1. No category

the
Image by ec-jpr copyright © 2011. Available under a Creative Commons license from http://www.flickr.com/photos/ec-jpr/4214127250/sizes/o/
c files
WA’s Hepatitis Newsletter
Issue 123 │ April/June 2011
WHAT IS THE HEPATITIS
B TREATMENT?
PREGNANCY:
Hepatitis, my Baby and Me
ANGELINA’S
STORY
+
A STORY OF 2
LOVERS
by
u
o
oy
t
t
gh
ou
Br
dont let hep c slow you down:
WANT TO KNOW MORE ABOUT VIRAL HEPATITIS?
Call us for information, resources, and support. If you
(08) 9227 9800 │ [email protected] │ www.hepatitiswa.com.au have a question about hepatitis, we’ve got the answer!
e
h
t
Note from the Editor
cf
Within this edition of the CFiles is a special treat of TWO personal stories,
both of which are extremely interesting. The story of two lovers, ‘Love,
Drugs & the Whole Damn Thing’, is told in a conversational style with the
lovers reminiscing about their experiences and lessons in life. The Story
of Angelina is written by a West Australian and can be found on page 12.
s
ile
The CFiles is the official newsletter of
A community-based non-profit organisation.
Editor:
Riana Young
Management Committee:
Dr Susan Carruthers (Chair)
Mr Mike Seward (Vice Chair)
Mrs Maria Kroon (Treasurer)
Mr Frank Farmer (ex officio)
Ms Leesa Tapping (Secretary)
Ms Tania Lamond
Ms Ursula Swan
Postal Address
PO Box 8435
Perth Business Centre
Northbridge, WA 6849
Information & Support Line
Mon-Fri 9am-5pm
(08) 9328 8538 Metro
1800 800 070 Country
Office
187 Beaufort St
Northbridge, WA 6003
Telephone: (08) 9227 9800
Fax: (08) 9227 6545
www.hepatitiswa.com.au
Proof Reading
Frank Farmer
Pregnancy and hepatitis looks at some questions a woman may have
about the effect of living with hepatitis B or C and her developing baby,
but also if being pregnant will affect her hepatitis. Pregnancy is usually
is a joyful time, and being a woman living with hepatitis B or C shouldn’t
change that.
There is also an article on hepatitis B treatment, which examines the
aims of treatment, what the treatment consists of, and the side-effects
of some common treatment drugs. This is an interesting read for anyone
who has wondered about hepatitis B treatment - like why the treatment is
recommended for people whose liver is being damaged by the virus.
As always, contributions from our members are welcome in the CFiles.
Mailing details changed? Please let us know on
(08) 9227 9806 or at [email protected]
About the Cover
This was a beautiful depiction of a pregnant woman found on flickr’s
creative commons. She could be from any race, age or background. In the
middle of her silhouette is a drop of blood - as transmission during birth is
a concern for mothers-to-be who are living with hepatitis.
1
3
4
5
6
8
10
11
12
16
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Love, Drugs & The Whole Damn Thing
Welcome Anju - Community Development Officer
Pregnancy and Living With Hepatitis C
Pregnancy and Living With Hepatitis B
Treatment for Hepatitis B
Hepatitis Awareness Day 2011
Spotting Gene Variants May Boost Hepatitis C Treatment
Anzac Biscuits Recipe
WASUA’s Dedicated Domain
Fingerprick Test for HCV Antibodies gets U.S. Approval
Body Piercing of Young People
Opinions published in the CFiles are not necessarily those of the editor or
of HepatitisWA (Inc). Information in this newsletter is not intended to take
the place of medical advice from your GP or specialist. You should always
get appropriate medical advice on your particular needs or circumstances.
MY STORY
We
want to tell
our story,
embarrassing
as it is, because we have
received and participated
in the incredibly positive
part peer education plays
in the lives of drug users.
So for all you lovers out
there listen up!
We were too old to be caught with our fits dirty (as
opposed to our pant downs!!!) so to speak. Both
extremely well educated about the risks of sharing we
hadn’t done so for over two decades (we are both in
our mid-forties). We were both involved in the early
days of establishing needle exchanges, HIV and HCV
education and user rights. But we can all be caught
out, no matter how much theory we know. Love does
not conquer all and it certainly doesn’t conquer the
hep C virus.
love/lust and it was going to stay that way and it was
safe using all the way………
…. but we were not having safe sex. I can’t quite
remember how we negotiated that one, but suffice
to say the first time we were both shit faced and after
that we discussed it and decided that for various
reasons we could safely have unprotected sex. One
of us has been neutered so unwanted pregnancy was
not an issue. When we first used together we would
try to prove to each other that one was more sterile
When we first met we were both long time methadone in our technique than the other ….he usually won
‘drinkers’ – our early heavy, frenzied drug using days (bastard) I couldn’t wait quite as long… but then I had
were over!! Having come out of an 18 year relationship hep C and he didn’t.
I was not expecting to fall hard and completely for
anyone but love is unpredictable!
But fate often throws up a curly one. An unexpected
opportunity to have a shot came up, but with only
I actually didn’t think I could fall in love. I’d been in one used fit on hand, and no possibility of getting
several committed relationships and the last one was clean equipment until the morning, what to do? We
with a non-user. Heroin always came before any man. spent 10-15 minutes discussing the options.
I knew I loved him when I was prepared to share my
tastes on an on-going basis even though he was on a I had a used fit, we were at my house and I had a few
lower dose of methadone, and as we all know, that stashed in places I’d forgotten. We’d been careful with
meant I needed more but for once it was the being disposal so we didn’t have any others.
together, the sharing, that mattered. I was in the love
zone.
I kept saying “I don’t care” and she replied “You can’t
do it!!” with the dope in the middle of us. I rationalised
We had used as much as our finances had allowed us with lines like “We sleep together” and “I’ve borrowed
over the years, both still besotted with the drug but your toothbrush”. I let him rationalise the dangers
not able to live the hard life of a committed user. We away. Despite all the best advice and intentions I went
loved each other and as lovers do you give the person ahead and had the whack using the dirty fit! (It wasn’t
you love what they love most and, beside each other, ‘dirty’ per se; it was infected with my HCV positive
that was heroin. I ran up credit card bills, she didn’t pay blood.) We bleached it, flushed it and bombarded
other bills, but we loved each other and we loved using. it with every type of cleaning protocol we’d heard
It was a special treat on top of an all encompassing about.
The C Files
Apr/Jun 2011
¤
1
MY STORY
It is really hard to be the person who has used the fit.
Although I do remember being in the reverse position
ten years previously when a HIV positive friend had
come around and we only had his fit and I decided
not to use it - but then we weren’t lovers so the
tension was different. I had been around the issue
for so long I had ‘the disease’ I wouldn’t wish it on
my worst enemy, why would I give it to the person I
loved? You don’t know if it will be transmitted but hep
C has run through our community like a runaway train
so it was really within the realms of possibility. But I
wanted a shot and we hadn’t been together that long
that having a shot did make the
whole thing a little easier. He
mightn’t see my stretch marks
quite so clearly.
So we whacked it up in that
particular frenzy that besets
one when having a long awaited
shot. We tried to forget what we
had done because we had to it was too hard to think about
after you’d actually done it. Well
you couldn’t enjoy the shot and
we prayed to Morpheus not to
punish us.
Over the next few weeks I had nagging worries that I
really had done the wrong thing. I had f***ed up!!
I surreptitiously looked at the whites of his eyes and
checked his appetite it was too early but I was really
sick with worry.
effort to take 100% responsibility and reassure her that
it was not her fault!
Well no one can make you feel any way other than the
way you feel and that was shithouse. I knew I should
have broken the tip off that fit and waited for the
morning. I was so sorry but that makes absolutely no
difference.
I continued to feel unwell for some time and didn’t
even want a shot as it made me too sick and we were
both really scared to have one in case I croaked it. Two
months later we thought we
should have another shot
(in the interests of medical
science) to see if I was any
better… I was - well at least I
could have a whack.
A little later I rang up a doctor
in Sydney with a view to getting
on interferon/ribavirin as I had
heard that there was some
research being done to look
at whether you had a better
chance of clearing it if you
went on treatment and I was
going to do anything I could to get rid of it even go to
bloody liver specialists. I was referred to the local Liver
Clinic to have tests and incredibly the results indicated
that I had sero-converted and my body had dealt with
the hep C!!!
It was a real Christmas present. I am catholic and I
prayed to baby Jesus for us both - me because I was
Three weeks later when I had a shot I became incredibly hep C free and her because she didn’t have to worry
sick - severe vomiting, the shakes – a bit like a dirty hit about being responsible when I died!! Because I was
which is what I convinced myself it was. A week later reasonably healthy - no pills, no fags, no booze, my
the same thing re-occurred and the thought of hep C body had been in a position to fight the virus. We know
began to whirl around in my mind.
a certain percentage of people do naturally seroconvert
and I did have the sero-conversion illness. But I really
This is when I knew it but didn’t want to be the one to believe if I hadn’t been in such good shape physically
really tell him. The doctor had to do that! He was not the result wouldn’t have been so very excellent for me.
well, generally lethargic not eating as usual and just a Just because we use heroin doesn’t mean we have to
little off colour, not yellow but not his normal colour. desecrate our bodies. After all the longer we live the
more we can… (fill in the blanks with whatever your
I went to my doctor for antibody tests and whilst waiting passions in life happen to be). I’m sure you know what
for the results I went yellow and felt really, really I mean.
lethargic. The test, of course, came back positive. Why
the hell had I been so STUPID? “Love” does not protect I was so grateful that he had such a good outcome.
you from hep C, or ANY virus for that matter!! I knew I don’t care who you are and how well you can kid
she would be really upset and feeling bad so I made an yourself, knowing you were responsible for assisting
2
¤
someone to get HCV doesn’t feel good and I wondered
if he hadn’t sero-converted and cleared the virus if
it would have become one of those things you start
throwing at each other later down the track - “You
gave me hepatitis!”.
Any way we are still together and continue to use
but we are so goddam careful it’s like an operating
theatre. Each on one side of the room, own equipment
HepatitisWA
and then we come together knowing we can enjoy
ourselves as we don’t have to worry about viral
transmissions.
So listen to two old users but young lovers and
remember…. All the knowledge and experience in
the world doesn’t protect you from the intoxicating
effects of love and drugs!!
Everybody has a story to tell...
Think that you have something you would like to share with our
readers? Writing down your thoughts and feelings can be very
therapeutic, while benefiting other people affected by hepatitis
who are reading your story.
Reading about other’s experiences can provide valuable comfort,
information and encouragement.
Reprinted with
permission from the
Australian Injecting &
Illicit Drug Users League
(AIVL)
This story and more can
be found at:
Support the newsletter that supports you by contributing to the
www.aivl.org.au
CFiles. Send stories, poems, artwork or anything else you’d like to
put in to Riana: [email protected] or call (08) 9227 9806.
WELCOME ANJU -
COMMUNITY DEVELOPMENT OFFICER
Anju joined HepatitisWA on 8th March 2011 as the newly created Hepatitis B
Community Development Officer.
She has extensive experience and passion for working closely with both Culturally and
Linguistically Diverse (CaLD) and Indigenous communities. Her previous employment
includes Grants Officer with the Office of Multicultural Communities, Project Officer
with the Sasa Youth Mentor Program, Community Development Officer with ASeTTS
and Support Worker with Multicultural Women’s Advocacy Service- to name just a few!!
She has also worked in a volunteer capacity at Amnesty International, in particular their
Stop Violence against Women campaign and Demand Dignity Campaign. Anju is of Sri
Lankan background, happily married with a 1 year old daughter, and is committed to
making a positive difference for disadvantaged communities in Australia.
Anju hopes to raise the profile of CaLD communities settling in WA and is positive about
putting Hepatitis B on the agenda for these new and emerging communities.
Image by Nats, copyright © 2011. Available under a Creative Commons license from http://www.flickr.com/photos/nats/4749911723/sizes/l/in/photostream/
The C Files
Apr/Jun 2011
¤
3
FEATURE
Hepatitis C
pregnancy
and Living
with
hepatitis
Most women become pregnant during the years between 20 and 40, which is also the age group in which the
diagnoses of hepatitis C infection is most common. Becoming pregnant and starting a family can be an exciting
time in a couple’s life, and when a person is living with hepatitis C it shouldn’t be any less wonderful. The only
time when a woman living with hep C should not become pregnant is while she is on conventional treatment
for hepatitis C, so two methods of contraception must to used to prevent pregnancy. This is because the effect
of the treatment on developing fetuses is unknown.
How will having hepatitis C affect my baby?
Around 98% of hepatitis C positive mothers do NOT
pass on the virus to their child. Women who are living
with both HIV and hep C have a higher risk of passing
on hepatitis C to their baby, as do women who acquire
the hepatitis C virus while pregnant (due to the initially
high viral load). That being said, the majority of babies
do not get the hep C virus — and you can enjoy a
happy, healthy pregnancy.
“A friend of mine who had hepatitis C was advised to
have an abortion. It can be a scary enough time when
you find out you’re pregnant without without being
given such stupid information”. - Franie, age 23.2
Is it ok to breastfeed?
You are encouraged to breastfeed your baby. Hep C is
not in breast milk, and can only be passed on if blood
is present. If your nipples become grazed, cracked or
How will being pregnant affect my hepatitis C?
bleeding, breastfeeding should be discontinued until
There seems to be no particular issues in women with they have healed. Your milk supply can be maintained
hepatitis C being pregnant. There are a few more by regularly expressing the milk and discarding it. If
noticeable symptoms in women with hepatitis C, such only one nipple is damaged, it is ok to feed to baby
as the ‘pregnancy itch’ from the extra stress the liver from the undamaged nipple. When your baby starts
is under during pregnancy. The changes in a woman’s teething, the risk of damage to your nipples increases.
hormones when she becomes pregnant can cause
the liver to react differently to the hepatitis C virus. Will my newborn baby have hep C antibodies?
Therefore, after the baby is born you will need to have Babies born to mothers with hepatitis C will show
your liver function tests repeated. It is normal for the antibodies in their blood until they are about 18
results to show an increase in values, and this may months old. The antibodies are acquired from the
readjust as your body returns to a non-pregnant state. mother during pregnancy and do not affect your baby
in any way. Having antibodies does not mean your
Should I have a caesarean or vaginal birth?
baby has contracted hepatitis C or that it has immunity
You have the same choices as a woman who doesn’t to hepatitis C. It is recommended that your baby is not
have hepatitis C. Talking with your doctor/midwife will tested until 12-18 months of age (or older) and, just as
help you decide what is best based on the information in adults, a positive antibody test needs to be followed
available (ie. progression of labour and the baby’s up by a PCR RNA test to determine if the virus is
health). Some procedures may be changed or avoided actually present. Babies, again like adults, have a 25%
during the birth (ie. avoiding the use of scalp electrodes chance of naturally clearing the virus and, like adults,
or forceps), but these will be explained to you and you will always show antibodies for the virus.
can talk about it with your midwife or doctor.
4¤
Image by Bethany Brown copyright © 2011. Available under a Creative Commons license from http://www.flickr.com/photos/bethykae/3377899114/sizes/l/
FEATURE
Hepatitis B
Most people living with chronic hepatitis B have no symptoms. As an expecting mother you should have
already been tested for hepatitis B, as without medical intervention a positive mother is likely to pass it onto
their child during birth. As a woman living with hepatitis B, it is best to plan your pregnancy with your doctor
as there are options available to reduce the risk of transmission to the future baby. For example, lamivudine
is safe to use during pregnancy. If a woman is on treatment for chronic hepatitis B and becomes pregnant, she
must tell her doctor immediately.
How will having hepatitis B affect my baby?
hepatitis B infection should not cause any problems
for you or your unborn baby during your pregnancy.
Whether a woman was diagnosed with hepatitis B
during antenatal screening or is considering starting a
family, they should talk with their hepatitis specialist. In
more than 90% of cases, transmission can be prevented
with simple interventions at birth. In addition, it is
recommended to completely abstain from alcohol.
has advanced liver disease or cirrhosis it may be
recommended by their hepatitis specialist to take oral
antiviral therapy to reduce the chance of a flare.
Should I have a caesarean or vaginal birth?
For both mother and baby, a vaginal birth is usually
preferred as it is the least traumatic. A caesarean is
usually performed when there is a medical reason
for doing so — and living with hepatitis B or C is not a
medical reason for a caesarean. Talking with your doctor
Usually, hepatitis B is transmitted during delivery with and/or midwife will help you decide what is best based
exposure to the blood and fluids during the birthing on the information available (such as progression of
process.
labour and the baby’s health). Some procedures may
be changed or avoided during the birth (ie. avoiding
As such, when your baby is born he/she should receive the use of scalp electrodes or forceps), but these will
hepatitis B immune globulin at birth and the first dose be explained to you and you can talk about it with your
of the hepatitis B vaccine. If these two medications midwife or doctor.
are given correctly within the first 12 hours of life,
a newborn has more than a 95% chance of being Is it ok to breastfeed?
protected against a lifelong hepatitis B infection.
You are encouraged to breastfeed your baby. The
benefits of breastfeeding outweigh the potential risk
Your baby needs to receive the second and third dose of acquiring hepatitis B, which is minimal. In addition,
of the hepatitis B vaccine at one and six months of age since it is recommended that all babies be vaccinated
to ensure complete protection. Lastly, you should have against hepatitis B at birth, any potential risk is further
your baby tested between 9-18months old to confirm reduced.
that the vaccine was successful and that your baby is
protected.
Will my newborn baby have hep B antibodies?
There are two types of antibodies we’re talking about
How will being pregnant affect my hepatitis B?
here: those transferred from the mother to the baby
The best answer is that it varies. It is important to note (which will persist in the baby’s serum for some time),
that all women living with hepatitis B should be referred and those made by the baby. The baby should have antito a hepatitis specialist during pregnancy for their own HBs from the immune globulin administered at birth,
health as well as the baby’s. During pregnancy the and will (hopefully) develop their own response from
immune system becomes more tolerant, or slightly the vaccine and remain anti-HBs positive. Because the
suppressed, and for some women will cause a flare- baby will have the maternal antibodies for some time
up after the birth of the baby. The flare may not be after birth, testing for the anti-HBs at least 3 months
noticed by the mother, but can be detected on the after the last dose of the vaccine is the only way to
LFTs by a rise in the ALT levels. As such, if a women determine an accurate result.
References:
1.
2.
3.
4.
http://www.hspace.org.au/images/factsheet_pregnancy.pdf
Women and hepatitis C. 2007. pp39-42
Hepatitis B Foundation. 2010. Pregnancy and HBV: FAQ. Accessed from http://www.hepb.org/patients/pregnant_women.htm
http://www.hepatitis-central.com/hcv/hepatitis/pregnancy.html
The C Files
Apr/Jun 2011
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5
FEATURE
Whilst this fact sheet
provides general information
about Hepatitis B (Hep B)
treatment, it is written as an
introduction to the medical
treatment available for people
who have been diagnosed
with chronic Hep B and have
had treatment offered as
an option to them by their
attending gastroenterologist,
hepatologist or infectious
diseases physician.
Medical treatment is NOT
recommended for all people
diagnosed with chronic
hepatitis B.
Treatment for Hepatitis B
What is the aim of medical
treatment of hepatitis B?
The piece can then be looked at under a microscope
and the amount of inflammation and scarring assessed.
The aim of medical treatment is to stop the virus
being active and replicating (multiplying) in the liver. What are current medical
If the amount of virus decreases due to treatment treatments and what do they
then the immune system may be able to overcome
do?
and inactivate the virus. This prevents further liver
Currently in Australia there are five drugs available
damage and reduces the risk of developing chronic
for the treatment of chronic Hep B. The two main
liver disease or cirrhosis (scarring of the liver) and liver
drugs are: Pegylated Interferon, often referred to
cancer.
as Peginterferon and Lamivudine. Adefovir (ADV)
is the third drug approved for use in Australia but is
Who should have treatment only approved for use in people who have become
resistant to Lamivudine. Other types of treatment
for hepatitis B?
About 95% of adults who contract Hep B will clear may sometimes be used in clinical trials. Newer drugs
the infection by themselves and will not need medical are Entecavir and Tenofevir.
treatment. However, some people who develop chronic
Hep B - that is when the virus is not cleared after six
months, symptoms of liver disease are present
and the virus is active (i.e. multiplying in the liver) may require treatment. They should be referred to a
gastroenterologist, hepatologist or infectious diseases
physician for assessment.
How can you get treatment
in Australia?
In Australia, treatment is free and available at major
hospitals through a liver or hepatitis clinic. To qualify
for treatment, people must have had Hep B for at least
six months; their blood tests must show that the liver is
being damaged and that the virus is active. Most people
will also need to have a liver biopsy, which involves a
very small piece of liver being taken out with a needle.
6
¤
Before commencing treatment you may be asked to
consent for blood tests for HIV and Hepatitis C as
some treatment options may interfere with treatment
for these infections and there is a small chance they
may also be present. Hepatitis A vaccine may also
be recommended as well as advice concerning the
vaccination of family members and lifestyle changes
regarding alcohol consumption and stress management.
What is Peginterferon?
Interferon is a protein naturally produced in our bodies
to fight viruses by boosting the immune system. The
medication is a synthetic reproduction of the naturally
produced Interferon. Whilst boosting the body’s own
immune response, Interferon also interferes with the
virus’s ability to multiply.
FEATURE
Peginterferon is given as an injection under the skin
once a week for six to 12 months. Most people can
learn to give the injection to themselves at home.
About 35% of people with chronic Hep B who have
Peginterferon achieve long term benefit. Blood tests
in these people show that the virus has stopped
multiplying and liver function is normal. Sometimes
after treatment ceases, the benefits increase.
These benefits include improved liver function as
demonstrated by blood tests and a reported decrease
in the severity of symptoms.
Liver inflammation may get worse for a short time when
the treatment is working. This is called a “Hepatitis B
flare.” Sometimes this “flare” will clear the virus and
the person will not get any more liver damage or
problems from the virus.
What are the side effects?
The most common is “flu-like symptoms”. This
can include fever, sweats, muscle/ joint pain and
headaches. Usually simple pain relief like paracetamol
(eg. Panadol) every four hours while the symptoms last
will help. Symptoms are usually worse at the beginning,
and may go away during treatment. They will not come
back after the end of treatment.
Depression and mood changes are another common
side effect. These can occur in people who have
not had any mental health problems. Support from
a counsellor or antidepressant medication may be
recommended. These problems usually settle down
as soon as the treatment is stopped.
Other side effects include changes in blood cell counts,
hair loss or thinning, thyroid problems and weight
loss. Most of these will go away after the treatment is
stopped.
Due to the side effects, it is very important that people
who are having Peginterferon treatment attend clinic
appointments and have regular blood tests. Most
side effects will get better once treatment is stopped.
Sometimes the dose of Peginterferon has to be
lowered, or treatment stopped for a short time, until
the blood tests return to normal or the side effects are
reduced.
What is Lamivudine?
Lamivudine is an oral antiviral medication that is used
to treat Hep B. An antiviral medication is a substance
that destroys a virus or suppresses its replication.
Lamivudine stops the virus from multiplying, which
means that it will stop damaging the liver. It is given
every day for at least one year, as a tablet.
Whilst on treatment, most people taking Lamivudine
will have tests showing decreased activity of the virus
with liver function tests returning to normal levels.
Approximately 20% - 30% of people will have longterm benefit after taking Lamivudine for one year.
Treatment can be continued for more than two years,
if required. Taking Lamivudine for longer than one year
will increase the likelihood of long term benefit.
What are the side effects?
Lamivudine is usually well tolerated. If side effects
do occur, the most common include headaches,
diarrhoea, abdominal discomfort or pain, feeling tired,
and nausea (feeling “sick”). Most of these side effects
will not last long and may go away even when the
person is still taking treatment. Treating doctors should
always be informed of any side effects experienced
whilst on treatment.
Whilst Lamivudine can be effective, the virus will
become active again if treatment is ceased too early.
Therefore, people taking Lamivudine should not
stop taking it without talking to their doctor first.
Sometimes the Hep B virus can become resistant to
Lamivudine. The longer someone takes Lamivudine,
the more chance they have of developing resistance.
This means that it will not work as well as before and
usually a new drug like Adefovir will be used.
What else is available? [ed.]
In the next article on hepatitis B treatment we will look
at other drugs available, such as Adefovir, Entecavir
and Tenofevir.
This Fact Sheet has been reprinted with permission from the HIV, Hepatitis & STI Education + Resource
Centre. The unabridged version is available from http://www.hivhepsti.info/
A revised version of this Fact Sheet will be available on the website within the next three months. Keep
an eye out for it! The updates will also be published in an upcoming edition of the CFiles.
The C Files
Apr/Jun 2011
¤
7
HepatitisWA
Hepatitis
Awareness
Day 2011
As of 2011 World Hepatitis Day will be held on Thursday
the 28th of July. Awareness Day has been realigned with
this date to commemorate the birthday of Nobel Laureate
Professor Blumberg, who discovered the hepatitis B virus,
and subsequently the hepatitis B vaccine.
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‘Note’ image by tijmen van dobbenburgh © 2011. Available from http://www.sxc.hu/photo/461979
HepatitisWA
HepatitisWA will be coordinating a range of events
on or around World Hepatitis Day, including hepatitis
presentations in the community and workforce,
a youth photo-essay exhibition (Street Shot), and
displays at the HepatitisWA office on Beaufort St.
A two hour Workforce Development workshop on
Hepatitis C will be held in Perth for health professionals,
providing education on workplace issues, prevention
and transmission, pre- and post test discussion,
treatment, living with hepatitis, co-morbidity issues
(for Alcohol & Other Drug and Mental Health workers),
psycho-social issues, and referral pathways. This will
be a great opportunity for people in the industry to
brush up on their hepatitis knowledge. Contact us on
9227 9802 to find out more.
In addition, for the first time, we will be holding a
presentation about Hepatitis B for members of the
community who are from culturally and linguistically
diverse backgrounds, and people who provide
services for them.
An event will be organised for people living with
hepatitis, for people who are interested in finding out
more information and support about living well with
viral hepatitis.
Love Your Liver lunches will be run again this year,
where members of the community can get a group
together and host a liver-friendly lunch. Posters,
invitations and recipes can be found at the website,
www.loveyourliver.com.au. From the website, people
can also use Everyday Hero to register a lunch, invite
guests, make donations and even keep a tally of
donations.
Lastly, everyone is welcome to visit the HepatitisWA
office. We will be giving out free hot soup
during World Hepatitis Day, July 28th,
from 10am - 2pm. The soup will
be made from a liver-friendly
recipe: perfect as a midwinter warmer!
Street Shot is a health promotion initiative in partnership with a
range of youth organisations.
2011 will be the second year of street shot in WA.
This project will work with young people through specific youth
organisations to create a photo essay focusing on issues associated
with viral hepatitis and blood awareness. This will be achieved by
exploring ‘Rites of Passage’, risky
behaviours and ways of keeping
safe. The key health messages
will be captured in images
by the participating youth.
Contact us for
exhibition dates
and times.
The C Files
Apr/Jun 2011
¤
9
RESEARCH UPDATES
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Scientists have pinpointed two gene variants that
protect hepatitis C patients from the anaemia that can
be caused by antiviral treatment.
The findings are detailed in two studies in the February
2011 issue of the journal Hepatology.
The ability to identify patients with the two variants in
the inosine triphosphatase (ITPA) gene will help ensure
that antiviral therapy is completed and the hepatitis C
virus is eliminated, the researchers say.
In one study, Italian researchers looked at 238 HCV
patients treated with the antiviral drugs and found that
the two ITPA variants were strongly associated with
protection from anaemia.
Alessandra Mangia, M.D., from Casa Sollievo della
Sofferenza Hospital in Italy, and colleagues evaluated
the association between ITPA variants and anaemia in a
cohort of 238 Caucasian patients treated with variable
pegIFN and weight-based doses of RBV. The research
team found that the ITPA variants were strongly
and independently associated with protection from
anaemia, but did not provide an increase in sustained
virological response.
“When anaemia develops only four weeks after the start
of treatment, physicians are required to immediately
reduce ribavirin dosages. This early reduction will
affect the overall duration of treatment which, with
the combination of pegIFN and RBV, lasts 24 weeks for
patients infected with HCV genotypes two and 3 (G2/3)
and 48 weeks for patients with HCV genotype one (G1)
infection.
“Currently, only the use of the drug erythropoietin
(EPO)—an expensive drug that due to its high cost
cannot be reimbursed in several countries—might
prevent unsuccessful antiviral treatment in these
cases,” explained Dr. Mangia.
“Our findings demonstrated that ITPA variants are
strongly associated with protection from week four
anaemia and help us in selecting in advance who
10
¤
will need early ribavirin dose reduction and possibly
supportive EPO treatment.
“This may lead to a more rational use of economical
resources and to an individualized use of supportive
EPO treatment,” concluded Dr. Mangia. “Patients with a
genetic profile that included the two ITPA variants may
be safely administered higher doses of RBV, increasing
the likelihood of HCV elimination after treatment—an
important finding given that to achieve viral clearance
high dosages of RBV need to be used in the early phases
of treatment.”
A related study by Japanese scientists found similar
results in 61 patients with HCV. In this series of
experiments led by Fumitaka Suzuki, M.D., from
Toranomon Hospital in Japan, patients received a triple
therapy of pegINF, RBV and the protease inhibitor,
telaprevir.
Dr. Suzuki and colleagues found that ITPA variants
impacted blood levels; however a sustained virological
response could be achieved with careful monitoring
of anaemia and prompt adjustment of RBV dose.
The authors suggest that future investigation of
the influence of ITPA gene variants on RBV-induced
anaemia are needed on larger scales and on patients
of various ethnicities.
This article originally
appeared in the Hepatitis
C Community News #51,
and can be accessed
online at www.
hepccouncilsa.asn.au.
Reprinted with
permission from the
Hepatitis C Council of
South Australia.
Background pattern by Billy Frank Alexander © 2011. Available from http://www.sxc.hu/photo/1320263
LIVING WELL
ANZAC biscuits recipe
Ingredients
125g butter
2 Tbsp golden syrup, treacle or honey
1 tsp baking powder
1 Tbsp hot water
1/2 cup coconut
1/2 cup sugar (brown for a richer, chewier biscuit)
1 cup rolled oats
3/4 cup plain flour
METHOD
1. Melt butter and golden syrup in a saucepan large
enough to mix all ingredients, cool slightly.
2. Dissolve baking soda in water and add to the
saucepan with coconut, sugar, rolled oats and
flour. Mix well.
3. Place rounded teaspoonsful of mixture on a
greased oven tray, allowing room for spreading.
4. Bake at 180° C for 15 minutes or until golden.
Makes 24.
Variations:
Add sultanas and/or chopped walnuts or
peanuts for a fun twist on a family favourite.
‘Poor Man’s Kingston Cream’
- Make Anzac biscuits smaller and a slightly
dryer mix by using more flour. Then sandwich
cooked biscuits together with the chocolate
cream (see below):
Chocolate Cream
1 cup (150g) Dark chocolate melts
1/4 cup (60mL) cream
1. Combine ingredients in a small heatproof
bowl, stir over pan of simmering water
until smooth.
2. Refrigerate for about 1 hour or until
spreadable.
Image by Michael Verhoef, copyright © 2011. Available under a Creative Commons license from http://www.flickr.com/photos/nettsu/4555506269/sizes/l/in/photostream/
The C Files
Apr/Jun 2011
¤ 11
WASUA
The Story
WASUA’s Dedicated Domain
(My journey
12
¤
I was fourteen years old when I ran away from home.
My family had migrated from Europe to Australia
when I was five years old. From all appearances, I
came from a good family and home structure. My
parents were strict and overly protective but at the
same time they were loving and wanted only the
very best for their children. Academically, I was a
high achiever and in sports usually one of the best
in the school. Regardless of all my achievements, I
was always petrified to bring my report card home.
I believed I could never live up to their expectations,
that I would never be good enough. I became
extremely angry, angry at being threatened, getting
hit and grounded. My parents had always maintained
that the lowest scum on the earth, dirtier than the
mud inside a gutter was a drug-taking prostitute.
I hated them for their arrogance. When I ran away,
I promised myself that regardless of what happens,
I would never, ever go back home.
I was 12 the first time I used heroin. I’d never even
been drunk before; smack was the first drug that I’d
ever tried. I’d talked a friend into giving me some
in exchange for the money she needed to “get on”.
Because she was hanging out and desperate she
consented. I know she only gave me a small amount
but it was enough to send me into convulsive spurts
of vomiting. I didn’t like it and thanked the stars that
my parents never found out. I didn’t touch it again
for two years.
As opposed to the 80’s, before Hepatitis C was
even known about and people were catching the
virus through blood transfusions, school in the 90’s
involved a better degree of education. Although I
was taught to believe that a girl would get pregnant
if she had sex without a condom, I was taught the
basics of blood-born-viruses; never share your
toothbrush, razors or god-forbid, your needles.
Always use a condom. That was about the extent
of my knowledge base when I left school at the end
of year ten.
I started using as soon as I left home. I tried cocaine,
speed, pot. I loved benzo’s and used them in excess
but my favourite drug was heroin. A year later I
had a habit and met my first real boyfriend. He
moved into my flat almost straight away. My main
purpose, my only purpose in life, was heroin and
together we shared a drug-filled existence that
today feels like a blur to both of us. Against his
wishes, I started working in brothels, something
that I’d done previously before I met him. I was
lucky to be introduced to a madam who knew
how old I was and had no problems hiring me
anyway. It would be our little secret. I knew that
I’d always be relatively safe working for her. I was
never left alone in the building with a client and
if they started getting heavy-handed or refused
to wear a condom I would get them kicked out.
It was during this period that I heard about WASUA
and I started going there to buy condoms and
exchange my fits.
During the first three years of drug use I never
shared a needle. My boyfriend and I were always
stocked up with cleanies. We were both vigilant,
being as safe as one can be when using IV. I believed
that as a prostitute and injecting drug user, I had
a responsibility to get tested regularly. Blood tests
every six months and pap smears once a year. I never
caught anything but at the same time my boyfriend
and I didn’t really associate with many drug-user’s.
At 16 I came into contact with Next-Step, initially
to do a rapid detox and get onto the methadone
program. When I decided to jump off the program,
some 6 months later because I wanted to use heroin,
I was put into contact with Next Step Youth Services
that had just opened. I can’t praise them enough
for their work. They saved my life on numerous
occasions, something I wasn’t happy about at the
time but am grateful for now.
I was 17 when the heroin drought hit Perth. It
was as if, from one day to the next, supplies had
shrivelled and dried up completely. A total smack in
the face but - not the enjoyable kind! Desperation
hit like a plague, infecting dealers and users from
all levels of the spectrum. As if by some twisted
and ironic pre-determined fate, ‘Ice’ hit the streets,
seemingly shovelled in by the truck load. Desperate
for anything to stop hanging out, anything to fill
the nightmarish darkness, the bottomless pit which
once upon a time had housed my soul, I turned to
“ice”, the only thing available.
I’d never heard of psychosis, or rather, never believed
it would be something that could happen to me.
With every hit, I still anticipated that down-town
feeling, that feeling that only smack can provide, and
with every hit I lost another layer of the cocoon I’d
wrapped myself up in. I was suddenly totally alone,
naked and vulnerable. Silence only filled the gaps
from the voices that laughed, tormented me inside
of Angelina
WASUA
with Hepatitis C)
and around my head. Heroin, my first and only true lover,
had deserted me and with it, so had my reason for living.
Three suicide attempts later, I finally gave into my friend’s
desperate appeal to give rehab a chance.
I found myself amongst a group of highly devoted
Evangelical Christians. Although I was a highly motivated
sceptic of organised religion, I realised I had nothing left to
lose and made a decision to put in the hard yards. I often
ran away to relapse during the first couple of months,
hoping that to them this would be the last straw and I’d be
kicked out. Instead, the coordinator would call me, even
come looking for me. Her compassion and the grief that
she felt for me rekindled the memory of what it was like to
feel loved, to be part of a family. I stayed, and eventually
accumulated almost six months of clean time.
Eight months into my stay I was asked to look after a girl
that had just come in. Trouble was, she was initially courtordered to stay there. Personally, she hated the idea and
had no intention of living up to the drug-free restrictions
imposed on her by the rehab. She ran away almost daily, at
least whenever she used up her stash.
One night, after returning from one of her escapades,
when we were in our room and all the girls were asleep,
she pulled out a bag of speed and offered me a whack. The
mere sight of it sent my body into perspiring goosebumps.
No, she didn’t have a clean fit, but she’d only used it once
and she swears that she’s clean. -Yes, no way would she
talk shit, she hasn’t got anything!
As for me, craving, apprehensive, shivering, shaking with
psychosomatic need, and total desperation, I should’ve
run out of that room as soon as she’d pulled out that bag.
I didn’t and although one part of me was screaming out
retreat, I knew that I wouldn’t. I wasn’t strong enough and
at that point I didn’t want to be. I noticed that the screams
of resistance inside my mind had gone quiet even before I
put the needle in my arm.
I was racked with guilt. I was supposed to be responsible. I
was meant to look after this girl, keep her away from drugs,
be a positive influence. I was fearful that the truth would
come out and I would be exposed so a few weeks later I
left the rehab to once again ride the merry-go-round. All
the while the memory of sharing that needle played and
churned inside my mind. It was the one thing I couldn’t run
away from. I knew that a blood test would be pointless and
that I’d have to wait three months for the window-period
to subside.
Test results confirmed my deepest fears. Yes, I was
Hep C positive or more accurately, I tested positive to
the antibodies consistent with the virus. Surprisingly,
and luckily, when they tested for the live virus (PCR)
my body had cleared itself of the Hep C. The antibodies
would always remain present in my blood but the virus
was dead. It couldn’t hurt me nor could I pass it on to
another person. I was elated. I’d been given a second
chance and never ever again would I let this happen again.
Six years past, I was still an addict, spending most of my
time up-town and using Subutex to ‘come down’. I shared
my addiction with my two best friends. Whilst I had access
to cheap and mostly free meth, one friend (X) had a car
and the other (Y) was on Subutex. When we didn’t have
any clean fits and only the one bag to mix up with, X would
mix up with his fit, mine would be next and Y would go last.
We used a complacent process of probabilities elimination;
X was my best friend and ex-boyfriend. I’d known him for
years. His blood tests had always come back negative.
I was the only person he shared drugs with, so X always
went first. Y used drugs with other people. I’d caught Hep
C from her needle years ago so, Y went last. Looking back,
it was a system doomed to fail but, at the time, it seemed
rational. After all, we mainly used clean equipment, we
only resorted to this method when there were seemingly
no other alternatives.
The C Files
Apr/Jun 2011
¤ 13
Image copyright © Martin Neuhof 2011. Available under a Creative Commons license from http://www.flickr.com/photos/ritman/4370123388/sizes/o/
The Story
WASUA
(My journey
I was picking up my results from a routine pap smear. The
doctor looked at me apologetically and said, “I’m sorry but,
are you aware that you have Hepatitis C?” No, I wasn’t, I
wasn’t aware at all, yet given the risks that I’d been taking,
why did it come as such a shock? It seemed like such bad
timing. I’d just started a new relationship. My girlfriend was
straight- she didn’t take drugs and neither did her friends.
She was dead scared of them. I’d told her I ‘used to’ have
issues around drugs but that was all she knew.
I felt a responsibility, a bit like a duty of care, to inform
her of my positive status. I was a carrier. However small
the potential of passing on the virus through sex, it still
existed. She had a right to be informed and exercise liberty
to make up her mind, to decide if this risk was something
she was prepared to live with. On the other hand, I would
be judged and discriminated against. We were still getting
to know each other and I didn’t know if I could trust her
to respect my privacy in the matter. In the wrong hands
this information could be used as ammunition and if it ever
came close to that I could save the hassle by changing my
name over to ‘Hepatitis C’ (&proud) I decided it was too
early to pull off the rose-coloured shades,complimentary
to new romance. I knew I had to tell her, I just wasn’t sure
how or when. Firstly, I needed to work out what to do.
For the first time in years, I took my heavy burden home
to my mother. I couldn’t have been more astounded by
her reaction if she’d ripped open her blouse to reveal
her ‘Wonder Woman’ suit and armour with special super
powers. She put aside our differences and stood beside me,
strong enough for the both of us and resolute that, if a cure
exists, we would find it. Luckily we only had to go as far as my
mum’s G.P. to find answers and get the treatment ball rolling.
I realised I knew nothing about living with Hepatitis C and
wondered if the doctor that told me about my positive
result was just as ignorant as I was. But the doctor
specialised in sexual health, surely they must know about
strains, genotypes, lifestyle factors and possible treatment
options?!
I’d walked in to pick up my pap results and walked out with
an infectious shadow hovering over my shoulder. That’s all
I knew. I was not given a follow-up appointment or referred
to someone possessing a higher level of expertise. It was a
devastating experience.
In contrast, my mum’s doctor had over twenty-five years
experience working in men’s prisons. He assured us that
treatment was available, arranged another set of bloods
to be taken and organised the necessary referrals. Both my
parents and I were anxious for me to get started as quickly
as possible. Based on my genotype and strain, I was to
undergo the Interferon and Ribaviran treatment for twelve
months.
Throughout the screening process, the issue that kept
repeating itself was the need for stability. Treatment
had to be considered a full time gig. Study, employment
and other types of physically or emotionally taxing
commitments would need to be put on hold throughout
the year. Environmental stability was most important,
so I moved home to my family. I finally told my girlfriend
and was pleasantly surprised that she chose to support
me through it. It took about six months of testing,
waiting, health care appointments and more waiting
before everything was deemed in order and I could start.
Those twelve months were probably the most difficult
months of my life. I suffered more than necessary because
I was still using drugs. Recently I was told that taking drugs
WASUA provides a number of services on premises
at 519 Murray Street, West Perth, including:
The WA Substance Users Association have a dedicated
section of the Cfiles, aimed at highlighting important services,
providing practical information and discussing current issues
and trends facing people living with hepatitis C.
Perth NSEP
Sat & Sun
Thurs - Fri
Mon - Wed
10am to 4pm 10am to 8pm 10am-12pm,
12.30pm-4.30pm
Closed Public Holidays
14
¤
Clinic Hours
Tuesday & Thursday
10am - 4pm
• NSEP (Needle and Syringe Exchange Program)
• Free hep A and B vaccinations for hepatitis C positive
people.
• Free blood testing in a friendly confidential environment
• Drug treatment support and referral
• Peer education and training
• Street-based outreach
• Advocacy and support for users
• Safe injecting and safe disposal education and
resources
• Hepatitis C/blood-borne virus information and resources
For more information:
(08) 9321 2877
www.wasua.com.au
of Angelina
WASUA
with Hepatitis C)
When I moved back home, I started getting
depressed and was always tired. My older brother
still refused to talk or acknowledge me for having
left ten years ago and I
displayed my hurt. I’m sure
to him my behaviour just
confirmed the reason for his
silence. Four months into
the treatment, I moved back
out of the family home. So
much for remaining stable
throughout the treatment
period!
I could go on about the
negative symptoms but I’m
sure that’s something you
can find out yourself.
myself up from there.
Treatment is something you’ve got to really want to
get through because it can be rough.
The younger you are the better the chance you can
give your body of clearing it.
I’m a much stronger person for it. The treatment
was tough and I could have given up many times.
But I made it! I am clear and am getting on with my
life.
My treatment
was successful.
I no longer have
Hep C...
Here, however, are some
positives and there are
many positives to having
treatment.
My
treatment
successful.
was
I no longer have Hep C. The
antibodies will always show
up in my blood but the virus
can’t harm me or anyone
else. I don’t have to walk
with the grim reaper casting
a shadow over my shoulder.
Completing Interferon was
my first real achievement
since I left home ten years
ago. Before this, I was
always attempting without
ever finishing anything.
WASUA’s Dedicated Domain
can greatly reduce the chance of treatment working
successfully. It sounds logical to me now but at the
time I wasn’t really aware of it. Before I started
treatment I was asked if I was still using. My mother
was sitting next to me so obviously I said no and
regardless, I was keen to get started and scared I’d
be rejected if I answered wrongly.
Six months after completing
treatment, I started my first
legal job and have worked
The C Files
Apr/Jun 2011
¤ 15
NEWS
Fingerprick test for HCV antibodies
gets approval for use in the U.S.
OraQuick(R) HCV Rapid Antibody Test
detects hepatitis C antibodies in whole
blood samples. The test provides results in
20 minutes and is more than 99% accurate.
OraSure Technologies recently gained
approval in the US to use their OraQuick(R)
HCV Rapid Antibody Test with fingerprick
samples, which originally was only used with
venipuncture whole blood.
“Receiving FDA approval to test individuals
at risk using a finger stick whole blood
sample significantly expands the flexibility
and versatility of our OraQuick Rapid HCV
Antibody Test,” OraSure CEO Douglas Michels
said in a news release. “By eliminating the
need for a blood draw, healthcare providers
will be able to identify more individuals
infected with hepatitis C and get them into
care.”
A positive result should be followed up with
a traditional HCV test with a doctor. The
presence of HCV antibodies indicates that
a person has been exposed to the hepatitis
C virus. Therefore, for people who have
cleared the virus through treatment or
naturally the antibody tests will always show
positive results. Only the polymerase chainreaction (PCR) test will confirm whether the
person is currently living with hepatitis C.
References:
1. Soper, S. 2011. OraSure gets approval for hepatitis C test. The Morning Call, February 22. Accessed from
http://articles.mcall.com/2011-02-22/business/mc-bethlehem-orasure-hepatitis-test-20110222_1_hepatitis-c-test-blood-sample-oral-fluids.
2. HIV and Hepatitis. 2010. FDA Approves First Rapid Hepatitis C Virus Antibody Blood Test. Accessed from
http://www.hivandhepatitis.com/hep_c/news/2010/0702_2010_a.html.
3. OraSure Technologies. 2011. OraQuick(R) HCV Rapid Antibody Test. Accessed from http://www.orasure.
com.
Body Piercing of Young People
If people are aware of the new amendments concerning the body piercing of young people, they will know what is
required of them when they go to a professional piercer. We encourage using the services of a professional piercer,
as young people will be protecting themselves from blood borne viruses such as hepatitis B and C, which can be
transmitted by unsterile piercing equipment.
The following information is found at the Department for Child Protection website at
http://www.dcp.wa.gov.au/ChildProtection/Pages/BodyPiercingOfYoungPeople.aspx
AMENDMENTS TO THE CHILDREN AND COMMUNITY SERVICES ACT 2004 SECTION 104A BODY PIERCING OF CHILDREN
-----------------------------------------------------------------------------------------------------------------------------------------------New provisions for the body piercing of children in the Children and Community Services Act 2004 came into
effect on 31 January 2011. The Department for Child Protection is responsible for administering this Act.
The new provisions on body piercing (under s.104A) prohibit the piercing of a child under 18 years of age in
any intimate area (genitals, nipples, anal area or perineum). A person who carries out this type of piercing on
a child under the age of 18 can be fined $18,000 and imprisoned for 18 months. It is not a defence to a charge
that the child, or a parent of the child, consented to the body piercing.
Additionally, a child will require the written consent of their parent for all non-intimate body piercings. Nonintimate body piercing means piercing a part of the body including the nose, tongue, face, belly button or
other skin surfaces. A person who carries out this type of piercing on a child without written parental consent
can be fined $12,000 and imprisoned for one year. The only circumstances where a child does not need their
parent’s consent is for ear piercing if the child is aged 16 years or over.
16
¤
nks
i
L
y
t
i
n
u
m
m
o
& C
s
t
c
a
t
n
o
C
l
u
f
e
Us
Health
HepatitisWA
Information, support and referrals
for people living with or affected by
hepatitis. Education for work places,
pharmacies, schools or other groups.
Participation in community events.
Call the Info and Support Line on
(08) 9328 8538 (metro)
1800 800 070 (country)
www.hepatitiswa.com.au
WA AIDS Council
provides a wide range of services in
the prevention of HIV, and the treatment and care of people living with
HIV/AIDS, including a Needle and
Syringe Exchange Program (NSEP).
(08) 9482 0000
www.waaids.com
Quit Line
Smokers Information & Treatment
13 18 48
Gay & Lesbian Community Services
of WA
provides a service which allows
people to explore homosexuality as
it relates to them personally, without
judgement or prejudice. Included in
this are issues such as identity
formation and coming out, and
relationship difficulties.
(08) 9420 7201
www.glcs.org.au
WA Substance Users Association
provides services that are nonjudgmental and user friendly. These
include a health clinic for BBV and STI
testing, hepatitis A&B vaccinations,
general health information and
referrals, as well as a Needle and
Syringe Exchange Program (NSEP).
(08) 9321 2877
www.wasua.com.au
Pregnancy Assistance
provides confidential and extensive
counselling in the following areas:
abortion alternatives, job/study
continuation and financial assistance.
(08) 9328 2929
www.pregnancyassistance.org.au
Magenta-Sex Worker Support
Magenta offers support, health services, education and information to
female, male and transgender workers in the sex industry. We provide
confidential and sex worker friendly
services.
(08) 9328 1387
NATURAL THERAPIES
Australia Natural Healthcare Centre
57/76 Newcastle St, Perth WA 6000
(08) 9228 8828
Australian College of Natural
Medicine
170 Wellington St, East Perth WA
6004
(08) 9225 2900
Chinese Medicine & Accupuncture
Association of Australia
84 Edward St, Perth WA 6000
(08) 9227 5766
Street Doctor (08) 9347 5488
OTHER
Derbarl Yerrigan Health Service
is an Aboriginal Community Controlled organisation.
(08) 9421 3888
www.derbarlyerrigan.com.au
Relationships Australia
provides relationship support
services to enhance human and
family relationships.
1300 364 277
LEGAL
Men’s Domestic Violence Helpline
1800 000 599
Legal Aid WA
provides information, advice and
other legal help, and assessment for
aid grants to cover legal fees.
1300 650 579
1800 241 216 (TTY)
www.legalaid.wa.gov.au
Aboriginal Legal Service of WA
provides legal aid services to Aboriginal and Torres Strait Islander peoples.
Phone: 08 9265 6666
Freecall: 1800 019 900
www.als.org.au
The Western Australian Equal
Opportunity Commission
The anti-discrimination information
gateway.
08 9216 3900 (metro)
1800 198 149 (country)
www.antidiscrimination.gov.au
Women’s Domestic Violence
Helpline
1800 007 339
Telephone Interpretor Service
13 14 50
Pharmaceutical Benefits Scheme
(PBS) Australia
1800 020 613
Australian Organ Donor Register
telephone enquiries
1800 777 203
Medicines Line Australia
1300 888 763
Cancer Council WA
Helpline: 13 11 20
These contacts are for information purposes only. HepatitisWA does not guarantee the services listed.
HALF FULL
or
or HALF
Need
to
Talk?
EMPTY??
Why not try one of the following
supplements to give yourself a boost...
Echinacea (1,000mg 120 tabs)
$20.00
Strengthens immune system and enhances tissue repair.
Livertone (120 caps)
Available Monday to Friday, 9.30am – 4.30pm.
Ginkgo Biloba (2,000mg 100 tabs)
$16.00
St John’s Wort (Hypericum) (60 tabs)
$16.00
Helps maintain blood circulation.
For the relief of stress, mild depression and viral infections.
St Mary’s Thistle (Milk Thistle) (10,000mg 60 tabs) $15.75
Promotes regeneration of liver tissue and detoxifies blood.
Super Charged B (100 tabs)
$18.60
Promotes stress relief.
Sodium Ascorbate Powder (400g)
$18.25
Promotes formulation of white blood cells and
strengthens immune system.
Swisse Men’s Multi-Vitamin (60 tabs)
$25.00
Swisse Women’s Multi-Vitamin (60 tabs)
$25.00
Mineral and anti-oxident
Omega 3 Natural Fish Oil (1000mg)
May provide relief from arthritis symptoms
and help maintain peripheral circulation.
Contact our Support Officer for a chat by phone
or visit by appointment.
Confidential, free, understanding.
$21.00
Liver tonic, aids digestion.
Mineral and anti-oxident
http://www.flickr.com/photos/trekkyandy/2132345694/sizes/l/
is
is your
your glass
glass
100 tabs $ 7.75
200 tabs $10.75
400 tabs $17.50
Postage by express mail $7.40 for maximum weight of 500g
(Please make cheque/money order payable to HepatitisWA
(Inc), or visit our office at 187 Beaufort Street, Northbridge
(near Newcastle Street).
Ph 9328 8538 (metro) or 1800 800 070 (country callers)
Image by Ayelie copyright © 2009. Available under SXC image license http://www.sxc.hu/photo/852619
(08) 9227 9806
187 Beaufort St, Northbridge WA
[email protected]
Does your organisation
work with people who are
affected by, or at risk
of, viral hepatitis?
=
The ABC of Hepatitis
Viral Hepatitis Education and Training
HepatitisWA can provide you with FREE education and
training for topics such as:
• Hepatitis A, B & C
• Workplace issues (eg.: Blood spill kits)
• Prevention and Transmission
• Pre- and Post Test Discussion
• Treatment
• Living with Hepatitis
• Co-morbidity issues (AOD and MH workers)
• Workforce Development
• Referral Pathways
Talk to Matthew today to arrange a workshop:
(08) 9227 9806 (metro) OR 1800 800 070 (country)