edition
23
May 2016
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PART ONE
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3
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CONTINUED PAGE 14
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HEP C TESTING
TESTING information
TO TEST FOR HEP C, START BY MAKING AN APPOINTMENT WITH YOUR DOCTOR, NURSE OR CLINIC.
ANTIBODY POSITIVE MEANS YOU HAVE BEEN EXPOSED TO HEP C AT SOME TIME IN YOUR ANTIBODY LIFE
ANTIBODY TEST
A
THIS BLOOD TEST WILL SHOW IF YOU HAVE EVER BEEN EXPOSED (HAD THE HEP C VIRUS IN YOUR BLOOD)
IF YOU ARE EXPOSED TO HEP C, FOR A 6 MONTH PERIOD, YOUR BODY WILL TRY TO CLEAR THE VIRUS.
PCR POSITIVE MEANS THAT THE HEP C VIRUS IS PRESENT IN YOUR BLOOD AND YOU HAVE HEP C
1 IN 4 PEOPLE WILL CLEAR HEP C WITHIN 6 MONTHS
NO MORE TESTS NEEDED
PCR TEST
THE PCR TEST SHOWS WHETHER THE VIRUS IS PRESENT IN YOUR BLOOD OR NOT
PCR
PCR
YOUR DOCTOR, NURSE OR CLINIC WILL DO A PRE-TREATMENT ASSESSMENT TO HELP THEM WORK OUT THE BEST TREATMENT FOR YOU. THEY COULD INCLUDE ANY OF THE TESTS BELOW.
PCR GENOTYPE TEST
*
A
ANTIBODY
LIVER FUNCTION TEST
*
FIBROSCAN
*
PCR VIRAL LOAD
*
PCR NEGATIVE MEANS YOU HAVE CLEARED THE VIRUS AND THAT YOU DO NOT HAVE HEP C
NO MORE TESTS NEEDED
FIBROSIS MARKER
WANT TO KNOW MORE? Call our Hepatitis Infoline 1800 803 990 8or look up our website www.hep.org.au 8
ANTIBODY NEGATIVE MEANS YOU HAVE NEVER HAD HEP C
*
PLEASE TURN OVER *FOR MORE DETAILS OF THE TESTS
HEP C TESTING
TESTING FLOWCHART
BELOW IS AN OUTLINE OF SOME OF THE TESTS YOU MAY NEED BEFORE GOING ON TREATMENT
PCR GENOTYPE TEST
A BLOOD TEST THAT CHECKS WHICH TYPE OF HEP C VIRUS YOU MIGHT HAVE. THIS WILL DETERMINE WHICH COMBINATION OF TREATMENT WILL BE PRESCRIBED FOR YOU. THE DIFFERENT TYPES OF HEP C VIRUS ARE GENOTYPES 1- 6.
LIVER FUNCTION TEST
FIBROSCAN
THIS IS A BLOOD TEST THAT MEASURES HOW YOUR LIVER IS WORKING. IT CAN BE HELPFUL IN LETTING YOUR DOCTOR, NURSE OR CLINIC KNOW MORE ABOUT HOW WELL YOUR LIVER IS WORKING BY MEASURING CERTAIN LEVELS IN YOUR BLOOD.
THIS IS A SIMPLE, QUICK, PAIN-FREE WAY FOR A NURSE TO CHECK FOR ANY LIVER DAMAGE. IT IS LIKE AN ULTRASOUND AND DOESN’T HURT. IT WILL SHOW UP ANY FIBROSIS AND CIRRHOSIS. (IF A FIBROSCAN IS NOT AVAILABLE AN ULTRASOUND MIGHT BE USED INSTEAD.) THIS BLOOD TEST MEASURES THE AMOUNT OF HEP C VIRUS IN YOUR BLOOD.
PCR VIRAL LOAD
FIBROSIS MARKER
OTHER MEDICAL HISTORY
THIS TEST MAY BE USED DURING YOUR TREATMENT TO SEE IF THE TREATMENT IS WORKING. YOU WILL GET THIS TEST AGAIN 12 WEEKS (MINIMUM) AFTER FINISHING TREATMENT TO CHECK IF YOUR TREATMENT IS SUCCESSFUL. YOU MIGHT ALSO GET YOUR VIRAL LOAD CHECKED BEFORE STARTING TREATMENT. NEW WAYS TO CHECK FOR LIVER FIBROSIS ARE AVAILABLE. THE APRI METHOD USES BLOOD TESTS (LIVER FUNCTION TEST/ FULL BLOOD COUNT). IT IS A USEFUL TOOL TO DETERMINE LIVER FIBROSIS WHEN A FIBROSCAN MACHINE IS NOT AVAILABLE. IT’S REALLY IMPORTANT TO TELL YOUR DOCTOR, NURSE OR CLINIC IF YOU HAVE BEEN ON TREATMENT FOR HEP C BEFORE. YOUR DOCTOR, NURSE OR CLINIC WILL ALSO LOOK AT YOUR MEDICAL HISTORY AND ANY OTHER MEDICATIONS YOU MIGHT BE TAKING TO WORK OUT THE BEST POSSIBLE TREATMENT FOR YOU. THEY WILL ALSO DISCUSS WITH YOU ANY OTHER FACTORS THAT MIGHT MAKE YOUR HEPATITIS C WORSE, LIKE HIGH ALCOHOL INTAKE, OBESITY OR DIABETES.
ONCE YOU HAVE BEEN CURED THROUGH TREATMENT, THERE IS NO NEED TO HAVE ANOTHER ANTIBODY TEST EVER AGAIN. THIS IS BECAUSE EVEN AFTER CURE, THE HEP C ANTIBODY TEST RESULT WILL SHOW POSITIVE, PROBABLY FOR AS LONG AS YOU LIVE. THE ANTIBODY TEST DOES NOT MEAN YOU HAVE HEP C. IT IS THE PCR TEST WHICH SHOWS WHETHER YOU HAVE HEP C OR NOT. AND AFTER CURE FROM TREATMENTS, YOUR HEP C WILL NOT COME BACK, UNLESS YOU GET RE-INFECTED BY A NEW EXPOSURE TO HEP C THROUGH BLOOD-TO-BLOOD CONTACT WITH SOMEONE ELSE WITH HEP C.
WANT TO KNOW MORE? Call our Hepatitis Infoline 1800 803 990 or look up our website www.hep.org.au
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R m r a h e h t Ask Dear Harm Reduction Lady, I inject drugs regularly but I’m not quite sure I’m doing everything safely. I know to use new, sterile gear and I don’t share. But what about water? Can you tell me what kind of water is the best for me to use? - Samantha A lot of people aren’t sure which water is safe to use for injecting drugs. It can be hard to keep everything sterile. You have to think about the quality of the water and you also have to think about the water container and where you’re mixing up. Here's your options, ranked from the best choice to the most risky. No risk: unopened ampoule (plastic vial, see picture) of sterile water for injections or water that has been boiled in a kettle and then cooled. You can get small ampoules or vials of sterile water at some NSPs and chemists. These are the only source of water made
specifically for injecting into veins. They’re the ‘gold standard’ for safe injecting. Ampoules that are freshly opened are the only water that you know for sure is sterile and free from viruses and bacteria. If you can't get sterile ampoules, boil water in a kettle. Boiling water for a few minutes will kill almost all viruses and bacteria. This is the best option if you don’t have a sterile ampoule. Let the water cool slowly to a safe temperature before injecting. Low risk: cold water freshly run from the kitchen tap or hot water from a tap. Water from the tap is low risk for injecting if you live in a town with treated water. The water will be less safe if you have tank water or if the pipes around your house are rusty. If you can’t boil your tap water, then run the tap for a little while before you use it. The cold tap is a safer option than the hot tap because bacteria can grow in the hot water tank. It’s better to use water straight from the cold tap than water of any kind that has been sitting around opened.
You can get sterile ampoules of water from some NSPs and chemists
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y d a L n o i t c Redu Medium to high risk: bottled water or toilet water. It might surprise you to know that bottled water is higher risk than tap water. It’s sterile enough to drink, but not sterile enough for veins. Water that stands for a long time without moving also grows bacteria. That’s why it’s best to use flowing tap water than water that’s been standing for a long time. Injecting with water from the toilet should be avoided where at all possible. High risk: ampoules of water that have already been used, puddle water, or a cup of water that more than one person is drawing up out of.
Shared used ampoules and shared cups of water are the riskiest water sources. It’s very easy to contract hepatitis B or C if the water is contaminated with blood. Remember that you can’t know another person’s hepatitis B or C status for sure. To stay safe, avoid sharing any injecting equipment or water with anyone. To sum up: there are lots of different water options, but sterile ampoules from an NSP or chemist are the safest option. You can find your nearest NSP on this map on the Hepatitis NSW website https://www.hep.org.au/nsp-map/
Puddle water can be full of very nasty bacteria and fungus. If you can only access water found on the street, try to catch rain water instead.
*"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 resources by harm reduction social enterprise Exchange Supplies and NSW peer drug user organisation NUAA. www.exchangesupplies.org www.nuaa.org.au stock image ©2004-2015 xiao-stock. Not the Harm Reduction Lady herself.
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This resource on FINCOL designed by community artist Mathew Johnson.
fincol poster
THE NEW HEP C TREATMENTS TALK TO YOUR DOCTOR, NURSE OR CLINIC ABOUT GETTING READY FOR TREATMENT SINGLE PILLS MADE UP OF SOFOSBUVIR AND LEDIPASVIR
SOFOSBUVIR PILLS AND RIBAVIRIN PILLS
SOFOSBUVIR PILLS AND DACLATASVIR PILLS
PARITAPREVIR/RITONAVIR/ OMBITASVIR PILLS AND DASABUVIR PILLS
VIEKIRA PAK
=
=
HARVONI
SOVALDI & IBAVYR
SOVALDI & DAKLINZA
FOR GENOTYPE
FOR GENOTYPE
FOR GENOTYPES
2
1&3
95%
95%
95%
1
OF PEOPLE CURED
=
SOMETIMES WITH RIBAVIRIN
OF PEOPLE CURED
8, 12 OR 24 WEEKS*
12
WEEKS*
=
FOR GENOTYPE
1
95%
OF PEOPLE CURED
OF PEOPLE CURED
12 OR 24
12 OR 24
WEEKS*
WEEKS*
WHO ARE THEY FOR? ADULTS WHO HAVE HEP C GENOTYPES 1, 2 OR 3 AND A MEDICARE CARD MOST PEOPLE HAVE NO OR VERY MILD SIDE-EFFECTS
*
FOR MOST PEOPLE, TREATMENT IS USUALLY TAKEN FOR 12 WEEKS
PEOPLE WITH GENOTYPES 4 - 6 ARE TREATED WITH SOFOSBUVIR TAKEN WITH PEGYLATED INTERFERON AND RIBAVIRIN TREATMENT. THEY HAVE MORE THAN A 90% CHANCE OF CURE.
WANT TO KNOW MORE? Call our Hepatitis Infoline 1800 803 990 or look up our website www.hep.org.au
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PART TWO
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THE END
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picture b
picture a spot 9 differences between pictures a&b
1)Background colour changed 2)Woman on the left has changed hair and shirt 3) Guy on the left now wears shorts 4) Frank’s glasses changed colour 5) Frank now holds a bottle 6) Woman the right of Frank has different hair colour 7) Guy to the right of Mark now has short hair 8) Woman to the right of Mark has let down her hair 9) Woman in the right corner has changed dress colour 10) Man on right now holds a green can 11) Woman at the right side now has blue hair
the difference
crossword
ACROSS: 3. In Australia, hepatitis C is most often spread by _____ injecting equipment. 4. If you have long term hepatitis B or C, this is known as a ______ infection. 5. Having hepatitis B or C for a long time can damage your _____. 6. _______ means 'inflammation of the liver'. 8. Hepatitis B and C are viruses that live in your ______. DOWN 1. Getting a ___________ will give you immunity against hepatitis B. 2. You can use _____ to safely clean up blood in prison. 7. Getting a ______ that is not done in a professional tattoo shop can transmit hepatitis B and C.
ANSWERS 1) vaccination 2) FINCOL 3) sharing 4) chronic 5) liver 6) hepatitis 7) tattoo 8) blood
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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 info@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.
HEP REVIEW MAGAZINE Do you want to read more about looking after your liver and living well with viral hepatitis? Hep Review contains stories from people living with viral hepatitis, articles on living well with hep B and C and reports on news and research covering treatment, nutrition, and the personal side of hepatitis. To sign up for Hep Review, email hepreview@hep.org.au.
SPEAKERS WANTED Do you have lived experience of hepatitis B or hepatitis C? Your story is powerful. You could become a positive speaker with our C'een & Heard service. Your personal account of living with viral hepatitis could educate people attending our workshops. Our paid speakers play a valuable role in challenging myths and stereotypes about viral hepatitis. Contact info@hep.org.au or call the Hepatitis Infoline on 1800 803 990 for more.
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Have you seen our new, mobile-friendly Hepatitis NSW website? Check it out at www.hep.org.au It's full of information about hep C and hep B. Find out how to look after yourself and protect yourself and others.
Scan me with your smartphone to visit our site.
Love transmission magazine?
You can have Transmission Magazine delivered to you. Sign up as a Hepatitis NSW member for free at www.hep.org.au or call 1800 803 990.
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n o i t s e u q r e w s n a &
with the
Q A
HEPATITIS INFO, SUPPORT, REFERRAL
I am in prison, waiting to be released next month. I have been told that I have hep C. What should I do when I am out? I would like to get rid of the virus! The nurse in prison said that hep C can be treated, is this true? It is true - hepatitis C can be successfully treated. New treatments can get rid of the virus in up to 95 out of 100 people. Once you are released and you want to have hepatitis C treatment, your first step is to see a doctor and ask to be tested for hepatitis C. Make sure you take your Medicare card with you, if you have one. Your medical team in prison may be able to give you your previous test results. The first test that is ordered is called an ‘antibody test’. If this comes back as ‘positive’ or ‘detected' you will need to have a second test called a PCR test. If this is also positive, this means you have chronic hepatitis C. You will need another blood test to find out which genotype (strain) of hep C you have. You’ll also need a simple, fast and pain-free procedure called a Fibroscan to find out the extent of damage to your liver. Your doctor will decide whether to prescribe treatment or whether to refer you to a liver specialist based on these tests.
Most people will only need tablets (no injections) for between 8 and 24 weeks. Most people don’t have many side effects on these treatments. It’s important to take all the medicine as directed, so talk to your doctor about lifestyle factors that may stop you doing this. Call the Hepatitis Infoline if you have more questions or need support.
send your questions to us ON
sms: 0404 440 103 ph: 1800 803 990 e: info@hep.org.au
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dial 3 on the Common Calls list (free!)
IF YOU HAVE A QUESTION CALL
HEPATITIS INFO, SUPPORT, REFERRAL
HEPATITIS INFOLINE
1800 803 990 INFO, SUPPORT, REFERRALS
Call 131450 to organise an interpreter service You also can now chat to us live at hep.org.au
the survey HOW TO GO IN THE DRAW TO WIN $50 go to
E FILL OUTNTDHYOU SURVEYDAWIN A COUL UCHER $50 VO
IT'S EASY!
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AND FILL OUT THE SURVEY ONLINE BY 1 SEPTEMBER 2016
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1 FILL OUT THE SURVEY ON THE BACK OF THIS PAGE 2 CUT THIS PAGE OUT OF THE MAGAZINE 3 FOLD IN HALF ALONG THE BLACK DOTTED LINE BELOW, SO THAT THE ADDRESS IS ON THE OUTSIDE 4 STICK THE 2 SIDES CLOSED WITH STICKY TAPE OR STAPLES (ALONG THE YELLOW EDGES ABOVE AND BELOW) 5 PUT IT IN THE POST TO US BY 1 SEPTEMBER 2016 (NO NEED TO BUY A STAMP, IT'S FREE TO SEND)
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the survey 2.After reading thisTransmission Magazine, I know more about keeping healthy with hep C
3. I think this Transmission Magazine is useful to me 4. Since reading this Transmission Magazine,
Strongly agree
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Strongly disagree
(tick all that apply) I have called the Hepatitis Infoline I have looked up the Hepatitis NSW website at www.hep.org.au
5. How do you think we could make this magazine better?
I have talked to someone else about my hep C I have made an appointment with my doctor or liver clinic I have made changes to my lifestyle I know how hep C is passed on I have made no changes
QUESTIONS ABOUT YOU 6. How old are you? 7. Are you:
male
11. Please describe yourself: (tick as many as you like) Person with hep C Person cured of hep C
female
trans/inter
8. What is your current postcode (or prison name)?
Partner/relative/friend of person with hep C Person with hep B Current prisoner Ex-prisoner
9. Do you speak a language other than English with your family?
GP or Health Care Worker Community or youth worker
No, only English
Person who currently injects drugs
Yes, the other language I speak is:
Person who used to inject drugs Worker in NSP sector
10. Are you Aboriginal and/or Torres Strait Islander? Yes
No
Worker in AOD or OST sectors Other (please say)
12. If you would like to go in the $50 voucher draw, please give us your name and phone number, email address or prison MIN (optional). This prize offer is for NSW residents only - one draw per person. Phone number: Name: or email address or MIN : 13.Would you like to be sent up-to-date hepatitis news and information? Write your email address here:
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Email address:
Hepatitis NSW respects and upholds your right to privacy protection. In accordance with National Privacy Principles, we have a detailed policy and set of procedures regulating how we collect, use, disclose and hold your personal information. For a copy of the policy, please contact us on 02 9332 1853 or visit our website: www.hep.org.au
IT'S EASY!
QUESTIONS ABOUT THIS MAGAZINE 1. After reading this Transmission Magazine, I feel I know more about hep C
UT FILL THISYOOU AND IN A COULD W ER $50 VOUCH
SPECIAL THANKS . . . to the education team at south coast correctional centre
The Multimedia projects run by the Education Unit at South Coast Correctional Centre provide inmates in maximum and minimum security with opportunities to gain knowledge on a number of health issues. The Education Unit integrates this training with vital literacy, numeracy, computer and communications outcomes that enhance education and employability skills.
EDITOR/DESIGNER Heather McCormack EDITORIAL COMMITTEE Tim Baxter Jenny Douglas Paul Harvey Alastair Lawrie Sonam Paljor Lucy Pepolim Kate Pinnock Rebecca Miers Rhea Shortus Megan Stapleton Robert Wisniewski COMIC WRITER Lawrence Gergich COMIC ARTIST Skye Ogden www.gestaltcomics.com
Hepatitis NSW would like to thank the students for their creativity and enthusiasm in developing this edition of Transmission Magazine.
ASIDE FROM HEPATITIS NSW EDITORIAL CONTENT, VIEWS EXPRESSED IN THIS MAGAZINE OR FLYERS ENCLOSED WITH IT ARE NOT NECESSARILY THOSE OF HEPATITIS NSW OR THE ORGANISATIONS WITH WHOM WE COLLABORATE. 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.
If you are a youth or health worker and would like to know more about how your clients can contribute to the development of Transmission Magazine call the Hepatitis Infoline on1800 803 990 or email transmission@hep.org.au
Hepatitis Infoline 1800 803 990 (freecall) Hepatitis NSW p: 02 9332 1853 f: 02 9332 1730 PO Box 432 Darlinghurst, NSW 1300 info@hep.org.au Level 4, 414 Elizabeth Street Surry Hills Sydney 2010 www.hep.org.au Hepatitis NSW is proud to acknowledge Aboriginal people as the traditional owners and custodians of our lands and waters. ABN 30 408 095 245 A non-profit health promotion charity funded by the NSW Ministry of Health. Accredited by the Quality Improvement Council of Australia (QIC). Donations of $2 and over are tax deductible.
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http://www.hep.org.au
PH: 1800 803 990 Transmission@hep.org.au www.facebook.com/hepNSW @HepatitisNSW