THE LITTLE HOUSE
IN THE TROPICS
he Therapeutic Community (TC) model of
treatment for alcohol and drug rehabilitation
is renowned around the world. Supported by
professional associations in Europe, Asia and
Oceania, the TC movement has been evolving for
more than half a century.
Services adhering to this particular
treatment modality have been
established in every State and
Territory in Australia since the
early 1970s. These TC treatment
facilities are well supported by
assistance for substance-
Communities are generally
clustered in and around
Australian major cities and
regional centres, above the
Tropic of Capricorn, the only
exponent of the TC movement
is Banyan House.
Banyan House was established
in Darwin in the mid-1970s by
a group of citizens concerned
about the raise of heroin-related
harm in the Northern Territory. Located in a
quaint urban suburb, Banyan House operated as a
residential treatment facility for sixteen years from a
small cottage in a quiet cul-de-sac, until it moved to a
semi-rural property on the outskirts of Darwin in 1992.
The new location, a dilapidated detention centre from the
mid-1970s, although less than ideal, presented the
opportunity for the establishment of a multi-faceted
facility providing a wide range of services to adults and
their children seeking assistance for substance
dependence and related harm.
Today, after several much needed facelifts, in addition to
residential rehabilitation, Banyan House provides
residential and outpatient pre-court and court diversion
programs, residential withdrawal, parenting programs
and programs specifically aimed at women
and their children.
We welcome enquiries from any
potential clients no matter what state or
territory you are currently living. Please
contact us on 08 8947 0832.
Image courtesy of www.google.com/images
The Hep C Review Edition 51 December 2005 31
Thousands of prisoners are exposing themselves to hepatitis C infection by
using dirty, resharpened needles, prisoner advocates report.
In its latest prison newspaper, Just Us, Justice Action argues an official
Justice Action is calling for a needle syringe program is the best
regulated needle syringe program and most cost-effective way of
across all Australian prisons to stem combating the problem.
the “rampant” tide of hepatitis C
infections. According to the Australian National
Council on Drugs, there are 19
More than one third of the country’s official prison needle and syringe
23,000 prisoners are infected with programs operating overseas and not
the disease that affects the liver and one has reported needles being used
causes nausea, fatigue and lethargy, as a weapon.
abdominal and back pain, and flu-
like symptoms, Justice Action Around 18,000 copies of Just Us are
researcher Michael Strutt says in this being distributed to prisoners across
month’s Just Us. Australia and New Zealand over the
In NSW adult gaols, it is estimated 68
per cent of women and 40 per cent Despite various hurdles to
of men would test positive for distributing the paper, including
hepatitis C, while it is thought half of initial reluctance from various state
all prisoners in that state have a corrective services departments to
history of injecting drug use. allow the paper into prisons, Justice
Action estimates around half of the
In comparison, just one per cent of prison population in the two
the general Australian population countries will read it.
carries the disease.
The paper carries a mix of articles,
“Almost all of those prisoners will letters, poetry by prisoners and a
eventually be released to carry the lonely hearts column requesting
virus back to their communities,” Mr letters from readers.
For information about Just Us, please
“Around a quarter of prisoners contact Justice Action on
continue in their furtive injecting and 02 9281 5100.
hasty cleaning of the hundreds of
reused, resharpened, dirty, pitted AAP, 29 August 2005
needles that circulate around the
HEALTH PROMOTION IN NSW GAOLS
Over the last decade, several health promotion initiatives have been implemented within NSW g
disinfectant (bleach) - - condoms - - bloodborne virus education programs - - peer support p
32 The Hep C Review Edition 51 December 2005 Image courtesy of www.google.com/images
HEPATITIS C OUT
OF CONTROL IN
In response to the recent calls for a needle and syringe
trial in gaols, Helen Tyrrell, the Executive Officer of the
Australian Hepatitis Council says, “It is imperative that
Australia develops a consistent, whole of government
approach to managing the health of prisoners with or at
risk from hepatitis C”
The response to hepatitis C in gaols needs to accept the
reality of the gaol experience where blood borne viruses
like hepatitis C are transmitted through sharing drug
injecting equipment, tattooing and body piercing, all of
which are banned but continue to occur. With up to 1 in
every 2 inmates in some States having documented
evidence of hepatitis C infection, transmission of the virus
between prisoners engaging in these activities is a major
public health concern.
Ms Tyrrell says that we are not going to reduce the
transmission of hepatitis C between prisoners unless gaols
are able to provide:
• Access to sterile injecting equipment
• Access to sterile tattooing equipment
• Access to sterile body piercing equipment
• Access to sterile hair clippers
• Access to education around the potential means of
transmission in gaol
• Access to support including treatment for those
inmates with hepatitis C
Helen Tyrrell pointed out that “Australia has largely led
the world in its response to hepatitis C in the general
community but it falls well behind the best practice
models developed in Europe to combat the spread of
hepatitis C within gaols.”
Hepatitis C is a major public health challenge with
significant costs to the government and tax-payer. Ms
Tyrrell says the Australian Hepatitis Council “will
continue to work with the government and encourage
them to take some bold steps to support the extension of
proven evidence-based harm minimisation strategies to
the corrections environment.”
programs - - the Health Promotion Diary - - methadone - - buprenorphine
The Hep C Review Edition 51 December 2005 33
a threat or an opportunity?
The World Health Organisation recently distributed to all European ministries of
health one of the most important documents on prison health ever published.
he report, Status Paper on Prisons, Drugs and Harm The fact that infection rates are still climbing confirms
Reduction, brings together the wealth of evidence that this approach does not work, but governments have
that shows that infectious disease transmission in been reluctant to endorse alternative strategies.
prisons can be prevented and even reversed by simple,
safe, and cheap harm-reduction strategies. Rather than a lack of evidence that key interventions
work, the prevention of infectious disease transmission in
Perhaps most importantly, the paper affirms WHO’s prison is hampered by a bizarre denial of governments of
commitment to harm reduction, despite opposition from the existence of injecting drug use and sexual
particular governments who view such approaches as a intercourse. Sadly, prison health is not high on the list of
tacit endorsement of illegal behaviour. The public-health the public’s concerns, so there is also little domestic
case for action is strong, but political commitment to this pressure to address the problem.
method of combating health problems in prisons remains
elusive. Some UN agencies, such as the United Nations Office on
Drugs and Crime, still question the efficacy of harm-
Indeed, health problems in prisons are numerous. reduction measures, despite much scientific evidence to
Prisoners are often from the poorest sectors of society and the contrary. The influential role played by the UN’s four
consequently already suffer from health inequalities. major donors—the USA, Sweden, Italy, and Japan—
Being in prison commonly exacerbates existing health which all favour prohibitionist approaches to drug use in
problems - incarcerating anyone, especially vulnerable prisons, means that harm-reduction measures have not
groups such as drug users and those with mental illness, been given the credit and status they deserve.
has serious health and social consequences.
The failure of governments around the world to
High rates of injecting drug use, risky sexual practices, implement measures that have repeatedly been shown to
and overcrowding have made prisons a perfect habitat for reduce harm wastes a vital opportunity to improve the
the spread of infectious diseases. In parts of Europe and health of a population that is often beyond the reach of
the USA, up to 20% of inmates are HIV-positive; and in public-health efforts. This failure is utterly shameful.
some prisons tuberculosis infection rates are 100 times Prisoners, a “captive group”, present a crucial
that of the civilian population. A study by Anna opportunity to address behaviours that pose a high risk of
Shakarishvili and colleagues in a recent Lancet medical disease transmission in society in general as well as in
journal highlights the need for interventions targeting prisons, with proven, easy, and cheap harm-reduction
vulnerable groups in detention centres to curtail the measures.
rapidly growing HIV epidemic in Russia.
It is important to remember that these health issues do
Harm-reduction efforts in prisons aim to prevent or not remain confined to prisons: the high level of mobility
reduce the negative health effects associated with certain between prison and the community means that the health
behaviour patterns, imprisonment, overcrowding, and of prisoners should be a fundamental issue of public-
adverse effects on mental health. Initiatives such as health concern. Infectious diseases transmitted or
needle-exchange programmes are effective and viable for exacerbated in prison inevitably become public-health
controlling the spread of HIV, and do not obstruct the issues when prisoners return to their communities.
safety or effectiveness of drug-use prevention policies.
However, the prison systems that have achieved the most It is time for a global approach: to acknowledge the
success in preventing the spread of HIV have promoted contribution of prison health to health inequalities; and to
harm reduction and treatment strategies together— make prison health a priority by convincing governments
making bleach, condoms, methadone maintenance, that health policy must be based on evidence and not
needle exchange, and other drug treatment available. political prejudice.
Despite these positive outcomes, the response to the HIV/ Abridged from The Lancet 2005; 366:1 (2/07/05)
AIDS epidemic in prisons has been slow and piecemeal, via www.dailydose.net/
and most governments continue to ignore the strategic
importance of prison health care to public health. Most
strategies for dealing with HIV in prisons focus on a zero-
tolerance approach to drug users.
34 The Hep C Review Edition 51 December 2005
The Probation and Community Corrections Officers’ Association (PACCOA),
believes that proposed changes to the structure and operations of the
Department of Corrective Services in NSW, which have been developed in
secrecy, may diminish the quality and nature of justice administration and lead to
significantly higher crime rates in the State.
ACCOA represents the professional interests of These announcements have been eagerly awaited for
probation and parole and community corrections many years, as has a promised re-grading of base-grade
personnel across the Commonwealth of Australia. probation and parole officer positions. Welcome as they
are, the improvements should not distract the
The NSW Department of Corrective Services has fundamental changes which are planned.
announced a planned restructure, in which the
organisational leadership of the Probation and Parole To our knowledge, no other jurisdiction in the world has
Service is to be abolished and fundamental changes to successfully brought together its prison and probation
ways of working with offenders in the community are to operations in the way planned for NSW and we fear an
be introduced. PACCOA is concerned that the proposed exodus of dedicated and skilled practitioners, who will
changes will lessen offenders’ capacity to reintegrate into be uncomfortable with the more surveillance-based
society and that this will lead to significant long-term approach to offender management that is proposed.
costs in social and dollar terms.
The planned restructure is, arguably, one of the most
Probation and parole officers work quietly at the front significant changes to criminal justice practice in this
line with people in trouble in the community. They country in over half a century. Yet no open inquiry was
maintain a skilled balance between activities to ensure conducted and no documents have been released,
that people under supervision comply with the terms of explaining why the restructure or operational changes
supervision, whilst working alongside them to enhance are considered necessary or what they are intended to
their lives, reduce risks of relapse and restore them, achieve.
wherever possible to full participation as citizens. Our
members do not shirk from their public responsibility and We understand that neither the Commissioner of
return people to courts and releasing bodies, in Corrective Services nor the Minister for Justice have been
circumstances where they fail to comply with the prepared to meet with our affiliate Association, the
requirements made of them. For many offenders in the Probation and Parole Officers’ Association of NSW to
community, however, Probation and Parole is the only discuss any of their concerns.
agency which will work with them to negotiate issues of
The noted Conservative politician, Winston Churchill, in
housing, employment, treatment for mental health and
the House of Commons, in July 1910, said, “The mood
dependency issues, to assist them to understand the
and temper of the public, in regards to the treatment of
effects of their behaviours on others and to develop
crime and criminals, is one of the most unfailing tests of
strategies to reduce their risk of getting back into trouble.
the civilisation of any country.” By the standards set by
NSW urgently needs to reduce, not increase, its reliance Churchill, work done by probation and parole officers
upon imprisonment because incarceration is with offenders encompasses “supervision more
demonstrated to predispose people to re-offending. There individualised, more intimate, more carefully considered
are estimated to be at least 2000 people in prison in and more philanthropically inspired.”
NSW, who could have been diverted into community-
PACCOA is concerned that NSW not fail Churchill’s test
based programs with minimal risk. Imprisonment comes
of civilisation by undergoing a fundamental restructure of
at the cost of services foregone to the community such as
its justice system, without public disclosure or
education (poor education is demonstrated to be one of
explanation. We urge that an open and independent
the most significant factors in the lives of many
inquiry be held, prior to the implementation of any
changes to the Probation and Parole Service.
PACCOA is pleased that the Department has recently
announced staffing improvements to address shortages, to This Media Release has been authorised by the
provide some relief for staff who are on leave and even Probation and Community Corrections Officers’
the appointment of a small number of psychologists to Association Inc. Graeme Pearce, President. Please
work in district offices. direct all inquiries to Marion Lofthouse,
Spokesperson, on 08 9317 3731.
The Hep C Review Edition 51 December 2005 35
’m writing this story from where I see it, grass roots Education programs should be designed around drugs
view. I myself have hep C for some time as you with a module in it about discrimination and blood borne
probably already know (I’ve written a couple of other diseases. This program should be offered to all
stories). I reckon whatever you would think that will help government and non government organisations that come
the “cause” out, don’t wait, write in and let everyone into contact with possible drug users or people that have
know what you think. caught hep C through other means.
Hep C Council is doing a pretty good job but more Education is a powerful tool. The program will give
funding from government is a must. Hep C Council needs people a better understanding of the drug culture and
to grow with the spread of hep C and relevant issues maybe show a bit of compassion.
surrounding this area. Hep C and the stigma that comes
with it is usually associated with drug use. Not everyone So what is a drug user in people’s minds? Junkie = square
that has hep C caught it through drug use but the general heads = heroin addict running wild = robberies. But these
consensus of Australians is drug use = problem to be stereotypes, heroin is not the only drug that goes into a
fixed by the “square heads” (police and courts). fit.
Illicit drug use is a DISEASE just like alcohol and An occasional user, regular user or the full on user have
tobacco, the first is illegal, the other two are legal. They different life styles but the common theme is the needle!
can all kill you if you over indulge. If you have lived the path you will know what I’m on
As soon as government and everyone across the board
realises what we are fighting here plus join forces, the Programs should be designed with culture content in
better chance we all have with this problem. Drug use is place to train different cultures on hep C issues and facts.
on the rise, these blood borne diseases are crippling our These people can go to their communities and educate
people. Things will only get worse, if you don’t put in others (Train the Trainer). These plain and simple
preventative measures. Our youth today are chopping programs should also explore the social disadvantage
into the speed, heroin, plus shooting up whatever comes which is a big issue for many using drugs across the
along (pills, done, etc). board.
Youth programs should be designed for the youth. These Alcohol and tobacco are legal drugs but there are more
programs should be run in Juvenile Centres, primary and deaths from these than illicit drugs. Even with money
high schools etc. People would say primary schools are a spent on education, it seems that more is spent on
bit young but teaching them about the dangers of needle alcohol and tobacco. Drugs affect you physically and
pricks, blood-to-blood contact would be a plus. mentally and depending on your drug of choice there is a
big chance of catching hep C or something else like HIV/
If you are dealing with people from the lower end of the AIDS, vein damage, abscess, etc.
social scale, chances are their children have been in
contact with the drug culture. We need a more direct Some people just like the thrill of the steel in their arm
approach in teaching our children today, the government and shoot anything!
and the square heads are behind the times.
Dual diagnosis is also a problem in this area - drug
Hep C and discrimination seem to go hand in hand, you problems combined with psych issues. I believe more
wouldn’t think so in this day and age, that you would run people should be trained in this area, instead of treating
into any form of discrimination. But here’s one for you: people like footballs kicking them to one department,
what if you’re black (Aboriginal), a junkie and a crim to back and forth, no one wants to stand up. You can’t just
boot? Chances are you will run into some form of treat one piece of the person’s problem, it is all
discrimination. interwoven, drug use, lifestyle, social issues, etc. All
government and non government departments should be
Even today, I myself still run into some form of inter-linked so referrals aren’t a problem.
discrimination. Gee, some people are backwards. Every
drug user should know their rights and the law in regards Politicians and social commentators MUST change their
to where they stand on discrimination issues. strategies and attitudes towards drugs as the war on drugs
has “failed”. Any fool can see this surely.
In these articles (pgs36-40), winners of our writing These views are not necessarily those of the Hepatitis C
competition (see p12) provide their personal views on Council of NSW not of our funding body.
matters related to hepatitis C.
36 The Hep C Review Edition 51 December 2005
Youth is a big problem area and programs should be Gaols and institutions across the board are a must for our
designed for schools, juvenile centres where ever programs. These places are breeding grounds and the
possible to get the message across. I reckon we need people that run them are fools with tunnel vision if they
more forums with guest speakers like people with hep C, can’t see this.
people that fight it, people that live with hep C but don’t
have hep C, carers, parents, school teachers, partners. Sincerely
Above image, detail taken with thanks from ‘Terra Nullius’. The artist is Lachlan Amore-Lloyd from Mowbray College, Melton, VIC.
Lachlan received the Chief Justice’s award. For full image see http://www.fedcourt.gov.au/students/studentsartprize.html#5
The Hep C Review Edition 51 December 2005 37
Detail from White Lines: Barcelona. Dowloaded with thanks from http://www.ixion.demon.co.uk/images.htm via www.google.com/images
38 The Hep C Review Edition 51 December 2005
epatitis C is a disease. It is caused by a virus. The and deserving of its protection not its punishment. Two of the
reactions of people who come into contact with the major sources of discrimination for people with hep C are
virus will differ, but it will have an impact on the life the infectious nature of the disease and its association with
of most people who cannot rid their bodies of the virus. The injecting drug use. I believe that the worry about infection is
most common way that people in Australia contract hepatitis easier to deal with and therefore shall deal with it first in this
C is by injecting drugs, and injecting drug users are brief discourse.
perceived by many in our society in a way that people who
suffer from a disease are not. People with a disease are seen Because of my background in market research I can see that
as unfortunate victims of their disease worthy of being helped viral hepatitis has a problem with it’s ‘branding’. The public
by medical professionals, but injecting drug users are usually is confused about the hepatitis “brands”. The average person
seen as being dangers to society who should be penalised for has heard that you can get hepatitis from eating food that has
their own and society’s sake. People with hepatitis C been contaminated by the person handling the food, or that
therefore become the subjects of discrimination because of you can get it from kissing. Although neither of these applies
their association with injecting illegal drugs. One way, and to hepatitis C the fact that they are both called hepatitis is
probably not a quick way, of changing people’s perceptions enough to make people worried about catching the disease
of hep C positive people is to change perceptions of injecting and fearful that they might get it quite easily from an infected
drug users. person. This, amongst the general public, is enough to fuel
fear, which fuels discrimination. My solution, with a couple
The main differences in perceptions between having a of million dollars, would be to ‘re-brand’ the hepatitis viruses
disease and being an injecting drug user is that injecting drug for the general public. Names, or sub-names, that indicate
use is seen as being voluntary and a crime. There is, their transmission routes would both educate the public
however, a problem with both of those perceptions. If, as about dangers and separate the different viruses that can
some do, we view problematic injecting drug use as a cause hepatitis in the public mind, and would help alleviate
disease process, then it may not be voluntary, and it is hard one source of fear and discrimination against those with hep
to see how young person in a terrible situation being offered C. The medical community could be drafted to assist in
a quick way to feel good could be seen as having much of a disseminating the new names so as to lower the cost of ‘re-
choice. But even if it is an entirely voluntary activity, isn’t the branding’.
protection of our young the main purpose of a society, and if
this is the case, are penalty and incarceration the best way to The second source of discrimination, the association with
protect young people from themselves? Surely branding injecting drug use, is a much more politically charged, and
someone as a criminal and using the legal system to control therefore much more difficult, issue. Injecting drug users are
their behaviour almost guarantees that they will take refuge committing a crime, and the consequences of problem use
in the company of people who accept them, and these are often shown in the popular media and in professional
people will usually be their fellow injecting drug users and publications. The association with injecting drug use is a
the dealers. Whether problem injecting drug use is a disease source of discrimination amongst both the general public and
process or a voluntary decision, penalty and incarceration health professionals. Drug users are perceived to be people
are not appropriate remedies. who steal our possessions, commit acts of violence and have
no self-respect or respect for those around them. As injecting
So the use of injecting drugs could simply be a crime and drug use is the most common transmission route for hepatitis
this would make penalty and incarceration acceptable C those with hepatitis C are tarred with the same brush.
treatment. However, the law is designed to protect people, However, I would argue that, by and large, injecting drug
and by extension their property, from harm. Not to protect users are young people who may have made some bad
the individual committing the action from harm. If a person decisions, and who deserve the protection of society, not
commits robbery, arson, murder, rape, fraud or theft, they punishment, and that prosecution and punishment serve
have impacted on someone else’s life. But no-one else is mainly to further alienate young people who probably
immediately affected by another’s use of drugs. Drug use is already feel alienated from mainstream society. I would
therefore often called a ‘victimless crime’. So, is drug use a argue that treating problem drug use as a medical problem
crime? Individual actions that may have a negative impact on rather than a legal problem would lead to a better outcome
an individual’s life and health are usually dealt with by for society at large and for many of the individuals
medical and allied health professionals, but there is no concerned. It would also, as a side effect, reduce public and
impact on another’s life unless they are robbed or care about professional discrimination against people with hep C.
the drug user. Robbery is a crime itself and when committed
by a drug user it is usually done to buy drugs, the amount of In closing, if anyone can work out how to achieve this rosy
robberies would be reduced by treating problem drug use as outcome with 2 million dollars or so please contact your
a disease rather than a crime. If someone cares about a drug local health professional, policeman or politician
user wouldn’t they want the user to be cared for by the immediately.
medical community rather than the police and courts?
Treating problem injecting drug use as a disease rather than a
crime would make society at large more productive and
happy, would help family and friends of users, and would
help the users themselves, most of whom are society’s young
The Hep C Review Edition 51 December 2005 39
never used much. I received prize money from an I am not on a crusade and gossip is a dangerous tool. So
exam, and gave it to someone as a present, to later when your family and closest friends - sometimes with
wake to a needle stab in the foot. The other time I tried their new born - still come and visit after you confide, I
to help my boyfriend get out of a gang by being part of it. am extremely grateful. Why? Because they probably feel
I used a dirty needle because I didn’t think ahead, but I threatened by it but are rising above their fears.
got my boyfriend off drugs in the end.
It isn’t that easy to catch, but it is a really bad disease.
A needle stick injury and a stupid mistake can cost such a People’s instinct would say avoid people with the virus.
lot. I feel like a leper, but I got my own health into shape, Education would allay some fears, but I couldn’t expect
my LFT’s are always normal. people to have no reservations.
I have a conscience towards other people. So when I was When I was in hospital I felt a level of prejudice, for all
going in for a gall bladder operation last year, I was asked my attempts at honesty. But I felt I did the right thing. I
did I have hep C, I said yes. This I said in the interests of cannot stand spiritual denigration when it is really severe
the staff but I knew it could alter the way I was treated. I and narrow minded, and it can be hard to get justice. I
felt it did a bit, but I still think I did the right thing. felt some of the staff appreciated me, so honesty really
I told my dentist when she asked as well. She may follow
the same procedure with everyone but that information Anna, NSW
gave her the chance to be as vigilant as possible. She
didn’t turn me away. I think she probably respected my
honesty and my concern for her and her staff. The
positive outweighs the negative for me. I’d much rather
prevent the spread of this disease than worry about
people’s opinions. But I am aware how bad people can
be towards treating you well and with dignity.
The other aspect of my life that has been affected is my
marriage. I married that boyfriend, and have been for 18
years, and thinking I had got hep C from him. The
genotype test was never offered, so when we finally got
the results, it was disturbing to discover I had the one that
was harder to treat.
Considering he had been a junkie, I got stabbed by
someone’s dirty needle, and used only once. It now made
our sex life difficult.
I don’t think anyone’s mad, depends on the circumstance.
I put down life’s ‘trips’ to experience. My husband is
reformed and doing art and I am steering away from
troublemakers, expecting a bit more from life.
To generalise about people with hep C is counter
productive and short-sighted. The drug scene can be a
horrible scene, as I knew from my husband’s experience,
hygiene too often gets forgotten. So I suppose hep C
carries those stigmas because most people with it were in
a scene, and people associate hep C with drug culture.
I, personally, do not like to tell anybody about my hep C
status. My GP says that you should tell someone if you
are going to sleep with them, and I agree with that, and I
would let medical personnel know. But I don’t want to
make it everybody’s business.
This image, detail from http://files.bitchx.ru/files/fotki/sett/drugs.jpg
40 The Hep C Review Edition 51 December 2005
DO YOU WANT
TO BE BETTER
CONNECTED Announcing a clinical trial to find out whether
acupuncture treatment has any effect on the health
outcomes of people with hepatitis C. The trial is
WITH OTHER being undertaken at the University of Technology,
Sydney, as part of a Master’s Degree research
HEP C Participants need to:
WORKERS? • have a documented positive PCR viral
HepLink is a NSW-wide network for health care and • be aged between 18 to 70 years
other workers who address issues relating to hepatitis C in • be not currently undertaking combination
their work. HepLink provides a forum for workers to
therapy (or have been on it within the last
share information, resources and support.
Members include dedicated hepatitis C workers, as well
as those for whom hepatitis C is just one area of their Treatment will include two acupuncture treatments
work. Our membership base includes specialists, nurses, per week over a twelve week period (24 treatments)
needle syringe program workers, drug & alcohol workers, at a Guilford acupuncture clinic. Five blood samples
youth workers, aboriginal health workers, researchers, will also be taken over a six-month period.
mental health workers, etc. Participants will also be expected to complete
questionnaires during the trial.
In addition to ongoing support and information through
email e-list contact, HepLink members can also
If you want to know more about this project,
participate in quarterly forums held in Sydney. Travel
grants and Telehealth videoconferencing are available for please contact Christine Berle on 9632 8989
our rural/regional HepLink members to take enable them or Christine.A.Berle@student.uts.edu.au
to take part.
HepLink forums for 2006 will be held on the following
dates from 10am - 1pm at the Kerry Packer Education
Centre, RPA Hospital, Camperdown:
21 March, 21 June, September (tbc) & 15 December.
If you would like more information about
HepLink, please contact Holly Beasley at the
Hepatitis C Council of NSW
ph: 9332 1853
This image, detail from http://history.grand-forks.k12.nd.us/ndhistory/ This image, detail from
The Hep C Review Edition 51 December 2005 41
THE NORMALISATION OF
USE: PART 1
In the first of two briefing papers,
Professor David Clark looks at research
which provided essential insight into
British youth culture and the role of In their book Illegal Leisure, Parker and colleagues
emphasised that this political discourse has an ‘energy’ of
drugs and alcohol among adolescents its own. It promotes public fear and anxiety about crime,
during the 1990s. drugs and youth, which in turn it then uses to interfere
simplistically, and with apparent public consent, in drugs
nly a small minority of people who try an illicit and criminal justice policy and practice. This process,
drug develop a problem. Many people who try because it can barely be challenged, thus spins along
an illicit drug do so on one or a few occasions reinforcing itself.
and decide the experience is not for them. Some may use
one or more illicit drugs on a periodic basis, while others But this simplistic rhetoric ignored the question as to why
may use more regularly; but still their use is recreational the majority of young people try illicit drugs and a
and controlled. significant minority continue to use them regularly.
The use of illicit drugs has increased greatly over the past In trying to understand this situation, Parker and
20 years, in particular during the 1990s. As an example colleagues emphasised that the very nature of
of this change, a large-scale annual survey by the adolescence was changing – the context and the
University of Exeter’s Health Education Unit (involving conditions in which young people were growing up were
30,000 children from 150 schools in England and very different to generations before.
Scotland) revealed that the proportion of 15- and 16-year-
olds that reported ever having tried an illicit drug rose The research study involved a sample of over 700 14-
from 10 per cent in 1989 to 40 per cent in 1996. year-olds being tracked annually for up to five years.
In 1991, Professor Howard Parker and his colleagues Each year, they were asked about their personal and
initiated a unique piece of research, which tracked a family circumstances, their disposable income, use of
large sample of young people (14 to 18 years old) from leisure, and perspectives on personal and social
the North West of England over a five-year period. The relationships. They were asked in detail about their use of
study confirmed the widespread recreational use of illicit tobacco, alcohol and illicit drug use.
drugs, and provided essential insight into British youth
culture and the role of drugs and alcohol among As they matured, more complex issues were pursued,
adolescents. including their attitudes towards drug use and drug users,
their assessment of health education they received, and
This study took place against the backdrop of a ‘youth their experiences at parties and nightclubs.
drugs crime danger’ message both from media and
politicians. When John Major, the then Prime Minister, Five annual self-report surveys were undertaken, and 86
announced his new drug strategy (Tackling Drugs interviews were conducted when respondents were 17
Together) in a speech to the Social Market Foundation in years old. Eight co-educational state secondary schools in
1994, he chose ‘yob-culture’ as the sound bite he wanted the North West metropolitan area of the UK were used.
the media to highlight. The questionnaires were distributed in the classrooms
with teachers absent.
Tackling Drugs Together was about offenders and crime,
indeed ‘no single crime prevention measure would be The overall aim of the study was to assess how ‘ordinary’
more significant than success on the front against drugs’. young people growing up in England in the 1990s
developed attitudes and behaviours in relation to the
One premise of the strategy was that young people were unprecedented ready-availability of drugs, alongside
‘at risk of drug abuse’ and succumb because of peer other consumption options such as alcohol and tobacco.
pressure. The second premise was that drugs are
dangerous and a menace. The third was that because The findings suggested that recreational drug use had
drug use leads to crime, local communities are at risk become widespread amongst British youth.
from drug users. More than 36 per cent of the sample had tried an illicit
The war-on-drugs rhetoric of the then conservative drug by age 14, and this increased to 51 per cent by age
Government, and the desire to link drugs and crime, was 16, and 64 per cent by age 18. More than 60 per cent
later hijacked by the Labour Party in opposition. It was and 90 per cent of the sample had received drug offers at
continued once Labour came into power. age 14 and 18 years, respectively.
42 The Hep C Review Edition 51 December 2005
DRUGS TO FEED
Some interesting facts and figures on
The most commonly tried drugs by age 18 were cannabis
(59 per cent tried), amyl nitrites or ‘poppers’ (35 per drugs and drug trafficking:
cent), amphetamines (33 per cent), LSD (28 per cent) and
200 million, or 5 percent of the world’s population aged
ecstasy (20 per cent).
15-64 have used illicit drugs at least once in the last 12
Only 6 per cent had tried cocaine and 0.6 per cent had months
tried heroin. $13 billion - estimated value of global illicit drug market
in 2003 at production level
Females were almost as likely as males to have tried an
illicit drug by age 18, and there were no differences $94 billion - estimated value at the wholesale level
between youth from working and middle class
$322 billion - estimated value at retail level
backgrounds. At age 18, nearly one-quarter of the sample
had tried an illicit drug in the past week. $70.5 billion - estimated value of cocaine alone at retail
The study also revealed that young people reported many
more positive experiences of drug use than negative $17 billion - value of exports worldwide of wine in 2003
outcomes. $6 billion - value of exports worldwide of coffee
By age 14 years, 90 per cent of the sample had tried $65.2 million - 1972 US Drug Enforcement
alcohol, with 30 per cent claiming to drink on a weekly Administration (DEA) budget
basis. This latter percentage rose to 80 per cent in 18
year-olds, with a mean consumption of ten units on the $2.1 billion - 2005 DEA budget
last drinking occasion. At age 18 years, just over a third 2,775 - number of DEA employees in 1972
of the sample were current smokers.
10,894 - number of DEA employees in 2005
Professor David Clark is from the Psychology 44 per cent - North America’s share of worldwide drug
department, University of Wales, Swansea UK. purchases
In the follow-up briefing paper, we look at the 33 per cent - Europe’s share of worldwide drug purchases
drug journeys that young people in this study 76 per cent - share of total drug profits generated in
took, and explore why adolescent recreational industrialised countries.
drug use became normalised.
1 per cent - share of profits earned by producers of
The reader is strongly recommended to read the cocaine and heroin in developing nations.
book, ‘Illegal Leisure: The normalisation of
Sources: UN Office on Drugs and Crime, Drug Abuse
adolescent recreational drug use’ by Howard
Warning Network (DAWN); DEA
Parker, Judith Aldridge and Fiona Measham;
Abridged from The Victoria Advocate, 06/11/05.
Abridged from www.dailydose.net/ http://victoriaadvocate-proxy.nandomedia.com/
[In Ed52, we will attempt to carry an overview of www.dailydose.net/
recreational drug use among young people here in
The Hep C Review Edition 51 December 2005 43
Low seizure rates give traffickers vast profits from an AUD$9.5bn a year business,
says report ministers refuse to publish
By Alan Travis
he profit margins for major traffickers of heroin into Danny Kushlik of the Transform drugs policy foundation,
Britain are so high they outstrip luxury goods which campaigns for legalisation, said the government
companies such as Louis Vuitton and Gucci, was hiding the parts of the report which demonstrated
according to a study that Downing Street is refusing to that, far from reducing production, trafficking and supply,
publish under freedom of information legislation. prohibition spawned the business.
Only the first half of the strategy unit study led by the The suppressed pages say that the drugs supply market
former director general of the BBC, Lord Birt, was into Britain is sophisticated and attempts to intervene
released last Friday. The other half was withheld but has have not resulted in sustainable disruption to the market
been leaked to the Guardian. at any level. “Government interventions against the drug
business are a cost of business, rather than a substantive
It says that the traffickers enjoy such high profits that threat to the industry’s viability,” it concludes.
seizure rates of 60-80% are needed to have any serious
impact on the flow of drugs into Britain but nothing Emphasising the inadequacy of seizure rates, the study
greater than 20% has been achieved. says the result over the past 10 to 15 years has been that,
“despite interventions at every point in the supply chain,
The study concludes that the estimated UK annual supply cocaine and heroin consumption has been rising, prices
of heroin and cocaine could be transported into the falling and drugs have continued to reach users”.
country in five standard-sized shipping containers but has
a value which at a conservative estimate tops UK£4bn It concludes that even if the government succeeded in
(AUD$9.5bn). reducing the availability of drugs, that could backfire
because the most addicted, “high harm” users might
The report was presented in its full form to Tony Blair in commit more crimes to fund the purchase of ever more
June 2003. Only 52 of its 105 pages were published, with expensive drugs.
a note saying the rest was being withheld under the
Freedom of Information Act. The report says the annual cost of crimes committed by
an estimated 280,000 high harm drug users to support
The government yesterday defended its decision not to their cocaine and heroin habits has reached £16bn
publish the half of the report that delivers a scathing (AUD$38bn) a year - a figure which rises to £24bn
verdict on efforts to disrupt the drugs supply chain. The (AUD$57.5bn) if the costs to the nation’s health and
first 50 pages deal with drug consumption patterns and “social functioning harms” are included.
The report says the drug supply business is large, highly
A Downing Street spokeswoman said the second half flexible and very adaptable, and even if supply-side
contained information supplied by law enforcement interventions were more effective it is not clear that the
agencies dealing with security matters, it concerned the impact of the harm caused by serious drug users would
formulation of government policy and its publication be reduced.
would be prejudicial to the conduct of public affairs. But
critics last night said much of the unpublished material The outlook for stopping drug production in developing
was already in the public domain. countries is equally gloomy and embarrassing to the
British government, which is leading attempts to curb
Opposition politicians last night criticised the partial heroin production in Afghanistan.
suppression of the report, saying it was a stark example of
the misuse of the Freedom of Information Act. The Birt report says a policy of compensated, forced
eradication is very expensive and actually encourages
The Liberal Democrats’ home affairs spokesman, Mark further planting by farmers, while the alternative of a
Oaten, called on the information commissioner to order comprehensive set of development interventions is also
full disclosure. “What this report shows and what the expensive, takes time and might only displace cultivation
government is too paranoid to admit is that the ‘war on to other countries.
drugs’ is a disaster. We need an evidence-led debate
about the way forward but if they withhold the evidence Alan Travis is home affairs editor at The Guardian
we can’t have the debate.” newspaper, UK.
Abridged from The Guardian, 05/07/05 via
44 The Hep C Review Edition 51 December 2005
UK DOCTORS WARN OF AUD
$19BN HEPATITIS C CRISIS
Up to 200,000 people will die from hepatitis C infection in Britain over the next 20
to 30 years unless diagnosis and treatment of the disease improves dramatically,
doctors predicted recently, writes James Meikle.
working group of UK health experts has warned People who come to Britain from abroad may have been
that the government was underestimating the infected through transfusions or medical equipment, and
looming hepatitis C public health disaster. other less common infection routes include poor hygiene
at tattoo parlours, shared toothbrushes and razors, mother
The group, led by William Rosenberg, a consultant at to baby transmission and, rarely, sex.
Southampton general hospital, for a study commissioned
by the Hepatitis C Trust, suggest that at least 500,000 Only about one in 20 people who know of their hepatitis
people carry the virus, and that conservative estimate is C status receive drugs that might cure them, say
double the government figures. They warned that over the campaigners, and that figure represents only 1-2% of
next 30 years, the cost to the UK National Health Service those who might be infected.
(NHS) could rise to £8bn (AUD$19bn).
Researchers say many people fall out of the system
Nine in 10 people are unaware of their infection and the between first warnings through blood tests and the
numbers will rise steadily unless public awareness eventual treatment. Some hospitals never receive GP
campaigns encourage people who might be infected to referrals, patients are often highly mobile and do not
offer themselves for screening via a blood test. receive the results of tests, and some either do not believe
Professor Rosenberg accused the NHS of regarding how serious the virus can be, or worry that there is a
hepatitis C as “a low-life disease” because many stigma linked to the disease.
diagnosed are drug injectors. Yet others included those Critics compare the £2.5m (AUD$6m) being spent on an
who only “dabbled” in drugs and decades ago. awareness campaign in England with the £50m
“My clinic is packed full of lawyers and bankers. They are (AUD$119m) being spent in the battle against sexually
what we would call respectable, middle-class, people transmitted diseases.
who dabbled when at university or in their teens. It might
be a person who injected a bit of speed in the 60s. You James Meikle is health correspondent with The
could have been a very infrequent injector in the past”. Guardian newspaper, UK.
Other people developed disease from infected blood Abridged from The Guardian, 30/09/05, via
products and transfusions. Heat treatment for products for www.dailydose.net/
people with haemophilia was only introduced in 1986
and a blood test to protect traditional blood transfusions
came five years later.
The Hep C Review Edition 51 December 2005 45
YOU are vital to US - WE are here for YOU
Here we highlight items of particular interest for
members and the benefits of financial membership. MEMBER NEWS . . . .
In Member News, our bulletin which debuted with In the December edition of Member News, please
Edition 50 and will continue to be mailed to all watch for:
financial members with individual copies of The Hep C
Review, members hear the “good oil” first and learn of → More on the opportunity for 2 individual
special benefits unavailable to our general readership. financial members to attend the 5TH
AUSTRALASIAN CONFERENCE ON VIRAL
HEPATITIS in Sydney in February 2006
CONGRATULATIONS go to the three →
Feedback on our 2005 ANNUAL GENERAL
financial members who are now enjoying the MEETING AND COMMUNITY
benefits of entering the computer age cour- INFORMATION SESSION held on 10
tesy of our ex-staff computers. November
CONGRATULATIONS also to the five
financial members whose names were picked
from the draw to join management committee
members, staff and volunteers in a very
special THANK-YOU event on board the tall
Our 2006 membership year begins on 1 March 2006
We will remind you of the renewal date again in Edition 52. However, to enable you to take advantage of our “early
bird” offer if you wish, we’ve enclosed a membership form with this issue. Professional and organisational members
will receive invoices seperately with Member News.
Don’t forget – All memberships require renewal each year, including zero fee category. PLEASE complete all
relevant sections of the membership form, sign and return the entire form to us.
If you are uncertain about the status of your membership, please give us a call on 02 9332 1853, or send an email to
When forwarding your membership application or renewal, please remember that cheques or money orders must be
made out to HEPATITIS C COUNCIL OF NSW MEMBERSHIP.
WHY NOT BE AN EARLY BIRD AND RENEW YOUR
2006 MEMBERSHIP BEFORE MARCH?
You’ll be covered till March 2007 and you could receive a pleasant
surprise! If we receive your 2006 renewal by 1 March, you will go
in a draw to win one of 5 copies of PROFESSOR GEOFF FARRELL’S
informative book “HEPATITIS C OTHER LIVER DISORDERS AND LIVER
HEALTH - A PRACTICAL GUIDE”. Normally retailing at $71.50, this 324
page guide is an excellent resource for workers in the field as well
as for people personally affected by HCV.
46 The Hep C Review Edition 51 December 2005
a Council profile research update
INTRODUCING Ribavirin plus interferon
OK for children with
KATY ROY: hepatitis C
PROJECT OFFICER, USA - The drug combo interferon alfa-2b plus ribavirin
appears to be effective and relatively safe for children
HEP C HELPLINE with chronic hepatitis C infection (HCV). Most serious
adverse events can be managed by lowering the dose of
ribavirin, the investigators report in the November issue
I have been in the role of project worker for six of Hepatology.
months now and have found the Hepatitis C Council
to be a supportive and dynamic working This drug combination improves virological responses in
environment. adults, lead author Dr Regino Gonzalez-Peralta and
colleagues note, but information is limited regarding its
Prior to working here, I have been employed in a use in children.
variety of client focused roles at ACON and most
In a phase I study, Dr Gonzalez-Peralta, from the
recently I worked with homeless young GLBT University of Florida in Gainesville, and his team tested
people at the Twenty10 Association where I am three doses of ribavirin (3, 12, or 15 mg/kg/day) in
currently a volunteer on their committee of combination with interferon alfa-2b (3 million IU/m2
management. three times weekly) in 56 children ages 5 to 16 years with
hepatitis C. The highest dose of ribavirin tested was the
At the moment I am working on a fact sheet looking most effective in reducing levels of serum HCV RNA and
at the issues around pregnancy and children, for had a comparable safety profile to the lower dose
people with hepatitis C. regimens.
I enjoy riding my bike to work, reading the weekend They then tested the efficacy of the higher dose regimen
paper and hanging out with my small dog. in 118 children ages 3 to 16. At the end of the 48-week
treatment period, 59% had undetectable HCV RNA
levels, which declined to 46% who achieved a sustained
viral response during a 24-week follow-up period.
Response rates were higher in children with baseline
levels of 2 million copies/mL or lower and those with
HCV genotype 2/3 compared with genotype 1. None of
the five African-American patients had a sustained viral
Severe adverse events were reported by 19% of subjects,
neutropenia being the most common. Depression was
reported by 13%, including three with suicidal ideation
and one attempted suicide. Dose modification occurred
in 31% of cases, and 7% discontinued treatment.
Although growth slowed during treatment, it rebounded
during the follow-up period.
“The paediatric safety data, pharmacokinetic profiles, and
efficacy for the combination are similar to that reported
in adults for the treatment of HCV infection,” Dr.
Gonzalez-Peralta’s group concludes.
Abridged from www.medscape.com
The Hep C Review Edition 51 December 2005 47
December 2005 Edition 51 The Hep C Review 48
phone the NSW Hep C Helpline on 9332 1599 (Sydney callers) 1800 803 990 (other NSW callers).
To clarify any medical terminology, or for further information, please speak to your doctor or specialist, or
particular research topic.
overall scientific debate. They help broaden our overall knowledge and help develop consensus opinion on
Individual articles may sometimes appear to contradict current knowledge but such studies are part of
These ‘research update’ pages in the magazine attempt to meet this need.
In our previous readership surveys many people say they want to see detailed information on hepatitis C.
Abridged from www.gastrohep.com
Journal of Hepatology 2005: 43(4): 590-8
this cohort within 25 years.”
“We confirmed the low risk of progression to cirrhosis in
cases, or develop mild chronic hepatitis C.”
morbidity may clear 1b infection in more than half of the
Dr Wiesea’s team concluded, “Young women without co-
low increase of fibrotic scores in the last 5 years.
Abridged from www.gastrohep.com via In addition, the researchers observed a continuous, but
Hepatology 2005: 42(4): 962-73 co-morbidity.
related complications, half of these related to additional
The team found that 10 women had died of hepatitis C
assignment of new genotypes and subtypes in the future.”
“The framework will internationally coordinate the with hepatocellular carcinoma.
developed pre-cirrhotic stages and one was diagnosed
store and provide access to data on the virus.”
Only nine had overt liver cirrhosis, whereas 30 women
the framework by which hepatitis C research databases
Dr Simmonds’ team concludes, “These proposals provide for Hepatitis C RNA.
tested positive for hepatitis C virus antibodies and 46%
new variants into genotypes and subtypes.
after 25 years, 86% of the 1,833 affected women still
The researchers also propose a particular classification of
70% of the total cohort of 15 centres. They found that
the six genetic groups. The researchers examined 1,980 women, representing
Hep C will be classified into six genotypes, representing
HCV 1b contaminated.
the future. reported that 14 anti-D immunoglobulin batches were
assignment of new genotypes as they are discovered in Dr Manfred Wiesea and colleagues from Germany
The team also planned to draw up revised criteria for the
subtype names among described variants of hepatitis C. to 2,867 women for prophylaxis of rhesus
The researchers aimed to resolve conflicting genotype or though, anti-D immunoglobulin had been administered
known dates of infection. Between 1978 and 1979,
status of HCV genotype nomenclature. There are few unbiased long-term follow-up studies with
hepatitis C genetic variability, met to re-examine the
Dr Peter Simmonds and a colleagues expert in the field of have a low risk of progression to cirrhosis.
morbidity may clear infection in most of the cases, and
needed. contaminated immunisations, young women without co-
variants of hepatitis C virus are termed is increasingly people who received hepatitis C genotype 1b
International standardisation and coordination of the way The latest Journal of Hepatology reports that in a group of
hep C virus genotypes source HCV outbreak
Unified system of naming Outcome of a single
New injecting practice Drug crime re-offending
increases HIV risk among drops in North Queensland
drug users in Tanzania This report on the North Queensland Drug Court presents
the findings of an evaluation of the implementation,
Female sex workers who inject heroin in Dar es Salaam, operation and outcomes of the North Queensland Drug
Tanzania, have created a new needle sharing practice Court pilot program for 26 months from its inception in
they call “flashblood.” After one woman injects, she 2002. The program operates within the Cairns and
draws blood back in her syringe until the barrel is full Townsville magistrates’ courts, and aims to target and
and then passes the needle and syringe to a female divert into treatment, rather than prison, high-volume
companion to inject. Women believe that such blood property or drug offenders whose offending is attributable
contains enough heroin to help them escape the pains of to their drug dependency.
withdrawal. They developed this practice in mid-2005 in
an altruistic attempt to help one another. These data are The evaluation discusses referrals to the program;
based on ongoing interviews with 63 injecting drug users. procedural issues; the operation of the program,
including absconding rates; implementation issues;
Research on the relation between drug injection and HIV differences in program operation and participant profile
transmission has long focused on the serial use of between the two courts involved, and between the North
syringes or needles, practices such as “backloading,” and Queensland and South East Queensland Drug Court pilot
reuse of paraphernalia before injecting. Flashblood is a programs; and the outcomes of the pilot program, in
new phenomenon that is, in a sense, a dangerous terms of re-offending, drug use and health and social
exaggeration of needle sharing that magnifies HIV functioning of participants.
transmission risk. If the first injector is infected with HIV
or hepatitis C virus the amount of virus directly With respect to re-offending, the evaluation finds, among
transmitted into the bloodstream by the second injector other things, that post-entry re-offending is significantly
could be quite large. reduced for those who successfully complete the drug
court program; and of those successful participants who
The rationale for the practice may be the price and do re-offend, the time taken to re-offend is significantly
quality of heroin. Since 2003 the price of heroin has longer.
doubled. Once pure, it is now reportedly adulterated.
Now a kete costs $1, and injectors reportedly need two to In terms of drug use and health outcomes, the evaluation
get high. Most female injectors are sex workers, and the finds evidence of reduced level of drug use for the
more successful are helping the more desperate with duration of participation, as indicated by the declining
flashblood. The women who accept flashblood are also number of positive drug tests; graduates of the drug court
the most likely to agree to clients’ frequent requests to program reported significant improvements across a
forgo condoms. range of physical and mental health measures; and at the
time of graduation, participant health status was
Injection drug use emerged in East Africa during the past equivalent to Queensland population norms.
five to six years, and it is spreading rapidly throughout
the region. If flashblood spreads to other cities in East The evaluation was also supplemented with qualitative
Africa, its impact on the rate of transmission of HIV and interviews with a variety of participants of the North
hepatitis C virus could be substantial. Queensland Drug Court program. These interviews
highlighted the importance of additional psychological
assessment and relationship counselling services for
BMJ 2005;331:778 (1 Oct 2005), doi:10.1136/ participants on the program.
Abridged from www.dailydose.net/ Technical and background paper series, No 17: Final
report on the North Queensland Drug Court, Jason Payne,
Australian Institute of Criminology, 2005.
Abridged from www.aic.gov.au/publications/tbp/
tbp017/ via NSP Forum.
The Hep C Review Edition 51 December 2005 49
Peg interferon alpha and ribavirin People with genotype 1, 4, 5 or 6 who are PCR positive at
week 12 but have attained at least a 2 log drop in viral load
Subsidised ‘peg combo’ treatment for people with chronic may only continue treatment after 24 weeks if HCV is not
hepatitis C is available to those who satisfy all of the detectable by a PCR qualitative test at week 24. Similarly,
following criteria: genotype 2 or 3 people with cirrhosis or bridging fibrosis
may only continue treatment after 24 weeks if HCV is not
1a Biopsy: people must have evidence of Metavir stage 2, detectable by a PCR qualitative test at week 24. PCR
3 or 4 fibrosis (or equivalent index), or stage 1 fibrosis qualitative tests at week 24 are unnecessary for people with
with grade A2 or A3 inflammation. genotype 1, 4, 5 or 6 who test PCR negative at week 12.
1b Biopsy: people with coagulation disorders severe
enough to prevent liver biopsy are exempt from 1a but
must have evidence of abnormal ALT levels. PegInterferon Alpha-2a or 2b
2 Blood tests: people must have documented chronic Australian Government-funded PegInterferon Alpha-2a or 2b
hepatitis C infection (repeatedly antibody positive or involves a course of weekly pegylated interferon injections
PCR positive). for up to 52 weeks. People are asked to visit their GP or
specialist for follow-up visits during and after treatment.
3 Contraception: women of childbearing age undergoing Aside from modest Pharmaceutical Benefits Scheme charges,
treatment must not already be pregnant nor breast- there should be no additional costs levied by treatment
feeding, and both a woman and her male partner must centres.
use effective forms of contraception (one for each
person). Men undergoing treatment and their female When interferon molecules are pegylated, the drug lasts
partners must use effective forms of contraception (one longer in the body. It is injected once a week and ensures a
for each person). Female partners of men undergoing more consistent therapeutic dose rather than the peaks and
treatment must not already be pregnant. troughs of thrice-weekly injections.
4 Age: people must be 18 years or older. PegInterferon Alpha-2a or 2b monotherapy leads to a
sustained response in around 25% of those who try it,
5 Treatment history: people must not have had prior basically doubling the sustained response rate of basic
interferon or peg interferon treatment. interferon monotherapy.
Government-funded treatment is offered to people 18 years
or older who have chronic hepatitis C and compensated liver
Duration & genotypes disease, and who have received no prior interferon therapy,
and who have a contraindication to ribavirin (can’t tolerate it)
For people with genotype 2 or 3 without cirrhosis or bridging and who satisfy all of the following criteria:
fibrosis, treatment is limited to 24 weeks. For people with
genotype 1, 4, 5 or 6 and those genotype 2 or 3 people with 1 Biopsy: people must have evidence of chronic hepatitis
cirrhosis or bridging fibrosis, treatment lasts 48 weeks. on liver biopsy (except in patients with coagulation
disorders considered severe enough to prevent liver
Monitoring points 2 Liver function tests: people must have abnormal ALT
levels in conjunction with documented chronic
People with genotype 1, 4, 5 or 6 who are eligible for 48 hepatitis C infection, i.e. repeatedly antibody positive
weeks of treatment may only continue treatment after the first and/or HCV RNA (PCR) positive.
12 weeks if the result of a PCR quantitative test shows that
HCV has become undetectable or the viral load has 3 Other liver damage: people mustn’t have other forms of
decreased by at least a 2 log drop. The baseline and 12-week chronic liver disease.
tests must be performed at the same laboratory using the
same type of test kit. PCR quantitative tests at week 12 are 4 Contraception: women of childbearing age must not be
unnecessary for people with genotype 2 and 3 because of pregnant, not breast-feeding, and must be using an
their higher likelihood of early viral response. effective form of contraception.
Treatment with interferon alpha has been associated with depression and suicide in some people. Those people with a history of suicide
ideation or depressive illness should be warned of the risks. Psychiatric status during therapy should be monitored.
A potentially serious side effect of ribavirin is anaemia caused by haemolysis (destruction of red blood cells and resultant release of
haemoglobin). People’s blood counts are monitored closely, especially in the first few weeks, and doctors may lower the ribavirin dose if
necessary. Adults who can’t tolerate ribavirin and have had no prior interferon treatment may be offered subsidised PegInterferon Alpha-2b if
they meet certain criteria.
Ribavirin is a category X drug and must not be taken by pregnant women. Pregnancy in women undergoing treatment or in the female partners
of men undergoing treatment must be avoided during therapy and for 6 months after cessation of treatment.
50 The Hep C Review Edition 51 December 2005
5a Duration: with Alpha 2a, the Complementary therapies
treatment course is limited to 48
weeks. People may only continue Good results have been reported by some people using complementary therapies
treatment after the first 12 weeks while others have found no observable benefits. As with any treatment, it’s
if PCR viral load testing shows important to remember that wrongly-prescribed medicines can be harmful.
that the plasma HCV RNA has
become undetectable or the viral A previous Australian trial of one particular Chinese herbal preparation has shown
load has decreased by at least a 2 some positive benefits and few side-effects (see Ed 15, p 6). A similar trial but on a
log drop. larger scale was carried out in the NSW Northern Rivers region (see Ed 24, p 8).
Currently, a trial of particular herbs and vitamins is being carried out by
5b Duration: with Alpha 2b, the researchers at John Hunter Hospital, Newcastle, and Royal Prince Alfred and
treatment course is limited to 48 Westmead hospitals, Sydney (see Ed 45, p 9).
weeks at 0.5 to 1 microgram per
kilogram weekly. People may Some people choose complementary therapies as a first or a last resort. Others
only continue treatment after the may not use them at all. Some may use them in conjunction with pharmaceutical
first 12 weeks if PCR viral load drug treatments. Whichever way you choose, you should be fully informed. Ask
testing shows that the plasma searching questions of whichever practitioner you go to:
HCV RNA has become
undetectable or the viral load has • Is the treatment dangerous if you get the prescription wrong?
decreased by at least a 2 log
drop. • How has their complementary therapy helped people with hep C?
• What are the side-effects?
• Is the practitioner a member of a recognised natural therapy organisation?
• How much experience do they have working with people with hepatitis C?
People wanting to access interferon-
based therapy outside of the • How have they measured the health outcomes of their therapy?
government subsidised S100 scheme
can purchase treatment drugs at full • How do they aim to help you?
price or seek access through industry-
sponsored special access programs. Remember, you have the right to ask any reasonable question of any health
practitioner and expect a satisfactory answer. If you are not satisfied, shop around
For more information, people should until you feel comfortable with your practitioner.
contact their nearest treatment centre.
For telephone numbers, please call the You cannot claim a rebate from Medicare when you attend a natural therapist.
Hep C Helpline (see p52). Some private health insurance schemes cover some complementary therapies. It
may help to ask your natural therapist about money before you visit them. Many
will come to arrangements about payment; perhaps a discounted fee?
NSW treatment centres It is also important to continue seeing your regular doctor and/or specialist. Talk to
them and your natural therapist about the treatment options that you are
Treatment centres exist in most parts of considering and continue to have your liver function tests done.
NSW. Phone the Hep C Helpline for the
contact details of your nearest centre. It is best if your doctor, specialist and natural therapist are able to consult directly
with one another. If a natural therapist suggests that you stop seeing your medical
NSW Justice Health has nine treatment specialist or doctor, or stop a course of pharmaceutical medicine, you may want to
assessment centres (two within gaols consider changing your natural therapist.
for women) and various clinics for
monitoring ongoing treatment. If you decide to use complementary therapies, it is vital that you see a practitioner
who is properly qualified, knowledgeable and well experienced in working with
people who have hepatitis C. Additionally, they should be members of a relevant
Phone the NSW Hep C Helpline (see p52) for more information and the contact
details of relevant professional associations.
The Hep C Review Edition 51 December 2005 51
support / info services
NSW Hep C Helpline Sexual health clinics
For free, confidential and non-judgmental information and Although hepatitis C is not classified as a sexually
emotional support you can phone the NSW Hep C Helpline. transmissible disease, staff at these clinics can offer a range
The service gives you the opportunity to talk with trained of services including pre- and post-test discussion and HCV
phone workers and discuss those issues important to you. It blood tests. They are listed in your local phone book under
also provides referral to local health care and support ‘sexual health clinics’.
If you are concerned about confidentiality, these clinics do
• 9332 1599 (Sydney callers)
not need your surname or Medicare card and keep all
• 1800 803 990 (NSW regional callers) medical records private.
Prisons Hep C Helpline Other support & counselling
A special phone service provided through the NSW Hep C Traids is a statewide counselling, support and advocacy
Helpline that can be accessed by NSW inmates and prison service for people with medically acquired hepatitis C and
staff. Call this free and confidential service by using the gaol HIV. They offer short and long-term counselling, information,
phone, or by calling the numbers above. support and advocacy to affected people and their families
and/or carers. Traids services are free and confidential, and
Community health centres on either a face-to-face or telephone basis. They also run
support groups and have a regular newsletter. Current
Community Health and Neighbourhood Centres exist in most hepatitis C information is available. For more information,
towns and suburbs. They provide services, including phone 02 9843 3143 (Traids have a call-back policy for NSW
counselling, crisis support and information on local health regional callers).
and welfare agencies. Some Neighbourhood Centres run a
range of support and discussion groups and activities that Family & relationship counselling
may range from archery to yoga. Look in your White Pages
under Community Health Centres. Neighbourhood Centres If hepatitis C is impacting on your family relationships, it
can be found by phoning your local town Council. may be wise to seek family or relationship counselling. To
find out more, contact Relationships Australia on 9418 8800
General Practitioners or 1800 801 578.
It is important that people find a well-informed GP who can Advice on food & nutrition
support all long-term health care needs. Ideally, a doctor
should be able to review and monitor a person’s health on a Accredited Practicing Dietitians (APD) are qualified dietitians
regular basis and provide psychological and social support if engaged in a formalised system of ongoing professional
needed. GPs should also be able to act as advocates to help updating. Dietitians work in hospitals and community health
with difficulties in other parts of the health care system. GPs centres, where there is usually no charge for their services.
should be able to advise when it is necessary to seek Alternatively, private practitioners are listed in the Yellow
specialist advice or further investigations or about research Pages. For information on healthy eating and referral to local
trial options. The NSW Hep C Helpline may be able to refer dietitians, call the Dietitians Association of Australia: 6282
people to doctors and other health care workers in their area 9798 or 1300 658 196 or www.daa.asn.au
who have been involved in hepatitis C training.
Cultural and linguistically diverse
Alcohol & other drug services
People who inject drugs and want to access peer-based
information and support should phone NUAA (the NSW The Multicultural HIV/AIDS and Hepatitis C Service
Users and AIDS Association) on 8354 7300 (Sydney callers) (MHAHS) works with culturally and linguistically diverse
or 1800 644 413 (NSW regional callers). individuals and communities to achieve better health and
wellbeing in relation to HIV/AIDS and hepatitis C, and to
NSW health services have a number of Drug and Alcohol encourage and support health services working in these areas
clinics set up around the state. These centres offer to respond appropriately and equitably. MHAHS targets 20
confidential advice, assessment, treatment and referral for different language groups, but is also available to other
people who have a drug/alcohol problem or who have individuals and communities from culturally diverse
concerns about the use of these substances. The services are backgrounds seeking assistance. For more details, phone
free and the staff are experienced in all aspects of drug and 9515 3098 or 1800 108 098 or just visit http://
alcohol use and associated conditions. If you are worried www.multiculturalhivhepc.net/ to access hepatitis C
about your own or someone else’s drug and alcohol problem, information in languages other than English.
phone the Alcohol & Drug Information Service (ADIS) on
9361 2111 or 1800 422 599, or contact your local hospital NSW Health hepatitis C regional
or community health centre who will also be able to advise coordinators
you on your nearest clinic.
Phone the NSW Hep C Helpline (above) for information
Family Drug Support about possible local services in your area and/or contact
details for your hepatitis C regional coordinator.
An organisation that provides assistance to families to deal
with drug issues in a way that strengthens relationships and
achieves positive outcomes. Phone FDS on 1300 368 186.
52 The Hep C Review Edition 51 December 2005
support / info services
Hep C Australasia Port Macquarie Hepatitis C Support
This Australasia-wide online internet community has over
two hundred members. You can start your own conversation Peer support available for people living with or affected by
thread or take part in existing threads, offer your point of hep C. For information, please contact Lynelle Wood on
view or share your experiences. Just visit http:// 6588 2750 or Alison Mears on 0418 207 939.
St Vincent’s Support Group
Central Coast HOTS group
HOTS: HCV and Offering Togetherness and Support. We are
a Central Coast hep C support group who meet twice a This treatment-related support group kicked off the new year
month on the 1st Wednesday evening of the month from 7.30 on 20 Jan and meets on the first Tuesday of each month. St
to 9.00 pm, and the 3rd Tuesday morning of the month from Vincent’s Hospital, Darlinghurst
10.30 am to 12 midday.
For information, please contact Zoe Potgieter 8382 2887.
These different times allow people who work or study to
attend as well. We meet at the PSN House at North Gosford.
We also have guest speakers, general discussion and outings.
You will always get a cuppa. St George Support Group
For information, please contact Leslie on 4323 2905. Group meets intermittently at the Waratah Clinic. For
information, please contact Philip on 9350 2961.
Coonabarabran Hepatitis C Support
Group Westmead Support Group
A support group for people living with hepatitis C, including
Meets in the Health Counsellor room, Coonabarabran
those on treatment. People from any area are welcome.
Community Health building. For information, please contact
Gary McKernan on 6842 2507. From 7pm to 8.30pm, every 1st Thursday of each month
(except Dec & Jan) at Room 2, Level 2, Parramatta Health
Service, 158 Marsden St, Parramatta. There is free parking,
with entry via George Street. Otherwise, it is a 10 min walk
Hunter Hepatitis C Support Services from Parramatta station.
A service that is open to all people of the Hunter living with For information, please contact Sen Kee on 9845 7706, Maria
HCV and is linked to a team of health care professionals on 9843 3143, or Frances or Susan on 9840 4110.
specialising in hepatitis C treatment & care. Based at John
Hunter Hospital, Lookout Rd, New Lambton.
For information, please contact Gabrielle Murphy on 4921 Westmead Hepatitis C Information
4762 or Tracey Jones on 4921 4789.
Our Information Nights are aimed for people with hep C,
Nepean Hepatitis C Support Group families, friends and interested others. Our speakers talk
about various aspects of hepatitis C such as: research about
Guest speakers keeping you informed about hep C. Family the virus, transmission, treatment and symptom relief. People
and friends are more than welcome. Light refreshments and who have hepatitis C or who have successfully undergone
supper are provided. treatment often speak of their experiences and we also allow
time for questions and answers.
Held in the Nurse Education Dept. Lecture Room (Somerset
Street entrance), Nepean Hospital. Supper is generally provided as we know this can be an
awkward time for some people. Parking is available at the
For further information, please contact Jo or Vince on 4734 hospital but you will need five dollars in coins. Alternatively,
3466. it is about a ten-minute walk from Westmead station. Go to
the main entrance of the hospital and ask for directions at
Reception, or look for our signs. There is no charge for the
Information Night and people from any area are most
Northern Rivers Support Group welcome.
Support groups often come and go. For information, please For information, please contact Sen Kee on 9845 7706, Maria
contact Wendi Evans on 6620 7539 or Marilyn Lebeter on 07 on 9843 3143, or Frances or Susan on 9840 4110.
The Hep C Review Edition 51 December 2005 53
Our loan library New HCV info booklet
Library loans are available for up to 4 weeks. Please call the available in 15 languages
Hep C Helpline on (02) 9332 1599 (Sydney callers) or 1800
803 990 (other NSW callers) to request the item you require. A new hepatitis C resource, developed by the
Items are loaned free of charge but borrowers are required to Multicultural HIV/AIDS and Hepatitis C Service (MHAHS)
pay return postage. Please enquire about postage rates when to raise awareness of hepatitis C among people from
you call the Helpline. CALD backgrounds in Australia, is now available.
Videos “Hepatitis C is Everybody’s Business” was funded by the
Australian Government Department of Health and
The Big Combo (HCCNSW, 2002): Approx 20 mins; two Ageing, the 12-page booklet is available in 15 languages:
people consider pharmaceutical treatment for hepatitis C in Arabic, Bosnian, Chinese, Croatian, English, Greek,
very different ways; information on current treatment and Indonesian, Italian, Khmer (Cambodian), Korean,
interviews with treatment specialists. Available with subtitles
Macedonian, Portuguese, Spanish, Thai and Vietnamese.
for people with hearing difficulties. English.
It is for anyone who wants to know about hepatitis C,
Everybody’s Business (MHAHS/ANCAHRD, 2004): Covering
including people who may have had a risk factor, their
hepatitis C and HIV; suitable for health workers working with
groups. Comes with a facilitator’s workbook. Available in families and friends.
English, Khmer, Somali, Indonesian and Thai.
As well as raising awareness of this important public
Look Back Look Forward (Kathy Sport/Ronin Films, 1998): health issue, the booklet also aims to reduce
Approx 30 mins; real-life stories of people’s experiences with misinformation and stigma associated with hepatitis C.
hepatitis C and interviews with health specialists. Suitable for The booklet contains information on transmission, testing,
individuals and health workers. English. (Council members prevention and support. It will be distributed across
only) Australia to multicultural organisations and hepatitis C
An order form for the booklet is available from MHAHS
Hepatitis C: An Australian Perspective (Crofts, Dore, on (02) 9515 5030.
Locarnini, 2001): Covers all aspects of hepatitis C clinical
management, treatment and prognosis. Suitable for health The booklet will soon be downloadable from
workers. (Council financial members only) www.multiculturalhivhepc.net.au
Hepatitis C, other liver disorders and liver health: A Practical
Guide (Farrell, 2002): Covers all aspects of hepatitis C
management, treatment and lifestyle issues, as well as other
liver disorders. Suitable for individuals and health workers.
(Council financial members only) Sharing a chuckle
Cassette Tapes There once was a man with hep C
Who felt as sickly as sickly could be
Hepatitis C: A Brief Introduction (HCCNSW, 2000): The
Council’s comprehensive brochure on audiotape for people So he went on the treatment
with reading difficulties. NB: treatment information has Virus gone in complete-ment
changed slightly since 2000. English. Now he’s happy and fit as a flea
HCCNSW There was a little flaviviridae virus
Who sobbed, interferon wants to fire us
We’re not wanted here
We’re to be thrown out on our ear
And no-one else wants to acquire us
5th Australasian Viral Hepatitis Conference
Monday-Wed, 20-22 February 2006
The Sydney Masonic Centre, Sydney NSW
14th National Symposium on Hepatitis B and C If you wish to make a complaint concerning our products or
Saturday, 18 November 2006 services, please visit our website for more information:
St Vincent’s Hospital Melbourne Vic
Email firstname.lastname@example.org www.hepatitisc.org.au
54 The Hep C Review Edition 51 December 2005
membership form / renewal / tax invoice
An invitation to 1. Please complete A or B or C, then complete other side
join / rejoin the A. For people affected by HCV, or other interested people
Hepatitis C Council of NSW
PO Box 432
DARLINGHURST NSW 1300 Suburb/town
Or fax: 02 9332 1730 State Postcode
About the Council Home phone Email:
We are a community-based, non-government,
membership organisation and a health promotion
charity. Our role is to represent and provide services
to people affected by hepatitis C throughout NSW. B. For individual healthcare or related professionals
The Council is overseen by a voluntary Management
Committee, primarily made up of people elected by Name
the membership. Although primarily funded by NSW
Health, we rely heavily on the involvement and Occupation
support of our members.
The Hepatitis C Council of NSW respects and upholds
your rights to privacy protection. In accordance with Suburb/town
National Privacy Principles, we have a detailed policy
and set of procedures regulating how we collect, use, State Postcode
disclose and hold your personal information.
For a copy of the policy, please contact the Council Work phone Work fax
office on 02 9332 1853 (Sydney and non-NSW
callers), or 1800 803 990 (NSW regional callers), Mobile Email:
or visit our website: www.hepatitisc.org.au
May we list you on our referral database?
Our membership year begins on 1 March and runs to Copies of The Hep C Review required 1 2 5 10
the end of February the following year. All members 20 50 100
(including Zero Fee members) must renew their
memberships on an annual basis.
Membership income assists the Council greatly C. For agencies, organisations and companies
in its work throughout the year.
For NSW health care workers agency
One of our services is the NSW Hep C Helpline,
an information and support phone line that is able to
refer callers to a range of services and health care Contact person
workers in their local area (within NSW only).
If you want to be listed on our database as a referral
option, please indicate on this form and return to us Postal address
by fax or post. We will provide posted regular HCV
update information. Please note that we encourage
services on our referral database to become members
of the Council. Suburb/town
As the most widely-read hepatitis C publication
in NSW, targeting both people affected by hepatitis C State Postcode
and health care workers, The Hep C Review is
provided free to all members of the Council. Work phone Work fax
If your service has clients/patients who may be Mobile Email:
interested in The Hep C Review, please indicate the
number of extra copies you would like to receive May we list you on our referral database?
on this form.
Copies of The Hep C Review required 1 2 5 10
20 50 100
The Hep C Review Edition 51 December 2005 55
membership form / renewal / tax invoice
2. Are you a new or existing member? 5. Separate donations are gratefully accepted by the Council.
Donations of $2 and over are tax deductible.
This is the first time I've applied to
become a financial member If you would like to make a separate donation,
please record the amount here: $.....................................
I'm already a financial member and
this is a membership renewal
I currently receive your magazine and 6. If paying by credit card, please provide all information in this
I want to become a financial member section.
I'm not sure - please check your Card number:
3. Our membership year begins on 1 March
Card type MasterCard Visa Bankcard
and finishes on the last day of February.
To become a financial member, please tick one
membership fee box, below:
Expiry date: month: year:
Waged: for people in paid $25
employment Cardholder signature:
Concession: for people on $10
Please print cardholder name:
Zero Fee membership: for people $0
in NSW experiencing severe financial
hardship (NSW prison inmates)
Individual health or allied $40 7. Payment, GST and postage instructions
Community-based agency $50 All Council membership fees are GST exempt but for most people, our
(Management Committee run) membership fees are not tax deductible.
If paying by cheque or money order, please make payments out to:
Public/private sector agency $70
Hepatitis C Council of NSW - Membership
NB: Above are Australian rates only. Overseas Please post payments to
applicants please contact the office or consult our Hepatitis C Council of NSW
website for additional surcharge information. PO Box 432 DARLINGHURST NSW 1300
Our ABN is 96 964 460 285
4. Contact with the Council office.
8. Would you like us to post you a receipt?
We post our magazine out every three months in
plain unmarked envelopes. Occasionally, we If you would like a receipt for your payment,
contact members (especially those living in please tick the box (right)
Sydney) by phone or mail, seeking volunteer
assistance here in the office.
I'd like to assist. Please contact me 9. Declaration - I accept the objects and rules of the Hepatitis C
regarding volunteer work Council of NSW and apply for membership of the Council.
I agree to my personal contact details being held by the Council
volunteer work for the Council
contact the office (02 9332 1853) or visit our website: www.hepatitisc.org.au
This section amount receipt membership info pack
date received date entered
office use only received number number sent?
56 The Hep C Review Edition 51 December 2005