The Magazine of Hepatitis Victoria
September 2016
Good Liver
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Countdown to elimination
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2030
Viral hepatitis
StreetShot 2016 This year Hepatitis Victoria expanded the StreetShot competition to include a video category. Eight video and 39 photographic submissions were recieved in total. Nine winning entries are revealed in this issue.
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Victoria’s new hepatitis B and hepatitis C strategies The Victorian hepatitis B and hepatitis C Strategies for 2016 to 2020 were launched on World Hepatitis Day, 28 July, 2016
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Ensuring access for all For hepatitis C elimination to become a reality access to the new Direct-Acting Antiviral (DAA) treatments is needed. We interviewed hepatitis treatment support specialist, Cheryl Lim.
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Staff
Contents
Contact and postal address:
Melissa Wright
Hepatitis Victoria
Health Promotion Officer Telephone: 9385 9104 melissa@hepvic.org.au
Suite 5, 200 Sydney Road, Brunswick, Victoria 3056. Telephone: (03) 9380 4644 Facsimile: (03) 9380 4688 Email: admin@hepvic.org.au Website: www.hepvic.org.au
HepatitisInfoline
1800 703 003
Shwetha Shankar Health Promotion Officer Telephone: 9385 9108 shwetha@hepvic.org.au
Kaz Cochrane Development Coordinator Telephone: 9385 9118 kaz@hepvic.org.au
Lien Tran Hepatitis B Community Education Project Officer Telephone: 9385 9123 lien@hepvic.org.au
Carolyn Mogharbel
Melanie Eagle CEO
Telephone: 9385 9102 melanie@hepvic.org.au
Garry Irving Programs and Operations Manager Telephone: 9385 9109 garryi@hepvic.org.au
Martin Forrest Health Promotion Program Manager Telephone: 9385 9111 martin@hepvic.org.au
Damian Salt Office Coordinator Telephone: 9380 4644 admin@hepvic.org.au
Jawid Sayed Health Promotion Project Officer Telephone: 9385 9121 jawid@hepvic.org.au
Tuan Nguyen Health Promotion Project Officer Telephone: 9385 9105 tuan@hepvic.org.au
Health Promotion Officer Telephone: 9385 9112 carolyn@hepvic.org.au
Shaun Knott Digital and Online Services Officer Telephone: 9385 9106 shaun@hepvic.org.au
Reece Lamshed HEPReady Business Development Manager Telephone: 9385 9116 reece@hepvic.org.au
Karen Greening HEPReady Project Officer Telephone: 9385 9117 karen@hepvic.org.au
Sione Crawford Health Promotion Officer Telephone: 9385 9110 sione@hepvic.org.au
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Communiqué
From the desk of the Chief Executive Officer
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De-livering the news
News, reports and papers
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StreetShot 2016
Nine winning entries are revealed
in this issue.
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Victoria’s new hepatitis B and hepatitis C strategies
10 Progress on hepatitis C treatment 11 Viral hepatitis elimination by 2030 12 Prevention:
13 14 16 18 19 20 21
It still has a part to play in the drive to eliminate hepatitis C
Personal story: Lien’s story Ensuring access for all 2016 hepatitis facts and stats Personal story: Moira’s story Introducing our newest Hep Heroes
A guide to healthy living Minestrone soup
A liver loving recipe to enjoy!
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Liver clinics Contacts
Kate Sievert Community Participation Officer Telephone: 9385 9114 kate@hepvic.org.au
Aurora Tang Community Education and Engagement Manager Telephone: 9385 9103 aurora@hepvic.org.au
Good Liver is produced by Hepatitis Victoria, with support from the Victorian Government. The opinions and language expressed in this magazine are not necessarily those of Hepatitis Victoria or the Department of Health and Human Services.
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Reader response Your comments or experiences in regard to any articles in Good Liver are welcome. Email: admin@hepvic.org.au
Graphic Design: Swivel Design 0435 733 206
Communique
From the desk of the Chief Executive Officer
While we’ve made great progress in recent times, there is still a lot of work to be done – especially in getting more people talking about viral hepatitis, and breaking down the stigma that surrounds it. T
he viral hepatitis landscape of today is very different to that a decade ago, and even last year. The new, highly successful treatments for hepatitis C (HCV) are now available in Australia through the Pharmaceutical Benefits Scheme (PBS). These treatments have the potential, not only to cure individuals of hepatitis C and therefore change lives in a very immediate sense, but to eradicate HCV entirely in our community. And while there is still no cure available for hepatitis B, anti-viral treatments can prevent progression to cirrhosis and liver cancer.
to 2020 at our StreetShot launch on World
Like all conditions, we need to look beyond
Hepatitis Day, 28 July, 2016.
how the condition was acquired, and
The strategies provide a road map for
instead ask, what can we do about it?
eliminating the burden of viral hepatitis
If we don’t, we’re never going to encourage
in Victoria through prevention initiatives,
people to get tested and treated, and
more testing and treatment, and reducing
we’ll never achieve the World Health
the stigma and discrimination associated
Organisation’s goal of eradicating viral
with the disease. The vision will see people
hepatitis by 2030.
living with hepatitis, clinicians, researchers, community and peer workers come together to achieve ambitious targets, and end new transmissions and unnecessary deaths from hepatitis B and hepatitis C. But while we’ve made great progress in recent times, there is still a lot of work to be done – especially in getting more people
The State Government launched the Victorian
talking about viral hepatitis, and breaking
hepatitis B and hepatitis C strategies for 2016
down the stigma that surrounds it.
This issue of Good Liver includes a range of articles and interviews that consider what else needs to happen – beyond treatment – in order to achieve our 2030 goal. Happy reading!
Melanie Eagle CEO, Hepatitis Victoria
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De-Livering the news Some frequently asked questions
PBAC recommends interferon-free regimen for HCV genotypes 4 and 6
Reports and papers
PBAC recommended that the combination of grazoprevir + elbasvir
Forthcoming Launch of the Third National Hepatitis B Mapping Project 2014-15
(ZepatierÂŽ) be listed on the PBS. It was also recommended as a
The Second National Hepatitis B Mapping Project 2013-14 reported
further treatment option for people with genotype 1. Merck Sharpe
that only 14% of people with chronic hepatitis B (CHB) received
and Dohme, who produce the medicine, also sought PBS listing
appropriate monitoring for their condition. CHB is estimated to affect
for genotype 3 but PBAC considered there was insufficient data to
approximately 220,000 Australians, however less than 50% have
The Pharmaceutical Benefits Advisory Committee (PBAC) has agreed there is a need for interferon-free treatment regimens for people with hepatitis C – genotypes 4 and 6. At its July 2016 meeting
support use with genotype 3 at this time.
been diagnosed. The third National Hepatitis B Mapping Project
Once approved by the Health Minister, this new medicine will join
Report to be launched later this year can be used to monitor the
the other antiviral medicines for hepatitis C that started becoming
impact of initiatives to increase treatment uptake and appropriate
available in March this year.
care for people with CHB.
Indigenous hep C intervention program to be rolled out in NSW A successful hepatitis C intervention program in Western Sydney will be rolled out across New South Wales thanks to a substantial NHMRC partnership project grant.
University of New South Wales), the South Australian Health and
Factors associated with regular medication taking in the treatment of hepatitis B
Medical Research Institute, with the NSW Ministry of Health and a
A recent study (the largest undertaken to date in Australia) of regular
The research collaboration, bringing together the Kirby Institute and the Centre for Social Research in Health, (both based at the
number of Local Health Districts, will implement the proven approach to increasing participation in testing for blood-borne viruses and STIs among Indigenous communities. https://kirby.unsw.edu.au/‌/deadly-liver-mob-goes-state-wide
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medication taking for oral treatments (tablets) for hepatitis B has provided important information on the factors contributing to patients not taking medicine. Understanding the factors is important to inform efforts to promote medication taking and to prevent illness.
The study looked at approximately 10% of all people receiving
For those who have liver damage or liver inflammation, treatment
antiviral treatment for chronic hepatitis B (CHB) in Australia during
is effective and reduces the risk of developing liver complications
the time period, and presented detailed background information
including cancer, but has to be taken for many years, so
of public hospital patients accessing treatment for hepatitis B.
understanding how we can support people to take their medication
Issues highlighted in the study included:
•
People who have many changes in doctors are less likely
The full article by N.Allard, A.Dev, J.Dwyer, G.Srivatsa, A.Thompson and B.Cowie was produced in the Journal of Viral Hepatitis
to take their medication regularly (previous studies have
(9 August, 2016) and can be accessed at:
shown that those people who see many different doctors
http://onlinelibrary.wiley.com/doi/10.1111/jvh.12582/full
throughout treatment also have poorer knowledge of the condition and its management).
• •
is important.
Or on request: Nicole.Allard@mh.org.au
Younger people are less likely to take medication regularly. The diversity of population receiving treatment in Australia was highlighted with more than 38 languages/60 countries of origin identified in just over 1000 individuals.
•
There were few Aboriginal Victorians on treatment in major centres.
The local and global burden of hepatitis B-related illness continues to increase, and liver cancer due to chronic viral hepatitis (which includes hepatitis B and hepatitis C) is the fastest growing cause of cancer-related death in Australia. For people living with hepatitis B only about a quarter need to take regular treatment and the rest need yearly testing and monitoring.
Join the HEPSpeak family! HEPSpeakers raise awareness about hepatitis B and hepatitis C and also help dispel myths, and reduce stigma and discrimination for those living with viral hepatitis. As a HEPSpeaker you’ll gain presentation skills to present to diverse audiences, including delivering key messages and calls to action around prevention and management of hepatitis B and hepatitis C.
What are the benefits of becoming a HEPSpeaker?
• Connect and meet other speakers and peers. • Help raise awareness about the issues of living with viral hepatitis. • Receive free training on presentation skills and storytelling. • Increase your confidence. • Practice your public speaking skills. What the HEPSpeakers are saying....
“I always experience a sense of achievement and self-worth after each presentation.” “I felt empowered during and after the speech and people approach me to show their appreciation”
For more information contact us on ph: (03) 9380 4644 or kate@hepvic.org.au Register to become a HEPSpeaker today
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2016 S
treetShot is an annual competition run by Hepatitis Victoria. It aims to increase awareness among young people about viral hepatitis through showcasing their peers’ creative interpretations of the fear and dangers of viral hepatitis. The creative works are displayed in an annual exhibition, and prizes are awarded to the most outstanding entries.
StreetShot is traditionally held on World Hepatitis Day – which is one of only eight designated health days endorsed by the World Health Organisation. Congratulations to the winners of StreetShot 2016! This year we expanded StreetShot competition to include a video category. We received 39
photographic and eight video submissions in total. The entries were very relevant and of a high calibre which made judging challenging. As you will see from the following list of winners (and indeed all the entries which can be viewed at: www.streetshot.org.au), the entries clearly highlighted the range of issues that accompany viral hepatitis and delivered excellent messages. Given that the video category was a new addition to our annual program, we were delighted with the response and are looking forward to continued engagement and participation among young people in 2017.
VIDEOS 1st place
Good choice, bad choice School: Upper Yarra Secondary College Group: Clair McDonald-Brown,
Holly Debono, Tara Matabele and Kealey Truscott
2nd place
Life goes on
School: Bendigo TAFE, BTEC Group: Rebecca Harris, Nuala Moore, Jessica Gillard
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People’s Choice Award Hep C don’t have me School: Upper Yarra Secondary College Individual: Cody Broadway
GROUP ENTRIES 2nd place Hep C can’t always be seen! School: Bendigo TAFE,
BTEC Group: Lissa West,
Isabella Richardson, Ulysses Koukouzas
People’s Choice Award Darkness School: SHARC Group: Brooke Finkel, Jaycob Grieve,
Krystal May, Ruby Stansfield
1st place
60%
School: Upper Yarra Secondary College Group: Holly Debono, Tara Matalele, Claire McDonald-Brow, Kealey Truscott
INDIVIDUAL ENTRIES 2nd place Priceless School: Upper Yarra
Secondary College Individual: Cody Broadway
People’s Choice Award
1st place
The follower
School: Upper Yarra Secondary College Individual: Rachel Tonkin
Dimicatio mea School: SHARC Individual: Joel Winder
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Victoria’s new hepatitis B and hepatitis C strategies
Increasing testing and treatment, and eliminating the stigma and discrimination
T
he Parliamentary Secretary for Health,
They set four ambitious targets including:
The Victorian hepatitis B Strategy 2016-2020
Mary-Anne Thomas launched the
• Reducing to zero levels of stigma and
will ensure efforts are focussed to improve
Victorian hepatitis B and hepatitis C Strategies for 2016 to 2020 at the StreetShot launch on World Hepatitis Day, 28 July, 2016. The Strategies reflect the Victorian Government’s commitment to decreasing the public health burden in Victoria; increasing testing and treatment rates for the conditions; and eliminating the stigma and discrimination that can be experienced by people living with viral hepatitis. The Victorian hepatitis B Strategy is a first for the state, while the hepatitis C Strategy is the first since 2009, and since the introduction of revolutionary new treatments for hepatitis C in early 2016.
discrimination experienced by people living with viral hepatitis.
adult vaccine and treatment uptake so no one needs to contract or die from the disease.
• Reducing by 90% the number of new hepatitis cases.
• Diagnosing 90% of all people living with chronic hepatitis B or hepatitis C
• Providing care and treatment to 90% of all people living with chronic hepatitis B or hepatitis C. Viral hepatitis is still a largely misunderstood condition. There is a low rate of awareness among certain groups of how to prevent transmission, or the importance of treatment. The Strategies reinforce that in key workforces, such as general practice,
The following is a summary overview of the
understanding who is at risk of being infected,
Government’s frequently asked questions
and the importance of screening and treating
on the Strategies. Full details are available
viral hepatitis must be increased.
on the Victorian government website: health.
They acknowledge that people living with
vic.gov.au/public-health/preventive-health/
viral hepatitis can also be subjected to stigma
sexual-health-and-viral-hepatitis/policy-and-
and discrimination because of their condition.
legislation-sexual-health.
This includes within communities as well as within the health system. These experiences can discourage people from engaging in prevention Strategies, or seeking appropriate care, treatment and support for their condition.
Target outcomes for people at risk of or living with hepatitis B
Target outcomes for people at risk of or living with hepatitis C Since the expiry of the last Strategy in 2009, there have been exceptional advances in the prevention and treatment of hepatitis C, which
By 2030, eliminate hepatitis B as a public
are giving new hope to people affected by the
health concern and eliminate stigma and
disease. In fact the treatments are so effective
discrimination associated with the disease.
that they are known as “the cure drugs”.
Affected communities, clinicians, researchers,
The Victorian hepatitis C Strategy 2016-
and community and peer workers will need
2020 will work to ensure people living with
to come together to make the reduction and
hepatitis C receive cure treatments as quickly
treatment targets achievable, if we are to end
as possible, and that those with complex
new transmissions and unnecessary deaths
needs are accessing treatment at the same
from chronic hepatitis B.
rate – so no one is left behind. At the same
Early detection and treatment are vital: once
time the Strategy will guide efforts to limit
hepatitis B develops into a chronic condition it
new infections in those who have completed
The Strategies are a roadmap for eliminating
cannot be cured, and can lead to liver damage
treatment.
the burden of viral hepatitis in Victoria
and liver cancer.
The Victorian hepatitis C Strategy 2016-
between now and 2030 through prevention
Hepatitis B is now a preventable disease. With
2020 will ensure that primary prevention is
initiatives, more testing and treatment,
the prevention and treatment tools available
strengthened in at risk communities, including
and reducing stigma and discrimination
to us, we can fundamentally change the
continuing harm reduction activities and
of the disease.
course of this disease in Victoria.
access to clean injecting equipment.
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Target outcomes for the Victorian health workforce The Strategies will ensure that knowledge of viral hepatitis diagnosis, treatment and management among primary healthcare
C deserve to live longer, healthier lives, free
hepatitis B, partners or household contacts
from stigma and discrimination.
of people living with hepatitis B, people
Stigma is also a very real obstacle to prevention, testing and treatment. People must be able to feel safe and supported in getting tested, receiving treatment and
professionals is high.
accessing the care they need.
The Victorian Government will work to build
These Strategies reinforce the Victorian
the capacity of healthcare professionals to deliver appropriate and evidence-based care and to meet the needs of priority populations
Government’s commitment to eliminate the stigma and discrimination experienced by people living with hepatitis B and hepatitis C
from culturally and linguistically diverse backgrounds, particularly people with an AsiaPacific or sub-Saharan African background, sex workers, prisoners, people living with HIV, and people who are immunosuppressed. The Strategies are also aimed at people who deliver services and support for people living with, or at risk of contracting, viral hepatitis. This includes general practitioners; practice nurses; allied health providers;
to achieve the bold targets in the Strategies.
in Victoria.
The Strategies will guide workforce efforts to
The Government will tackle stigma and
services; multicultural health services; workers
discrimination by ensuring the participation,
in the Alcohol and Other Drugs sector;
engagement and experiences of affected
prison services; community organisations;
individuals and communities are core to our
and, tertiary hospital providers, including
prevention, treatment and care approaches.
hepatology, infectious diseases and
assist health professionals to understand the impact of stigma and discrimination on people living with hepatitis B and hepatitis C and eliminate it in their practice. The Victorian Government aims to increase clinicians to test, treat, monitor and manage
How were the Strategies developed?
the health and care needs of people living
In 2014 and 2015, the Department of Health
with hepatitis B and hepatitis C.
and Human Services hosted sector-wide
training and clinical support for primary care
The Strategies will work to ensure that community and primary health workforces and settings are accessible and inclusive of people with viral hepatitis.
immunisation services; Aboriginal health
gastroenterology services.
consultations to identify key priorities for viral hepatitis in Victoria. Representation at these consultations included people living with viral hepatitis, clinicians, researchers, policy makers and community organisations. Organisations that contributed to the development of the Strategies include Hepatitis Victoria, Harm Reduction Victoria, the Multicultural Health and Support Service, Living Positive Victoria, the Victorian AIDS Council, the Doherty Institute, cohealth, Cancer Council Victoria, the Victorian Aboriginal Community Controlled Health Organisation, the Victorian Aboriginal Health Service, the Burnet Institute, St. Vincent’s
Evaluating outcomes Four-yearly outcome measures will be developed to guide and support effective implementation of the actions identified in
Hospital Melbourne, the University of
the Strategies. This will include the use of
Melbourne and La Trobe University.
surveillance data to monitor performance against national indicators.
Who are the What will the Strategies Strategies for? do to address stigma and The Strategies are aimed at people living with, or affected by viral hepatitis, their discrimination? The Victorian Government’s position on discrimination is clear: any level of stigmatisation is completely unacceptable. All Victorians with hepatitis B and hepatitis
The Department of Health and Human Services Advisory Committee on Blood Borne Viruses and Sexually Transmissible Infections will provide ongoing oversight of the Strategies
families and communities.
and their implementation, with time-limited
These populations include Aboriginal
working groups and other mechanisms
Victorians, gay and bisexual men, people who established as necessary to advise and progress work on specific priority initiatives. inject drugs, children born to mothers with
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Progress on hepatitis C treatment
Initial uptake of new hepatitis C treatments positive
H
epatitis C could be eliminated in 10 years IF record numbers of people living with the virus continue to seek and receive breakthrough antiviral treatment, according to a new analysis released on World Hepatitis Day this year.
chronic, irreversible liver damage, which could have been prevented,”
Data from the Kirby Institute at the University of New South Wales reveals that since new generation hepatitis C medications were made available on the Pharmaceutical Benefits Scheme (PBS) five months ago, 22,470 Australians have already commenced treatment – a massive increase on the 2,000-3,000 people with hepatitis C treated annually prior to the listing.
notification data from 2001-2012 to the number of Medicare claims
Professor Greg Dore from the Kirby Institute recently remarked “To put this into perspective, we are on track to cure more people with hepatitis C this year than in the past twenty years of interferon-therapy.”
“We also know from previous research that many GPs aren’t aware
BUT maintaining momentum is critical.
Ms Snow says. The project, lead by Associate Professor Ben Cowie of the Peter Doherty Institute for Infection and Immunity, compared hepatitis C for the two follow-up tests recommended for people with suspected hepatitis C. The results show that between 40% and 70% of Victorians with suspected hepatitis C were not properly followed up. that hepatitis C can be cured, and that many people with hepatitis C have never been referred to a specialist,” Ms Snow says. “We need to ensure that older people who may have been diagnosed with hepatitis C a long time ago are informed of their new treatment options, and that young people with recent a diagnosis remain
Anyone who has ever been exposed to the hepatitis C virus, or has been told they’re living with the virus, should speak to their doctor about a liver check-up and accessing the new treatments.
engaged in care.” Ms Snow says.
The new medicines can cure in as little as 12 weeks and have far fewer side effects than previous treatments. And there is no limit on the number of patients that can be treated.
Australian_and_New_Zealand_Journal_of_Public_Health.pdf
Hep C researchers urge - get tested, get treated While recent take up of the new treatments has been very positive, University of Melbourne researchers say that up to 70 per cent of Victorians with suspected hepatitis C may not have received follow-up testing, putting them at risk of chronic liver disease and even cancer. Testing rates for the virus — which affects almost 10 times more Australians than HIV — have been found to be lowest among young people aged 15 – 24, representing a massive missed opportunity for treatment before the disease becomes serious, according to a paper in the Australian and New Zealand Journal of Public Health.
A copy of the paper can be downloaded at: https://engonethepvic. blob.core.windows.net/assets/uploads/files/Snow_et_al-2016-
Let’s not forget about the hepatitis B. The response has to be stepped up! It is estimated that nearly half of the more than 213,000 people living with the hepatitis B virus remain undiagnosed and only around 5 per cent are currently receiving treatment. Without the appropriate management and treatment, these people are at heightened risk of liver cancer. Even though there is no cure as yet for hepatitis B, serious liver damage and complications including liver cancer caused by hepatitis B infection can be prevented. Associate Professor Ben Cowie recently emphasised: “People
Lead author Kathryn Snow, of the University’s School of Population and Global Health, warns that liver cancer rates — which have tripled in Australia since 1982 — could spiral without a concerted effort to raise awareness of hepatitis C among GPs and people living with the disease.
sometimes think that if they have no symptoms then they don’t need to
“Our research tells us that the highest rates of follow-up testing are among people aged 65 and over —potentially after decades of
doctor and receive a regular liver check-up to protect themselves
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see their doctor, but often symptoms of long-term hepatitis B infection only appear when it’s too late – when the liver is already severely damaged. “We therefore encourage everyone with hepatitis B to speak to their against serious liver disease.”
Viral hepatitis elimination by 2030
T
he goal to eliminate viral hepatitis by 2030 is a global one. In some ways in Australia we are ahead of the game. This is evident from callers to the Hepatitis Victoria Infoline enquiring about getting treatment for family and relatives who are living overseas, who cannot afford the options that are available to them. We have readily available vaccines for hepatitis B (HBV), and direct acting antivirals that are affordable for hepatitis C (HCV). Clearly we are the envy of many. But elimination will not take care of itself. It takes commitment. 2030 is only 14 years away, so if we are to be successful there is a great deal of work to be done. The key to success will have many elements:
• Continued uptake of treatment or vaccination - early indicators look encouraging.
• Health promotion - continue to raise awareness and inform hard to reach audiences.
• Harm reduction - the reality is that behaviour is hard to modify, so reduce the risk by minimising transmission opportunities.
• Ongoing advocacy.
Local networks are of critical importance if
eliminated as a public health threat, but
we are to be successful. Partnerships where
there will be significant numbers of people
expertise can be combined will play a key
who have ongoing liver disease or will not
role in tackling local issues. But ultimately we
have cleared the virus.
will have to consider the global perspective. Diseases do not require passports and visas, so we have to take every opportunity to act. For every person who is vaccinated or cured of hepatitis, there is less chance of transmission.
Some estimates put the rate of liver disease as high as 50% for people who are affected by hepatitis, with the risk increasing with age and the length of infection. This gives an added challenge to the task of elimination. These people
One significant barrier to achieving
will require ongoing support and care.
elimination is the discrimination that is
There is a major risk that the virus may be
directed at the affected community. This
eliminated, but stigma and discrimination
comes from all quarters and results in people
will linger, unless concerted effort and
being reluctant to come forward and be tested
resources are directed to initiatives
or seek support. Tragically, this occurs across
that target and tackle stigma and
all sectors of society, including in the health
discrimination.
care sector.
Martin Forrest
Achieving elimination targets will rely on tackling these insidious behaviours head on. The most effective way is to break down myths and misconceptions is by providing education. Caution must be applied when nominating a
Reference: Australian Institute of Health and Welfare 2015. Leading cause of
premature mortality in Australia fact sheet: liver disease.
date for elimination. Yes the virus might be
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Prevention
It still has a part to play in the drive to eliminate hepatitis C
T
he goal of eliminating hepatitis C as a public health risk has become feasible as a result of effective new hepatitis C treatments that are now available in Australia and subsidised by the Commonwealth government. While medical breakthroughs such as these are critical to being able to even consider this goal, there are also several structural and community issues that need to be overcome for us to achieve elimination.
Prevention is one of these. It will be critical to not lose sight of prevention goals in the drive to treat everyone who wants it. The Burnet Institute’s Eliminate Hep C study identifies several of these issues and includes the prevention of hepatitis C transmission as one of the “four pillars” of the study. The World Health Organisation (WHO) identifies prevention scale up globally as critical to any elimination strategy. It calls for a ten-fold increase from current global averages to a minimum of 200 syringes per person, per year, to be distributed (to those who inject drugs). The WHO prevention target is laudable, but the actions outlined risk being too narrow. Not only is widening the coverage of syringe programs necessary, so too is targeting syringe and, crucially, other injection equipment provision towards those who need it most, and who are most likely to be part of a transmission episode. People should be able to access sterile equipment for every single injection episode. The evidence suggests that up to 37% of people injecting do not have access to sterile syringes for each injection. In addition, it appears, perhaps not surprisingly, that those not “covered” completely are more likely to report sharing of syringes. This is despite the fact that in Victoria and Australia syringe coverage is just above the WHO benchmark.
We also know that in some studies 45% of NSP clients have multiple vulnerabilities including social disadvantage. It is well established that social disadvantage has a negative impact on health and service access . We must continue to provide effective transmission prevention options for those not able or likely to access hepatitis C treatment in the near term. Sitting alongside the challenge of injecting equipment coverage is that of transmission in prison. Without an official sterile syringe program in prison it will be an uphill battle for hepatitis C treatment to eliminate hepatitis C. Even if prisoners access treatment, the risk of reinfection in the absence of sterile injecting equipment is high. No single solution will be sufficient. Like any good public health strategy we need a range of approaches for a range of populations, communities and individuals.
Victoria has a number of reasons to be optimistic - we have an engaged and committed NSP workforce, skilled peer and community organisations, and extremely low rates of HIV in this population to complicate the picture. The Australian government has, rightly, invested a sizable chunk of funding into a medical solution to hepatitis C. For this to be as effective as possible it is also important that we do not forget about prevention, and in fact that we try to upscale it alongside treatment, in a targeted and thoughtful way.
Sione Crawford
Reference:
It appears that while a general coverage rate goal such as “200 syringes per injector per year” is a good starting point, we also need to ensure that options such as unlimited supply of all injecting equipment beyond syringes; peer-based needle and syringe programs (NSPs); legitimised peer distribution; and, innovative approaches for Aboriginal people and rural areas are maintained or scaled up alongside hepatitis C treatment.
https://www.burnet.edu.au/centres/24_eliminate_hep_c
NSPs in Australia were set up originally to prevent HIV and have done a spectacular job of that. Australia has one the lowest prevalence rates for HIV in the world, in people who inject drugs.
Newland, J., Newman, C., & Treloar, C. (2016). “We get by with a little help from our friends”: Small-scale informal and large-scale formal peer distribution networks of sterile injecting equipment in Australia. International Journal of Drug Policy (2016). doi: http://dx.doi.org/10.1016/j.drugpo.2016.04.005
Hepatitis C is a different virus that requires different strategies. Nevertheless, for a long time we have leaned on the “one fit for every hit” health promotion message that was formulated in the early days. In fact we now know hepatitis C is also likely to be transmitted via other injecting equipment such as spoons, water, cotton wool and tourniquets, and even household items such as toothbrushes. It is important to ensure we review prevention approaches so that they continually evolve with drug use trends. The current NSP services can’t be in all places at all times, which means that sterile injecting isn’t always achievable. NSPs and related primary health services will need to continue to look at new ways and means of increasing the reach and uptake of sterile equipment.
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WHO; Combating Hepatitis B and C To Reach Elimination by 2030; May 2016: http://www.who.int/hiv/pub/guidelines/hepatitis/en/ Bryant J, Paquette D, Wilson H. Syringe coverage in an Australian setting: does a high level of syringe coverage moderate syringe sharing behaviour? AIDS Behav. 2012;16(5):1156–63. O’Keefe et al. Individual-level needle and syringe coverage in Melbourne, Australia: a longitudinal, descriptive analysis BMC Health Services Research (2016) 16:411
Fisher K, Smith T, Nairn K, Anderson D; Rural people who inject drugs: A crosssectional survey addressing the dimensions of access to secondary needle and syringe program outlets; Aust J Rural Health. 2016 Treloar, C., Mao, L., & Wilson, H. (2016). Beyond equipment distribution in Needle and Syringe Programmes: an exploratory analysis of blood-borne virus risk and other measures of client need. Harm Reduction Journal, 13, 18. http://doi. org/10.1186/s12954-016-0107-0 Treloar, C., Mao, L., & Wilson, H. (2016). Beyond equipment distribution in Needle and Syringe Programmes: an exploratory analysis of blood-borne virus risk and other measures of client need. Harm Reduction Journal, 13, 18. http://doi. org/10.1186/s12954-016-0107-0 http://www.aihw.gov.au/socio-economic-disadvantage-and-health/
Personal story Lien’s story
L
ast weekend, I took my two little daughters to Melbourne Zoo
herself for not trying hard enough, and thought it was her fault that
where they enjoyed chasing the birds, and the three-year-old told
I got hepatitis B.
me about the giant lions with a lot of love “Mummy, look! Oh, baby lion!” Sometimes we have friends coming over on Saturday. During the week, I study and have a part time job. It is just an ordinary life for many people but for some time after I got the hepatitis B diagnosis, I could never imagine such a stunning life.
Anyway, that was 13 years ago. She is now relieved because she knows hepatitis B can be well managed and I am ok. Vietnam implemented the free universal hepatitis B vaccination in 2002, two years after Australia. I’m glad that children born today in both Vietnam and Australia have access to the hepatitis B vaccine, and
It was early 2003. I was at my first year at University in Vietnam
I believe vaccination coverage will ensure that there is no Mum suffering
and was happy to be awarded a scholarship to study overseas.
the same feeling that my Mum had to experience, and no child rejecting
For Vietnamese students from the countryside, there was nothing
a good education opportunity in the way that I had to do.
more hopeful and proud than getting a scholarship and going to Europe to study.
After some time in depression, I decided to go on the internet to learn about hepatitis B – I don’t know why I did not think of going to a doctor.
I had no idea about hepatitis B until I went for a health check for the
I found out I could live with hepatitis B as long as I had a healthy
scholarship paperwork. The doctor told me that I had hepatitis B
lifestyle with regular liver health monitoring. Life went on, I finished
and I could not go abroad! That’s all he told me that day; no
my university, had a job, married the man I loved, and had two
more information and no referral. I was freaking out.
children with him.
Seeing the happiness of people living with hepatitis C clearing the virus, I wish there would be a cure for hepatitis B available soon. After being so hopeful with the scholarship, I now thought there was
We moved to Australia in 2015 for my study and it was when hepatitis
no future for me. More seriously, my grandmother died from liver
B came back to me - this time is in a positive way. I joined Hepatitis
cancer and I thought the same thing would happen to me. I rejected
Victoria as a volunteer from August 2015 and then got more involved
the scholarship and continued to study in Vietnam.
in hepatitis B community education, especially for the Vietnamese
I told my Mum about the diagnosis and she blamed herself badly
community in Victoria.
because she could not get me vaccinated even though she tried
I recognised that if the community is informed and empowered, if they
when I was little. In the 1990s, my hometown was a small village in a
are aware of prevention and management, not only can they take better
north eastern province of Hanoi – the capital city of Vietnam. People were poor and did not have awareness about vaccination. One day, the local health worker advised that a mobile health service would provide hepatitis B vaccine to the children in the village at their parents’ cost and asked people to register. My Mum signed me up even though they were not among the rich people in the village, and hepatitis B vaccine was very expensive for them.
care for themselves, but also for other people in the community, no matter if they live with hepatitis B or not. I was asked by SBS news on World Hepatitis Day, at the launch of the Victorian hepatitis B Strategy 2016-2020 about what I wished for. The answer was: “Seeing the happiness of people living with hepatitis C clearing the virus, I wish there would be a cure for hepatitis B available soon. Then one day I can say I used to live with hepatitis B, but now I’m cured”.
However, too few people signed up and the service was cancelled. It hurt me when my Mum immediately recalled the story and blamed
13
Ensuring access for all
Sione Crawford (SC) interviews hepatitis C treatment worker Cheryl Lim (CL)
F
or hepatitis C elimination to become a reality we need to be sure that everyone who wants to, is able to access the new Direct-Acting Antiviral (DAA) treatments. One person who is contributing to this in a specific and important way is Cheryl Lim, who specialises in hepatitis C treatment support. Sione Carwford spoke to Cheryl about her role, the importance of peer support, systemic issues and other barriers that marginalised people face.
uSC: Tell us a little bit about your role.… uCL: I facilitate a Healthy Living Peer Support group at Innerspace, a Needle and Syringe Program (NSP) in Collingwood. This group runs in conjunction with the Hepatitis Clinic operating at this centre. It is rooted in the belief that this ‘hard to reach’ community are better supported in a centre they are familiar with. I also support two hospital-based clinics through the Alfred Gastroenterology Clinic. Often I would have counselling sessions in a non-clinical setting in Moorabbin. This outreach via the clinics is essential but more community outreach would be ideal.
uSC: What differences do you see between treatment in large hospitals and treatment in an environment like Innerspace? uCL: The service system cannot always meet the needs of marginalised people. So while they might be categorised as “hard to reach” I think they are actually not always supported adequately. The service system does not lessen anxiety well. Just entering hospital environments can be overwhelming and tip a person over the edge into distress. A lot of my work is supporting people through that. Not all medical staff have the training, communication skills or time to effectively manage some of the things that manifest for patients with complex issues. People need to be treated in an environment where they feel safe. Safety and trust are probably the biggest factors that I spend time building up with this group.
14
Building trust may be something as simple
This is so important - knowing and
as keeping your promise to call back at a
actually believing that they are eligible for
specific time. Not doing so might be enough
treatment while they are still using and
to break that trust. So I have to be realistic in
that we will support them in that.
community is essential. There is a real role for those who have been treated with the new treatments to have a voice in their peer group.
uSC: What population are we talking
current injectors can’t access
uSC: Do you think there is any danger of this population being left behind in our drive to eliminate hep C?
about and who accesses Innerspace?
treatment?
uCL: Definitely. Firstly I think we will be
uCL: There are people who access the NSP
uCL: Absolutely. There is a lot of
for less than a minute to obtain equipment,
self-discrimination and fear of being
and then there are those who access the GP,
judged, and rejected for using. There
but are also quite marginalised and have
is an expectation that they will not be
friends who never enter the service. We have
considered for treatment.
what I offer people.
to be creative to engage this group who do not access services. However, my contact is mostly with those who already trust a service enough to access it for support. The Healthy Living Group fosters a sense of community and they feel safe enough to give me their mobile number, and to share stories and build connections with peers.
uSC: So there is still a belief that
We need to get the message out there that you can access treatment if you are still using or even re-infected. This is still very surprising to some people, especially if they aren’t well connected to services. They’ll say, “Come on, are you serious?” It’s not that people don’t want treatment but that they are not yet able to
treating those who are comfortable enough engaging with services, whether primary or tertiary. But of course to eliminate hep C, we need to access the community who have not even come for a blood test, who are really doing it hard. In addition to more satellite clinics in existing services there is a need for more counselling support. There needs to be more outreach to where people are living, whether under a bridge or in a park. We need to join forces with services that are providing outreach, like home care nursing and homelessness support to access people. And we then need practitioners to offer rapid testing and follow up where the client chooses.
Of those who engage, only around half
grasp the concept that they are
come regularly but they are learning how to
even included.
uSC: And if that is literally on the street?
uSC: You mention that re-infection
uCL: Yes. I believe there is a bus that
support themselves, to build relationships and build a rhythm in attending regularly. They raise questions they would not consider asking their doctor. The group also attempts to address issues of self-care; healthy meal
is not a barrier to treatment. Do you think it’s understood why that is the case?
preparation…while creating community and
uCL: I’ve never had a situation where
kinship. Friendships have developed and
a client was refused treatment. But I
clients have bonded over meals like a
would say that if workers find themselves
family unit.
judging others for things like re-infection
uSC: How does this tie in to people accessing treatment?
then they need to see the person’s decision to get treatment for what it is: as a positive health decision. This is a highly
uCL: To have socialisation and be able to
marginalised group and we need to treat
test themselves in the service setting…has
them without reluctance because they
provides treatment on the street, so it can be done. But the outreach needs to be more assertive and widespread. On the other hand, sometimes we need to step back from the urge to just treat, treat, treat. There is sometimes a need to take psychosocial factors into account. When I talk about accessing this population and engaging them, it is sometimes just about making a link and building the person’s trust and faith in the system until they are ready for treatment.
uSC: Thank you Cheryl.
eased people into having the confidence
are highly sensitised to discrimination.
to see a health worker. Others have found
Driving them away from health services
As well as Cheryl’s service there are a
overcoming issues like agoraphobia and
with reinforcing stigma is not the way
number of other services, which focus on
being able to access public transport has
to help them. I prefer to see a return
providing access for people who either
increased their capacity to make changes
client as an opportunity to engage and
do not have a GP, or who face barriers in
and consider being hep C free.
assist the person rather than as a failure.
accessing mainstream health services.
Further than that we send a positive
These include nurse lead models at
message to their peer group: that they
community health centres and Aboriginal
are welcome to our service.
Health Services. If you want more
and we work on that. That and the creation
A core part of my role is to clarify
information about these services call the
of a rhythm in their life, and trust building
processes and demystify ideas that
Hepatitis Victoria Infoline on 1800 703 003.
so that they know that if something does go
clients carry. This is why peer-support
Sione Crawford
awry in their treatment they will be supported.
and working with the client’s partners and
There are so many other priorities and social factors to manage before being in a position to make changes like accessing treatment,
15
2016 FACTS AND STATS HEPATITIS C
PEOPLE LIVING WITH CHRONIC HEPATITIS C
RATES OF CIRRHOSIS
25%
of Australians are undiagnosed.
230,470
in Australia 2
130 -150 million worldwide 1
65,000
in Victoria 1
DEATHS AND TRANSPLANTS
500,000 deaths globally each year from hepatitis C 1
81 liver transplants in
690 deaths in Australia
The estimated number of people with severe liver disease or hepatitis C related cirrhosis has
more than doubled
from 18,580 cases in 2004 to 44,730 in 2014. 2
TREATMENT CURE RATES
from hepatitis C Australia related to hepatitis C in 20141 in 2014 1
STARTING TREATMENT
Estimated numbers of people starting treatment in March–May 2016: an extrapolation on data taking into account time lag in reporting.3
HEPATITIS C AND PEOPLE WHO INJECT DRUGS People who inject or have a history of injecting make up 90% of new hepatitis C diagnoses.6
People who inject or have a history of injecting make up 80% of existing diagnoses.6
RATES OF DIAGNOSIS IN ATSI
Old interferon treatments had a 50–70% cure rate.5
New direct acting antivirals (DAAs) have a 95% cure rate for most genotypes.5
HEPATITIS C IN PRISONS Over 40% of male prisoners have hepatitis C.5 Up to 70% of female prisoners have hepatitis C.5
HEPATITIS C REFERENCES 1. World Health Organisation 2015, Hepatitis C Factsheet No: 164. Accessed 2 June 2014. (http://www.wh.int/mediacentre/factsheets/fs164/en/) 2. The Kirby Institute, HIV, viral hepatitis and sexual transmissible infections in Australia Annual Surveilance Report 2015. The Kirby Institute. UNSW Australia, Sydney NSW 2052. 3. The Kirby Institute, Monitoring hepatitis C treatment uptake in Australia, Issue 3, July 2016. The Kirby Institute. UNSW Australia, Sydney NSW 2052. 4. Hepatitis C Virus Infection Consensus Statement Working Group. Australian recommendations for the management of hepatitis C virus infection: a consensus statement 2016. 5. Melbourne Gastroenterlogical Society of Australia, 2016. Australian Society for HIV, Viral Hepatitis and Sexual health Medicine, General Practitioners and Hepatitis C. Australian Society for HIV, Viral heaptitis and sexual health Medicine, Darlinghurst NSW 2010.
ATSI constitute 8.3% of 234,470 ATSI make up 2.4% of people living with HCV. Australia’s total population.
16
6. Australian Government Department of Health, Fouth National Hepatitis C Strategy 2014–2017. Commonwealth of Australia, Canberra, ACT 2601.
2016 FACTS AND STATS HEPATITIS B
PEOPLE LIVING WITH CHRONIC HEPATITIS B
Hepatitis B Prevalence by Priority population 11
44%
don’t know they have Hepatitis B.
240 million
220,000
worldwide 10
in Australia 2
56,000
in Victoria
DEATHS AND LIVER CANCER
780,000
deaths globally each year from hepatitis B 7
4.4% Men who have sex with men (Australian born)
19%
5.4% Other (not-stated)
9.3% 20,000 are Aboriginal or Torres Strait Islander people
7.1% 10.1% People born People born in Africa/ in Europe Middle East
Other (Australian born)
38%
81,000 were born in the Asia-Pacific region
395 deaths in 1 in 4 Australia from people with hepatitis B in hepatitis B will die 2014 2 from liver cancer
TREATMENT RATES
5.7% People who inject drugs (Australian born)
HEPATITIS B IN PRISONS
5%
The percentage of people living with hepatitis B who were on treatment in 2013 (11,527) 7
15%
The percentage of people that need to be on treatment to impact liver disease and liver cancer rates (21,000) 7
RATES OF DIAGNOSIS IN ATSI
18% The percentage of people entering Australian prisons who tested positive to hepatitis B 9
HEPATITIS B REFERENCES 7. MacLachlan J. H. et. al. Hepatitis B Mapping Project: Estimates of chronic hepatitis B diagnosis, monitoring and treatment by Medicare Local, National Report 2012/13. Australian Society for HIV, Viral hepatitis and Sexual Health Medicine. Darlinghurst NSW 2010. 8. Adamson E. et. al. Perceptions of liver cancer and hepatitis B in the Victoria Chinese community, Summary Report 2013. Cancer Council Victoria. Melbourne VIC 3004. 9. Austrailian Institute of Health and Welfare 2015. The health of Australia’s prisoners 2015. Cat. no. PHE 207. Canberra ACT 2061. 10. World Health Organisation 2015, Hepatitis B Factsheet No. 204. Accessed 2 June 2016. (http://www.who.int/mediacentre/factsheets/fs204/en/).
1% of non-ATSI people are living with chronic HBV.
Between 9–16% of ATSI people are living with chronic HBV.
11. McLachlan J.H. et. al. Australia and New Zealand Journal of Pacific Health. Melbourne VIC 3000.
17
Personal story Moira’s story
Tonight, without fanfare, a quiet revolution has occurred within our family. I have finished treatment, and I no longer have Hepatitis C.
t’s morning. I get up, do a few stretches, go to the kitchen, start
I
daughter is home when I return. We finish preparing dinner. None of
breakfasts, make lunches, kiss my children good morning.
my muscles are hurting and I haven’t needed a sleep during the day.
I get in the shower, get out of the shower, get dressed, kiss my
I pick up my son from training and the usual evening wrangle ensues
children goodbye as they leave for school.
- dinner, homework, showers, pyjamas.
I wash dishes, write a shopping list. Get in the car, drive to the
My alarm goes off. I go to the fridge and take out the Harvoni. ‘Kids’,
supermarket, do the shopping, drive home and carry the shopping in.
I say. They look up from their screens. ‘This is my last Harvoni’. I
Put it away.
swallow it.
The dog is looking eager. I clip his lead on to his collar and off we
My son comes to me and leans in. I hold him. My daughter says
go for a walk. We take the long way to the footy ground. I take easy
‘That’s so great, mum’, and her smile shines.
strides and do three laps of the oval. I notice my legs taking these easy steps. I think about how far I’ve walked. I’ve been up for three and a half hours, and have been on the go the whole time. I notice
Seven years ago, I was on the Telapravir/Interferon/Ribaviran trial and developed an allergic reaction to the Telaprevir. I can’t describe
that I’m not tired. I smile. I call the dog and put his lead back on. We
how awful, how painful, how mentally taxing it was. My children lived
walk home again.
through it with me. It was a version of hell for them too.
I make a cup of tea, sit down and start my work on the computer. I
Tonight, without fanfare, a quiet revolution has occurred within our
notice that I’m concentrating well. My head is not foggy. I can work for
family. I have finished treatment, and I no longer have Hepatitis C.
two hours. Make some lunch. Another cup of tea. I don’t feel sick. I walk up the street to the shops to run a few errands. Return home
Moira Burke has lived with hepatitis C for approximately 34
and start dinner. My son arrives home. I drive him to training. My
years. She was diagnosed when pregnant with her first child.
18
Introducing our newest Hep Heroes Peter Jones and Chris Green
Liver Clinic in Heidelberg. I have also had
that I suffered from these from a far earlier
hepatitis B twice and self-cleared.
time. I was over the moon when I found
I am 58. I am a semi-retired artist. At the moment I am working on a theatre project to
out that Interferon- based treatment had worked for me.
raise awareness about lung cancer. I have
I was also involved in the support group
struggled with drugs, including alcohol, for
at Hep Vic some time ago so I’d like to
many years. This is how I got hepatitis I
be involved again to help others undergo
think, by sharing needles.
treatment, and to help them deal with the
I am now clear of all these diseases and
stigma surrounding this debilitating illness.
no longer take drugs of any sort apart from
With the new initiative of the Federal
copious amounts of coffee. I am a father of
Government, and the new drugs available, it
two boys and am so grateful to be free from
is important to get people to sign up to these
Peter Jones
the threat of liver cancer.
new treatments and to get cured from hep C.
I don’t consider myself that much of a hero,
infection from hepatitis of one sort or
but I would like to share my experiences with others so that they may benefit from treatment the way that I have.
My whole life from around 25-52 years of age was dominated by a background another. I cleared hep B twice by careful attention to my health and some good luck I suppose,
Peter’s message to others: Treatment is worthwhile and by refusing treatment, while an option, it is unnecessarily putting yourself at greater risk of health and psychological complications in the future. Even though the treatment may require you
I’d like to encourage people to try the new
only to find out in my mid 30s that I had
treatments, which is apparently much easier
hepatitis C.
to focus on your health during the taking of
to tolerate than the Interferon that I had to
I was in denial big time for many years.
take. It also has a higher success rate.
I found that being infected with hep C
and stigma associated with being a carrier
I have been cured of hepatitis C by
really depressing.
participation in the Interferon Combination
I was diagnosed with depression and anxiety otherwise be denied you if you gamble around the same time, though I now believe with not having treatment.
therapy program at the Austin Hospital,
Chris Green I am a Hep Hero because I have had the virus for over 30 years that I kept secret – but now I have come out to all my friends and associates on Facebook and my social group this year. As a 67 year old woman who has had a wonderful life, full of adventure, I retired to
the medications, it will free you from the fear of this illness, and allow you to hopefully live a long and fulfilling life, which may
Soon after a friend died, and we had a bigger reunion to celebrate her life. It was that weekend that I decided to come and live in Melbourne and reconnect, and start to live a productive life again. I have been going to St Vincent’s Hospital about my hep C. I have finished the treatment, and the specialist said wait three months after you
the country in 1994 when I found out I had
finish to get the blood test, which will be at
hep C and became a hermit.
the end of September.
It had a devastating effect on me when I
Chris’s message to others:
found out. I missed out on 20 years of life because of the shame.
There is so much info about hep C now, and with a cure…hep C hasn’t got the stigma
I came to live in Melbourne three years ago,
it used to have. Never give up, smile at
as I had reconnected with some old friends.
people in the street, and enjoy every day.
19
A guide to healthy living I
t’s spring – a great time to take a look at your diet and lifestyle, and make some positive changes. Not only will your health improve, your
relationships will benefit as a result of you being mindful of your health as you move toward a holistic approach to a healthier you. Baby steps are the key to maintaining health choices. It’s not hard – just follow some of the techniques that have worked for me (Damian Salt):
Juice your way to good health One of the best routines I have in my life is to begin my day with my favourite juice. It is instantly absorbed into the blood stream, and the benefits I feel are immediate. The preparation, which takes no time at all, promotes a sense of well-being, in the thought that you are taking
Hit the mat for health
the time to care for yourself: 4 carrots 2 apples
Fend off the spring/summer allergy season by making friends with a
2 sticks celery
dog… the downward dog that is! Practicing yoga can strengthen your
1 large knob ginger
immune system and is shown to double the peptides in the body that
1 handful of parsley
attack illness-causing microbes.
2 small whole beetroot
The relaxation provided by yoga also lowers the production of the
There’s no need to peel anything – just process using a good quality
hormone cortisol. While cortisol is an essential, life-sustaining
juicer. Delicious!
hormone, it is important to keep the levels balanced. Too much or too little cortisol can have negative health effects.
Power lunch – ready in minutes 1 red capsicum – cut into strips
10,000 - a great number to live by! A recent study has shown that people who log 10,000 steps a day slashed their odds of developing cardiovascular disease by 69%.
Half a zucchini cut into strips 1 cooked chicken breast cut into thin slices 2 wholemeal tortilla wraps
With the current trend of fitbits and tracking gadgets, it has never
Lay out the wraps, layer the chicken and vegetables.
been easier to keep a count of your steps. As you work to increase or
If you want you can add a good dollop of guacamole or sliced
improve your output, the challenge and desire to do better will kick in,
avocado to finish.
and in no time it will be a walk in the park!!
Fold and enjoy.
20
Minestrone soup
which means there is little cleaning up afterwards. Soups and cas-
Method
seroles are my favourites, and this Minestrone, courtesy of Hepatitis
Chop all the vegetables into small pieces.
When it comes to cooking I prefer recipes that only need one pot,
South Australia is one of the best I’ve had. The only addition I make is some good quality sourdough bread:
Finely chop the onion and garlic.
Ingredients
SautĂŠ onion in olive oil in a large pot, over a low heat, until soft.
1 x 400g tin of tomatoes
Add tomatoes, herbs, harder vegetables like celery,
1 handful of fresh basil
carrots and potatoes, and stock.
1 teaspoon oregano
Bring to the boil, reduce heat and simmer uncovered
Salt and pepper to taste
for about 7 minutes.
1.5 litres of vegetable stock
Add pasta and other softer vegetables (zucchini, mushrooms
3 potatoes
and string beans, and cook for another 10 minutes.
3 carrots
Rinse cannelloni beans and add to the pot.
handful of string beans handful mushrooms 1 x 400g tin of cannelloni beans
Add garlic and cook for one minute.
Soup is ready when the pasta is cooked and the vegetables tender. Sprinkle with fresh, chopped parsley.
1 cup dried pasta (penne works best)
Enjoy!
2 cloves garlic
(serves 6)
1 zucchini 2 tablespoons olive oil
21
Contacts Needle and Syringe Programs Warragul, Morwell, Sale
Belgrave
La Trobe Community Health Service, Hepatitis C Nurse
Inspiro Community Health Service
1800 242 696
Contact: (03) 9738 8801
Wodonga
Fax: (03) 9739 4689
Melbourne Sexual Health Centre 580 Swanston Street, Carlton Contact: (03) 9341 6200 Fax: (03) 9341 6279 Email: enquiries@mshc.org.au
Gateway Community Health Service
Email: hello@inspiro.org.au
Carlton North
155 High Street Wodonga VIC 3690
Belmont
(03) 5723 2000
Needle and Syringe Programs Alexandra Alexandra Community Health Services – Needle Exchange Program 12 Cooper Street, Alexandra Contact: (03) 5772 0900 Fax: (03) 5772 0919 Email: alexandrachs@humehealth.org.au
Altona Meadows Isis Primary Care 330 Queens Street, Altona Meadows Contact: (03) 8368 3000 Fax: (03) 9360 7534
Apollo Bay Otway Health & Community Services 75 McLachlan Street, Apollo Bay Contact: (03) 5237 8500 Fax: (03) 5237 6172 Email: otwayhealth@swarh.vic.gov.au
Bairnsdale Bairnsdale Community Health Centre – Needle and Syringe Program 48 Ross Street, Bairnsdale Contact: (03) 5152 0222 Fax: (03) 5152 1500 Email: email@brhs.com.au Bairnsdale Community Health Centre – Emergency Department offer needles 24/7 122 Day Street, Bairnsdale Contact: (03) 5150 3333 Fax: (03) 5152 6784 Email: email@brhs.com.au
1624 Burwood Highway, Belgrave
Barwon Health – Needle and Syringe Program 1-17 Reynolds Road, Belmont Contact: (03) 4215 6800 Fax: (03) 4215 6839 Email: receptionbelmont@barwonhealth.org.au
Benalla
Benalla Community Health 45 Coster Street, Benalla Contact: (03) 5761 4222 Fax: (3) 5761 4502 Email: communityhealth@benallahealth.org.au
Bentleigh East
Bentleigh Bayside community Health, Glen Eira Site 2A Gardeners Road, Bentleigh East Contact: (03) 9575 5333 Fax: (03) 9579 3623 Email: info@bbch.org.au
Braybrook
Cohealth, Braybrook Community Centre 107-139 Churchill Avenue, Braybrook Contact: (03) 9334 6699 Fax: (03) 9312 3507
Cohealth, Carlton North Centre 622 Lygon Street, Carlton North Contact: (03) 9349 7333 Fax: (03) 9349 7300 Email: info@cohealth.org.au
Castlemaine
Castlemaine District Community Health Centre 13 Mostyn Street, Castlemaine Contact: (03) 5479 1000 Fax: (03) 5472 3221 Email: email@cdch.com.au
Caulfield
Caulfield Community Health Service – Alfred Health 260 Kooyong Road, Caulfield Contact (03) 9076 6666 Fax: (03) 9046 4060 Email: access@cgmc.org.au
Chelsea
Central Bayside community Health Service 3/1 The Strand, Chelsea Contact: (03) 9782 7633 Fax: (03) 9782 7600 Email: info@cbchs.org.au
Churchill
Broadmeadows
Latrobe Community Health Service 20 - 24 Philip Parade, Churchill Contact: 1800 242 696 Fax: (03) 8746 1100 Email: info@lchs.com.au
Brunswick
Cobram
Dianella Community Health 42-48 Coleraine Street, Broadmeadows Contact: (03) 8301 8888 Fax: (03) 8301 8889
Merri Community Health Services 11 Glenlyon Road, Brunswick Contact: (03) 9367 6711 Fax: (03) 9387 5417 Email: mchs@mchs.org.au
Cobram District Health 24 - 32 Broadway Street, Cobram Contact: (03) 5871 0777 Fax: (03) 5872 2406
Camperdown
Merri Community Health Services 93 Bell Street, Coburg Contact: (03) 9350 4000 Fax: (03) 9350 1518 Email: mch@mchs.org.au
Manifold Place Community Health Centre 140 Manifold Street, Camperdown Contact: (03) 5593 1892 Fax: (03) 5593 2010 Email: MPlace2@swh.net.au
Cann River
Cann Valley Bush Nursing Centre 27 Monaro Highway, Cann River Contact: (03) 5152 6210 Fax: (03) 5158 6409
22
Carlton
Coburg
Cockatoo
Monash Health Community Services 7 - 17 McBride Street, Cockatoo Contact: (03) 5968 7000 Fax: (03) 5968 7030 Email: MHCAccess@monashhealth.org
Colac Colac Area Health 2-28 Connor Street, Colac Contact: (03) 5232 5100 Email: dmelville@cah.vic.gov.au Collingwood
Eltham
Nillumbik Health 917 Main Road, Eltham Contact: (03) 9430 9100 Fax: (03) 9431 0339 Email: nchs@nillumbikhealth.org.au
Cohealth 4 Johnston Street, Collingwood Contact: (03) 9468 2800 Fax: (03) 9417 1499 Email: info@innerspace.org.au
Epping
365 Hoddle Street, Collingwood Contact: (03) 9411 4333 Fax: (03) 9411 4300 Email: info@cohealth.org.au
Euroa
Corio
Barwon Health - Needle Syringe Program 2 Gellibrand Street, Corio Contact: (03) 4215 7100 Fax: (03) 4215 7193
Corryong
Upper Murray Health and Community Services 20 Kiell Street, Corryong Contact: (03) 6076 3200 Fax: (03) 6076 1739 Email: Enquiries@umhcs.vic.gov.au
Cranbourne
Monash Health Community 140 - 154 Sladen Street, Cranbourne Contact: (03) 5990 6789 Fax: (03) 5990 6328
Dandenong
Community Access Partnership (CAP) 84 Foster Street, Dandenong Contact: (03) 9792 7630 Fax: (03) 9794 0979 Email: SEADS@monashhealth.org.au
Drysdale
Bellarine Community Health 21 Palmerstone Street, Drysdale Contact: (03) 5251 2291 Fax: (03) 5258 0864
Eaglehawk
Bendigo Community Health Services, Eaglehawk 3 Seymoure Street Eaglehawk Contact: (03) 5434 4300 Fax: (03) 5434 4355 Email: bchs@bchs.com.au
Echuca
Echuca Regional Health 226 Service Street, Echuca Contact: (03) 5485 5000 Fax: (03) 5482 5478 Email: erhexec@erh.org.au
Plenty Valley Community Health 187 Cooper Street, Epping Contact: (03) 9409 8787 Fax: (03) 9408 9508 Euroa Health 36 Kennedy Street, Euroa Contact: (03) 5795 0200 Fax: (03) 5795 0240 Email: eh@euroahealth.com.au
Fitzroy
Turning Point Alcohol & Drug Centre 54-62 Gertrude Street, Fitzroy Contact: (03) 8413 8413 Fax: (03) 9416 3420 Email: info_group@turningpoint.org.au Cohealth 75 Brunswick Street, Fitzroy Contact: (03) 9411 3555 Fax: (03) 9411 3500 Email: info@cohealth.org.au
Footscray
Health Works, Cohealth 4 -12 Buckley Street, Footscray Contact: (03) 9362 8100 Fax: (03) 8362 8180
Frankston
Frankston City Council 30 Davey Street, Frankston Contact: (03) 9784 1888 Fax: (03) 9784 1094 Frankston Integrated Health Centre 12-32 Hastings Road, Frankston Contact: (03) 9784 8100 Fax: (03) 9784 8149 Southern Hepatitis/HIV/AIDS Resources & Prevention Services (SHARPS) 20 Young Street, Frankston Contact: (03) 9781 1622 Fax: (03) 9781 3669 Email: customer.relation@phcn.vic.gov.au
Geelong
Wathaurong Aboriginal Cooperative 62 Morgan Street, Geelong North Contact: (03) 5277 2038 Fax: (03) 5277 3537 Email: healthservice@wathaurong.org.au
Glenroy Youth Projects – Foot Patrol Needle and Syringe Program 6 Hartington Street, Glenroy Contact: (03) 9304 9100 Fax: (03) 9304 9111 admin@youthprojects.org.au
Gisborne Macedon Ranges Health 5 Neal Street, Gisborne Contact: (03) 5428 0300 Fax: (03) 5428 0399 Email: healthcare@mrh.org.au
Greensborough Banyule Community Health Service, Greensborough Centre – Needle Syringe Program Unit 3, 25-33 Grimshaw Street, Greensborough Contact: (03) 9433 5111 Fax: (03) 9435 8922 Email: banyule@bchc.org.au
Hastings Hastings Community Health Service 185 High Street, Hastings Contact: (03) 5971 9100 Fax: (03) 5971 9106
Hawthorn Swinburne University Health Services Level 4, George Swinburn Building, 34 Wakefield Street, Hawthorn Contact: (03) 9214 8483 Fax: (03) 9818 7548 Email: healthservice@swin.edu.au
Healesville Healesville & District Hospital – Needle Exchange Program 377 Maroondah Highway, Healesville Contact: (03) 5962 4300 Fax: (03) 5962 3429
Heidelberg West Banyule Community Health Service – Needle Syringe Program 21 Alamein Road, Heidelberg West Contact: (03) 9450 2000 Fax: (03) 9459 5808 Email: banyule@bchs.org.au
Horsham Wimmera Health Care Group 83 Baillie Street, Horsham Contact: (03) 5381 9111 Fax: (03) 5381 9196 Email info@whcg.org.au
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Contacts Kangaroo Flat
Bendigo Community Health Services, Kangaroo Flat Site 13 Helm Street, Kangaroo Flat Contact: (03) 5430 0500 Fax: (03) 5430 0544 Email: bchs@bchs.com.au
Kyneton
Cobaw Community Health Service 47 High Street, Kyneton Contact: (03) 5421 1666 Fax: (03) 5422 2161 Email: admin@cobaw.org.au
Lakes Entrance
Gippsland Lakes Community Health Centre 18-26 Jemmeson Street, Lakes Entrance Contact: (03) 5155 8300 Fax: (03) 5155 4057 Email: contact@glch.org.au
Leongatha
Gippsland Southern Health Services Koonwarra Road, Leongatha Contact: (03) 5667 5555 Fax: (03) 5667 5516 Email: info@gshs.com.au
Lilydale
Inspiro Community Health Service 17 Clarke Street, Lilydale Contact: (03) 9738 8801 Fax: (03) 9739 4689 Email: hello@inspiro.org.au
Melton
Djerriwarrh Health Services Yuille Street, Melton Contact: (03) 8746 1100 Fax: (03) 9743 8640
Mildura
Orbost Regional Health 104-107 Boundary Road, Orbost Contact: (03) 5154 6666 Fax: (03) 5154 2366 Email: orh@orh.com.au
Moe
Monash Health Community 66-70 Princess Highway, Pakenham Contact: (03) 5941 0500 Fax: (03) 5941 0542 Email: mhcaccess@monashhealth.org
Sunraysia Community Health Services 137 Thirteenth Street, Mildura Contact: (03) 5022 5444 Fax: (03) 5022 5445 Email: schs@schs.com.au Latrobe Community Health Services 42-44 Fowler Street, Moe Contact: 1800 242 696 Fax: (03) 5127 7002 Email: info@lchs.com.au
Mornington
Mornington Community Information and Support Centre 320 Main Street, Mornington Contact: (03) 5975 1644 Fax: (03) 5975 5423 Email: manager@mcisc.org.au
Morwell
Latrobe Community Health Services 81-87 Buckley Street, Morwell Contact: 1800 242 696 Fax: (03) 5136 5450 Email: info@lchs.com.au
Melbourne
Melbourne City Council 200 Little Collins Street, Melbourne Contact: (03) 9658 9658 Fax: (03) 9658 9685
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Portland
Portland District Health 141-151 Bentinck Street, Portland Contact: (03) 5521 0333 Fax: (03) 5521 8162 Email: pdh@swarh.vic.gov.au
Prahran
Newcomb
Mansfield
Maryborough
Bellarine Community Health 39 Fenwick Street, Portarlington Contact: (03) 5258 6140 Fax: (03) 5258 0864 Email: intake@bch.org.au
Darebin Community Health 125 Blake Street, Reservoir East Contact: (03) 8470 1111 Fax: (03) 8470 1107 Email: info@dch.org.au
Newcomb Community Health Centre – Needle syringe Program 104-108 Bellarine Highway, Newcomb Contact: (03) 4215 7520 Fax: (03) 4215 7795 Email: receptionnewcomb@barwonhealth.org.au
Community Services Maryborough 75-87 Claredon Street, Maryborough Contact: (03) 5461 0400 Fax: (03) 5461 4489
Portarlington
Myrtleford
Lucas
Mansfield District Hospital 53 Highett Street, Mansfield Contact: (03) 5775 8800 Fax: (03) 5775 1352 Email: reception.main@mdh.org.au
Pakenham
Needle Exchange Program 240 Malvern Road, Prahran Contact: (03) 9525 1300 Fax: (03) 9521 2474 Email: adminenquiries@ischs.org.au
Gateway Health 32 Smith Street, Myrtleford Contact: (03) 5731 3500 Fax: (03) 5751 1822 Email: info@gatewayhealth.org.au
Ballarat Community Health Centre – Needle syringe program 12 Lilburne Street, Lucas Contact: (03) 5338 4500 Fax: (03) 5332 6617 Email: info@bchc.org.au
Orbost
Reservoir East
Richmond
North Richmond Community Health Needle and Syringe Program (NSP) 23 Lennox Street, Richmond Contact: (03) 9418 9800 Fax: (03) 9428 2269
Northcote
Ringwood
Derebin Community Health 42 Separation Street, Northcote Contact: (03) 9403 1200 Fax: (03) 9482 3690 Email: info@dch.org.au
EACH Ltd 46 Warrandyte Road, Ringwood Contact: 1300 003 224 Fax: (03) 9870 4688 Email: info@each.com.au
Nowa Nowa
Ringwood East
Nowa Nowa Community Health 6 Bridge Street, Nowa Nowa Contact: (03) 5155 7294 Fax: (03) 5155 7296 Email: email@nnch.org.au
EACH Ltd 75 Patterson Street, Ringwood East Contact: (03) 9837 3999 Fax: (03) 9879 6356 Email: info@each.com.au
Rosebud
Southern Peninsula Community Support and Information Centre 878 Point Nepean Road, Rosebud Contact: (03) 5986 1285 Fax: (03) 5982 2601 Email: admin@spcsic.org
San Remo
San Remo Community Services 1 Back Beach Road, San Remo Contact: (03) 5671 9200 Fax: (03) 5678 5595
Sebastopol
Ballarat community Health Centre Doctors Clinic – Needle Syringe Program 260 Vickers Street, Sebastopol Contact: (03) 5338 4585
Shepparton
Primary Care Connect 399 Wyndham Street, Shepparton Contact: (03) 5823 3200 Fax: (03) 5823 3299 Email: support@primarycareconnect.com.au
South Melbourne
Inner South Community Health Services 341 Coventry Street, South Melbourne Contact: (03) 9690 9144 Fax: (03) 9696 7228 Email: adminenquiries@ischs.org.au
South Yarra
St. Kilda
Warragul
Inner South Community Health Services 18 Mitford Street, St. Kilda Contact: (03) 9534 0981 Fax: (03) 9525 3730
West Gippsland Healthcare Group Community Services Division 31-35 Gladstone Street, Warragul Contact: (03) 5624 3500 Fax: (03) 5624 3555 Email: info@wghg.conm.au
Resourcing Health and Education in the Sex industry (RhED) 10 Inkerman Street, St. Kilda Contact: 1800 458 752 Fax: (03) 9525 4492 Email: sexworker@sexworker.org.au Salvation Army Health Information Exchange 29 Grey Street, St. Kilda Contact: (03) 9536 7703 Fax: (03) 9536 7778
Sunbury Sunbury Community Health Centre 12-28 Macedon Street, Sunbury Contact: (03) 9744 4455 Fax: (03) 9744 6777 Email: admin@sunburychc.org.au
Timboon Timboon & District Healthcare Services 21 Hospital Road, Timboon Contact: (03) 5558 6000 Fax: (03) 5598 3565 Email: timboon@swarh.voc.gov.au
Torquay
Victorian AIDS Council/ Gay men’s Health Centre 6 Claremont Street, South Yarra Contact: (03) 9865 6700 Fax: (03) 9826 2700 Email: enquiries@vac.org.au
Torquay Community Health Centre – Needle and Syringe Program 100 Surf Coast Highway, Torquay Contact: (03) 4215 7800 Fax: (03) 4215 7843 Email: chrisinfoaccess@barwonhealth.or.au
Springvale
Traralgon
Monash Health Community 55 Buckingham Avenue, Springvale Contact: (03) 8558 9080 OR (03) 8558 9000 Fax: (03) 8558 9011 Email: intakeGDCHS@southernhealth.org.au
St. Albans
Isis Primary Care 1 Andrea Street, St. Albans Contact: (03) 9296 1200 Fax: (03) 9366 2086
Stawell
Stawell Health & Community Centre 8-22 Patrick Street, Stawell Contact: (03) 5358 7400 Fax: (03) 5358 4113 Email: gch@grampianscommunityhealth.org.au
Latrobe Community Health Services Seymore Street, Traralgon Contact: 1800 242 696 Fax: (03) 5171 1470 Email: info@lchs.com.au
Warrnambool Brophy Family & Youth Services 210 Timor Street, Warrnambool Contact: (03) 5561 8888 Fax: (03) 5561 8816 Email: admin@brophy.org.au Warrnambool Community Health Koroit Street, Warrnambool Contact: (03) 5563 4000 Fax: (03) 5563 1669
Wendouree Ballarat Community Health Centre – Needle Syringe Program 10 Learmonth Road, Wendouree Contact: (03) 5338 4500 Fax: (03) 5339 3044 Email: info@bchc.org.au
Wodonga Gateway Community Health, Wodonga 155 High Street, Wodonga Contact: (02) 6022 8888 Fax: (02) 6024 5792
Wonthaggi Bass Coast Health – Needle Syringe Program 237 Graham Street, Wonthaggi Contact: (03) 5671 3333 Fax: (03) 5671 3300
Yarra Junction
Wangaratta
Yarra Valley Community Health – Needle Exchange Program 2475 Warburton Highway, Yarra Junction Contact: 1300 342 255 Fax: (03) 5962 3429
Gateway Health 45-47 Mackay Street, Wangaratta Contact: (03) 5723 2000 Fax: (03) 5722 2313 Email: info@gatewayhealth.org.au
Yarrawonga Health 33 Piper Street, Yarrawonga Contact: (03) 5743 8111 Fax: (03) 5743 8118
Northeast Health 35-47 Green Street, Wangaratta Contact: (03) 5722 5239 Fax: (03) 5722 4382 Email: enquiries@nhw.hume.org.au
Yarrawonga
Yea Yea & District Memorial Hospital 45 Station Street, Yea Contact: (03) 5736 0400 Fax: (03) 5797 2391
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Contacts Alcohol and Drug Programs, Primary Health Care Centres Alcohol and Drug Programs Bayswater
Anglicare Victoria 666 Mountain Highway Bayswater VIC 3153 contact: (03) 9721 3688
Cobaw
Cobaw Community Health Service 47 High Street, Kyneton Contact: (03) 5421 1666 Fax: (03) 5422 2161 Email: admin@cobaw.org.au
Craigieburn
Anglicare Victoria 59 Craigieburn Road Craigieburn VIC 3064 Contact: (03) 9483 2401
Fitzroy
Youth support + Advocacy Service (YSAS) Level 1, 131 Johnston Street, Fitzroy Contact: (03) 9415 8881 Fax: (03) 9415 8882 Email: reception@ysas.org.au Turning Point Alcohol & Drug Centre 54-62 Gertrude Street, Fitzroy Contact: (03) 8413 8413 Fax: (03) 9416 3420 Email: info_group@turningpoint.org.au
Frankston
Anglicare Victoria Level 2 / 60-64 Wells Street Frankston VIC 3199 Contact: (03) 9781 6700 Frankston Integrated Health Centre 12-32 Hastings Road, Frankston Contact: (03) 9784 8100 Fax: (03) 9784 8149
Geelong
Barwon Health – Alcohol and Drug Services 40 Little Malop Street, Geelong Contact: (03) 5273 4000 Fax: (03) 5273 4044
Lucas
Ballarat Community Health Centre – Mobile Drug Support Worker 12 Lilburne Street, Lucas Contact: (03) 5338 4500 Fax: (03) 5332 6617 Email: info@bchc.org.au
Melbourne
Druginfo Level 12, 607 Bourke Street, Melbourne Contact: 1300 85 85 84 Fax: (03) 8672 5983
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Mildura
Drug Treatment Services 137 Thirteenth Street, Mildura Contact: (03) 5021 7694 Fax: (03) 5021 7695 Email: schs@schs.com.au
Eaglehawk
Eaglehawk Community House 19 Bright Street, Eaglehawk
Geelong
North Melbourne
Barwon Mental Health, Drug and Alcohol Services 40 Little Malop Street, Geelong Contact: (03) 4215 8792 Fax: (03) 4215 8793
Portland
Jigsaw Youth Health Service Yarra Street, Geelong Contact: 1300 094 187 Fax: (03) 4215 8298
Harm Reduction Victoria 128 Peel Street, North Melbourne Contact: (03) 9329 1500 Fax: (03) 9329 1501 Portland District Health 141-151 Bentinck Street, Portland Contact: (03) 5521 0333 Fax: (03) 5521 8162 Email: pdh@swarh.vic.gov.au
Preston
Anglicare Victoria 42 Mary Street Preston VIC 3072 contact: (03) 8470 9999
Richmond
Drug Safety Program 23 Lennox Street, Richmond Contact: (03) 9418 9800 Fax: (03) 9428 2269
Werribee
Anglicare Victoria 2 Market Road Werribee VIC 3030 contact: (03) 9731 2500
Primary Health Care Centres (for PWID) Melbourne
Living Room, Youth Projects (Hepatitis programs – Thursdays every fortnight) 7 – 9 Hosier Lane, Melbourne Contact: (03) 9662 4488 Fax: (03) 9662 4400 Email: living@youthprojects.org.au
North Melbourne Harm Reduction Victoria (HRV) 128 Peel Street, North Melbourne Contact: (03) 9329 1500
Regional services
These contacts are able to provide information about local viral hepatitis related services as well as active support groups.
Bendigo
Bendigo Health Lucan Street, Bendigo Contact: (03) 5454 6000 Fax: (03) 5454 8419
Healesville
Yarra Valley Community Health Service (Once per month clinic- hepatis clinic Contact: 1300 130 381 Fax: (03) 5962 3429
Lucas
Ballarat Community Health 12 lilburn street, lucas Telephone: (03) 5338 4500 Fax: 5338 0520 Email: info@bchc.org.au
Mildura
Sunraysia Community Health 137 Thirteenth Street, Mildura Contact: (03) 5022 5444 Fax: (03) 5022 5445 Email: schs@schs.com.au
Mornington
The Bays Hospital Vale Street, Mornington Contact: (03) 5975 2009 Fax: (03) 5975 2373
Morwell
Moe Community Health Centre 81-87 Buckley Street, Morwell Contact: 1800 242 696 Fax: (03) 5136 5450 Email: info@lchs.com.au
Portland
Glenelg Southern Grampians (Drug Treatment Service) Bentinck Street, Portland Contact: (03) 5521 0350 Fax: (03) 5521 0625 Email: pdhspecialistcentre@swarh.vic.gov.au Dhauwurd-Wurrung Elderly and Community Health Service (Community Health Centre) 18 Wellington Rd, Portland VIC 3305 Contact: (03) 5521 7535 Fax: (03) 55211299
Contacts Related Health Services Shepparton Primary Care Connect 399 Windham Street, Shepparton Telephone: (03) 5823 3200 Fax: (03) 5823 3299
Tatura Tatura Medical Centre 4 Thomson Street, Tatura Telephone: (03) 5824 1244 Fax: (03) 5824 2551
Torquay Surf Coast Health Service - Barwon Health 100 Surfcoast Hwy, Torquay Telephone: (03) 4215 7850 Fax: (03) 4215 7889
Traralgon Latrobe Regional Hospital Princess Highway, Traralgon Contact: (03) 5173 8000 Fax: (03) 5173 8444
Wangaratta Gateway health 45-47 Mackay Street, Wangaratta Telephone: (03) 5723 2000 Fax: (03) 57222313 Email: infowang@gatewayhealth.org.au
Warragul West Gippsland hospital Landsborough Street, Warragul Contact: (03) 5623 0611 Fax: (03) 5622 6403 Email: info@wghg.com.au
Warrnambool Western Region Alcohol and Drug Centre (WRAD) 172 Merri Street Warnambool 1300 009 723 Fax: (03) 5564 5700 Email: wrad@wrad.org.au
Wendouree Ballarat Oncology and Haematology Services 1117 Howitt Street, Wendouree Contact: (03) 5339 8000 Fax: (03) 5339 8111
Wodonga Gateway Health 155 High Street, Wodonga Contact: (02) 6022 8888 Fax: (02) 6024 5792 Email: info@gateqayhealth.org.au
Related Health Services Carlton
Victorian Equal Opportunity and Human Rights Commission (Information on state and federal equal opportunity laws and programs) Level 3, 204 Lygon Street, Calrton Telephone 1300 891 848 Fax: 1300 891 858 Email: information@veohrc.vic.gov.au Web: www.humanrightscommission.vic.gov.au
Hampton East
Haemophilia Foundation Victoria 13 Keith St, Hampton East, VIC 3188 Contact: (03) 9555 7595 Fax: (03) 95557375 Email: info@hsv.org.au
Prahran
Alfred– HIV:Hepatitis:STI Education and Resource Centre (Statewide resource centre on HIV/AIDS, Hepatitis and Sexually Transmissible Infections) 8 Moubray Street, Prahran Telephone: (03) 9076 6993 Fax: (03) 9076 5294 Email: erc@alfred.org.au Web: www.alfredhealth.org.au
Melbourne
Health Services Commissioner 26th Floor, 570 Bourke Street, Melbourne Free call: 1300 582 113 Fax: (03) 9032 3111 Email: hsc@dhhs.vic.gov.au Cancer Council Victoria – Living with Cancer Education Program 615 St. Kilda Road, Melbourne Contact: 13 11 20 Fax: (03) 9514 6800 Email: enquiries@cancervic.org.au
Sexual Health Box Hill
Family Planning Victoria 901 Whitehorse Road, Box Hill Contact: (03) 9257 0100 Fax: (03) 9257 0112 Email: fpv@fpv.org.au
Carlton
Melbourne Sexual Health Centre 580 Swanston Street, Carlton Contact: (03) 9341 6200 Free call: 1800 032 017
Melbourne
Red Aware Level 2 south tower 485 latrobe street Melbourne Contac: (03) 9670 6171 Email: resources@yeah.org.au
Era Health 563 Bourke Street, Melbourne Contact: (03) 9944 6200 Fax: (03) 9944 6290 Email: info@erahealth.com.au
North Melbourne
Ilbijerri Theatre Company 5 Blackwood Street, North Melbourne Contact: (03) 9329 9097 Fax: (03) 9329 9105 Email: infor@ilbijerri.com.au
Richmond
Multicultural Health and Support Services (HIV, hepatitis C and sexually transmissible infections) 23 Lennox Street, Richmond. Telephone: (03) 9418 9929 Fax: (03) 9421 4662 Email: enquiries@ceh@org.au Go to: www.ceh.org.au/mhss.aspx
Southbank
Straight Arrow Suite 1, 111 Coventry Street, Southbank Contact: (03) 9863 9414 Fax: (03) 9863 9421 Email: information@straightarrow.org.au
South Yarra
Victorian AIDS Council 6 Claremont Street, South Yarra Contact: (03) 9865 6700 Fax: (03) 9826 2700 Email: enquiries@vac.org.au
St. Kilda
Royal District Nursing Services (RDNS) 31 Alma road, St. Kilda Contact: 1300 33 44 55
Rural services Geelong
Barwon Health – BRASH Clinic Outpatients Annexe, 66 Bellerine Street, Geelong Contact: (03) 4215 0000 Fax: (03) 4215 1378
Portland
Portland District Health Bentinck Street, Portland Contact: (03) 5521 0333 Fax: (03) 5521 0388
Warrnambool
Warrnambool Base Hospital Ryot Street, Warrnambool Contact: (03) 5563 1666 Fax: (03) 5563 1660
27
Hepatitis Infoline Call the Hepatitis Infoline to talk about: Information: We can answer questions and mail information to you. Support: We can provide support for a range of issues and concerns. Referral: We can refer you to other organisations and services. The Hepatitis Infoline is a free and confidential service for all Victorians. Hours Monday to Friday 9.00am – 5.00pm
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