Title: Novel HCV harm reductions approaches in Australia
1Novel HCV harm reductions approaches in Australia
- Levinia Crooks
- Chief Executive Officer
- Australasian Society for HIV Medicine Australia
2Approaches
- Needle and syringe programs
- Community pharmacy
- Leadership
- Pharmacotherapy
- Prison settings
- Supervised injecting
- Targeted education programs
- Leadership, political support policy
3Needle syringe programs
- Initiated in 1986 by Alex Wodak
- St. Vincents Hospital Sydney
- The harm associated with injecting using a
contaminated needle and syringe outweighed to
harm of providing clean needles to people who
inject
4NSP practicalities
- Primary NSP are facilities designed for NSP as
their main purpose - Secondary NSP are facilities which distribute
needles and syringes and include hospital
emergency departments, community health other
community agencies - Community pharmacy is the distribution (usually
sale) of needles and syringes via chemist shops
in the community
5Problems and solutions for NSP
- Location not near schools or churches, also
mobile vans and vending machines - Fit-packs used for the safe disposal of used
equipment - Needles in the street clean-up hotlines to
facilitate quick removal of used equipment - Potential for harassment - liaison with local
police - Distance from government reduce questions and
media interest
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7Brief prevention strategies
- Training of NSP staff, particularly secondary
outlet staff to provide information to clients - Postcards and other discrete prevention
materialspackaged with fit-packs
8NSP worker training kit topics
- Alcohol and Other Drugs
- Minimising the Harm of
- Injecting drug use
- Getting the Right Fit
- Looking at Attitudes Values
- Looking after Ourselves
- A Tough Call
- Advocacy in NSP
- Sex n Drugs
9Community pharmacy
- Community pharmacy has played a large role in the
distribution of clean injecting equipment - More recently there has been considerable
planning in place to look at furthering the role
of community pharmacy in an HCV treatment
awareness campaign.
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11High level leadership
- Policy and other advisory groups kept abreast of
program and prepared to support program if under
threat - Ongoing attempts to reinforce the idea that the
harm associated with spread of infection is what
needs to be reduced and this (harm) needs to be
removed from the health issue of drug use,
particularly among young people and people
experimenting with drug use
12Detailed information provided regularly to senior
advisors
13Excerpt from NSW Parliament
- NSW Health has a public health obligation to
provide these services. Federal and State
governments across Australia support the
provision of needle and syringe programs, as do
the chairpersons of the HIV and Hepatitis C
Advisory Councils, Dr Roger Garcia and Professor
Geoff McCaughan. Since 1986, needle syringe
programs have prevented an epidemic of HIV among
Australian drug users. In Australia less than 2
per cent of drug users are infected, compared
with far higher ratessome as high as 30 or 40
per centin most other countries in Europe, Asia
and America. At the same time, it has been shown
that needle and syringe programs do not lead to
higher rates of drug use, nor do they interfere
with the work of police. - John Della Bosca 25 May 2005
14Treatment in drug alcohol settings
- While treatment per se as a prevention strategy
is a long way off, optimising opportunities to
engage with treatment is feasible. - ASHM along with a number of state governments and
researchers are making training available to AOD
and pharmacotherapy centre to maximise their
capacity to provide education and treatment.
15Methadone buprenorphine
- Pharmacotherapies are available in the community
and dispensed in the community via community
pharmacies - Increase in places not sufficient to meet demand
- Limited pharmacotherapy for amphetamines and not
in any regular usage
16Prisons as treatment opportunities
- Australia has been very slow in developing a
national policy on HCV prevention in prisons.
This is largely a result of an HIV transmission
from inmate to prison officer in 1990 which let
to the derailing ofprevention efforts
17Populations in prison
- Aboriginal Australians are vastly over
represented in prisons 2 of population and 20
- 80 of prison populations - Women are often diverted from prison and thus
women who are incarcerated have had a longer
exposure to hepatitis C outside prison 50 - 70
of women inmates have been exposed to HCV - 30 - 40 of men in Australian prisons have been
exposed to HCV
18Prison prevention strategies
- No NSP though regularly called for
- Henna tattooing and prison sanctioned tattooing
- Improved barberingand blood safetystrategies
- Greater educationof prison staff
19Supervised injecting centre
- In Kings Cross (inner city with high street based
injecting overdose rate) - Established as harm reduction strategy to reduce
overdose and highly regulated as a pilot project - Considerable objection in media and some arms of
government - Point for interaction and diversion to prevention
and therapy services
20Supervised Injecting Centre
- Has been run as aa pilot
- Has been evaluatedas effective inreducing harm
- Has reduced streetbased injecting
- Provided considerablereferral
- Constantly threatened
21Prevention of transition to injecting
22Interventions in drug use practice
- Treloar, C., Laybutt, B., Jauncey, M., van Beek,
I., Lodge, M., Malpas, G., Carruthers, S. (in
press). Broadening discussions of 'safe' in
hepatitis C prevention A close-up of swabbing in
an analysis of video recordings of injecting
practice. International Journal of Drug Policy.
23Targeted education programs
24Chopped liver http//www.ilbijerri.org.au/show3.h
tm
Chopped Liver The Blak comedy show you cant
liver without Written by Kamarra
Bell-WykesDramaturgy by John RomerilDirected by
Rachael Maza LongFeaturing Isaac Drandich
Melodie Reynolds After huge success in 2006
2007, Chopped Liver is hitting the road again in
2008, with a massive five month tour around the
nation. In 2005, Ilbijerri teamed up with the
Victorian Department of Human Services, the
Victorian Aboriginal Community Controlled Health
Organisation, and the Hepatitis C Council of
Victoria to develop a play that would communicate
Hepatitis C prevention and education messages to
the Indigenous community. The result was Chopped
Liver, which has gone on to tour to over fifty
communities and prisons in Victoria and South
Australia over the last two years. This year,
with interest continuing to grow, Ilbijerri has
joined forces with key state and local health
bodies in NSW, Victoria, South Australia,
Tasmania and Western Australia to send Chopped
Liver out on its biggest tour yet. Told through
the stories of Lynne and Jim, the play uses
comedy to humanise the experience of Hepatitis C
and to break down social boundaries surrounding
the virus, raising awareness and opening
opportunities for discussion, prevention and
support. Its about knowing that people with
hepatitis C are so much more than Chopped Liver.
25South Australia Indigenous Project
- Dont be Buntha, Hep C Dont Let It Be
26Hepatitis A and B Vaccination
- Vaccination for atrisk groups
- Vaccination for allpeople who inject
- Increased HBVvaccination
27Leadership, political support policy
- Strong leadership is hugely important
- Leadership may not be public promotion
- Political support may not be political promotion
- Sound policy and research underpinning
interventions will provide greater protection
28Acknowledgements
- Shehana Mohammed, Kirstie Ford, ASHM Secretariat
Greg Dore, ASHM Board - Carla Treloar, National Centre HIV Social
Research - Helen Tyrrell Hepatitis Australia
- Lisa Ryan, NSW Health
- Craig Rogers and staff from the SIGC and Kirketon
Road Centre - I do not have any conflicts or financial
relationships with any individuals or companies
and would like to thank the organisers for
inviting me
29Monday 20 -
Wednesday 22
October 2008
www.hepatitis.org.au