Download Module 1

Your trainers today are:
• Names
What we will cover in today’s training:
Three Modules
1. Setting the context: overview
of hepatitis C and viral hepatitis
2. Harm Reduction and the Needle
and Syringe Program
3. Engaging young people around injecting
drug use and harm reduction services
First Module
1. Welcome and Introductions
2. Evidence around young people
and risk of hepatitis C
3. Overview of hepatitis C and other
forms of viral hepatitis
Exercise: Getting to know you
• Find someone you don’t know so well
• Spend five minutes getting to know each other
and find out the following:
• Their name and their role at work
• What they hope to get out of today’s training?
• Something we wouldn’t expect to know about them?
(i.e. they are a trapeze artist, belly dancer or hula-hooper
in their spare time, they love heavy metal music etc.)
• You will be required to introduce your new friend to the group
Evidence around Young People
and Hepatitis C Risk
Some of the key issues
• Most common age to initiate into injecting is 18
• Young people have low levels of knowledge around
hepatitis C and available harm reduction services
• There can be a relatively short period between the
starting of injecting drugs and getting hepatitis C ie
1.6 to 2 years (Maher et al)
Therefore Hepatitis C information should be given
early - before young people start injecting
Context for the day – some statistics
• Australian NSP surveys show decreasing number
of young people accessing surveyed NSPs
• 374 new hep C notifications a year in NSW young
people aged 15-24 in 2012/2013
• 90% of all new infections of hep C in Australia
through injecting
‘The exposure and transition study’
(Bryant et al)
This study looked at exposure to injecting and
hepatitis C among young people at risk
Drug use is generally not widespread among
young people. Rather it is concentrated among
particular groups of youth.
A particularly affected group is young people who
are socially disadvantaged.
‘The exposure and transition study’
(Bryant et al)
Examined contexts in which drug use occurs.
Choices that young people make about using or
not using drugs were strongly brought about by:
• Peers networks
• Place and space – opportunistic aspects of drug use
• Families
• Social and Economic capital
‘The exposure and transition study’
(Bryant et al)
Characteristics of young people who inject
More likely to:
• Have experienced homelessness
• Feel less close to parent/caregiver
• Be male
• Be diagnosed with mental health issues
• Leave school early or poor academic performance
‘The exposure and transition study’
(Bryant et al)
Combination of previous factors make a young person
vulnerable in relation to their drug use
May lead to injecting
‘At risk’ young people have little perceived risk
of hepatitis C
‘At risk’ young people have poor knowledge and
connection to NSP services
NSW ‘Big Day Out’ Survey 2009
1.How many young people know someone who
injects drugs?
2.Would they know how to be safe if they were
thinking about injecting drugs?
NSW ‘Big Day Out’ Survey 2009
¼ knew someone who had injected drugs or
had been offered an injection in the previous
12 months
Of those people;
• Only 2/3 knew that hepatitis C could be transmitted by
using a needle that someone else had already used
• Only 1/3 knew where to obtain sterile needles and
syringes
The Context - A Summary
• Young people “more likely to seek help for drug use from
youth services” than Alcohol and Drug services Bryant et al
• It is a challenge in making hepatitis C matter and link it to
wider issues of a ‘normal’ life.
• There is poor knowledge of harm reduction services
indicating that better links necessary between youth services
and harm reduction services.
• Youth workers have been identified as a key group to
provide information and referral
Overview of hepatitis C
and other forms of viral hepatitis
What do you know about hepatitis?
• Breakup into small groups
• Each person will write down three things you know to be
true about hepatitis C, other forms of viral hepatitis
• Write an additional three things you have heard that ‘may
or may not be true’
• Write three further things you want to know about
hepatitis
• You have 10 minutes
Viral Hepatitis
The following slides are to be used to support
discussion during the hepatitis brainstorm
activity if needed
Hepatitis C prevalence
In Australia approximately 300,000 people
have been exposed to hepatitis C
That’s roughly 1.3% of the population
Three quarters of these people
will have long term hepatitis C
BBV – how many?
(As at Dec 2012)
Hep B Virus
207, 000
Hep C Virus
230,000
National BBV and STI Surveillance and Monitoring Report 2013
HIV
25,708
What is hepatitis?
• Hepatitis = inflammation of the liver
Hepatitis has many different causes
• Hepatitis C = a virus that causes hepatitis
Hepatitis C is different from A & B
A healthy liver
An unhealthy liver
Disease progression
Left untreated, hepatitis C can lead to:
- Fibrosis
Liver scarring and
impaired liver function
- Cirrhosis
- Liver failure
- Liver cancer
}
Hepatitis C is the most common reason
for liver transplantation in Australia
Hepatitis C progression
If hepatitis C is left untreated:
Out of 100 people who have been living with hep
C for 20 years:
• 45 will not develop serious liver damage
• 31 will develop mild to moderate liver damage
• 20 may develop cirrhosis of the liver
• 4 may develop cirrhosis followed by liver
failure or cancer
THE B
OF
HEPATITIS
Hepatitis A is transmitted by. . .
...for example in contaminated food.
It causes an acute illness that lasts a few weeks or so.
THERE IS A VACCINE
Hepatitis B is transmitted by. . .
...and can be transmitted through sexual contact
and injecting drug use. The good news is,
it rarely results in a long term illness.
THERE IS A VACCINE
Hepatitis C is transmitted by. . .
...and in Australia it is usually transmitted through
injecting drug equipment.
It leads to long term illness in ¾ people exposed
THERE IS NOT A VACCINE
(and exposure doesn’t provide immunity)
Transmission and hepatitis C
So what puts
someone at risk
of transmitting
hepatitis C?
Well, first off,
for hepatitis C to be
passed on, there must
be blood present from
someone who actually
has the virus
Transmission Risk
Tattooing and piercing
Non-professional
tattooing and
piercing is increasing
amongst young
people – putting
them and their peers
at risk of blood
borne infections
Performance & image-enhancing drugs
• Injecting becoming
more common
• More younger people
using them
• Accurate information just
not out there
• Unknown risks
Not just about blood borne infections
Myth-conceptions
IS HEP C A SEXUALLY TRANSMITTED
INFECTION (STI) ?
NO
•If there’s no blood and no cuts, there is
no risk of hepatitis C transmission.
•Hepatitis C is not classified as an STI
but if there is blood to blood contact,
transmission could occur.
Play it safe and use one of these
Hepatitis C - testing
Symptoms of chronic hepatitis C
People with chronic hepatitis C infection may
appear well while others will develop symptoms
such as:
– fatigue
– loss of appetite
– nausea/vomiting
– abdominal pain
– joint pains
– depression
Symptoms of acute hepatitis C infection
• Most people have no symptoms when they are first
infected with hepatitis C
• If there are symptoms, they usually develop within one to
three months of infection and can include:
– a mild flu-like illness
– a yellowing of the skin and eyes (jaundice)
– abdominal pain
– loss of appetite
– nausea
– vomiting
– dark urine
– fatigue
Hepatitis C Treatment
• Treatment outcomes are improving rapidly at the
moment
• New treatments over the next couple of years will
continue this improvement
• Current drug regimens offer around 80% success
rates
• Treatment length dependent on ‘genotype’
• Anyone with hepatitis C should have it monitored
by their GP or other health service.
What are the side effects of current treatments?
• Most people experience some side effects
• Most common side effects are flu-like symptoms
such as chills, fever, muscle and joint pains,
headaches, nausea and loss of appetite
• Other common side effects include depression,
mood swings, sleep disturbance and ‘brain fog’
• In addition, anaemia and skin rash are common
Alcohol and hepatitis C
• Research shows that the risk of developing
liver damage is higher in heavier drinkers
• Alcohol intake can increase the severity of
hepatitis C, non-alcoholic fatty liver and other
liver injury
• Reducing alcohol intake can restrict the severity
of liver injury
Morning tea break
(15 minutes)