edition
22
feb 2016
The way we are
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PART ONE Mmmmmm. I swear babe, you’re almost as good a cook as you are a painter.
well I’m glad you appreciate it, Andy, but that’s not true.
I can barely sell my paintings at the markets. nobody is going to want to buy my marinara sauce.
I’d buy your marinara, vic honey. And I’d buy your paintings too.
Mmmmm, so good!
I’d definitely buy that.
yeah, but you have to. you love me.
it’s not even 6 o’clock yet. Normally you cook but why tucker after so early, well, you seven. babe? might buy my marinara, but nobody else would. and you might buy my paintings, but not many others do. so I still have to work at the supermarket sometimes.
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tonight I’m filling in a late shift from 7:30 to 11:30, so dinner has to be a bit earlier.
that’s fine by me, honey. your food tastes good any time of day.
before I go to work, I wanted to talk to you, babe.
is it about me getting a job? about something important.
because I swear I’m trying, but it’s not easy.
no baby, that’s not it at all. I don’t care about that.
I know how hard you’ve been trying. and I know how hard it is.
it would be hard enough if you just had to get past all the racist dicks out there. it’s even harder since you’ve spent some time in prison. but that’s not your fault, andy. that’s their own stupid prejudices. I could never blame you for that.
what? no, of course not.
well if that’s not it, what is it? the drugs?
while you were in prison was a really hard time for me.
I didn’t and well, want to bother I decided I love you with it as you more than soon as you anything and I wanted came out. and always will. I missed to give you a I decided you so much. bit of time to something I had a lot of adjust. else. time to think about life and stuff and everything.
why the hell would I have a problem with that?
I enjoy my gear, too. Duh!
I want to have a baby.
but it has been a couple of months since you got out and I can’t put it off any more.
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yes! definitely yes!
you had me worried that it was going to be something bad then.
I’d love to start a family with you, my girl. we’re already a family. we’re just going to make it bigger.
no, you dill. nothing bad.
but there are still a few things we should talk about before I go to work.
like what? for a start, you told me that you contracted hep c in prison about the same time I was you in prison, thinking of having you getting hep a baby. c, people I realised discriminating I didn’t care at against you, people all, that’s when I not understanding knew that there’s about us using nothing life can gear. throw at us that we can’t make it screw them through. all. we’re stronger than all of them.
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damn right, babe.
we’re stronger than anything.
yeah, yeah, but but II don’t don’t see see why. why. II feel feel fine, fine, and and II don’t don’t like like hospitals. hospitals.
II know know you you hate hate hospitals, hospitals, andy. but there andy. but there are are other other places places you you can can go go for for treatment*. treatment*.
they’re they’re fucked, fucked, unna? unna? II hate hate ‘em. ‘em.
you you know know how how II want you want you to to go go on on treatment treatment for for hep hep c, c, though? though?
and if you’re gonna be a dad then you have to look after andyourself. if you’re gonna be a dad andyou I’llhave then still help to look after you through yourself.it, every step of andthe I’llway. still help * As well as hospitals, you can get treatment for hepatitis C you through it, from liver clinics and some specialists. every The Hepatitis Infoline step of can connect you to treatment near theyou. way.
the And the thing medications And is, if you’re onthe thething are really the is, if you’re treatment, you’re on the dangerous medications treatment, not supposed to you’re so the forare unborn really not supposed to conceive. babies. dangerous sooner you After you’ve conceive. start, the sooner for unborn finished the afteryou you’ve can have a babies. we so treatment have finished the little the version to wait up to six sooner you treatment you of you running months before you start, the sooner still have to wait around the can have kids. we can have six months before house. a little version you’re supposed of you running to to have The length of time you need waitkids. between treatment and pregnancy is around theman or different with different drugs. You need to wait 24 weeks after either the house. the woman is treated with ribavirin, or 5 weeks after treatment with daclatasvir. Talk to your doctor about treatment with sofosbuvir/ledipasvir in pregnancy.
if if you you want want more more of of me me around around the the house house then we should then we should just just hang hang up up those those nude nude paintings paintings you did of you did of the the two two of of us. us.
I’ll I’ll be be good. good. Just Just promise promise that you that you won’t won’t fork fork me. me. if if you you want want to to have have aa baby, baby, it’s it’s got got to to be be the the other other way way around. around.
don’t don’t think think I’m I’m going going to to let let you put those you put those paintings paintings up up either either way... way... watch watch it, it, buster, buster, or or you’re you’re gonna wake gonna wake up up with a fork in with a fork in your your forehead. forehead.
...or ...or change change the the subject. subject.
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what’s that? it’s like one of those ultrasounds that they do to see a baby, except they do it to your liver.
I want you to get the treatment for hep c before we can have a family.
okay, vic babe. what do I gotta do?
it gives the doctor a reading that tells them if there is any liver damage, like scarring from inflammation.
well the first thing you’re going to have to do is go for a fibroscan.
I still don’t like hospitals.
I know you don’t, honey.
but I’ll be there with you every step of the way.
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don’t get too far ahead of yourself, “dad.” there’s still a lot to do before then.
this is pretty exciting, the idea of being a dad.
yeah, I know. But we can do it. together.
oh no, Brendan. By all means, just walk right into our house.
what’s up, losers?
don’t bother knocking on the door like a normal person or anything.
how many times have I told you to stop calling me baby? I’m not your baby.
don’t be like that, baby.
I’m andrew’s baby. he’s the only one who and the gets to call only reason I was me baby. happy to see you is because you’re my dealer.
you were happy to see me when I got out of prison a couple of months before andrew did.
you were happy to see me here all the time.
I know that...
the guy I used while you were inside was even more annoying but even than you are. he knew not to call me baby.
...baby.
you know there’s nothing to worry about right? you’re the only man for me.
CONTINUED PAGE 14
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CUPID: Couples who inject drugs Researchers from the Centre for Social Research in Health spoke to straight couples who inject drugs in Sydney and Melbourne. They also spoke to harm reduction workers in these cities. They asked questions about hepatitis C, injecting drug use, and relationships. They wanted to understand how couples work out injecting and hepatitis C risk in their relationships. Here’s what we know from research about couples who inject drugs: ➲➲ Relationships between couples typically involve forms of love, trust and intimacy that differ from those found in relationships between friends. ➲➲ These features may make sharing injecting equipment more likely. ➲➲ About half of people who inject drugs interviewed for this study said they have shared injecting equipment with a sexual partner. Hepatitis C health promotion materials are usually not written with couples in mind. This means that the resources that tell people how to avoid hep C transmission don’t show how people in couples manage risk. Research also shows that couples who inject may not be respected. Their relationships may not be seen as “authentic” as other couples. People thought that they were just in love with drugs and not each other. This can affect how workers and services treat them. What did the couples say? Trust was spoken about as the most important feature of the couples’ relationships. It was also related to safety and security. Trust was important in lots of ways, including their drug use. Nearly all participants said they had rules around injecting drugs with other people. Sticking to the rules was really important to create trust in the relationship. A lot of the people in the study said that they do everything together. They said that they knew all the details of each other’s injecting practices, blood test results, and medical check-ups. This sharing of information also helped build trust and affected how couples managed hep C risk. The couples’ ideas about risk and safety changed over time. Some couples relaxed their attitudes about hep C as they grew closer. This sometimes meant that people cared less about keeping injecting equipment separate as the relationship got more serious. Other couples became more strict as they learned more about hep C or after one of them started treatment. The key finding was that decision making about hep C risk was complex. But most saw their relationship as really safe and trusting. Almost everyone said that sharing injecting equipment with their partner was a “last resort” and not something they’d do with other people.
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What did the workers say? Most workers felt that they didn’t have much experience working with couples in harm reduction. Some felt that couples had the same needs as single people. The stereotype of couples as more in love with drugs than each other also came up. Workers didn’t talk about things like love and care very often. What does this mean? The researchers said that their study challenges stereotypes of couples who inject drugs. Couples who inject drugs are often seen as “unhealthy” relationships, but these couples talked about love, care and commitment. The couples wanted to keep themselves and their partner healthy and safe. They saw their relationship as an emotional refuge and wanted to keep it safe. Couples relied on their relationship to protect them in a world that they saw as hostile and stigmatising. Recommendations To reduce hepatitis C transmission, recognise the strength in relationships between couples who inject drugs. This means including messages and strategies in hepatitis C prevention that are relevant and meaningful to couples.
The CUPID Couples Who Inject study is funded by the National Health and Medical Research Council. The chief investigators of this project are Carla Treloar, Suzanne Fraser, Joanne Bryant and Tim Rhodes. The associate investigators are Nicky Bath and Mary Ellen Harrod and the research associate is Jake Rance. https://csrh.arts.unsw.edu.au/research/projects/cupid-project/
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R m r a h e h t Ask
Dear Harm Reduction Lady,
I just found out that a friend of mine overdosed last weekend. I'm a bit shaken up because I've used drugs with this guy before. What can I do if I'm using drugs with someone and they overdose? -Bernie An overdose is what we call it when someone takes too much of a drug. This can cause a toxic state or even death. You didn't saywhat drug your friend was using. Overdoses on depressants and stimulants look different. You need to respond to them differently. An overdose on depressants (downers) like heroin, morphine, oxycodone or fentanyl can look like: ➲➲ “Dropping” into sudden unconsciousness. ➲➲ The person fading in and out of consciousness and others not being able to wake them up. ➲➲ No response when you call their name, shake their shoulders, or tell them the police are coming. ➲➲ Snoring and not staying awake. ➲➲ Not breathing or only taking a breath now and then. ➲➲ Clammy, pale face or blue skin. ➲➲ Difficulty speaking. ➲➲ Slow heart beat. ➲➲ Limp body. So what do you do if someone you are with ODs on depressants? First up: roll the person into the recovery position. They should be on their side with their head tilted back to clear their airway. Secondly: Call 000 and ask for an
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ambulance. They won’t bring the police unless the paramedics or the person making the call think there is a risk of violence. Thirdly: give mouth to mouth if you feel able to. The 000 operator can talk you through it. Tilt their head back and check their airway. Fit your mouth over theirs and pinch their nose closed. Give two short breaths, then watch their chest for breath. Repeat until they start breathing or the ambulance gets there. You might keep someone alive until the ambos get there even if you don't have training in mouth to mouth. The paramedics will use naloxone (also called NARCAN) which reverses opiate overdoses. Naloxone takes 2-5 minutes to work and lasts about 20 minutes. GREAT NEWS! Naloxone will be available over the counter from some chemists in Australia from 1 February 2016. For further information and instructions on how to use naloxone call NUAA on (02) 8354 7300 (Rural NSW callers: 1800 644 413) or visit www.nuaa. org.au It’s important to call the ambulance even if you have your own naloxone. It can help you save your mate, but they may still need to go to hospital. An overdose on stimulants like methamphetamine (ice) or cocaine is
y d a L n o i t c Redu different. It has body symptoms and mind symptoms. It can look like:
the police unless they think there will be violence.
➲➲ Racing pulse.
Roll the person into the recovery position and keep them warm.
➲➲ Heavy sweating and body chills. As the OD goes on, the person may stop sweating and get very hot. ➲➲ Extreme thirst. ➲➲ Trouble breathing. ➲➲ Nausea or vomiting. ➲➲ Chest pain and a pounding heart. ➲➲ Seizures or fits. This can look like the person being knocked out, but their body jerking around. ➲➲ Stroke. These can include headaches, loss of balance, difficulty in speaking, numbness or part of the body being paralysed.
If they black out and start jerking around, they might be having a seizure. Check out what’s around them and get rid of anything that might hurt them. Don’t try to restrain them: the seizure should only last for a little while. You don’t need to put anything in their mouth or try to stop them swallowing their tongue. When they’ve stopped, roll them into the recovery position. They might be confused when they wake up, so stay calm and let them know they're OK.
➲➲ The person losing consciousness, or falling asleep and others not being able to wake them up. ➲➲ Anxiety and fearfulness. ➲➲ Delusions (seeing or hearing things that aren’t there). ➲➲ Psychosis (losing touch with reality). If someone you are with has taken stimulants and passes out, you need to call 000 and ask for an ambulance. Again, they won’t send
*"Harm reduction" refers to all the work done by groups, workers and peers to reduce the harms of drug use to people who use drugs. This column is based on the In Case Of Overdose cards by NSW peer drug user organisation NUAA. www.nuaa.org.au stock image ©2004-2015 xiao-stock. Not the Harm Reduction Lady herself.
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PART TWO she’s only saying that because you’re here, brus.
what’s good in here?
I’m going to leave you guys to it.
there’s some chook, I think.
I have to go to work.
And maybe a bit of rissole that vic made a few days ago.
be good while I’m gone. Love you. love you too, baby. see you later.
bye baby.
man, you’re a right dick sometimes.
so how come you’re here?
I’m bored. yep. but that’s why you love me.
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wanted to get into some mischief.
man, not one minute ago Vic asked me to be good while she’s gone.
mischief? does that mean jack a car and go joyriding?
and now you’re asking me to go joyriding?
so? do you always do what your old lady says you should do?
yep.
ever since we were kids you’ve had a knack for anything with an remember engine. that old mazda aunty had? you got that running again even though it was for the wreckers.
you telling me you don’t get off on thrashing the hell out of some car?
you know I love it but that’s not the point. I gotta do right by vic. I gotta get a job. that ain’t gonna happen. ever. you think some white guy is gonna hire you straight out of prison with no qualifications?
I’m not whipped!
man, I didn’t realise vic had you so whipped.
well, if you’re not whipped, let’s go have some fun!
fine! let’s go.
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a few hours later.
hurry up, man! They’re catching up on us!
those pigs ain’t ever catchin’ me again!
oink! oink!
nah, brus. they ain’t catchin’ me.
it’s okay, man. I’ve got a spot ahead picked out for this. yeah? and how’re you gonna make that happen?
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planned ahead!
hold on tight!
man, that was hectic. we’re not too far from home. let’s dump this here and leg it.
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that was deadly. we showed those stupid cops.
and how that car, man? she ran like a BEAUTY!
I had her
fuck yeah! Those pigs had no chance.
hey. that was sick.
you’ve had some fun.
I know you’ve got to be you, babe.
...but I can’t handle you going away
I get that...
shit yeah we did!
we only got into a bit of mischief.
you here, not in prison.
but we didn’t get caught. we were fine.
let’s celebrate. you got some fits?
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sigh
those pigs had no chance of catching us.
...fine. I had a shocking night at work.
the fits are in the lounge
the fits?
yeah.
you guys are the best.
you always have new everything.
yeah, it’s important. otherwise vic might get hep c from either one of us.
so go wash your hands first.
why you make sure that we each have fit and tourniquet and swabs.
yeah, okay.
come on, guys. get a move on. yeah, I’m just drawing it up for you.
not much later...
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she’s
oD-ing!
call the ambulance while I get the Narcan!
you okay, vic?
vic honey, are you okay?
she’s not moving!
keep going, brus!
I know she isn’t! just lay her out on the floor! I’m sorry. they’re on their way.
Man, I can’t go back to prison. I can’t do that again. they’ll know she got the gear from me.
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I just can’t be here.
I have to go. ssssh, it’s okay baby. it’s okay. you’re gonna be alright. I’m here, baby.
Knock Knock
Come in.
no. neither do I.
hey guys. I came to shout Gear.
that’s why I can’t let you be a bad influence on me.
kinda to bailing on you last night.
stop you can’t pretending come around like you’ve got here causing something trouble any and go with mine. more. find your own girl.
I just don’t want to go back to prison.
yeah, I’m jealous of what you guys have. I want relationship of my own
I’m just jealous.
sigh
jealous?
okay, you
but you
welcome here.
causing problems.
you’ve got, andrew, with vic helping you with your health and
I don’t know anything about myself with my hep c. and I want I don’t have that anyone to help me.
if you’re serious about it, you can spend more time with us you.
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I can answer this one. vic was telling me about it.
yes, really.
well, what do I have to do? to look after my hep c, I mean.
we need to get a fibroscan.
it’s like an ultrasound, the thing they use to look at babies. instead of a picture, it gives a reading to your doctor about how much liver damage you have. that’s the first step we need to take to treat our hep c.
if you promise to cool it, then we’ll look after you like we look after each other.
if you want, we can go together.
you guys would do that for me?
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in their home and in their lives.
and so, brendan joined andrew and victoria.
and some of the big ones.
joined them in all the little moments.
they helped him look after himself.
even in the most boring ways.
more than just friends...
in short they became his support network.
...family.
THE END
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picture b
picture a spot 9 differences between pictures a&b
1) Wall colour changed 2) Andrew’s shirt is different colour 3) Eyes on the Owl clock are looking in a different direction 4) Owl clock shows different time 5) Pasta sauce on stove has changed colour 6) Vic’s nose-stud has disappeared 7) Vic’s arm tattoo is missing 8) Vic’s hair highlight is a different colour 9) The fridge is missing some notes
the difference
crossword N S B P P B X V Q I S N C T Y
O I R L V S T S E W O L R F G
I T A N I C C A V T S C K S T C E J N I R B I O N Z E F I S W A P C T N Z F R I Y N N D O L I S O O O R D S I A L E T E I O I L M O T L B A A N N N D I I N B I C R P T G I S R E N S I G X E U O S E M X I E S T R H E I V T V I R U S S N S W I A R C P W Y M G T A I E K Z G G E E Q U R H N E V W V U A S F R E O E I B R O S C A N D M X L L K D P W S Y C W Z X A
W T K N P G F T U L E K W L E
ANTIBODIES BLOOD CLEAR CLINIC CONSENT DRUGS FIBROSCAN HEPATITIS INFOLINE INJECT LIVER NSP PCR SYRINGE TEST TRANSMISSION TREATMENT VACCINATION VIRUS
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EDUCATION AND TRAINING SESSIONS We design workshops and education sessions for people who work with communities affected by hep C and hep B. We can come to you or you can come to us. We can tailor our workshops to suit your needs, and we include a C'een & Heard speaker who has lived experience of hep C. For more information about our education and training services, please email education@hep.org.au If you or your community want to be part ofTransmission Magazine, please email transmission@hep.org.au. We can put together a training package for your organisation and help produce a story that could become a future edition of the magazine.
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A
Having hep C will generally not affect your pregnancy and being pregnant will generally not affect your hep C. Really importantly, it’s good to know that the overwhelming majority of mums with hep C do not transmit hep C to their babies. The risk of transmission from mother to baby is small, around 5%. Being on hep C treatment and being pregnant have to be avoided due to risks of birth defects. This might be an issue if your girlfriend is thinking about the new treatments. Women are encouraged to breastfeed their baby whether they have hep C or not, but when nipples are cracked/bleeding, because hep C is spread by blood, your girlfriend should stop nursing temporarily. Instead, she can express and discard her breastmilk until her nipples are healed.
Your girlfriend doesn’t have to tell her doctors and nurses about her hep C. But if she does tell them, they can possibly avoid using forceps or other invasive procedures during birth - which might cause bleeding and risk of transmission from mother to baby.
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SPECIAL THANKS . . . to the COUPLES who participated in the CUPID study
EDITOR/DESIGNER Heather McCormack EDITORIAL COMMITTEE Tim Baxter Jenny Douglas Paul Harvey Sonam Paljor Lucy Pepolim Kate Pinnock Rebecca Miers Rhea Shortus Megan Stapleton Robert Wisniewski COMIC WRITER Lawrence Gergich
The Couples Who Inject Drugs (CUPID) project was funded by the NHMRC and began in 2012. The aim of the study was to examine, in detail, the experiences of injecting among heterosexual couples.
COMIC ARTIST Daryl Toh www.gestaltcomics.com
In conducting this project, researchers from UNSW’s Centre in Social Research in Health undertook in-depth interviews with heterosexual couples in Sydney and Melbourne. They also interviewed front-line health workers (recruited from harm reduction services) in both cities.
ASIDE FROM HEPATITIS NSW EDITORIAL CONTENT, VIEWS EXPRESSED IN THIS MAGAZINE OR FLYERS ENCLOSED WITH IT ARE NOT NECESSARILY THOSE OF HEPATITIS NSW. NEITHER ARE SUCH VIEWS NECESSARILY THOSE OF OUR FUNDING BODIES. TRANSMISSION MAGAZINE DOES NOT PROMOTE OR CONDONE THE USE OF ILLICIT DRUGS. RATHER, IT SEEKS TO PROVIDE ACCURATE INFORMATION THAT WILL HELP PEOPLE WHO ALREADY USE DRUGS TO REDUCE RISKS AND MAKE SAFER CHOICES. NOTHING IN THIS MAGAZINE SHOULD BE TAKEN AS RECOMMENDING DRUG USE.
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