2. Your trainers today are: Names

3. 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

4. 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 First Module

5. 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 Exercise: Getting to know you

6. Evidence around Young People and Hepatitis C Risk

7. 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

8. 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

9. 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)

10. 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)

11. 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)

12. 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 ‘The exposure and transition study’ (Bryant et al)

13. 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?

14. 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 NSW ‘Big Day Out’ Survey 2009

15. 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

16. Overview of hepatitis C and other forms of viral hepatitis

17. 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

18. Viral Hepatitis The following slides are to be used to support discussion during the hepatitis brainstorm activity if needed

19. 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

20. BBV – how many? Hep B Virus Hep C Virus HIV National BBV and STI Surveillance and Monitoring Report 2013 230,000 207, 000 25,708 (As at Dec 2012)

21. 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

22. A healthy liver

23. An unhealthy liver

24. Left untreated, hepatitis C can lead to: - Fibrosis - Cirrhosis - Liver failure - Liver cancer Disease progression } Liver scarring and impaired liver function Hepatitis C is the most common reason for liver transplantation in Australia

25. 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

26. THE OF HEPATITIS A B C

27. 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

28. 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

29. 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)

30. 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

31. Transmission Risk

32. Non-professional tattooing and piercing is increasing amongst young people – putting them and their peers at risk of blood borne infections Tattooing and piercing

33. Performance & image-enhancing drugs Injecting becoming more common More younger people using them Accurate information just not out there Unknown risks

34. Not just about blood borne infections

35. 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

36. Hepatitis C - testing

37. 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

38. 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

39. 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.

40. 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

41. 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

42. Morning tea break (15 minutes)