News
Community News
#61 • September 2013
F O E D I S K R THE DA
PLUS
World Hepatitis Day • Doctors vs Hep B Lab-Grown Livers • Vietnam & Africa
FREE! Please take one
SEPTEMBER 2013 • HEPATITIS SA COMMUNITY NEWS •
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News
Street: 3 Hackney Road, Hackney Mail: PO Box 782, Kent Town SA 5071 Phone: (08) 8362 8443 1300 437 222 Fax: (08) 8362 8559 Web: www.hepsa.asn.au STAFF
The Radio Adelaide window on North Tce, dressed up for World Hepatitis Day 2013
Executive Officer: Kerry Paterson Administration: Megan Collier Kam Richter Information and Support Coordinator: Deborah Warneke-Arnold Hepatitis SA Help Line Volunteers: Debra Karan Louise Michele Will Education Coordinator: Dr Tessa Opie Educators: Nicole Taylor Michelle Spudic (Rural) Health Promotion Officer: Shannon Wright
Cover photos of Rangda masks by the Blackthorn orphans [flickr.com/ people/kellyandroger], and used under a Creative Commons license Correspondence: Please send all correspondence to The Editor at PO Box 782, Kent Town, SA 5071, or email editor@hepatitissa.asn.au. Editor: James Morrison Non-staff Contributor: Danella Smith
Hepatitis B Coordinator Elaine Lloyd Information and Resources Coordinator: Cecilia Lim Information and Resources Volunteers: Amita Deo Menuka Phil
Contents
Publications Officer: James Morrison
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World Hepatitis Day
Information and Resources Officer: Rose Magdalene
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NAIDOC Week
ICT Support Officer: Bryan Soh-Lim
5 News
Librarian: Joy Sims
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African Communities
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See the Real Thing Winner
Peer Education Coordinator: Vacant Peer Educator Mentor: Fred Robertson Peer Educators: Dean Karan Penni Will
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BOARD Chairperson: Arieta Papadelos
8 Doctors vs Hep B 11 Troy’s Treatment 12 The Dark Side of Bali 14 Vietnamese Communities 15 What’s On
Vice-Chairperson: Lisa Carter
16 Livers in the Lab
Secretary: Lindsay Krassnitzer
18 In Our Library
Treasurer: Vacant Senior Staff Representative: Kerry Paterson Ordinary Members: Gillian Bridgen Catherine Ferguson Carol Holly Jeff Stewart
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Disclaimer: Views expressed in this newsletter are not necessarily those of Hepatitis SA. Information contained in this newsletter is not intended to take the place of medical advice given by your doctor or specialist. We welcome contributions from Hepatitis SA members and the general public. Department for Health and Ageing, SA Health has contributed funds towards this program.
• HEPATITIS SA COMMUNITY NEWS • SEPTEMBER He 2013 had many friends [citation needed].
B Soh-Lim/Hepatitis SA
Hepatitis SA provides free information and education on viral hepatitis, and support to people living with viral hepatitis.
News
World Hepatitis Day 2013 Highlights from South Australia Six clean needle programs across the metropolitan area used the Hepatitis SA small grants to focus on raising awareness about hepatitis prevention through safe practices.
The 20 youngsters watched the ‘A to Z of Hepatitis B’ video made by Fairfield High School students and answered questions based on facts highlighted in the movie. They also enjoyed a replay of an SBS report on a mass citizenship ceremony for their community during Refugee Week. The participants each took some exercise-promoting bookmarks to distribute in their neighbourhoods.
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rug Arm was one of 11 organisations who took advantage of a World Hepatitis Day small grant from Hepatitis SA to do something to raise awareness about liver health. Thirty-five Drug Arm volunteers and staff attended the event across four days where they enjoyed a ‘Liver-Loving Light Lunch’. A fact sheet was included with each dish explaining why it was liver-friendly.
H Nguyen/CASSA
Each lunch was followed by an education session and presentation by a positive speaker from Hepatitis SA. Activity organiser Debby Kadarusman said participants enjoyed the presentations, gained new knowledge, and could see the relevance of learning about hepatitis for the client groups to which they provide support.
D Kadarusman/Drug Arm
The WHD activity was organised by two students who had recently done their Year 10 work experience at Hepatitis SA, with the support of the Migrant Resource Centre SA. The participants were all from the Bhutanese refugee community. Some had been in Australia less than three weeks.
Sixteen support group members at Community Access & Services SA had to sort out fact from fiction to test their knowledge of hepatitis B and C. According to organiser Hoa Nguyen, some proved themselves to be quite knowledgeable.
“The highlight of the activities will have to be the food,” she added. “Participants consistently spoke of how surprised they were that liver-friendly food could still be tasty.”
C Lim/Hepatitis SA
D Kadarusman/Drug Arm
It was movies, a quiz and lunch for a group of Bhutanese youth who got together for their World Hepatitis Day activity.
She said the World Hepatitis Day activity was great because participants had to interact with each other as they sorted themselves into the ‘Fact’ or ‘Fiction’ groups. Winners walked away with hampers of food and toiletries. Hepatitis SA supported the activity by providing a small grant and information material.
SAVIVE sites distributed tooth care products and special injecting equipment. They also provided nutritious snacks and juices to emphasise the importance of staying healthy. Nunkuwarrin Yunti distributed tourniquets with single-use injecting equipment at their fixed site in the city. All the CNPs also set up displays that provided hepatitis-related information and gave away Love Your Liver pens and frisbees. Finally, over 25,000 exercisepromoting bookmarks have been distributed to 114 suburbs by over 100 Hepatitis SA supporters. The bookmarks promote liver awareness and the importance of physical activity in maintaining liver health. A free recipe book and free pamphlet on exercising for healthy livers is sent out on request.
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News From the Community Left: Auntie Josie This image: The annual celebratory march Below: The Kurruru Youth Performing Arts dancers
NAIDOC
O
n Friday, 12 July, National Aboriginal and Islander Day Observance Committee (NAIDOC) Week celebrated with a family fun day held at Torrens Parade Park. Many organisations joined in on the fun and displayed stalls full of information in the hope of spreading vital information about their services and improving awareness of the issues they campaign for. Hepatitis SA was one of the organisations present on the day, and we handed out brochures full of information on issues such as how hepatitis is contracted, where to go to get tested, and treatment options. Chronic hepatitis B and C both occur at much higher rates among Aboriginal people compared with non-Aboriginal people, and so indigenous Australians are therefore a priority population for Hepatitis SA.
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Despite the rain, the day saw hundreds of people from all nationalities get together to celebrate Aboriginal culture. With a special visit from Kaurna Elder ‘Auntie’ Josie Agius and a traditional dance by the Kurruru Youth Performing Arts group, the culture and ways were beautifully showcased. Blood-borne virus coordinator Michael Larkin, from the Aboriginal Health Council of South Australia (AHCSA), said community events like NAIDOC Week are a great opportunity for organisations to engage with the Aboriginal community and raise awareness around important health issues such as hepatitis. Mr Larkin works closely with Hepatitis SA to deliver education within the community. “There are still significant numbers of adults from remote Aboriginal communities who have chronic
• HEPATITIS SA COMMUNITY NEWS • SEPTEMBER 2013
hepatitis B, probably contracted around birth, usually from a mother with chronic hepatitis B,” he explained. “Hepatitis C, however, is more common in urbanised areas, which is due to intravenous drug use being rare in remote Aboriginal communities, but present in urban areas. “There is a need to strengthen awareness of the risk factors for transmission of hepatitis B and C, and the importance of being tested to know your status. “It is vital that Aboriginal community-controlled organisations and the NGO and government sectors work together so that we can reduce the incidence of hepatitis C and B, and improve access to potentially life-saving treatment.” For more information on AHCSA and their services, visit www.ahcsa. org.au. Danella Smith
All photos © Nharla Photography [www.modelmayhem.com/2679780]
Raising awareness at NAIDOC week
News
BBV/STI Funding Announcement
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epatitis SA joins the Australasian Society for HIV Medicine (ASHM) in welcoming the federal government announcement that it will invest around $30 million for a major new prevention program and research to address increasing rates of sexually transmissible infections (STIs) and blood-borne viruses including HIV, hepatitis B, and hepatitis C.
people, non-Anglo Australians, the young, people in rural and regional areas, and people who inject drugs. “This funding represents the kind of commitment required if we are to turn around the increase in rates of STIs and blood-borne viruses we have seen across Australia over the last five years,” said ASHM CEO Levinia Crooks.
The $25.4 million new prevention program, committed to in the 2013 Federal Budget, and so unaffected by the election outcome, will focus on priority populations including gay and bisexual men, Aboriginal and Torres Strait Islander
“We are particularly pleased to see funding specifically allocated for improving the testing, diagnosis and uptake of treatment for hepatitis B—a long-overdue investment. At the heart of all of these prevention programs there needs to be a
well-educated, well-trained health workforce, fully supported to offer patients the best quality of care available internationally. In particular, we need to see an increase in capacity at a primary care level to cope with an increase in testing and treatment, with the integration of HIV and STI screening into standard patient care. “Only by working together can health professionals, government, community organisations and patient groups secure the best outcomes for people affected by these diseases and stop the rise in new infections.”
AIDS Council Closes Financial problems prove insurmountable
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he AIDS Council of South Australia (ACSA) closed on 29 July. At a Special Members Meeting in March 2013, ACSA announced that they were working with SA Health to attempt to find a solution to address a significant budget deficit.
SA Health will contract with three organisations to auspice prevention programs over the next 11 months (to 30 June 2014):
However, since ACSA was not able to demonstrate its viability and SA Health could not continue to contract in these circumstances, ACSA appointed an Administrator in late June 2013. Funding continued while the Administrator assessed the situation.
All Clean Needle Program sites are operational except the Keswick site which is permanently closed.
It is anticipated that SA Health’s tendering arrangements for services from 2014/15 will commence soon.
It is expected that SA SIN (South Australian Sex Industry Network) may be auspiced by Scarlet Alliance Australian Sex Workers Association.
If you would like to discuss this matter further or would like some extra information, please contact one of the following organizations.
The administrator found that ACSA did not have sufficient assets to cover its liabilities. For the company to remain solvent would have required funding from government to cover immediate liabilities, but with no guarantee of ongoing ability to sustain services.
SIN premises on Henley Beach Road are open and operational on a limited basis with volunteer staff and the support of Scarlet Alliance. Their contact phone number remains the same.
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Drug and Alcohol Services South Australia (DASSA): 8274 3333
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Hepatitis SA: 8362 8443
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Relationships Australia SA: 8245 8100
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SA SIN: 8351 7626
On 6 August, a creditors meeting voted to wind up the organisation.
It is expected that SAVIVE (South Australian Voice for IV Education) may soon be housed with Hepatitis SA.
It is expected that GMH (Gay Men’s Health) may be auspiced by Relationships Australia SA. The counselling service for gay men is already operational.
Resumption of other services for gay men will be announced in due time. All other existing services with other agencies remain the same at this time.
Rob OBrien Executive Officer Positive Life SA
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Working with Communities
Spell ‘Africa’ without B Hepatitis B awareness for African communities
On Friday, 31 May, leaders and educators from African communities in Adelaide came together with Hepatitis SA and Relationships Australia to discuss how hepatitis B affects their communities. Forum participants discussed how to take vital information back to the people they represent. Peter Agalla, originally from South Sudan, is a community educator, and says he is very grateful for the forum as he learnt a lot about hepatitis B. “I have this responsibility now to bring information back to my people,” Peter said. “Most of us [African people] are conditioned around worrying about HIV, not hepatitis.” Peter explains African communities in Adelaide are small and often intertwined so people are afraid to speak up about hepatitis B. He said, “We feel as though if I discuss this with him, is he going to go and tell somebody else? “There is often that lack of trust when you are speaking about something with such stigma.” Clinical Practice Consultant from the Flinders Medical Centre, Rosalie Altus, and Royal Adelaide infectious disease specialist Dr David Shaw presented at the forum to provide
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insights into disease progression, transmission, treatment and testing. Shedrick Kennedy Yarkpai is in charge of an organisation known as African Youth Drive, and also made an appearance on the day. African Youth Drive aims to spread important messages about health to the African and wider communities through dance, song and art. Shedrick performed a song called ‘STI’, which addresses measures of preventing sexually transmitted infections and highlights the importance of being cautious. Shedrick said that it is through education and knowledge that diseases can be prevented. “A lot of us haven’t heard of hep B before, so today has been very educational,” he said. Shedrick explains he feels happy and fulfilled when he has the opportunity to help and educate others. “The more you say to people [about hepatitis B] then the more aware you are yourself.” The community leaders and educators brainstormed effective ways to educate their people, some of which included workshops about hepatitis B after church, an African call-up radio program, more education and awareness about hepatitis B and the promotion of confidentiality. The African leaders and educators plan to continue their work with Relationships Australia and Hepatitis SA to raise awareness and reduce hepatitis B infection rates in their communities.
• HEPATITIS SA COMMUNITY NEWS • SEPTEMBER 2013
Danella Smith
All photos: S Ciotti/RASA
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epatitis B is common in African communities, and African people can begin to experience disease progression as early as their twenties or thirties, which is usually much earlier than for people of Caucasian backgrounds.
Shedrick Kennedy Yarkpai
Safer Communities
See the Real Thing Winner ‘C the Real Me’ for a future free of Hep C
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ladmir Zokic’s personal connection with hepatitis C moved him to enter the short film competition ‘See the Real Thing’. It bore fruit when his film was voted best entry and he took home the ultimate $10,000 cash prize. A graphic designer based in Canberra, Mr Zokic impressed with his short film ‘C the Real Me’, which effectively portrayed the crucial messages around living with hepatitis C. “This is a story that is close to my heart,” he said. “A person very close to me was diagnosed with hepatitis C a couple of years ago and he was really devastated because he didn’t know what it meant for him or how it would affect his life and health.” Mr Zokic’s interest in the competition was driven by the desire to reduce hepatitis C-related stigma and highlight the fact that hepatitis C is not contracted through casual contact. ‘C The Real Me’ showed the main character, who lives with the hepatitis C virus, and the difficulties he had at work and sporting events as people were afraid to share cups or come into close contact with him. “There are so many misconceptions in the community around hepatitis C,” he said.
“People have the idea that only intravenous drug users or people covered in tattoos are at risk of hep C, but it’s not just those people in high-risk groups.” He said it could happen to others and people should “get tested and treated—it’s a simple as that.” Unlike many, Mr Zokic’s experiences with hepatitis C have turned out well, and he now understands the importance of going to your doctor and getting tested. “The happy ending to this story is that my friend was treated and his hepatitis C was cured. So that’s what motivated me to make this video.
an important role within the community in the fight against hepatitis C. The winning film had to include an aspect of Russel Morris’ song ‘The Real Thing’ and convey important messages such as seeing the real person and not the hepatitis infection, seeing a future free of hepatitis C, and seeing a doctor about treatment options.
‘C the Real Me’ will be used as a community service announcement in the hope of seeing a happy ending to more hepatitis C stories. For more information on the campaign or to watch the winning film, visit www.seetherealthing. com.au. Danella Smith
“I hope it helps other people.” The ‘See the Real Thing’ campaign, launched by Hepatitis Australia in March, invited film makers to create a short film which best raised awareness and had the potential to play
Vladmir Zokic Above: From his award-winning film
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Hepatitis B
Doctors vs Hep B Monitoring patients with hepatitis B is crucial to stop the development of liver cancer
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epatitis B is a diverse illness — both in terms of the ways the disease manifests and the broad range of communities it affects in Australia.
It is estimated that more than 218,000 Australians have chronic hepatitis B — which is about 1% of the population. About 45% of the 100,000 Australians estimated to be living with hepatitis B haven’t even been diagnosed.1
Diagnosis To assess a patient’s hepatitis B status, order HBsAg, antiHBs and anti-HBc to determine susceptibility, immunity through previous vaccination or past infection; or current acute or chronic infection (table 1).6
This results in poor outcomes for those affected, including liver failure and liver cancer, and the risk of ongoing transmission to other susceptible people.
Liver cancer, of which most is caused by viral hepatitis, is the fastest increasing cause of cancer death in Australians.2 Most people diagnosed with liver cancer die within 1-2 years of diagnosis. A significant number die within the first month after diagnosis.3 Prevention of liver cancer, particularly through the effective treatment of people living with viral hepatitis, is an urgent public health priority.
Monitoring Once diagnosed, a person with chronic hepatitis B should be monitored regularly to assess their level of disease activity and to allow consideration of treatment where appropriate. The virus can reactivate after years of immune control; we now know that there is no such thing as a healthy carrier. Factors that influence the frequency of monitoring include:
Although hepatitis serology tests attract a Medicare rebate, to order all three diagnostic tests (HBsAg, anti-HBs, and anti-HBc)
There is increasing evidence that the early detection, followup and monitoring of chronic hepatitis B substantially reduces the risk of poor outcomes. GPs have a central role to play in the process. Testing is simple and covered by Medicare. Australia has recently published the National Hepatitis B Testing Policy, which offers guidance for clinicians regarding testing.4
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simultaneously and to qualify, the requesting doctor should write “? chronic hepatitis B” or something similar on the request slip. If acute HBV is suspected, IgM anti-HBc can also be ordered.
• HEPATITIS SA COMMUNITY NEWS • SEPTEMBER 2013
The phase of chronic hepatitis B (see below). The extent of liver damage. The presence of complicating factors (see below).
Every person with chronic hepatitis B needs to be monitored annually at the very least. This includes clinical review, LFTs and HBV DNA viral load. These are funded by Medicare — once a year for any patient with chronic hepatitis B and four times annually for those on antiviral treatment. Other tests to consider will depend on the phase of infection and the degree of liver disease. Hepatocellular carcinoma surveillance with liver ultrasound +/- serum alpha-fetoprotein should be performed every six months in eligible patients.
When to refer The first-line oral treatments available for chronic hepatitis B (entecavir and tenofovir) are highly effective, extremely well tolerated and associated with very little viral resistance.8 Many liver cancers caused by the virus can be prevented through appropriate antiviral treatment. This is estimated to be one of the most cost-effective cancer prevention interventions that we can undertake.
Despite the fact that antiviral therapy more than halves the risk of developing liver cancer in only a few years, less than 3% of people living with hepatitis B in Australia are currently receiving treatment.9-12 Importantly, at least 15% of all people living with chronic hepatitis B are estimated to require treatment to reduce their risk of progressive liver disease and liver cancer.13
Chronic hepatitis B patients who should receive 6-monthly HCC surveillance:
A patient’s phase of infection determines the need for referral for treatment (see figure 1, over page).
Source: Bruix J, Sherman M.7
In general, look for: • Active viral replication — indicated by elevated hepatitis B viral load. • Active liver damage — indicated by elevated ALT or inflammation on biopsy. • Liver fibrosis — determined by biopsy or non-invasive testing (eg, FibroScan). Any patient with active liver disease or suspected cirrhosis should be referred for specialist assessment and possible therapy.
Who should be offered hepatitis B testing? • People born in intermediate- and high-prevalence countries (offer interpreter) • Aboriginal and Torres Strait Islander peoples • Patients undergoing chemotherapy or immunosuppressive therapy (who are at a risk of reactivation) • Pregnant women • Infants and children born to mothers who have HBV (> 9 months) • People with clinical presentation of liver disease and/or elevated ALT/ alpha fetoprotein (AFP) of unknown aetiology • Health professionals who perform exposure-prone procedures • Partner/household/sexual contacts of people with acute or chronic HBV • People who have ever injected drugs • Men who have sex with men • People with multiple sexual partners • People in custodial settings or who have ever been in custodial settings • People with HIV or hepatitis C • Patients undergoing dialysis • Sex workers Source: ASHM.5
• Those with cirrhosis • Those with a family history of liver cancer • Asian men aged over 40 years; Asian women aged over 50 years • African men and women aged over 20 years
When chronic hepatitis B is complicated by other factors, such as pregnancy or co-infection with HIV, hepatitis C and/or hepatitis D, expert advice should be sought. Also, any patient with hepatitis B undergoing immunosuppressive therapy should immediately be referred for consideration of preemptive treatment to reduce the risk of a flare-up, which in some circumstances can be fatal. Conclusion There are some things every doctor should know about hepatitis B. Knowing who to test, how to test and what to do about the results is essential for GPs. By gaining this core knowledge, and adopting a systematic approach to chronic hepatitis B testing for our patients, we can help address a key driver of liver cancer, the fastest increasing cause of cancer deaths in our community. Dr Ben Cowie Dr Cowie is an infectious diseases physician with the Victorian Infectious Diseases Service at the Royal Melbourne Hospital, and an epidemiologist at the Victorian Infectious Diseases Reference Laboratory. This article was first published in Australian Doctor (2 August 2013) and is reprinted with permission of the author and Australian Doctor. www.australiandoctor.com.au See over for references.
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Figure 1
References 1. MacLachlan JH, et al. The burden of chronic hepatitis B infection in Australia, 2011. Australian and New Zealand Journal of Public Health 2013; online. 2. Nguyen VT, et al. Hepatitis B-related hepatocellular carcinoma: epidemiological characteristics and disease burden. Journal of Viral Hepatitis 2009; 16:453-63. 3. Carville KS, et al. Liver cancer in Victoria, 1982-2007: Epidemiological determinants and secular and geographic trends 2012; online. 4. Australian Government Department of Health and Ageing. National Hepatitis B Testing Policy2012; online. 5. ASHM. Decision-making in HBV 2013; online. 6. Towell V, Cowie B. Hepatitis B serology. Australian Family Physician 2012; 41: 212-14. 7. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53:102022. 8. Zoulim F, Locarnini S. Hepatitis B virus resistance to nucleos(t)side analogues.Gastroenterology 2009; 137:1593-608. 10
9. Kumada T, et al. Effect of nucleos(t)ide analogue therapy on hepatocarcinogenesis in chronic hepatitis B patients: A propensity score analysis. Journal of Hepatology 2012; online. 10. Marcellin P, et al. Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year openlabel follow-up study. Lancet 2013; 381:468-75. 11. Papatheodoridis GV, et al. Incidence of hepatocellular carcinoma in chronic hepatitis B patients receiving nucleos(t)ide therapy: a systematic review. Journal of Hepatology 2010; 53:348-56. 12. Thein H, Dore G. Trends in chronic viral hepatitis: notifications, treatment uptake and advanced disease burden. Cancer Forum 2009; 33:97-105. 13. Robotin M, et al. Using a population-based approach to prevent hepatocellular cancer in New South Wales, Australia: effects on health services utilisation. BMC Health Services Research2010; 10:1-9.
• HEPATITIS SA COMMUNITY NEWS • SEPTEMBER 2013
Additional resources The Australian Society for HIV Medicine (ASHM), together with Cancer Council NSW, have produced a RACGP-accredited hepatitis B online learning module for GPs. Visit www.gplearning.org. au and search for hepatitis B. The ASHM also publishes plenty of useful information about hepatitis B on its website: www.ashm.org.au Cancer Council National GP Portal includes numerous items on liver cancer and hepatitis B. Visit gp.cancer.org.au/online-learning/ B Positive: All you wanted to know about hepatitis B (administered by ASHM and Cancer Council NSW). Visit bit.ly/18kCQeL HepBHelp: an online resource for GPs diagnosing hepatitis B at www. hepbhelp.org.au The Australian Immunisation Handbook, 10th Edition — 4.5 Hepatitis B (pages 208-30). National Cancer Prevention Policy — Liver Cancer at: wiki.cancer.org. au/prevention/Liver_cancer Recent review articles in Australian Family Physician outlining how to test for and manage chronic hepatitis B can be accessed at www.racgp. org.au/afp
Using is no barrier to treatment
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roy has been on hepatitis C treatment for three months, and he is really glad he decided to do it. He had a response within the first month, his blood test result at 12 weeks was excellent, and he is looking forward to a new life free of hepatitis C. It hadn’t always been easy. “I asked about treatment four years ago, and they said they wouldn’t waste $30,000 on someone who was still using,” he said. However, now it’s different. Troy said the fact that he was still using was no barrier to accessing treatment. The treatment staff didn’t give him any hassles around his drug use. “I’m really careful these days—only use my own clean equipment. Back then, three or four of us would share spoons and other gear. “But I’m lucky in a way because I was diagnosed early. I reckon it was about five or six years after I contracted it. Also, I’m a genotype 3, which responds well to pegylatedInterferon and ribavirin. Troy started treatment after much encouragement from his doctor. “I had watched a friend die from liver cancer. That was the extra push I needed to make the decision,” he added.
“At first I was a bit concerned about side effects, but I haven’t had any bad ones... a bit of tiredness, loss of appetite, that’s all.” Troy expects to clear the virus and hopes to build new relationships unencumbered by hepatitis C. “My last relationship broke up because of hep C,” he said. “It shouldn’t be a barrier to personal relationships but, sadly, it happens.” Troy said he’s telling his friends all about his treatment and encouraging them to consider it too. “You may think you’re fine now but wait till you get cirrhosis,” he said. “That’s what may be down the track for you.” Troy said it’s mainly the side effects stopping people from going on treatment. “I would encourage people to think again,” he added.” Treatment may be tough but it’s totally worth it.” Cecilia Lim
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Photo CC Renato Pequito [flickr.com/photos/kyanos_aum]
Troy’s Treatment
Cover Story
The Dark Side of Bali How to ruin your life with a holiday
Danella Smith
W
ith an estimated 800,000 Australians travelling to Bali in 2012, it seems to be a hot tourist destination that Aussies cannot get enough of. Enjoying a cocktail by the pool, beach walks and cheap shopping—it is always going to be a holiday of choice.
Unfortunately, Bali is not always as desirable as it seems, and there are serious precautions which should be taken to avoid contracting an infectious disease. In particular, hepatitis A, B and C are ongoing concerns, and Australians need to be mindful of that before booking their holiday. This is especially true now that getting a tattoo has become a normal part of the trip for younger Australians. 22-year-old Joshua D’antuoni travelled to Bali in June for his sister’s wedding, and stressed that although it is a beautiful spot “you just have to be so careful”. A major concern for Joshua was the risks associated with tattoo parlours. Joshua said, “I was going to get a tattoo when I was in Bali, and I checked out a few parlours to see who would give me the best price and whatnot. “However, I pretty quickly realised I was uncomfortable with the idea just by judging the cleanliness of the parlours—they’re certainly a lot different to Australian ones. “I ended up not getting a tattoo, and decided I would just get one back home where I knew appropriate safety measures would be in place.” Hepatitis B and C are spread through blood-to-blood contact, and can damage your liver and potentially lead to cirrhosis and cancer.
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Although many tattoo parlours are hygienic and follow proper safety precautions, there is always a risk of contracting a blood-borne virus such as hepatitis B or C when getting a tattoo; Bali does not follow strict rules surrounding the matter. It is important you do your research and feel comfortable with the tattoo parlour before making the final decision. Another concern for travellers is the risks of contracting hepatitis A, which can be contracted through contaminated food and water. It is unsafe to drink water tap water in Bali, and accidently drinking the shower water or brushing your teeth with tap water should be avoided. Bali warungs are small restaurants where the locals eat traditional Indonesian food, which tourists often want to experience
Photo CC Tom Hodgkinson [flickr.com/photos/hodgers]
Right: What not to do when getting a tattoo Below: A row of warungs and other shops Opposite: A Balinese tattoo parlour taking appropriate precautions while on holidays. However, the locals generally wash their ingredients in contaminated water, and do not always practice hygienic methods for storing food and cleaning utensils and plates.
just have to make sure you don’t eat or drink in those areas.” Before travelling to Bali, ensure you are vaccinated against hepatitis A and B, and aware of the safety precautions you will need to take.
Although hepatitis A is a shortterm virus, it can make you very sick with vomiting, fever and fatigue for around 30 days.
For more information of vaccinations, please visit Hepatitis SA’s website at www.hepsa.asn.au. Danella Smith
Safety precautions summarised: • Always purchase bottled water to avoid drinking contaminated water.
21-year-old Lauren Willgoose visited Bali in May for a holiday with friends, and said she was very cautious with food and drink as she was aware of the consequences.
• If you are going to drink ice, ask the waiter if it is safe for tourists to drink (some restaurants create their own ice out of contaminated water and others purchase ice which is made from bottled water).
Lauren said, “We would always leave a restaurant if we felt uncomfortable and the cleanliness wasn’t up to standards.
• Pay close attention to the cleanliness of a restaurant, and if you are not happy with it then leave straight away—there are plenty of other restaurants to choose from!
“It is just not worth the risk.”
• If you wish to get a tattoo, pay close attention to the cleanliness of the parlour and if you are not happy either choose another parlour or pay the extra money to get one done back home.
“There are many areas in Bali that are very dirty and unhygienic—you
• If you choose to get the tattoo done in Bali, ask the tattoo artist before they begin what precautions they take in their store regarding cleanliness and safety. If your questions cannot be answered, choose another parlour. • Make sure the needle has been taken out of its packaging in front of you and is only for single use. • Make sure needles are disposed of appropriately, such as in a biohazard-labelled container.
Danella Smith
• Make sure your tattoo artist is wearing gloves at all times while tattooing, and that they wash their hands when swapping gloves. • Ultimately, use your instinct. If you feel you’re in an unhygienic and dirty environment, it is best to move on regardless of what you are doing there.
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Working with Communities
Viêm gan B—Bạn có thể có nó và không biết A Vietnamese HBV Testing Resource
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he Vietnamese people of SA are one of the most important groups to reach with hepatitis education, because of the high prevalence of hepatitis B. Hepatitis SA and the PEACE Multicultural Service recently formed a partnership, in consultation with the Vietnamese Women’s Association, to develop a resource that would encourage the Vietnamese community to make use of testing, vaccination and treatment for hepatitis B. The lack of appropriate HBV resources in Vietnamese was identified in the National Hepatitis B Strategy 2010-2013, and anecdotally through the services working with Vietnamese communities in this state. The high prevalence of HBV in the Vietnamese community is largely due to vertical transmission, where 90% of people infected at birth go on to have lifelong chronic HBV, with the risk of developing fibrosis, cirrhosis, liver cancer or liver failure. The goal of this project was to develop a poster which provided information about HBV testing in Vietnamese so that Vietnamese community members would be prompted to request HBV testing from their GPs, and to lead people to appropriate medical care to prevent ongoing health issues related to chronic HBV. The poster was launched at the Vietnamese Catholic Community
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Church in June. The community event included a basic HBV education session followed by a barbeque lunch. The event was attended by 70 Vietnamese community members, and the church provided an interpreter. The church is also prominently displaying the posters to the large numbers of Vietnamese people who make attend their services and community events. Feedback from a PEACE worker demonstrates the response to the poster campaign: “I just got a call from a worker, who is part of the Vietnamese community [in the northern suburbs], and she has caught wind of our campaign through her mother [who attended an information session]. She told me that everyone in the community is now talking about it and passing around the Vietnamese posters. She also indicated that her mother spoke to her about the importance of booking a doctor’s appointment and getting tested; this was something she had never thought about recently and is booking herself in this week!” Beyond the launch, four popular Vietnamese Restaurants have agreed to display the posters on the back of their toilet cubicle doors in order to promote awareness of HBV testing. The posters will also be distributed elsewhere by both PEACE and Hepatitis SA. Elaine Lloyd & James Morrison
What’s On Hepatitis C peer educators available to provide information and support to clients at the following services:
Affected by hepatitis C?
• Information and support in a conidential, friendly environment • Speak to others who have had treatment • Partners, family and friends welcome
Now meeting at HACKNEY and ELIZABETH Meet us fortnightly on Tuesdays, 12.30pm-2.30pm at Hepatitis SA, 3 Hackney Rd, Hackney Live in the Northern Suburbs? Can’t make it to Hackney? Come to
CALMING the C in the NORTH Every fourth Friday of the month 1–3 PM Room C20, GP Plus Elizabeth 16 Playford Blvd, Elizabeth light lunch provided
For information, phone 8362 8443
2013 Dates Tuesday, 8 January
Tuesday, 22 January
Tuesday, 23 July Tuesday, 6 August
Tuesday, 5 February Tuesday, 19 February
Tuesday, 9 July
Tuesday, 5 March Tuesday, 19 March
Tuesday, 3 September Tuesday, 17 September
Tuesday, 2 April Tuesday, 16 April Tuesday, 30 April
Tuesday, 1 October Tuesday, 15 October Tuesday, 29 October
Tuesday, 14 May Tuesday, 28 May
Tuesday, 12 November Tuesday, 26 November
Tuesday, 11 June Tuesday, 25 June
Tuesday, 10 December
Tuesday, 20 August
CALMING THE C IN THE NORTH Friday, 25 January
Friday, 28 June
Friday, 22 February
Friday, July 26
Friday, 22 March
Friday, August 23
Friday, 26 April
Friday, September 27
Friday, 24 May
Friday, October 25
Photo © S.Allen
Photo © S.Allen
Warinilla Outpatients Hepatitis C Treatment Clinic 92 Osmond Tce, Norwood Tuesdays fortnightly 2–5pm Upcoming dates: Sep: 10 & 24 Oct: 8 & 22 Nov: 5 & 9 Dec: 3 & 17 Southern DASSA 82 Beach Rd, Christies Beach Monday monthly 9am–12pm Upcoming dates: Sep: 16 Oct: 14 Nov: 11 Northern DASSA 22 Langford Dr, Elizabeth Thursday fortnighty 10am–12pm Upcoming dates: Sep: 5 & 19 Oct: 17 & 31 Nov: 14 & 28 Dec: 12 Byron Place (New Roads Program) 61 - 67 Byron Pl, Hindmarsh Wednesday weekly 9am–12pm Hutt Street Centre 258 Hutt St, Adelaide Wednesday Weekly 9am–12pm
Hepatitis SA AGM 3pm, Thurs 21 November SACOSS, 47 King William Rd, Unley Ring 8362 8443 for more info Tax Help @ Women’s Information Service A network of community volunteers provide a free and confidential service to assist women earning around $50,000 or less a year complete their tax returns. Volunteers are fully trained, accredited and supported by the Australian Taxation Office. To make an appointment, call 8303 0590 Appointments on Mon and Fri mornings until the end of October Women’s Information Service Chesser House 91-97 Grenfell St, Adelaide Seniors on Screen at the Mercury Cinema A film club for the over-50s, the Mercury’s Seniors on Screen calendar regularly sees packed-out foyers, full of tea-swilling, biscuit dunking adults. For a film, you’ll nary find a better way to spend a couple of hours each Friday from April to December. Friday @ 11am Mercury Cinema, 13 Morphett St, Adelaide $6 tickets Program: mercurycinema.org. au/wp-content/uploads/SOS_ Season2_2013_online.pdf
Now That’s a Good Question! Hepatitis SA workers get asked all sorts of questions about hepatitis. Here’s one of them... Q: I share my drug-injecting equipment with my relatives, because we can’t give each other hep C since we have the same blood. Is that OK? A: No! No-one has a natural sterile filters, tourniquets, immunity to hepatitis C. swabs, spoons, surfaces, Being related does not make and water. Remember any difference. Sharing any to wash your hands and drug-injecting equipment mix up on clean surfaces. is always extremely risky. Insist on only using sterile Make sure you always use equipment.
SEPTEMBER 2013 • HEPATITIS SA COMMUNITY NEWS •
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Treatment Futures
Livers in the Lab Lab-grown liver cells are a step closer to treating liver disease
T
he liver is a special organ. Mature liver cells—or hepatocytes—have the capacity to continually divide and repair damage. But only so far. Excessive drinking and chronic liver disease, for example, can lead to irreparable damage and the need for a transplant. Unlike some other cells, replicating how liver cells grow in a lab is incredibly difficult. Now researchers at the Massachusetts Institute of Technology (MIT) say they have found a dozen chemical compounds that help liver cells maintain their function outside the body. Not only that, but the cells are able to multiply and produce new tissue. Dr Sangeeta Bhatia, Director of the Laboratory for Multiscale Regenerative Technologies at MIT, said their findings could mean “off-the-shelf” livers that can be transplanted rather than relying on a transplant from an organ donor. It’s early days, but researchers say their work paves the way for artificially engineered tissue, which could help treat many people suffering chronic liver diseases such as hepatitis C. Liver tissue engineering, compared to other organ tissue engineering, is difficult. “It’s a paradox because we know liver cells are capable of growing, but somehow we can’t get them to grow,” Bhatia said. “The liver has many specialised functions that are vital for life; virtually all of these are lost rapidly
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when liver cells are isolated from the body – including their ability to replicate.” They start to deteriorate straight away, she said, but most noticeably after a few days. However, the MIT team, including MIT graduate Jing Shan and researchers from the Broad Institute, Harvard Medical School and Wisconsin University, were able to grow liver cells by identifying and using a dozen chemical compounds that help liver cells to continue to function. Bhatia had previously managed to prolong liver cell function, albeit temporarily, by mixing liver cells “like liver polka dots” with fibroblast cells from mice – a type of stem cell and the most common cells found in connective tissues in animals – to stabilise them. The researchers then simplified this system, instead arranging cells “like a layer cake”. While the cells still don’t live for too long, they did so long enough for the researchers to discover chemical compounds that drive replication. The team tested how 12,500 different chemicals affected cell growth and function and found some 12 compounds which helped the liver cells to maintain function and grow tissue. Last year, Japanese scientists said they had induced stem cells to create a liver-like tissue in a dish by reprogramming human skin cells. After nine days, the team produced a biochemical marker contained in the mature liver cells.
• HEPATITIS SA COMMUNITY NEWS • SEPTEMBER 2013
But the MIT team’s work goes further in maintaining existing hepatocytes and the team now plans to embed treated liver cells in mice using specially created “scaffolds” to see whether they can create replacement liver tissues. They say they are also exploring the possibility of developing the chemical compounds into drugs that could be used in people to regenerate damaged human liver tissue. Bhatia said their work offered a way to solve “two of the longstanding challenges in liver tissue engineering: growing a large supply of liver cells outside the body and getting the tissues to graft to the transplant recipient.” “An immediate application would be in drug testing,” Professor Philip Newsome, Clinical Director
Call Us! of the Birmingham University Stem Cell Centre said. “Many drugs fail to enter clinical practice because of unwanted interaction with the liver. If these drugs could be tested on functioning liver cells it would be a great advantage.” Another application could be in cell infusions, where functioning cells are harvested – currently from a donor – are introduced into another patient. Though not everyone supports this approach, Newsome says infusions can be a way of treating those who can’t undergo liver transplants or in children, for example. “Most people have cirrhosis, where the liver is damaged over many years and in time builds
scar tissue,” Newsome said. “With cirrhosis and more advanced liver damage, you can get improvement but it’s unlikely a liver will completely recover.” He said the MIT research has great potential, but creating whole organs could still be “a little way off”.
For free, confidential information and support on viral hepatitis call:
1300 437 222
CNP Hepatitis SA
Jo Adetunji Editor, Health & Medicine, The Conversation Originally published at The Conversation (theconversation. com/lab-grown-liver-cells-area-step-closer-to-treating-liverdisease-14914) and reprinted with permission.
Monday - Friday 9am - 5pm Full range of syringes and needles. Water and filters also available for sale.
SEPTEMBER 2013 • HEPATITIS SA COMMUNITY NEWS •
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In Our Library Review Making Art With Communities: A Work Guide Published by Arts Victoria, VicHealth and Castanet. 14/06/2013 Call No: 5.7 Vic 29
This is a beautifully illustrated step-by-step manual for people embarking on community arts projects. The book is divided into nine sections: • Arts in the Community • Working with Communities • Working with Artists • Developing the Project Concept • Managing the Project • Managing People • Managing Budgets and Resources • Managing Events • Completing the Project The first eight sections are illustrated with inspiring examples and pictures. Each of these sections is capped off with a list of links and resources. The sections take you through the theory and philosophy behind community arts, including a brief history, to practical considerations in working with communities, artists and organisations.
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We are reminded of the importance of respecting and acknowledging participants, and provided with tips on where to look for an artist and how to choose one, including a small section on payments. The handbook also outlines the process of developing project concepts as well as managing the project. Practical issues like health and safety, risk management and evaluation are discussed. Managing People discusses contracts, letters of agreement, conflict resolution and permissions such as working with children and model releases. There is a practical guide on understanding terms and concepts relating to financial matters in the Managing Budgets and Resources section. There are tips on identifying income sources and how to prepare a budget. If you want to finish your project with a bang, the Managing Events section takes you through the nitty gritties of planning, licenses and getting an audience. The final section, Completing the Project, emphasises celebration and appreciation—creating a happy ending—but also touched on the need for evaluation, documentation, reporting and financial acquittal. All in all, this is an excellent guide for community workers thinking of starting a arts project. This handbook is available from the Hepatitis SA library in printed form or online at www.bit.ly/art_ communities.
• HEPATITIS SA COMMUNITY NEWS • SEPTEMBER 2013
New Library Quick Search for online resources We’ve recently added a new ‘Quick search’ feature on the library catalogue search page: you can now click on any of the subject headings (listed on the right hand side of the page) and go straight to a list of all resources for that topic. All of these resources can then be accessed online via the link in that item’s record.
Recent Acquisitions Healthy plant based cooking Di Cornelius, Cancer Care Centre, Adelaide 2013 On the shelf: 4.1 CAN 41
Practical Infection Control N & D Cimolai, Populus Productions and Publications, BC Canada, 2012 On the shelf: 2.4 CIM 25 Family Focus: Talking together about parental depression and anxiety (DVD) COPMI Project, AICAFMHA, Adelaide, 2013 On the shelf: 4.3 AV 7
Jail Birds: Voices from the inside (DVD) Jonathon Welch, ABC DVD, Sydney, 2009 On the shelf: 5.7 AV 4
Hepatitis C Treatment for Injecting Drug Users European Monitoring Centre for Drugs and Drug Addiction, Lisbon, 2013 On the shelf: 2.1 EMC 142 Addressing Hepatitis C in Prisons and Other Places of Detention Hepatitis C Trust, London, 2013 On the shelf: 7.3 HCT 34 Diet and Liver Disease, British Liver Trust, London, 2011 On the shelf: 4.1 BLT 40 Hep B: Diagnosis and management of chronic hep b in children, young people and adults NICE, London, 2013 On the shelf: 1.0 NIC 2
News
Useful Services & Contacts Hepatitis SA Free education sessions, printed information, telephone information and support’, referrals, clean needle program and library. (08) 8362 8443 admin@hepatitissa.asn.au www.hepsa.asn.au Hepatitis SA Helpline
1300 437 222 (cost ofa local call)
Adelaide Dental Hospital A specially funded clinic provides priority dental care for people with hepatitis C with a Health Care Card. Call Hepatitis SA on 1300 437 222 for a referral. AIDS Council SA ACSA has closed down. See p3 of this issue for details and replacement service contact details. beyondblue Mental health information line 1300 224 636 www.beyondlbue.org.au Clean Needle Programs in SA For locations call the Alcohol and Drug Information Service. 1300 131 340
headspace Mental health issues are common. Find information, support & help at your lcoal headspace centre
P.E.A.C.E. HIV and hepatitis education and support for people from non-English speaking backgrounds.
1800 650 890 www.headspace.org.au
(08) 8245 8100
Lifeline National, 24 hour telephone counselling service.
Positive Life Services and support for HIV positive people – including treatments information and peer activities.
13 11 14 (cost of a local call) www.lifeline.org.au
(08) 8293 3700 www.hivsa.org.au
Mental Health Crisis Service 24 hour information and crisis line available to all rural, remote and metropolitan callers.
SA Sex Industry Network Promotes the health, rights and wellbeing of sex workers.
13 14 65
(08) 8351 7626
MOSAIC Counselling service For anyone whose life is affected by hepatitis.
SAVIVE Clean needle program and peerbased support information and education for people who use drugs.
(08) 8223 4566
(08) 8334 1699
Nunkuwarrin Yunti A city-based Aboriginal-controlled health service with clean needle program and liver clinic.
The Second Story Free, confidential health service for youth aged 12 to 25.
(08) 8406 1600
Youth Helpline: 1300 13 17 19 Parent Helpline: 1300 364 100
Hepatitis C Community nurses Care and assistance, education, streamline referrals, patient support, monitoring and follow-ups. Clients can self-refer. Contact nurses directly for appointment.
Community Access & Services SA (a service of the Vietnamese Community in Australia, SA Chapter) Alcohol and drug education; clean needle program for the Vietnamese and other communities.
Central & North:
(08) 8447 8821
Rosalie - 0466 777 876 rosalie.altus@fmc.sa.gov.au Emma - 0466 777 873
Margery - 0423 782 415 margery.milner@health.sa.gov.au Debbie - 0401 717 971 deborah.perks@health.sa.gov.au Jeff - 0401 717 953 jeffrey.stewart@health.sa. gov.au Trish - 0413 285 476 South:
Are you interested in volunteering with Hepatitis SA? Give us a call on 08 8362 8443 or drop us a line at admin@hepatitissa.asn.au. We rely on volunteers for many of our vital services. SEPTEMBER 2013 • HEPATITIS SA COMMUNITY NEWS •
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• HEPATITIS SA COMMUNITY NEWS • SEPTEMBER 2013