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Welcome to the latest edition of the Hepatitis Scotland e-Bulletin.
A review published in the Harm Reduction Journal has looked into social factors influencing treatment access and uptake among people who inject drugs (PWID). It documents successful Hepatitis C virus treatment outcomes for PWID and interest in HCV treatment among this population, noting that it can be an effective way of preventing HCV infection in the general population. However, Hepatitis C treatment among PWID remains low.
The review concludes that intervention approaches need to encompass social interventions in relation to housing, stigma reduction and systemic changes in policy and health care delivery. It recommends that future research be carried out in these areas pertaining to Hepatitis C.
Less wealth, less health
A report published by the Scottish Public Health Observatory has said that socioeconomic inequality is a fundamental cause of health inequalities and that focusing on controlling proximal indicators (e.g. tobacco, alcohol and drug use) will ultimately fail to eradicate socioeconomic inequalities in health.
Referring to the differences in the amount of life lived between the most and least deprived members of society as an injustice, the report concludes that tackling underlying inequalities in income, wealth and power is likely to be the only way to sustainably achieve the goal of eradicating socioeconomic health inequalities in Scotland.
The report concluded that 'fundamental causes' theory was applicable to Scotland and that policy solutions should seek to address these rather than proximal causes of health inequalities such as tobacco, alcohol and drug use.
Responding to the report, the BMA in Scotland said that health inequalities in Scotland have never been more apparent, and called for health inequality impact assessments to be carried out across all areas of government policy to improve the life chances of people living in Scotland's poorest communities.
Scottish public health minister Michael Matheson said "At the root is the issue of income inequality - we need a shift in emphasis from dealing with the consequences to tackling the underlying causes, such as ending poverty, fair wages, supporting families and improving our physical and social environments."
Does money affect childrens' outcomes?
The London School of Economics and the Joseph Rowntree Foundation have published research showing that children in lower income households do less well in school and have worse health outcomes than their better off peers in part because they are poorer.
The researchers reviewed reviewed 34 studies from OECD and European Union countries with strong evidence about whether money affects children’s health, social, behavioural and cognitive outcomes.
Conservatives consider cutting benefits for under 25s
David Cameron used his speech to the Conservative Party Conference to say that the party will look at ending benefit automatic benefit payments to those under the age of 25, in addition to definite plans to end housing benefit for under 25s in the next Conservative manifesto.
Citizens Advice Scotland Chief Executive Margaret Lynch responded, “We would be very concerned about the impact further cuts would have on young people in Scotland. Far from helping them into work, it would be more likely to reduce their personal independence and force them instead towards poverty and debt.”
See also 'Being Young Being Heard', a Citizens Advice Scotland publication on the impact of the recession on young people in Scotland.
Work not leading to an escape from poverty
The first report from the Social Mobility and Child Poverty Commission has shown that two thirds of children officially deemed to be poor now come from families with at least one working parent. It said that low and middle income children face being worse off than their parents due to falling earnings and rising prices. It said that the 'twin problems of high youth unemployment and falling living standards' were storing up problems for the future.
The report goes on to say that the 5 million adults and children in working poor households are the forgotten people of Britain and that the whole UK needs a new approach focused on tackling in-work poverty.
The recommendations include:
The report also mentioned Scotland specific figures on health and education. Despite educational attainment improving among the most deprived pupils, children from the most deprived areas still on average only achieve an S4 tariff score that is 60% of that achieved by those in the least deprived areas.
The proportion of children with a health body weight in Scotland has decreased from 70.1% in 1998 to 67.5% in 2012. It pointed to an association between deprivation and proportion of children with a healthy body weight, with figures showing that those from the most deprived quintiles were considerably less likely to have a healthy body weight.
In addition to a large body of assembled evidence considered in previous Hepatitis Scotland e-Bulletins, these reports and research pieces suggest that efforts to eradicate health inequalities around viral hepatitis are being undermined by policies with a high potential to increase poverty, wealth and income gaps; and which are unlikely to be conducive to creating the conditions in which people feel empowered to protect and improve their own health.
The Scottish Health Observatory report concludes that current approaches to tackling health inequalities targeted at proximal causes of inequalities - such as tobacco, alcohol and drugs - will ultimately fail.
In 2012 health analysis research into young people's knowledge and understanding of sexual health and blood borne viruses was carried out for the Scottish Government. Pupils in Scottish secondary schools from S3 to S6 were asked a series of questions aiming to ascertain how often they had been taught about sexual health, what their understanding is; and how they think they will use this understanding in the future.
It found that knowledge about sexual health and blood borne viruses in Scottish secondary schools was generally high - other than for Hepatitis B and C. It was notable from the research that:
NICE has raised concerns over the issue of injection drugs for vanity purposes and the risk of blood borne viruses.
Prof Mike Kelly, Director of the NICE Centre for Public Health Excellence, said: "Since we last published our guidance on needle and syringe programmes in 2009, we've seen an increase in the use of performance-and-image-enhancing drugs such as anabolic steroids, Botox, tanning agents and the use of dermal fillers like collagen.
"We've also heard anecdotal evidence that more teenagers are injecting these performance-and-image-enhancing drugs too. We're updating our guidance to make sure all of these groups of people are considered in the planning and delivery of needle and syringe programmes."
Among the proposed recommendations are that local councils provide sharps bins to those who inject beauty products.
Supervised injectable opioid treatments are more cost effective than oral methadone treatment according to new research from Kings' College London. (Athens access required)
The RIOTT trial showed that injectable heroin was more effective in treating chronic heroin addiction. 72% of participants responded well to treatment compared to those treated with injectable methadone (39%) or oral methadone (27%).
However, this study shows that despite injectable treatments being more expensive to provide, they are associated with reduced levels of crime and that providing them in England could save between £29million and £59million per year.
Drug and Alcohol National Occupational Standards has published their service user consultation report. The service user consultation sought to capture what service users felt they needed in a worker or service in terms of support. The results of the survey will be used alongside the feedback from the wider National Occupational Standards(NOS) consultation to inform the revised NOS.
View the consultation report here.
Hepatitis C reinfection common among HIV positive gay men in Europe
FIndings reported at the 14th European AIDS Conference have shown that nearly 10% of HIV positive gay men became reinfected with Hepatitis C after clearing the virus, with some having 3rd and 4th infection episodes. The European AIDS Treatment Network (NEAT) looked at rates of hepatitis C reinfection among HIV positive people in the UK, Austria and Germany.
Factors associated with HCV transmission included anal sex, fisting, group sex, presence of other sexually transmitted infections and use of non injected recreational drugs. The investigators said "Understanding of risk behaviours and promoting strategies for risk-avoidance will be important to prevent reinfections in this population."
US Doctor calls for gay men to be tested for Hepatitis C
Dr. Lawrence D. Mass, co-founder of charity Gay Mens Health Crisis (GMHC), has criticised the excessive caution around Hepatitis C testing recommendations for gay men, arguing that there ought to be greater awareness of and testing for Hepatitis C as an sexually transmitted infection. He also criticises public health advice regarding hepatitis C testing for gay men as being unclear.
Dr. Mass notes that despite gay men not being perceived as 'high risk' for Hepatitis C, the fact that they are 'at risk' merits testing in this group. He cites European research like the study above as well as growing numbers of cases in gay men generally as justification.
He concludes, 'If you are a sexually active gay man/MSM, if you've had sex with multiple partners over time, get tested for hepatitis C. If your doctor or health care provider declines to offer the testing based on perceived low risk and unclear public health services recommendations, seek testing from another health care provider.'
The US Food and Drug Administration has urged people to stop using the Dietary supplement Oxyelite Pro after it was linked to 29 cases of acute non-viral hepatitis in Hawaii. 11 of those 29 cases have been hospitalised, 2 have received liver transplants and 1 has died.
Since the FDA issued it's warning the UK Food Standards Authority as well as authorities in Spain, Denmark, Australia and New Zealand have all followed suit.
The product is often used as a pre-workout metabolism booster. The FDA and CDC have advised consumers in the United States to avoid using Oxyelite Pro until further investigations have been concluded.
The Hepatitis C Trust has released a report looking at Hepatitis C efforts in England. It says that the disease continues to be overlooked and under prioritised despite all national data showing that Hepatitis C related hospital admissions and deaths are increasing.
Read report here.
Opt out BBV testing for Prisons in England and Wales
The Hepatitis C Trust has welcomed the decision to introduce opt out testing for blood borne viruses in prisons in England and Wales. A new National Partnership Agreement will see the policy implemented by April 2014.
Becky Hug, Policy and Public Affairs Advisor at The Hepatitis C Trust said: “This is a brilliant step forward to improving public health, both inside and outside prison walls, and in reducing health inequalities. This policy change will have a huge impact on reducing unidentified hepatitis C in prisons.
World AIDS Day takes place annually on December 1st. This year there are a variety of events and community gatherings taking place across the country, running from November 22nd up until December 1st.
For a full listing of activities taking place across Scotland, visit the HIV Scotland website.
Janssen Hepatitis Awareness Month survey - 91% of people know nothing of hepatitis.
Hepatitis B Aware: Website with information on Hepatitis B risk for those travelling abroad.