The CFiles (June 2012)

the

cfiles WA’s Hepatitis Newsletter

THE CFILES IS GETTING A MAKE-OVER

Issue 127 │ June 2012

NEW ANTIVIRAL TREATMENTS

AIM TO ERADICATE HEP C

SEND US SUGGESTIONS & HELP US CHOOSE A NEW NAME

HEPATITIS AWARENESS WEEK

HEPATITIS C SCREENING

23RD-28TH JULY

AUSTRALIA’S HEALTH 2012

THE IMPORTANCE OF PRE-TEST DISCUSSION

A REPORT ON OUR HEALTH STATUS

PRESIDENT OF THE PROFESSIONAL rought by B you to TATTOOing ASSOCIATION HEPATITIS AWARENESS WEEK

WANT TO KNOW MORE ABOUT VIRAL HEPATITIS?

Call us for information, resources, and support. If you (08) 9328 8538 │ info@hepatitiswa.com.au │ www.hepatitiswa.com.au have a question about hepatitis, we’ve got the answer!

The C Files

October 2011

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The CFiles is the official newsletter of

A community-based non-profit organisation.

Editor: Felicia Bradley

Board of Management: Dr Susan Carruthers (Chair) Mr Damien Roper (Vice Chair) Mrs Maria Kroon (Treasurer) Mr Frank Farmer (ex officio) Dr Judith Pugh (Secretary) Ms Tania Lamond Ms Ursula Swan Mr Sam Hastings

Postal Address PO Box 8435 Perth Business Centre Northbridge, WA 6849

Information & Support Line Mon-Fri 9am-5pm (08) 9328 8538 Metro 1800 800 070 Country

Office

Note from the Editor

W

elcome to the June edition of the CFiles! If you’ve been waiting for this, we would like to take the time to apologise that there hasn’t been an issue since December 2011, as the lovely Riana Young has moved on and left HepatitisWA... this is where I would like to introduce myself; Felicia Bradley, as the new editor of the CFiles! I’m excited to be on board. I’ve hit the ground running and am pumping out this issue as the last in it’s name.

Help us find a new name, and put forth any suggestions for future issues, which will have a new look and flavour! Please email me at eto@hepatitiswa.com.au. In this issue, our feature is on tattooing, professional vs. backyard - I sit down with the President of the PTAA (Professional Tattooing Association of Australia) Gary Welsh as he gives me the 411 on tattooing.

The staff at HepatitisWA has been extremely busy this past month, planning for Hepatitis Awareness Week (23rd - 28th of July 2012) and World Hepatitis Day (28th July). Checkout page 10 for a list of events going on every day of that week.

If you’re living with viral hepatitis, managing your lifestyle is imperative towards helping your liver. In this issue, I’ve included an article on new antiviral treatments, and a healthy (plus tasty) Love Your Liver recipe!

About the Cover The cover is a capture of Gary Welsh, President of the PTAA. The photo was taken at his tattoo shop, “The Celtic Circle Tattoo Company” in Kalamunda. Photo taken with permission by Felicia Bradley.

187 Beaufort St Northbridge, WA 6003 Telephone: (08) 9227 9800 Fax: (08) 9227 6545 www.hepatitiswa.com.au

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The Needle and the Damage Done - Ella’s story

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Hepatitis C Screening

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Body Armour Coming To Perth Soon (Promotions)

Proof Reading

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A Personal Perspective

Frank Farmer

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HepatitisWA is Celebrating 20 Years (Promotions)

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Australia’s Health 2012 - Hepatitis B & C Rates Declining

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Think Before You Ink (We Speak With The President) FEATURE

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Hepatitis Awareness Week & World Hepatitis Day (Promotions)

Annual Membership Renewal form is included in this issue.

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New Antiviral Treatments Aim To Eradicate Hep C

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Love Your Liver Smoked Salmon Delights Recipe

Please fill it out and send it with payment to:

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HepatitisWA Annual Membership Renewal Form

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The CFiles is Getting A New Name (Promotions)

Contents

12-13 WASUA’s Dedicated Domain - WASUA Services

HepatitisWA PO Box 8435, Perth Business Centre, Northbridge, WA 6849

Opinions published in the CFiles are not necessarily those of the editor or of HepatitisWA (Inc). Information in this newsletter is not intended to take the place of medical advice from your GP or specialist. You should always get appropriate medical advice on your particular needs or circumstances.

MY STORY

The Needle and the Damage Done - Ella’s story

My brother contracted hepatitis C when he was 17. I was only 14 at the time and had no understanding of the virus. I don’t think he realized the impact it would make either.

At the time he was using heroin. I think he thought that I didn’t know about that and he swore he had got Hep C from a tattoo shop, but I know this is very unlikely. I assume that he contracted the disease from sharing needles. Such a simple act can lead to such terrible consequences.

I believe that the Hep C increased his depression. The physical and mental are connected after all. I think it was just another negative factor in his life that he was forced to contend with, another barrier to feeling a part of the community, feeling connectedness with his fellow man, feeling youthful and healthy and alive.

My brother went missing eight years ago and has never returned. I don’t blame Hep C for this but, as I said, it’s another obstacle to a The first sign was his eyes. He had the most balanced and healthy life. beautiful blue and sparkling eyes, like the I feel that people need good education and ocean on a cloudless day. His eyes began to support put in place when they are diagnosed yellow over time and became tired and worn to have chronic hepatitis C. It takes therapeutic out looking. and practical treatment to empower people My brother enjoyed a drink both before to change their lifestyle and be supported and after he was diagnosed. But he couldn’t emotionally and psychologically. People with recover from the hangover like he once did. hepatitis C need to know they are not alone, He would become very, very sick after a night that there is a good chance of achieving of drinking and some months later he realized balance and good health if you conduct he would no longer be able to partake in such yourself well and with foresight. You need behaviour, even though everyone around him to have hope. Sadly, I suppose that was one thing that my brother lost a long time ago. who were the same age was still able to.

- Anonymous

“He had the most beautiful blue and sparkling eyes, like the ocean on a cloudless day. His eyes began to yellow over time and became tired and worn out looking.”

Article re-printed with permission. Available at www.hepcvic.org.au (12 June 2012) http://tinyurl.com/ellas-story.

Image available under a creative commons license at www.sxc.hu. Photography by Nadjib Aktouf © 2006.

The photography used for this article is for illustrative purposes only and any person depicted therein is a model.

CF June 2012

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FEATURE

Hepatitis C Screening Recently, there has been a call for fathersto-be to be screened for hepatitis at the same time as their pregnant partners in a bid to improve rates of testing and diagnosis. This should lead to an increase in the number of those undertaking hepatitis C and/or hepatitis B treatment and a concomitant reduction in the rates of cirrhosis and liver cancer in the future.

The Centenary Institute Liver Research Centre advises that hepatitis B and C are among the most common conditions leading to cirrhosis which, in itself, results in about 3000 deaths annually. Untreated liver disease can lead to needing a transplant; which is a problem in Australia with a chronic organ shortage and less than 220 liver transplants performed each year.

Early diagnosis of hepatitis B and hepatitis C has many benefits. It allows for regular monitoring and assessment to be done. It allows for lifestyle changes to be made where necessary. It reduces the likelihood of ongoing transmission of either of these viruses. It reduces the overall health burden of liver disease on the individual, their partners and families, and the community as a whole. In the case of hepatitis C, it allows for treatment to be undertaken before extensive fibrosis occurs thus improving the likelihood of successful treatment. In the case of hepatitis B, it allows for treatment to be commenced at the appropriate time dramatically reducing the likelihood of cirrhosis and/or cancer at a later date.

The National Hepatitis C Testing Policy 2012 was also released recently and is available for download on the ASHM (Australian Society for HIV Medicine) website (see below). This document has a section on Informed Consent which states, in part: “Informed consent for testing means that the person being tested agrees to be tested on the basis of understanding the testing procedures, the reasons for testing and is able to assess the personal implications. Informed consent is required for HCV testing, except for rare occasions when a legal order is made for compulsory testing or in emergency settings. On these rare occasions where informed consent cannot be attained, pre-test provision of all appropriate information to the person should still

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take place. The person performing the test should use their clinical judgment in securing informed consent. This should be based on their understanding of the context in which the test is being performed, taking into account: • the factors which indicate a need for testing such as clinical presentation, risk exposure, prevalence and individual initiation; and • an assessment of the understanding of the HCV testing process and the consequences of the result to the person being tested “ 2012 NATIONAL HEPATITIS C TESTING POLICY (2012, p.13).

The word “should” is emphasised by the authors, not by me. I would probably have capitalised and italicised it, along with any other ‘ised’ I could think of. I have, however, italicised a couple of points. Why? Because experience shows us that the way in which a person is diagnosed plays a large part in how they manage their condition in the future, even down to when, or if, they undertake treatment. This document also lists eight basic guiding principles for hepatitis C testing. One of which is that testing be “of benefit to the person being tested”.

Regarding the subject of testing fathers-to-be and antenatal screening for pregnant women, HepatitisWA is not opposed to these, but we are opposed to testing people without their Informed Consent. And proper Informed Consent cannot be obtained without pretest discussion taking place. We believe that testing and diagnosis is, in most cases, of benefit to the person concerned. And it is certainly of benefit to the community as a whole. But for the individual, it is so much more than a statistic for the epidemiologists. It is more than a prevention of future transmission. It is an impact on their life, on the way they think about themselves, on future decisions and plans. The importance of pre-test discussion and informed consent cannot be underestimated. So to all the doctors, nurses and other medical personnel out there – take a couple of minutes to talk to the people you are testing. And make sure they understand what it might mean for them to receive a positive diagnosis. Just remember, a positive diagnosis can be difficult enough to deal with.

A positive diagnosis of something you didn’t know you were being tested for is even more difficult.

Written by Lyn Tolliday, Information & Support Officer - HepatitisWA

References: Silmalis, L, 2012. ‘Medics want to screen fathers-to-be for hepatitis C to prevent liver disease epidemic’, The Sunday Telegraph, 24 June 2012 http://tinyurl.com/fathers-to-be-hep-c-screen.

NATIONAL HEPATITIS C TESTING POLICY, 2012, National HCV Testing Policy Expert Reference Committee, 24 June 2012 http://testingportal.ashm.org.au.

Image available under a creative commons license at www.sxc.hu. Photography by Jason Nelson © 2007.

FOR MORE INFO, CONTACT MAX E: pp@hepatitiswa.com.au

P: (09) 9227 9802

Meet Dannii, Harley and Rose. Three teenagers. Three individuals. Three modern-day warriors on a quest for identity; fuelled with attitude and armed with ink and steel.

When their paths cross unexpectedly, they realise that they might have found more than they were looking for. And that sometimes, the best way to look forward is by looking back…

Body Armour is the next installment from the team behind the multi award-winning Chopped Liver (which has been seen by almost ten thousand people in over 150 communities, schools and prisons across Australia).

Fresh, sassy and razor-sharp, Body Armour has been specifically designed for high school audiences, to raise awareness of hepatitis C in the Indigenous community and beyond.

The story follows the journey of three teenagers as they experiment with at-risk activities such as piercing, tattooing and blood sharing. Timely comparisons to ancient body modification rituals gently remind us of the importance of history and culture in the search for identity and the need to belong.

Vibrant, funny and non-judgemental, the show’s power lies in its ability to open minds, discussions and possibilities. www.ilbijerri.com.au

Information and image taken from Ilbijerri’s “Body Armour” Media kit.

MY STORY

a personal perspective March 2011 I received a panic phone call from my doctor “You have Hepatitis C!” he said. He did further blood tests, gave me a poorly photocopied one-page information sheet, then told me to eat organic foods as much as possible and avoid processed food as he shoved me out the door.

As most of you will know, being diagnosed HCV positive is a devastating and often unexpected piece of news that most GPs are just not equipped to deal with. Then Google “Hepatitis C” and nothing you will find is good, so many of us find ourselves alone and afraid.

Fortunately during my web browsing I found HepatitisWA. The website said they had counselling services, so tearfully I rang the number and was lucky that Lyn had time to talk with me over the phone there and then.

She explained the disease, sent me information and generally was available anytime I needed help from then on.

Being able to talk things over with Lyn, and knowing that HepatitisWA was there with help and resources helped me enormously. Despite strong support from my family, I felt alone and a fraud since I was advised to keep my HCV positive status a secret. I had no one else I could really talk with.

This year HepatitisWA will be celebrating its 20th anniversary. Over that time the organisation has grown from a small group of people who recognised the need to provide support for people with viral hepatitis, to a large professional, and well resourced organisation.

The organisation has changed its name, and at times broadened its charter, but at its core, the aim has been to help people trying to cope and live with the disease.

- MCD HepatitisWA is planning to compile a publication that documents the development of the organisation over the last 20 years, including stories from people who have been involved with the organization, from volunteers to clients. If you have a story that you would like to share about how HepatitisWA has helped you, we would like to hear from you. Please contact Viv at HepatitisWA on vivb@hepatitiswa.com.au or (08) 9227 9802.

Deadline for write-ups is July 31st 2012.

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Image available under a creative commons license at www.sxc.hu.

Photography by Jesse Therrien © 2010. The photography used for this article is for illustrative purposes only and any person depicted therein is a model.

Disclaimer: Disclosure around hepatitis C is not generally mandatory and HepatitisWA does advise clients of this. It must be noted that secrecy, as such, is not advocated by HepatitisWA. Secrecy can be, and often is, an unhealthy burden to carry. In many circumstances, there is absolutely no need to disclose one’s hepatitis C status. What HepatitisWA does recommend is discretion. Discretion allows the individual to make a personal choice about disclosure based on their individual circumstances, situation and available support.

NEWS

AUSTRALIA’S HEALTH 2012 HEPATITIS B & C RATES DECLINING A new report released by The Australian Institute of Health and Welfare (AIHW), reports on Australia’s health status, the health care sector, spending, workforce, health research, and the future.

We are a healthy nation • Australians enjoy one of the highest life expectancies in the world—79.5 years for males and 84.0 years for females, both 25 years longer than a century ago.

• Most Australians feel positive about their quality of life. In 2007, 82% said they were delighted, pleased or mostly satisfied, 14% said they had mixed feelings, while only 4% felt mostly dissatisfied, unhappy or terrible.

• Australia’s level of smoking continues to fall and is among the lowest of Organisation for Economic Cooperation and Development (OECD) countries, with 1 in 7 people aged 14 and older smoking daily in 2010.

• In June 2011, most children were fully immunised—92% of 1 year olds, 93% of 2 year olds, and 90% of 5 year olds. This is an improvement for 5 year olds over the past few years, but there has been little change for the younger ages.

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But some groups experience found disability reported poor or fair health, compared with 5% for poorer health • Aboriginal and Torres Strait Islander people generally fare worse on a number of health measures— for example, life expectancy is about 12 years shorter than for other Australians. And access to and use of health services is often lower—for example, in 2009–10, 36% of Indigenous women were screened for breast cancer, compared with 55% of non-Indigenous women.

• Many aspects of health are related to how well-off people are financially: generally, with increasing social disadvantage comes less healthy lifestyles and poorer health. For example, in 2010, 25% of people living in the lowest socioeconomic areas smoked tobacco, twice the rate of people living in the highest socioeconomic areas.

• The further people live away from major cities, the less healthy they are likely to be. For example, in 2009–10, the rate of hospitalised injury cases for residents of very remote areas (4,299 per 100,000 population) was more than twice that for people in major cities (1,728 per 100,000).

• Severe or profound disability often carries an extra health burden: in 2007–08, 46% of people aged 15–64 with severe or pro-

those without disability.

And there is other room for improvement • In 2007–08, almost all Australians aged 15 and over (99%) had at least one risk factor for poorer health (such as high blood pressure or not eating enough vegetables), and about 1 in 7 people had 5 or more risk factors.

• Comparisons among OECD countries show that Australia has one of the highest rates of obesity. In 2007–08, 1 in 4 Australian adults and 1 in 12 children were obese.

• Although most babies (96%) in Australia in 2010 were initially breastfed, only 39% of infants were exclusively breastfed to around 4 months, and 15% to around 6 months, the recommended period.

• The prevalence of diabetes more than doubled between 1989–90 and 2007–08. An estimated 898,800 people have been diagnosed at some time in their lives.

• The number of people on the organ transplant waiting list continues to exceed the number of available organs. In 2010, there were about 1,770 Australians on the list.

Source: Australian Institute of Health and Welfare 2012. Australia’s Health 2012. Australia’s Health series no.13. Cat. no. AUS 156. Canberra: AIHW. © Australian Institute of Health and Welfare 2012 under a Creative Commons (CC) BY 3.0 licence from www.aihw.gov.au.

NEWS • In 2010 there were more than three-quarters of a million workers in health occupations. This is an increase of 26% since 2005— more than double that of the overall workforce (12%).

• Employers of health workers across Australia report workforce shortages or recruitment difficulties for many health professions, particularly midwives and physiotherapists.

Helping it happen: health research and information • Health and medical research spending comprises 14% of all research and development spending in Australia, and this figure has been climbing over the past two decades.

• The AIHW contributes to the health and medical research effort by analysing and reporting on data, making data holdings available to other researchers, and developing and promoting information standards for the health sector.

The health sector is busy • A typical day in the health sector includes: 342,000 people visiting a GP, 742,000 medicines being dispensed by community pharmacies, 23,000 people being admitted to hospital, and 17,000 people presenting to an emergency department at larger public hospitals, and that’s only part of the story.

• There was a 51% increase in the number of palliative care hospitalisations between 2000–01 and 2009–10.

• The most commonly used medicines in Australia in 2010–11 were for reducing blood cholesterol, lowering stomach acid, lowering

• Along with other stakeholders, the AIHW continues to develop health data and information, Making it happen: health leading to new collections, and spending and workforce • Australia spent $121.4 billion on expanded and higher quality data health in 2009–10, which account- collections, which in turn lead to better information on Australia’s ed for 9.4% of total spending on all goods and services—similar health. to the average for all OECD counAustralia’s Health 2012, tries. blood pressure, and antibiotics.

• Hospitals were by far the biggest area of health spending, consuming $4 in every $10 of recurrent health spending.

• Cardiovascular diseases accounted for the greatest spending ($7.9 billion or 11%) followed by oral health ($7.1 billion, or 10%) and mental disorders ($6.1 billion or 8%).

reported that the incidence of blood borne viruses Hepatitis B and Hepatitis C in Australia are declining, and the trend was seen as “favourable”. (Table 1.2) CF June 2012

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FEATURE

“If you’ve got a bad attitude, and you don’t want to talk to a health inspector, then you’re not a professional tattooist”.

Neil is sitting in what looks like a “dentist’s chair” getting a “Hammers” tattoo (West Ham United) soccer team’s nickname.

Gary the tattooist explains that he makes a stencil of the tattoo first to get an accurate design, and then applies it to the part of the body where it’s desired. In this instance, it’s going on Neil’s right forearm.

He then goes over it with the tattoo gun.

I ask Neil if it hurts and he says “Nah!” Gary teases “He’s lying!”, then Neil says “A little bit… it pinches a little bit.”

Gary then starts whistling while he works. A comforting sign, in what can be a nerving experience.

Gary Welsh runs The Celtic Circle Tattoo Company in Kalamunda.

He is also the President of the Professional Tattooing Association of Australia. His business has been around for 9 years, and he has been tattooing for 25.

drawing.” He jokes “I used to draw tattoos on my friends for lunch money.” I then ask him what are his thoughts on “backyard tattooing”.

“It’s inappropriate and dangerous”.

He adds “Tattooing is minor surgery, and it should be conducted in a safe environment, and to ensure the safety of the environment, it needs to be inspected by a local Health and Environmental Health Inspector.

Even if a backyard operator tries their hardest to do the right thing, they’re not educated, so they don’t know their enemy when it comes to viruses, and blood borne pathogens.”

“For me, going to a backyard tattooist is like going to a backyard dentist… it’s stupid.”

Neil starts laughing.

But what Gary says isn’t a laughing matter. There has been a steady rise in backyard tattooing in Australia.

Many people have come to Gary with a backyard tattoo to get them fixed.

When asked what that procedure is like, he responds “You will never get as good a tattoo, as you would with

the first go at it, because you have to cover up the mess that was put there to start with, and it can be a little more painful, because you’re usually going over damaged nerve tissue for the second time.” In his career, he has done about 25,000 tattoos on clients, and of that, has fixed about a thousand backyard tattoos. That’s 1 in 25 people.

The demographic of people who come in with a backyard tattoo is very wide. “Sometimes parents have their children tattoo them - It’s a strange world”.

So how does one get the title of “Professional Tattooist?” The tattoo industry is mostly unregulated, so really, anyone who sets up a shop, could call themselves a “professional tattooist”.

“It’s really a lot of buyer beware” remarks Gary. “If I were shopping for a tattoo, I’d want to smell the premises, have a good look around, and check that it was clean and hygienic.” Gary adds that you should meet with your potential tattooist and ask him or her about their sterilizing and hygene procedures, without

Celtic Circle offers the community a reasonable product for a reasonable price in a safe environment. When asked how he got into tattooing, he remarks “I’ve always been Image of tattoo gun vector available under a creative commons license from www.bulletproofvectors.com.

8 Photography by Felicia Bradley © 2012. The photography used for this article has been taken with permission from Gary Welsh and Neil Cressey.

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FEATURE

we speak with the president feeling angst about those questions. The tattooist should be open and responsive. Naturally, you should also request to see photographs of THAT tattooist’s work, keeping in mind that what they show you will be their very best work. Just make sure that it’s good enough for you. “It’s really a case of doing your homework in these areas.”

Any equipment that comes into contact with blood has to be either sterilized or thrown away. There are three forms of sterilization that are acceptable. There is the autoclave with steam and heat, there is Ethylene oxide gas (EO), and there is dry heat. There is no such thing as sterilising solution.

“People who think there is a sterilizing solution are only using a disinfectant solution and it’s not designed to kill viruses”.

sterilizer itself, to test that it’s actually doing the job.”

Any backyard tattooist who says they are “certified” isn’t being honest. “There is no certification to be a tattooist.

You can be a member of the Professional Tattooing Association, but in order to be a member, we will inspect your studio. You have to have a studio, and you have to be a legitimate registered business. If you don’t, you’re basically a backyard tattooist.”

“As soon as you put a tattoo on someone, you could call yourself a tattooist, and that’s because the industry is not properly regulated”.

Backyard tattooists watch “Miami Ink” but that’s just a TV show - it doesn’t really bear any resemblance to the truth of tattooing.”

Finally, your tattooist should be an “artist”.

“People often get their aspirations mixed up with their capabilities because their mum tells them they’re really good… then I see their artwork and I wouldn’t dream of putting that on me! It just goes back to the analogy: “There’s good mechanics, and there’s bad mechanics.”

If you’re using disposable tubes and disposable colour trays, there is no need for a sterilizer, because there isn’t anything to sterilize.

Gary remarks “I prefer the stainless steel tubes, and I go through the sterilizing process, and even go as far as monthly checks (micro- Written by Felicia Bradley, biological checks), on the

CFiles Editor

CF June 2012

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NEWS

New antiviral treatments aim to eradicate hep C SCALING up GP training to prescribe antiviral drugs is more important than ever, with Australia on the verge of therapeutic changes that could turn the tide of the hepatitis C epidemic, experts say.

PBS funding of new direct acting antiviral (DAA) drugs could occur this year, but the real revolution in therapy will come with a move to interferon-free (IFNfree) regimens, according to Professor Greg Dore, head of the viral hepatitis clinical research program at the Kirby Institute, Sydney.

“Simplified, short duration therapy... could be very easily administered by primary care practitioners - in fact that would be the ideal environment for it to be delivered.”

“It seems likely that within five years, we will have short duration anti-HCV therapy with minimal side effects and cure rates about 90%,” Professor McCaughan said.

The real challenge would be to engage GPs and provide them with appropriate education and training.

Meanwhile, a study of people with HCV at 24 clinics across Australia showed 60% achieved SVR, similar to clinical trial results, despite the inclusion in Existing platforms such as the the study of injecting drug users Australian Society for HIV and patients with comorbidities Medicine training schemes who were typically excluded could be scaled up, he said. from trials.

According to liver specialist Professor Geoffrey McCaughan, Phase III studies of IFNfree from the Centenary Research therapy will commence this Institute and Royal Prince year, heralding an era of Alfred Hospital, Sydney, the treatment with reduced toxicity, use of DAAs telaprevir (Janssen) simplified dosing and monitoring, and boceprevir (MSD) with he wrote in the Medical Journal pegylated interferon and of Australia. ribavirin has boosted sustained virological response (SVR) from “If we are going to scale up 45% to 70% among patients and hepatitis C treatment with new halved duration of treatment to therapies... we are not going to just six months, albeit at the cost do it through just the established of increased side effects. large hospital base,” Professor HCV polymerase inhibitors Dore told MO. and protease inhibitors in the pipeline will take SVR to the next level, he wrote in an MJA editorial.

Source: Hoffman, L. & Rouse, R, 2012. New antiviral treatments aim to eradicate hep C. National Medical Observer, 08 Jun, pp. 1, 4.

Dr Margaret Hellard, head of hepatitis services at Alfred Hospital, Melbourne, noted that people who injected drugs were the group at highest risk of infection and the least likely to access treatment.

Appropriate training and resourcing of primary health care practitioners was vital to allow management of drug users in shared care, she said.

This article was written

by Lynnette Hoffman and Rada Rouse, National Medical Observer

CF June 2012

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WASUA’s Dedicated Domain

WASUA

WASUA SERVICES The Western Australian Substance User Association (WASUA) is the state-wide peer based drug user organization and has been incorporated since 1996.

Funding is received from both State and Federal Government to deliver a range of health and harm reduction services to people who use drugs in WA, with a focus on illicit and injecting drug use.

Within the WASUA perspective the term ‘peer’ alludes to the fact that most of the staff members and many volunteers identify as having, or have had, a personal experience of substance use (and/or misuse). WASUA have always had a strong peer-affirmative action policy which has produced a strong and unique organisation.

Due to having a organizational-foundation of peer staff, there is the ability to engage with consumers efficiently, effectively and with immense authentic empathy. Consumers immediately identify with and openly appreciate; often giving the feedback that they welcome the spirit of inclusivity and community Volunteers: WASUA highly appreciates and when engaging with any of the WASUA services and acknowledges the time donated by our volunteers. team members.

Volunteers are provided with mentoring and are offered the opportunity to attend (free of charge) WASUA consists of fours teams: NSEP (Needle Syringe professional development training courses that are Exchange Program), Outreach Team, Health Team available to all WASUA staff members. and the South West Team. All teams provide support, education, advocacy, and referral and aim to reduce Safe Disposal Officers provide a safe disposal service transmission of Blood Borne Viruses (BBV’s) and the to the community. WASUA receives a number of calls harms and hazards associated with substance use. requesting discarded equipment be collected. Most However each team works in a specific manner in common are the entertainment centers or abandoned delivering the above services. buildings. Upon collection, the Safe Disposal Worker educates and busts myths pertaining to the dangers NSEP team consists of: NSEP Coordinator, Community of unsafe disposal of injecting equipment.

Education Officer, Safe Disposal Officer and Volunteers.

WASUA Combined Outreach team consists of: Outreach Coordinator, Core Outreach, Regional The NSEP Coordinator is in charge of running the & Remote, South/West Outreach Worker, Youth, Needle Syringe Exchange Program located on 519 and Peer Education Project Worker (OPAM). The Murray Street, West Perth 6000. The NSEP is opened Outreach Team takes WASUA services into the field.

7 days a week: Mon to Wed from 10am to 5 pm, Thu Outreach acts as a bridge between drug users and to Fri from 10am to 8pm & Sat & Sun from 11am to drug treatment and allied health agencies.

4pm.

WASUA provides a number of services on premises at 519 Murray Street, West Perth, including: PERTH (08) 9321 2877 www.wasua.com.au Perth NSEP Monday - Wednesday: 10am-4pm Thursday-Friday: 10am-8pm Saturday & Sunday: 10am-12pm Clinic Hours Tuesday & Thursday: 10am-4pm

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The Community Education Officer’s duties involve: working in conjunction with the NSEP, as well as developing and maintaining partnerships with key stakeholders; provision of tailored information training session’s from a consumer perspective to a diverse range of organizations and participation at community events (e.g. Big Day Out, Gay Pride Fair day etc). These events provide the opportunity for WASUA to liaise with other agencies as well as to raise public awareness regarding harm reduction. Such events allow WASUA to engage the general public to address the taboo surrounding harm reduction and other issues surrounding stigma and discrimination, as well as disseminating general information and resources.

The Community Education worker also organizes volunteer training and facilitates ongoing volunteer mentoring and support.

Closed Public Holidays

• NSEP (Needle and Syringe Exchange Program) • Free hep A and B vaccinations for hepatitis C positive people • Free blood testing in a friendly confidential environment • Drug treatment support and referral • Peer education and training • Street-based outreach • Advocacy and support for users • Safe injecting and safe disposal education and resources • Hepatitis C/blood-borne virus information and resources

WASUA

The credibility of the education and consultancy we offer to other agencies largely rests on our flexible, adaptive, client-centric and directed model of service delivery. The information gained by WASUA’s outreach services is unique due to our ability to access premises and gain trust as a direct result of our peer based positioning. This team also provides educational sessions to many services, and represents peer communities on various agency bodies/ committees.

Health Team: Consists of Treatment and Referral Coordinator, Counsellor, ORPACS, Hep C Educator and the Health Clinic (Nurse). The Treatment and Referral Coordinator/Counsellor adopts a “holistic” approach to the provision of services. She advocates on behalf of clients and refers them onto other agencies such as; accommodation services, mental health and legal services. Due to the often complex nature of client’s needs, a multifaceted approach is employed which may mean engaging with families, assisting with transport, advocacy, referring onto GP’s and other health services in order to provide a comprehensive structure of support, which thus enables clients to begin to address areas causing concern within their lives that they wish to change. Supported referrals and case management of clients form the basis of this treatment program, which includes AOD/mental health counselling, referral to detoxification services and AOD rehabilitation centres.

no identification or appointments are required. WASUA clinic services are also available via outreach and can be accessed at HepatitisWA every fortnight on a Wednesday afternoon.

ORPACS (Opioid Replacement Pharmacotherapy Advocacy and Complaints Service) offers information, support, advocacy, referral and mediation for pharmacotherapy consumers, prescribers and dispensers. The overall aim is to improve treatment outcomes and to prevent or solve problems that may impact upon the relationship between prescriber, dispenser and consumer. Any problems with your Methadone or Suboxone dosing call WASUA and ask for assistance from the ORPACS worker.

Hep C Educator role involves education, support and information regarding BBV and liver disease with expert knowledge on Hep C. Support and assistance are available for people who are investigating or are already accessing hepatitis treatment. Information is given regarding ‘living well’ and ‘living healthily’, especially if infected with Hepatitis B and/or C . We also advise consumers on legislative issues such as discrimination, rights and responsibilities etc.

South West team is proud to announce the new NSEP fixed site recently opened in Bunbury located at 97 Spencer St, Bunbury. Opening times: Mon – Wed 10 am to 2 pm, Thu- Fri from 3:30pm to 7:30 pm. The SWMNSEP (South West Mobile NSEP) provides mobile NSEP services around the South West region e.g. Busselton, Collie, Manjimup, Bridgetown, etc. as well as community development, education/training, advocacy and outreach services. A dedicated outreach worker is able to provide services to clients that are unable to attend the MNSEP or the fixed site. The Bunbury service can be contacted on 08 9791 699 or the mobile van on 0417 973 089.

The Health Clinic provides access to health services for people who inject drugs, providing a range of BBV testing (e.g. HIV, Hep A, B & C) as well as other tests including Hep C PCR, genotype and liver function etc. This is done in conjunction with pre and post test counselling. Sexual health tests and treatments are also available. The clinic also provides Hep A & B vaccinations. The clinic can be accessed on WASUA premises every Tuesday and Thursday between 11am and 4pm, is free, discrete, confidential and Written by Emila Lingi, Laura Jinks & Frankie Valvasorie.

South West Mobile Needle Syringe Exchange Program (NSEP) SOUTH WEST

Van Phone 0417 973 089 Office 08 9791 6699 or 08 9721 1449

Margaret River Tuesday: 12pm-1pm Hospital Carpark Busselton Tuesday: 5pm-7pm Hospital Carpark Donnybrook Wednesday: 9am-10am Hospital Carpark Manjimup Wednesday: 12pm-1pm Hospital Carpark Jaycee Park, Bunbury Wednesday: 4:30pm-5:30pm Hudson Road, Bunbury Wednesday: 6pm-7pm Community Health Carpark Bunbury Hospital Wednesday: 7:15-9:15pm Dental Clinic Carpark Harvey Thursday: 7-8pm Hospital Carpark Collie Thursday: 9-11pm Hospital Carpark Article written by Emila Lingi (Outreach Worker), Laura Jinks (OPAM Project Officer) & Frankie Valvasorie (Health Team Co-ordinator) at WASUA.

The C Files

CF June 2012 ¤ 13 October 2011 ¤ 11

LIVING WELL

SMOKED SALMON DELIGHTS RECIPE Packed with protein, oily fish is also a good source of omega 3 fatty acids – a type of unsaturated fat with huge health benefits. Omega 3 decreases cholesterol and triglyceride levels, preventing the clogging of arteries and lowering blood pressure which, in turn, lowers the risk of heart disease and stroke. There is also evidence to suggest it can help reduce inflammation associated with arthritis, prevent memory loss and reduce depression.

INGREDIENTS Preparation time: 20 minutes Cooking time: Nil Serves: 8 Storage: Store covered in gladwrap in the fridge – not suitable for freezing

• 16 watercracker biscuits (optional) • 8 pieces of smoked salmon (approximately 400g) • 100g reduced-fat ricotta cheese • 60g extra light cream cheese • 1 teaspoon capers • 1 teaspoon lemon juice • 0.25 teaspoon lemon zest • 1 teaspoon spring onions or chives, chopped • 1 teaspoon dill, chopped

14

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METHOD 1. Lay the salmon out on a clean board 2. Place all remaining ingredients (except the biscuits) into a bowl and mix well 3. Spread 1 tablespoon (20g) of the mixture over each piece of salmon 4. Roll the salmon up into a tube 5. Serve as fingerfood or on individual plates with water crackers The salmon roll can also be cut up and put onto water crackers.

Receipe written by Hepatitis Australia, and re-printed with permission. Available at www.loveyourliver.com.au (12 June 2012) http://tinyurl.com/smoked-salmon-delights.

MEMBERSHIP RENEWAL

ABN 42743157642

ANNUAL MEMBERSHIP RENEWAL FORM TAX INVOICE Please complete your details below in block print, cut-out and return with payment First Name (Mr/Mrs/Ms/Dr):______________________________________________ Last Name:____________________________________________________________ Agency/Organisation:____________________________________________________ Address:_______________________________________________________________ Suburb/Town:_____________________________ State:________ Postcode:________ Phone:____________________________ Email:______________________________ Please tick your membership category Unwaged

$11.00 incl. GST

Waged

$22.00 incl. GST

Associate/Organisation

$55.00 incl. GST

Payment options 1 - Attach cheque or money order made payable to HepatitisWA or 2 - Attach a copy of EFT receipt BSB 066118 Acct 10021906 HepatitisWA and

Mail to:

HepatitisWA (Inc) PO BOX 8435, Perth Business Centre WA 6849

or 3 - Pay in person at HepatitisWA 187 Beaufort St, Northbridge HepatitisWA (Inc) is an income tax exempt charitable entity and deductible gift recipient.

Your membership and financial support enables us to continue our work in responding to hepatitis.

Our quarterly newsletter, the CFiles, which carries the latest information on hepatitis C and related viral hepatides, is forwarded to all our members.

HepatitisWA (Inc) PO BOX 8435, Perth Business Centre WA 6849

t (08) 9227 9802 f (08) 9227 6545 email info@hepatitiswa.com.au Information (08) 9328 8538 Metro - 1800 800 070 Country Web www.hepatitiswa.com.au

s k n i L y t i n u m Com & s t c a t n o C l Usefu NATURAL THERAPIES

HEALTH HepatitisWA Information, support and referrals for people living with or affected by hepatitis. Education for work places, pharmacies, schools or other groups. Participation in community events.

Call the Info and Support Line on (08) 9328 8538 (metro) 1800 800 070 (country) www.hepatitiswa.com.au WA AIDS Council provides a wide range of services in the prevention of HIV, and the treatment and care of people living with HIV/AIDS, including a Needle and Syringe Exchange Program (NSEP).

(08) 9482 0000 www.waaids.com Quit Line Smokers Information & Treatment 13 18 48 Gay & Lesbian Community Services of WA provides a service which allows people to explore homosexuality as it relates to them personally, without judgement or prejudice. Included in this are issues such as identity formation and coming out, and relationship difficulties.

(08) 9420 7201 www.glcs.org.au WA Substance Users Association provides services that are nonjudgmental and user friendly.

These include a health clinic for BBV and STI testing, hepatitis A&B vaccinations, general health information and referrals, as well as a Needle and Syringe Exchange Program (NSEP).

(08) 9321 2877 www.wasua.com.au

Magenta-Sex Worker Support Magenta offers support, health services, education and information to female, male and transgender workers in the sex industry. We provide confidential and sex worker friendly services.

(08) 9328 1387 Street Doctor (08) 9347 5488 Derbarl Yerrigan Health Service is an Aboriginal Community Controlled organisation.

(08) 9421 3888 www.derbarlyerrigan.com.au

LEGAL Legal Aid WA provides information, advice and other legal help, and assessment for aid grants to cover legal fees.

1300 650 579 1800 241 216 (TTY) www.legalaid.wa.gov.au Aboriginal Legal Service of WA provides legal aid services to Aboriginal and Torres Strait Islander peoples.

Phone: 08 9265 6666 Freecall: 1800 019 900 www.als.org.au The Western Australian Equal Opportunity Commission The anti-discrimination information gateway.

08 9216 3900 (metro) 1800 198 149 (country) www.antidiscrimination.gov.au

Australia Natural Healthcare Centre 57/76 Newcastle St, Perth WA 6000 (08) 9228 8828 Australian College of Natural Medicine 170 Wellington St, East Perth WA 6004 (08) 9225 2900 Chinese Medicine & Accupuncture Association of Australia 84 Edward St, Perth WA 6000 (08) 9227 5766

OTHER Relationships Australia provides relationship support services to enhance human and family relationships.

1300 364 277 Men’s Domestic Violence Helpline 1800 000 599 Women’s Domestic Violence Helpline 1800 007 339 Telephone Interpretor Service 13 14 50 Pharmaceutical Benefits Scheme (PBS) Australia 1800 020 613 Australian Organ Donor Register telephone enquiries 1800 777 203 Medicines Line Australia 1300 888 763 Cancer Council WA Helpline 13 11 20

These contacts are for information purposes only. HepatitisWA does not guarantee the services listed.