HepatitisWA Newsletter (Dec 2013) by HepatitisWA

DEC 2013

contents

PERSONAL PERSPECTIVE

COMMUNITY NEWS

WASUA’S DOMAIN

04 Ed’s Story A personal perspective on a young

06 Going Viral A round-up of articles on viral

24 Bunbury and Regional Areas

man’s recovery of hepatitis B and a new outlook on nutrition.

Features

10 Rising Deaths from Hep C Spur New York City Action Written by Gerard Flynn.

08 Hepatitis B Mapping Project VIDRL & ASHM’s Hepatitis B

hepatitis.

22 Hepatidings

HepatitisWA Community Activities.

Mapping Project.

14 Closer than you thINK A sharp rise in the availability

of DIY tattooing and piercing kits, as well as an increase in young Australians travelling to Bali, has prompted peak organisation Hepatitis Australia to issue a warning about the dangers of blood-borne viruses such as hepatitis C.

HEALTH & LIFESTYLE 18 Staying on track when eating out Healthy eating habits don’t have

20 Sleep management and hepatitis C Among a number of factors, having

HEPATITISWA Newsletter // Dec 2013

to slip just because you’re eating out. Read up on these tips to stay on track when choosing restaurant and takeaway foods.

poor sleep and lack of rest can sometimes contribute to fatigue in people with hepatitis C.

Feature by the WA Substance User’s Association (WASUA).

PROMOTIONS 26 SiREN SiREN is coordinated by Curtin University and is funded by the WA Department of Health Sexual Health and Blood-borne Virus Program. They offer help with applied research and evaluations and are calling for abstract submissions for their 2014 symposium.

27 HepatitisWA Peer Support Group Advertisement

Share experiences and thoughts with peers in a friendly, non-judgemental environment.

28 Happy holidays! Season’s greetings from all of us

at HepatitisWA.

HepatitisWA is open from 9am to 1pm on Tuesday December 24th. We will be closed from December 25th and re-open again on Monday, January 6th 2014.

Going VIRAL A round-up of articles on viral hepatitis

HEALTH GROUPS backing plan for needle exchange

n a move praised by health bodies, the ACT government has reconfirmed its commitment to trialling a needle and syringe program in the territory’s prison. The government on Thursday released a framework for drug policies and services at the Alexander Maconochie Centre and its strategy for managing bloodborne viruses at the prison. It also provided a final report on the 2011 drug policy recommendations for the prison made by the Burnet Institute, a non-profit organisation that researches communicable diseases and viruses. In the government’s plan to manage blood-borne viruses in the centre, regulated access to sterile injecting equipment is listed an ‘’actionable priority area’’, along with consistent and appropriate access to condoms and dental dams and prisoners’ own razors and toothbrushes. In a joint statement, leaders of the Public Health Association of Australia, Hepatitis Australia and the Alcohol and Other Drugs Council of Australia said they were hopeful prisoner access to sterile injecting equipment in the Canberra prison had moved a step closer to becoming a reality. Leaders of Winnunga Nimmityjah Aboriginal Health Service in Canberra, the ACT Hepatitis Resource Centre, the Mental Health Community Coalition ACT and the Alcohol, Tobacco 6

and Other Drug Association ACT were involved in developing the policy documents. They praised the government for its “continued commitment to preventing and reducing bloodborne virus transmission by providing regulated access to sterile injecting equipment in the AMC’’. The Community and Public Sector Union, which represents prison guards at the centre, had previously opposed a needle and syringe program at the centre. A spokesman for the union said it would consider the reports before making further comments. In its final status report on the Burnet Institute recommendations, the ACT government said under its current industrial agreement, implementation of a needle and syringe program required union consent. “The government is committed to seeking that agreement through consultation with relevant unions,’’ it said.

BY LARISSA NICHOLSON.. Oct 25, 2013 for The Canberra Times. tinyurl.com/backing-plan-needle-exchange

CLINIC GIVES out 1,000 needles a day

PSWICH health services hand out 1000 syringes a day to drug users — solely for the purpose of injecting illicit intravenous drugs.

A drug expert says the figure is an indication of the seriousness of Ipswich’s heroin and speed problem, but health officials and the police believe intravenous drug use is not on the rise. West Moreton and Health dispenses the clean from Ipswich Health reduce the spread and hepatitis B and C.

Hospital Service syringes Plaza to of HIV

Chief executive Lesley Dwyer said the Queensland Needle and Syringe program dispensed 35,799 syringes a month, with 85% going to illicit drug users. More syringes go to drug addicts in West Moreton then in the Darling Downs Hospital and Health Board region. The DDHHS dispenses 36,867 syringes a month, with 68% given to drug users. The remaining syringes are used by patients with medical conditions requiring regular injections. “Making sterile injecting equipment available is a public health strategy that does not condone illicit drug use, but rather complements a range of strategies - both public health and treatment oriented - for the reduction of illicit drug use and associated harms,” Ms Dwyer said. She said no additional funds were allocated to the program this financial year. Pharmacist John Ward operates the Ipswich Dosing Centre, a methadone clinic based only a few hundred metres from Ipswich Health Plaza. He said the high number of needles was an indication that heroin and amphetamine abuse was a

HEPATITISWA Newsletter // Dec 2013 Disclaimer: The news articles and excerpts displayed in the HepatitisWA Newsletter remain the copyright of the original authors and news publications.

community news

huge problem in Ipswich. Mr Ward said clean needles curbed the spread of HIV and hepatitis but were used by addicts to inject heroin or speed. “It’s a good thing we do but it’s an indication that we have a lot of people using drugs,” he said. Ipswich District Inspector Dave Preston said speed and heroin were the most common powder-based drugs used in Ipswich. But he said marijuana remained Ipswich’s most commonly used recreational drug. “The use of drugs is usually related to crime and usually attached to the fact that they commit crimes to support their habit,” he said. Inspector Preston said officers rarely discovered incorrectly disposed of syringes, but often found utensils and pipes for marijuana use. The Queensland Times (QT) last week reported calls for the Ipswich Dosing Clinic to be moved away from the city centre. Methadone treatment involves patients visiting a pharmacist to receive a dose of the drug, which is taken orally. Shadow Health Minister and Bundamba MP Jo-Ann Miller said the clinic was saving lives and preventing crime. “There is clearly a great need for the clinic’s services and that’s not surprising because there is a drug addiction problem in Ipswich,” she said. “There is no use trying to hide it. It exists and the city needs to deal with it.”

BY KIERAN BANKS.. Nov 26, 2013 for Queensland Times (QT). tinyurl.com/1000-needles-a-day

BRISTOL TO STOP EARLY RESEARCH IN THREE DISEASE AREAS

ristol-Myers Squibb Co (BMS) said on Thursday that it would no longer conduct research to discover new drugs for hepatitis C, diabetes and neuroscience, but will increase spending on medicines that harness the immune system to fight cancer. BMS company spokeswoman Laura Hortas said the shift in its research and development focus was “slight” and not geared toward cost cuts. But she said 70 to 75 R&D positions will be eliminated, or less than 1 percent of its research workforce. The company, in an emailed statement, said it will continue with all ongoing late-stage trials of its medicines, including treatments for hepatitis C, and with trials exploring new potential uses of its drugs that are already on the market. Hortas said early-stage trials of some neuroscience drugs might be scrapped, although BMS will continue with one such trial involving the treatment of Alzheimer’s disease.

Otherwise, she said ongoing early-stage and mid-stage trials of its many medicines will continue as planned. The company said it will continue to conduct discovery research, meaning the earliest stages of research before drugs are tested in people, to find new treatments for HIV, hepatitis B, heart failure, oncology, immunoscience and fibrotic diseases. “We are focusing our R&D organization on delivering the opportunities where the value is greatest to patients,” Francis Cuss, BMS’ chief scientific officer said. BMS is considered a leader in the field of immunooncology, in which drugs are used to unlock the immune system to go after cancer cells. Its approved Yervoy treatment for melanoma has provided durable benefits to patients, and the company aims to eventually pair the drug with other therapies that also harness the immune system. Rival drugmakers are also racing to develop immunooncology medicines, which industry analysts expect to garner eventual combined annual sales of up to $50 billion.

BY REUTERS NEWSWIRES.. Nov 07, 2013 by Reuters Newswires, ANZ. tinyurl.com/no-hepatitis-for-BMS HEPATITISWA Newsletter // Dec 2013

FEATURE

hepatitis b

mapping project Dr ben cowie launched Victoria’s Infectious Diseases Reference Laboratory (VIDRL) & The Australasian Society for HIV Medicine (ASHM)’s mapping project at hepatitis australia’s health promotion conference in november 2013.

he Hepatitis B Mapping Project is a joint initiative of ASHM and VIDRL, funded by the Australian Department of Health and Ageing. The project will produce a comprehensive understanding of chronic hepatitis B (CHB) in Australia using data that will help to inform awareness and intervention campaigns to suit the particular local needs of people living with CHB and those providing services to them.

Why do we need to map the extent of hepatitis B? Around 218,000 people were estimated to be living with CHB in Australia in 2011, approximately 1.0% of the population. In

Australia, people born overseas (particularly from Asia, the Pacific and Africa) and Aboriginal and Torres Strait Islander people are disproportionately affected by CHB. Due to these epidemiological

determinants, CHB is not evenly distributed geographically in Australia with wide variation by area.

of indicators to estimate the burden of disease and the uptake of treatment and care, while also including census demographic data, surveillance notifications, hepatocellular carcinoma (HCC) incidence and prescriptions for CHB antivirals.

Enhancing access to treatment and care, a priority action in the National Hepatitis B Strategy, relies on people receiving information, being diagnosed, and able to access culturally appropriate and safe healthcare.

What is being mapped? The project uses a range

Source: Society for//HIV (ASHM), Hepatitis B Mapping Project: Estimates of chronic hepatitis B prevalence and cultural and 8 Australasian HEPATITISWA Newsletter DecMedicine 2013 linguistic diversity by Medicare Local, 2011 – National Report, J. MacLachlan and B. Cowie. Copyright © 2013. URL: tinyurl.com/hep-b-mapping Australia image available under a creative commons license at www.sxc.hu. Photography by Sefton Billington. Copyright © 2013.

The demographic approaches used allow the most affected groups (by country of birth or Aboriginal and Torres Strait Islander status) to be identified in particular Medicare Locals.

The impact of public health and clinical service interventions to increase access to diagnosis and treatment will also be evaluated at a population level over time.

How can the project outputs be used? The project is geographically mapping the burden of disease to identify priority Medicare Locals with a significant burden of CHB and outcomes including liver cancer and to help inform appropriate responses to suit the needs of the affected population in those areas. As the priority populations affected by CHB in Australia are subject to broader health disparities, the project will allow for awareness and intervention campaigns to be targeted in the most direct and appropriate ways.

Who is behind Mapping Project?

the

Hepatitis

ASHM and VIDRL are working in partnership to produce a comprehensive understanding of the epidemiology of hepatitis B in Australia.

Download the hepatitis B mapping project To learn more about where the 218,000 people in Australia who have chronic hepatitis B reside and their predominant languages other than English, go to: tinyurl.com/hep-b-mapping

HEPATITISWA Newsletter // Dec 2013

community news

RISING DEATHS FROM HEP C SPUR NEW YORK CITY ACTION Deadlier than HIV, the disease can appear years after infection, and testing and treatment are complicated. New York city’s Action Plan draws praise, but advocates want more resources applied.

lthough the hepatitis C epidemic receives less than three percent of the federal funding given to the fight against HIV/AIDS, it is the most common chronic bloodborne infection in the United States today, and the deadliest. Since 2007, the New York City Department of Health and Mental Hygiene reports, hepatitis C (HCV) deaths in the nation have been increasing yearly and have surpassed those from HIV/AIDS. Nationwide, of an estimated 4 million infected with HCV — almost four times the number believed to be infected by HIV/AIDS — around 85 percent are chronic carriers of the virus. Because 80 percent of infections don’t show signs

for decades, treatment for HCV is often delayed, allowing the virus to replicate and undermine liver function. In New York, at least half of those with HCV don’t know they are infected. In the nation the figure is estimated to be closer to 75 percent. There are an estimated 146,000 infected people in the city. But limited surveillance may have obscured the true picture of viral incidence citywide — it could be significantly higher. The city’s health department, or DOHMH, is mounting its firstever campaign to reduce illness and death from HCV. But due to a lack of financial commitment (from the federal government), city and healthcare workers find themselves limited in what they can do.

Advocates from Vocal NY called for more aggressive action against hepatitis C at a lobby in Albany, NY. 10

HEPATITISWA Newsletter // Dec 2013

A LINGERING THREAT While viral hepatitis comes in many forms, acute or chronic, all types inflame the liver. Hepatitis A, for instance, is transmitted by eating contaminated food or drinking tainted water. It tends to be acute, meaning people get over it after a short illness. Hepatitis B is spread via blood, semen and saliva and is often chronic, through there is a vaccine. In 80 percent of infections, HCV is chronic. It can spread, like hep-B, via a range of bodily fluids* but primarily is bloodborne. There is no vaccine, though rapid improvements in drug treatment means the disease is curable in up to 75 percent of infections. In New York City as around the country, HCV disproportionately affects people of color. Blacks are much more likely than their white counterparts to be admitted into hospital with complications from the virus. Because HCV is carried by blood, people who inject drugs represent the single biggest risk factor for infection. Among IV-drug users, HCV is more easily transmitted than HIV. Worldwide, 10 million intravenous drug users carry the virus. An estimated 70 to 80 percent of the 35,000 new HCV infections occurring

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ith schoolies week recently in effect, and school holidays coming up, young teens looking for a “rite of passage” run the risk of exposing themselves to unsterile tattooing and body piercing equipment that can carry blood-borne viruses (BBVs) such as hepatitis B, hepatitis C, and HIV.

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The only way to sterilise tattoo equipment is by using an autoclave machine

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sharp rise in the availability of DIY tattooing and piercing kits, as well as an increase in the number of young Australians travelling to South East Asia, has prompted peak organisation Hepatitis Australia to issue a warning about the dangers of blood-borne viruses such as hepatitis C — a serious disease that affects the liver, for which no vaccine is available.

esearch has shown that the use, and reuse of unsterile tattooing needles, and the sharing of ink is associated with a higher risk of hepatitis C infection — the other major risk factor being the sharing of drug injecting equipment.

FEATURE

A “starter” tattoo kit, available to purchase online he Internet has proven to be an easy gateway to accessing DIY tattoo kits, with websites such as ebay.com.au selling kits for as little as $25, posted to anywhere in Australia.

Just typing in the key words “tattoo kit” into ebay’s web search bar, returns over 3000 results. These “starter” kits come complete with all the necessities — two tattoo machines, tattoo grips, power supply, plastic foot switch, tattoo needles, alloy tips, tattoo nipples, rubber o-rings, ink, and other attachments with an instructional DVD. Some physical stores around

WA are now selling tattoo kits to the general public. Research indicates that employees who work at some physical stores selling the tattoo kits are not educated about providing consumers with even the basic answers to questions such as “How do I sterilize my equipment?”, or “Where can I find more information on the risks of tattooing?” Under the Children and Community Services Act 2004, it is illegal to tattoo anyone under the age of 18, without parental consent in WA, but without legislation governing backyard tattooing, anyone could easily purchase a tattoo kit online or from a

store, and tattoo themselves or others without the essential skills or knowledge needed to stay safe. Besides any legality issues, an untrained tattooist may not have the skills to know how hard to penetrate a person’s skin while tattooing, which is why a lot of “backyard tattoos” become infected and can develop severe scarring, becoming unsightly. Not to mention that any pigments or “ink” purchased online from sellers overseas could potentially be poisonous if they are not “genuine” pigment that is designed for placement under human skin. HEPATITISWA Newsletter // Dec 2013

HEALTH & LIFESTYLE

Staying oN track when

EATING OUT C HINESE food • Avoid foods that are deep-fried, such as spring rolls, prawn crackers and dim sims. Look instead for steamed options. • Choose stir-fries with plenty of vegetables, or noodle and vegetable-based soups. • Go easy on the rice. Remember, half a cup of cooked rice equals one serve.

I NDIAN FOOD • Cream-based curries are high in saturated fat. For a healthier alternative, try dishes that are tomato-based or baked in the Tandoor oven and served without sauce. • Choose either rice or Naan bread – not both – and keep the servings small. • Hold the “extras”. Poppadums and samosas are high in fat.

I TALIAN food • Start the meal with a salad rather than garlic bread, which can be high in fat. • Ask for salad dressing to be served on the side. That way, you can use only as much as you want. • Avoid thick crusts and high fat pizza toppings such as bacon, salami, meatballs and cheese. • Instead try a gourmet-style pizza with vegetable or seafood toppings. • Cream-based pasta sauces are generally high in fat. •Choose a tomato-based pasta sauce, like napolitana instead. Source: 18 http://www.shapeup.gov.au/start-shaping-up/food/eating-out HEPATITISWA Newsletter // Dec 2013 All images available under a creative commons license at www.sxc.hu. Photography of Chinese soup by Michel Collot © 2005 | Chicken wings by Anthony Smolenski © 2004 | Spaghetti by NEONZA © 2012 | Indian food by PIXAIO © 2011 | Thai salad by Mathilda Tan © 2005.

Healthy eating habits don’t have to slip just because you’re eating out. Follow these simple tips to stay on track when choosing restaurant and takeaway foods.

A USTRALIAN food • Fish and chips are a popular takeaway option. Make it healthier by swapping the chips for a salad and asking for your fish to be grilled.

• Choose a plain hamburger with lots of salad. Leave off the bacon, cheese and fried egg.

• Barbecued chicken is a good option

– but remember to remove the skin and serve with a salad rather than chips.

T HAI food • Coconut milk-based dishes are high in saturated fat. Choose instead stir-fried dishes made with lime, basil, chilli and lemongrass. • Don’t forget to check out the soups and salads. These dishes are often among the healthiest on the menu. • Look for hot and sour soups or salads served with lean meat or seafood. • Don’t overdo it on the satay sauce.

HEPATITISWA Newsletter // Dec 2013

Establishing a regular sleep ritual is helpful for good sleep. Try to go to bed at the same time each night and if you nap during the day keep it short and early in the day.

Avoid alcohol near bedtime. A heavy meal too close to bedtime interferes with sleep. If you eat something, choose food that is light and nutritious. Avoid spicy or greasy food.

Keep your bedroom temperature cool and don’t a have a television in the

Exercise relaxes muscles and aids sleep. But vigorous exercise just

bedroom.

before bed may interfere with

Light can also interfere with a good night sleep, so close the blinds before you

Here are some tips that may help you get a good night’s sleep:

go to bed.

Go to bed only when you are sleepy. Get out of bed if you can’t fall asleep within 10 – 15

If you have a clock that is always lit up, turn it so you can’t see the time.

four

six

hours

minutes and return when sleepy. A comfortable bed and supportive pillows

Reduce caffeine intake and avoid it altogether

sleep.

before

bedtime.

will do wonders for your sleep. Reduce

stress

much

possible.

If you toss and turn, get up. For example,

Stop smoking or reduce nicotine intake

try and write down all the things that are

during the four hours before bed, and

preoccupying your mind before you go to bed.

don’t have any at least 45 minutes

You can then put them out of your mind until

before bed.

the next day.

Consider a warm bath before bed to

Learn relaxation techniques to reduce

relax your body, adding a few drops of

stress and worrying e.g. yoga techniques,

lavender oil may help relax your mind.

listen to relaxation tapes before retiring.

Source: Sleep Management & Hepatitis C by Hepatitis Australia. Re-printed with permission. Available at: www.hepatitisaustralia.com/sleeping (1 November 2013)

HEPATITISWA Newsletter // Dec 2013

This program targets and supports people working with youth who are a priority population for reducing hepatitis C prevalence.

WELCOME SALLY HepatitisWA has welcomed Sally Rowell, our new Community Services Projects Manager. Sally comes with over 17 years of experience in the sexual health and blood-borne viruses sector and will oversee all areas of HepatitisWA’s projects including Community and Youth Services, Workforce Development, Information and Support Services, Multicultural Services, the Needle and Syringe Program, and Marketing and Resources.

Vending machines In December 2013, the Sexual Health and Blood-borne Virus Program in collaboration with HepatitisWA will be trialling the installation of a Needle and Syringe Vending Machine (NSVM) in the Armadale/Kelmscott District Memorial Hospital. Although similar NSVM’s are currently operating at hospitals in some WA regional areas, this will mark the first occasion that a machine will be located within a Perth metropolitan community hospital. It was prompted by the 2007 review of local Needle and Syringe Program (NSP)

services in WA that highlighted the need for vending machines in areas with high levels of unmatched demand. A decision was made to trial a NSVM at a secondary hospital site in the outer metro area where access is otherwise limited. Currently the only NSP services that operate in the Armadale area are the mobile van service operated by the West Australian AIDS Council (WAAC) for 2 hours once a week, and the local pharmacies. It is hoped that a NSVM located at the hospital in Armadale will assist in matching the demand in the outer metro areas, particularly by increasing access to sterile injecting equipment after hours. HepatitisWA, in collaboration with SHBBVP, WAAC, and the West Australian Substance Users Association (WASUA), have been working to promote the awareness of this service amongst key NSP service providers within the Armadale/Kelmscott community, particularly local pharmacies. The machine itself will be operational 24/7. It will only dispense Fitstick and Fitpack plus products at a cost of $3 per product (the machine itself will only take 3x $1 coins). It is located to the left of the main entry doors, and will be operating on a trial basis for 3 months.

Photographs L - R (Clock-wise): HepatitisWA’s Taryn Gaudoin presenting at the Natitional Hepatitis Health Promotion Conference, HepatitisWA’s Damien Roper with Phone Shot winners Letiesha and Cam, HepatitisWA’s new Community Services Project Manager, Sally Rowell, and a Needle and Syringe Vending Machine.

HEPATITISWA Newsletter // Dec 2013

For more information, please contact Kim Rossow on 9227 9806 or support@hepatitiswa.com.au

HEPATITISWA Newsletter // Dec 2013