they had to do was answer a few questions. The stall was a collaboration and staffed by a Liver Clinic CNC, a dietician specialising in liver health, and a Harm Reduction Officer. On offer was information and resources, and a lot of discussion regarding liver health, hepatitis C prevention, safe tattooing and piercing, getting your liver staged, risk factors, and fibroscan access (yes, we are one of the lucky areas that have a fibroscan machine!). The Northern Rivers has the highest percentage of people with hepatitis C in NSW outside of metropolitan Sydney. The Lismore Liver Clinics recent acquisition of a fibro scan is encouraging for people who were reluctant to have a liver biopsy. Hearing personal accounts of new medications, less side effects and an increase in successful treatments, have started people seriously thinking about beginning treatment and that they could one day be Hepatitis C free.

48 Hep Review #89 | Nov-Feb 2016

A big thank you to all the staff from these organisations for their NSW Hepatitis Awareness Week reports & hard work!

halc what can you do about discrimination?

I have hep C easy read booklets

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

CALL 1800 063 060

HIV/AIDS LEGAL CENTRE halc.org.au

Psst! Want the chance to win a $100 Coles/Myer gift card?

$ $

$$ $

Itâ&#x20AC;&#x2122;s easy! Just give us your feedback and help us develop a better magazine.

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hepcaustralasia.org The largest online support community for people living with hep C in Australia run by people with hep C for people with hep C

â&#x20AC;&#x153;What I love about hepcaustralasia is that it gives me a place to go where everyone is in the same boat. We can talk freely about our experience without having to disclose to the wider world. And, most importantly, it provides valuable advice and support for those of us on treatment. It is a long, hard road but itâ&#x20AC;&#x2122;s made a lot easier by having sympathetic, like-minded people to talk to.â&#x20AC;? Dee hepcaustralasia forum moderator

Stories of courage, resilience and hope for a future free from hepatitis C More than 230,000 Australians are living with hepatitis C, yet only one percent of these people receive treatment each year. It is almost impossible to combat this heavily stigmatised condition, but Together we Can make a difference. Together We Can: See Our Future encapsulates the personal stories of a group of Australians who have been impacted by hepatitis C and details of their fight to break the chains of stigma and cure the virus that threatens their health and well-being. Read online: hepatitisaustralia.com/together-we-can

50 Hep Review #89 | Nov-Feb 2016

PETER’s Story A few years ago, I took the plunge, to rid myself of the wretched Hep C virus and undertook the interferon/ribavirin process, which was 12 months of 12 tablets a day and an injection once a week. Initially, I didn't realise I was hep C positive until the bloods came back showing that I had even been in contact with the virus. I had the antibodies and further testing proved I had it. I didn't really appreciate how ill I felt whilst being hep C positive - until I found out just how much better I felt once I was rid of it. I saw the specialist involved in my initial consultation, who gave me all the good and bad news, with three months to make my decision. I'd basically decided before leaving his office, but he insisted I have a good think and read all the literature. I thought, “yep, I can handle this”. The three month recess to contemplate undertaking the program also allowed me time to prepare myself, which was invaluable. I'm on Methadone, so during the three months I doubled my dose and began anti-depressants. I then returned and said “let's get this party started”. For the first two months, I had no idea what they meant by side effects, even to the point of cockiness, saying “how weak these others must be”. Then it hit me. Not every day was a bad day, but when it was there was lack of appetite, anti-social-just get my methadone and go home. Sometimes it would just be for the day, sometimes a few days. What got me through, I believe, is I used to say “anyone can chuck

it in” to myself and I'd keep taking my tablets; and again say, “I'll throw it in tomorrow”, or the next time I saw the support staff. I also believe, since I was living alone, I wasn't a burden on anyone and had nobody on my back. Short story is, I finished the 12 months, but it wasn't easy, nor was it really that hard either. About two months after finishing my course, I began to notice the benefits of not carrying hep C around. I had more energy than I'd ever had, but the main thing I believe, is to keep looking after yourself, food, sleep and exercise - before, during and after the entire program. Having said all this, I'm so glad I completed the entire program and encourage anyone contemplating it to give it a go. Don't wait for the upcoming new treatments, because you'll be waiting forever. They are continually getting better and shorter programs, so when you've decided you want a healthier and better life, start right now. The sooner you start, the sooner you'll be free. The positives far outweigh the negatives.

Peter Central Coast Many thanks for sharing your story with us, Peter! (not pictured). As for the availability of the new treatments we’re certainly hoping on sooner rather than forever!

hep.org.au | Hep Review 51

HORRORSCOPE* Aries

Leo

Sagittarius

Taurus

Virgo

Capricorn

Gemini

Libra

Aquarius

Scorpio

Pisces

Other people might put you on the spot for no apparent reason. Having several plausible alibis fully memorised and rehearsed can be useful. Try not to get your stories mixed up, and avoid using your trump card alibi for trivial sticky situations as you can only play it once.

For a while now you’ve been doing research on the best way to proceed. Up? Down? Back? Forward? Left? Right? A combination of all? Living in a three dimensional universe sure is confusing at the best of times. Toss a coin or throw a dice instead, that’s usually just as effective.

If someone challenges you, talk your way out of it. After all, Geminis are renown as the double talking BSers of the zodiac par excellence and you can make even the most outlandish excuse seem reasonably plausible. It’s like your super power.

Cancer Rescue an injured bird or do something to help save the whales. Just make sure you use the right techniques; for example, don’t roll the bird back into the ocean and if you must put the whale in a cardboard box make sure there are some holes in the lid for it to breathe through.

Remember that strength lies in numbers. This is a fundamental fact of nature which is why so many animals stick together in large groups... they’re secretly hoping the lion will eat the other guy. But you are the lion, Leo, so pretty much you’ve got the pick of the menu.

This is a good time to put your plan for world domination into effect. Avoid rambling monologues when you have the upper hand, and never tell your plans to the secret agent sent to stop you, even if you believe they’ll never escape from the shark tank you’ve dangled them over.

Take care of domestic issues and stick to household chores and duties. You never know what you might find down the back of the lounge... money, jewelry, the budgie, even a long lost relative. Remember, “cleanliness” is next to “godliness” only in really bad dictionaries.

Don’t be surprised if emotions flare up between you and someone close on a professional level - they’re onto the fact that you nicked their collection of green pens. There’s only one course of action - blame the boss then take the week off.

People may be coming on strong, the problem is, the person who confronts you is talking about apples and you’re talking about oranges. Get the upper hand by slipping in a banana or mango reference. The fruit salad is a time honoured debating technique.

If something doesn’t make sense to you chances are you have the page upside down. Or worse, you may be trapped in an episode of the Twilight Zone where capricious supernatural forces are teaching you a pointless life lesson for their own amusement.

It may feel like others are trying to put a monkey wrench in your gears. These people are jerks and should be avoided at all costs. If that proves impossible at least find some suitable way to cover up your gears, leaving them dangling out in public is unwise anyway.

Think of your heart as a powerful muscle that needs a tough workout. Let’s face it, Pisceans are softies at the best of times. Try watching tear jerker movies without reaching for the Kleenex and you’ll soon be able to suffer the insensitive buffoonery of the other zodiac signs.

*please note that these horrorscopes are like election promises: neither real nor accurate. 52 Hep Review #89 | Nov-Feb 2016

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

ACROSS 1. Hep Review is one of these (8) 5. Make a hole in the ground (3) 7. A mini whirlpool or whirlwind (4) 8. Bamboo loving Chinese bear (6) 9. Bouncing marsupial (8) 11. Old distance measurements (5) 13. Fizzy water (4) 16. Someone doing all the talking (6) 20. Bodyâ&#x20AC;&#x2122;s largest organ (4) 21. Melbourne transport (4) 22. Beat; pulsate steadily (5) 23. Slice; chop (3) 24. Soccer, rugby, league... (6) DOWN 1. Background music (5) 2. A verdant colour! (5) 3. Star signs collectively (6) 4. Work; a job (10) 5. Peril (6) 6. Wine making fruit (6) 10. A long time ___ (3) 12. Female deer (3) 13. Radio noise (5) 14. Go; leave (8) 15. Keeps your drinks cool! (4) 17. 22/7 or 3.14285714... etc (2) 18. Cosmic fate 19. Revolutionary; anarchist (5)

hep.org.au | Hep Review 53

CLINIC LISTINGS

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

MONITOR MANAGE TREAT

CLINIC The Albion Centre Surry Hills

CONTACT 02 9332 9600

SERVICES

C B F* *fridays only

clinic highlight Hunter New England Local Health District Liver Clinics (02) 49213478 HNE Liver Clinics provide culturally appropriate and friendly services. They provide education and information on viral hepatitis and access to hepatitis treatment. They also provide information and support to patients preparing for treatment, supportive counselling during all stages of treatment, ongoing case management and health monitoring in relation to liver care.

Bathurst Liver Clinic Bathurst Hospital

02 6330 5346 0407 523 838

Bega District Hospital Interferon Treatment Unit

02 6492 3255

C B F

C B

Hepatitis Infoline 1800 803 990 Info, support, referrals

Burwood Endoscopy Centre

02 9745 3988 endoscopy@iinet.net.au

Canberra Gastroenterology Hepatology Unit

02 6244 2195

C B F

Canterbury Hospital â&#x20AC;&#x201C; Outpatients Liver Clinic

02 9767 6372 legan@ med.usyd.edu.au

Coffs Harbour Health Campus â&#x20AC;&#x201C; Clinic C

02 6656 7865

Coffs Harbour Sexual Health Clinic 916

02 6656 7865

C B

Concord Hospital Liver Clinic

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

C F

54 Hep Review #89 | Nov-Feb 2016

Treatment through Bankstown Hospital Outpatients Clinic

CLINIC LISTINGS

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

MONITOR MANAGE TREAT

clinic highlight Hunter New England Local Health District Liver Clinics (02) 49213478 HNE Liver Clinic Locations John Hunter Hospital - New Lambton

CLINIC

CONTACT

SERVICES

Central Coast Hepatitis C Clinic

02 4320 2390 helen.blacklaws@ health.nsw.gov.au

C B F* *two days/month

Centre for Addiction Medicine, Westmead

02 9840 3462

C B F

Clinic 16 Royal North Shore Hospital

02 9462 9500

C B F

Clinic 33, Port Macquarie Community Health Centre

02 6588 2750 hdc@midcoast.com.au

C B F* *one day/month

Eastern Suburbs Endoscopy Centre Bondi Junction

02 9387 6600 paullgoodman@ gmail.com

Excel Endoscopy Centre, Campsie

02 9718 0041 C B excelendocentre@ gmail.com

Gosford Hospital – Endoscopy Unit

024320 2111

Gosford Hospital – Teaching & Research Unit (Wyong)

02 4320 2390

Tamworth Newcastle Cessnock Raymond Terrace Taree

C B F* *one day/month

Goulburn Community 02 4827 3913 Health Centre

Holdsworth House Medical Practice – Byron Bay/Sydney

C B

02 6680 7211 (Byron) 02 9331 7228 (Sydney)

hep.org.au | Hep Review 55

CLINIC LISTINGS

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

MONITOR MANAGE TREAT

I MY

CLINIC

CONTACT

SERVICES

John Hunter Hospital Viral Hepatitis Service Newcastle

02 49214789 tracey.jones@ hnehealth.nsw.gov.au

C B F

Kempsey Liver Clinic

02 65882750

C B F

Kirketon Road Centre (KRC) Kings Cross

02 9360 2766 phillip.read@ sesiahs.health.nsw.gov.au

C B* F

Lidcombe Hospital Outpatients Liver Clinic

02 9722 8400

Lismore Liver Clinic

02 6620 7539 mark.fuller@ ncahs.health.nsw.gov.au

C B F

Liverpool Hospital Department of Gastro & Hepatology

02 8738 4074 miriam.levy@ sswahs.nsw.gov.au

C B F

*one clinic/month

Hepatitis Infoline 1800 803 990 Info, support, referrals

Narooma Community Health Centre

02 4476 2344

Nepean Hospital Outpatients

02 4734 3466 vincenzo.frageomeli@ health.nsw.gov.au

C B F

Nepean Private Specialists Centre

02 4722 5550

56 Hep Review #89 | Nov-Feb 2016

CLINIC LISTINGS

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

MONITOR MANAGE TREAT

Is your hepatitis clinic or treatment centre located in NSW but not listed here? Already listed but the info is out of date? Contact us with the details and we’ll add you to/update our clinic directory! hepreview@ hep.org.au

CLINIC

CONTACT

SERVICES

Northern Rivers Gastroenterology Lismore

02 6622 0388 nrgstaff@tpg.com.au

C B

Clinic 96 Kite St Community Centre Orange

02 6392 8600 debra.goodacre@ health.nsw.gov.au

C F

Orange Base Hospital

02 6369 3000

C F

Prince Of Wales Hospital Liver Unit

02 9382 3100 cherie.raby@ sesiahs.health.nsw.gov.au

C B F

Port Macquarie Liver Clinic

02 65882750

C B F

Royal Prince Alfred Hospital AW Morrow Liver Clinic

02 9515 7049

C B F

St George Hospital – Hepatology & Liver Clinic

02 9113 3111 Lisa.Dowdell@ sesiahs.health.nsw.gov.au

C B F

St Vincents Specialist Medical Centre Lismore

02 6622 0388 nrgstaff@tpg.com.au

C B

St Vincents Hospital – Viral Hepatitis Clinic

02 8382 3707 viralhepatitis@ stvincents.com.au

C B F

Shoalhaven Hospital Hepatology Clinic

0477 300 445

C B F

hep.org.au | Hep Review 57

CLINIC LISTINGS

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

MONITOR MANAGE TREAT

I MY

CLINIC

CONTACT

SERVICES

Sydney Clinic for Gastrointestinal Diseases

02 9369 3666

C B

Wagga Wagga Hospital Hepatitis Treatment Unit

02 6921 2711

C B* *referred to private rooms

Westmead Childrens Hospital

02 9845 3989

C B

Westmead Drug & Alcohol Services North Parramatta

02 9840 3462

C F

02 9845 7705 Westmead jacob_george@ Gastroenterology Hepatology Department wmi.usyd.edu.au

C B F

Wollongong Hospital Hepatology Unit

C B F

02 4222 5180

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

In prison and want to get treated for hep C? You need to make an appointment to see the Justice Health nurse at your Centre and tell them that you would like to be treated for hep C. It may take some time â&#x20AC;&#x201C; they will do some preparation work to find out which treatment is best for you â&#x20AC;&#x201C; after that you will join the waiting list for treatment. You can find out more about treatment by calling the Hepatitis Infoline (dial number 3 on the common calls list) 1800 803 990. 58 Hep Review #89 | Nov-Feb 2016

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Congratulations to Mark! Winner of the $100 Coles/Myer gift card for issue #88 60 Hep Review #89 | Nov-Feb 2016

hello hepatitis infoline

Let’s Talk about:

Positive Psychology

by Lila Pesa, Hepatitis NSW

Living

with chronic illness, addressing on-going health issues, going through difficult treatment or trying to recover after treatment and find our lost equilibrium, learning to self-manage or caring for someone dealing with serious health issues can be a major life challenge for anyone affected this way.

It is a well-known fact that our physical health and wellbeing depends a lot on our emotional health, state of our mental health, our moods, mindsets and attitudes. Positive psychology is the scientific study of optimal human functioning and what makes life worth living. In other words, it is the psychology of the characteristics, conditions and processes which lead to flourishing. Positive psychology has its roots in the work of William James in the late 19th century and humanistic psychologists of the mid-20th century, as well as in the work of ancient philosophers such as Aristotle and Plato. It is not science for its own sake – it’s the practical applications that we are interested in – how can we can

“A joyful heart is good medicine.”

use the findings of empirical research and apply those to improve our own well-being. When we use the term well-being we often associate it with the word happiness. What has been researched and confirmed that happiness is not a passive entity which can be obtained. More exactly, long-lasting happiness can be achieved by changing how we spend our time on day to day basics and changing our outlook on life once finding that our current mindset is not very helpful. It is work in progress and requires commitment, determination and quite a lot of responsibility.

Continued next page... hep.org.au | Hep Review 61

Positive Emotion

Accomplishments

Engagement/ Flow

Meaning/ Purpose

Relationships

Continued from previous page... It may seem way too hard, but when we ask ourselves what’s at stake here – the answer is - our chance to have more balanced, more fulfilling life – better health, enhanced sense of well-being, better overall quality of life. Most of us would probably agree that this is something worth investing into. So, where do we start? There have been many different theories / models of well-being that psychologists, philosophers and social researchers used over the years. We have a chance to get familiar with one of the models, called PERMA, which consists of five separate elements that are all intertwined / interconnected – please, see diagram above. In this issue we are choosing to look at one of the components from this diagram: Positive Emotions, and continue “unpacking” and investigating other components in our next publications. Positive emotions are linked to: longevity, better mental and physical health and ability to manage illness, more efficient decision-making, creativity, greater persistence and improved performance on difficult tasks – the list can go on. What kinds of practical things we can derive from positive psychology research to invite Positive Emotions into our day to day life?

One of the suggestions that we liked is to create a personal “playlist” of all activities that we remember enjoying in the past, for example: n Reading or watching something funny or interesting n Singing or dancing by yourself n Playing with kids n Watching sun rise or set n Walking in nature n Preparing and enjoying a special meal with someone or on our own n Starting a humour diary We can keep working on expanding our Activities that Promote Positive Emotions List and make it very long. More importantly – let’s keep it as a call to action – and actually practice things that we put on our personal lists to really feel the powers of Positive Emotions.

If you feel like sharing with us your own Playlist – what works for you - we’d be happy to hear from you – please, write or email to HepReview! In our next article we shall be exploring our next component of the diagram: Engagement or Flow.

Resourses: “Positive Psychology: a Practical Guide” by B. Grenville-Cleave; “The Will to Believe and Other Essays on Popular Philosophy” by William James; positivepsychology.org

Highly skilled, hepatitis-informed counsellors supporting clients affected by viral hepatitis living in NSW by delivering telephone, Skype and face to face counselling sessions. Our service is free. More information: Hepatitis Infoline: 1800 803 990 Counselling Coordinator: 02 8217 7717 62 Hep Review #89 | Nov-Feb 2016

Alcohol & Other Drugs Support & Information Services

Get Bloody Serious!

A workshop (mostly) about hep C

Think. Plan. Act A comprehensive workshop that will help you work better with your clients around hep C Upcoming workshop dates

n Friday 30 October, 2015 n Friday 29 January, 2016 n Friday 29 April, 2016

NUAA

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

ADIS

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

Family Drug Support

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

working towards a world free of viral hepatitis hep.org.au | Hep Review 63

Hep C is spread by blood

Only use your own needles, syringes, spoons, water and other injecting equipment

Hepatitis INFOLINE

1800 803 990

info, support, referrals

hep.org.au

Hepatitis NSW Working towards a world free of viral hepatitis