So, you have HIV. How does that make you feel? Usually the answer to that ranges from numb to shock, anger to despair. Whatever your reaction has been, its probably been shared by others. You are not alone.

I remember my own. It was 1989 and I received a call from my doctor suggesting I have an HIV test. Me!! There I was, 30, living in the suburbs, a middle management job in the Health Department. Life was about to change. When I received the call I felt as though I had plugged my body into a 240 volt socket.

INDEX

SUPPORT SERVICES

Straight Arrows
Formed in 1995, Straight Arrows is run by and for HIV Positive heterosexuals and their families. Straight Arrows provides services and support including:
• Treatment information from a Treatments Officer (in conjunction with Positive Women) fortnightly
• Medical and paramedical services information
• Legal services referral (HALC)
• Social contact
• Assistance with housing needs, and referral to AHAG
• One-to-one peer support
• Massage
• Hospital/ward visits
• Outreach/home visits
• Monthly lunch (free of charge)
• Speakers for education in wider community
• Drop in space for coffee and/or a chat
• Financial relief and Child Care reimbursements.

Fairfield House
The Alfred
Moubray Street
Prahran 3181
Hours: Monday – Friday 10am – 4pm
Tel: (03) 9276 3792
Fax: (03) 9276 3817
Anytime Arrowline 24hrs/365days (03) 8302 7222
Email: straightarrows@bigpond.com.au
Web: http://www.straightarrows.org.au

People Living With HIV/AIDS (PLWHA - Vic.)
PLWHA provides advocacy, representation, information and support for all HIV/positive people in Victoria. It focuses its attention and energies on advocacy, particularly in the areas of health service delivery, treatments activism, housing, anti-discrimination and quality of life issues for people living with HIV/AIDS.
Membership in PLWHA also entitles a person to a free regular newsletter, notification of upcoming events (including social functions) and gives the right to vote at the AGM or any special meetings of the organisation. PLWHA has a variety of ways in which HIV+ people can be active, including the Speakers Bureau, Treatments Action Group, HIV+ Radio or the Board of Management.

Ground Floor
6 Claremont Street
South Yarra 3141
Tel: (03) 9865 6772
Fax: (03) 9804 7978
Email: plwha@netspace.net.au
Web: http://www.gaynet.com.au/plwha

HIV Support Services – Victorian AIDS Council
• Services offered include:
• Support for partners, family and friends
• Information and advice in relation to your health care
• Referral to other agencies
• Social and emotional support and outings
• Financial assistance
• Legal assistance
• Advocacy on behalf of clients
• Personal care in your home
• Assistance with gardening, shopping, washing and other domestics tasks
• Transport to medical appointments

Check you eligibility with the Victorian AIDS Council on
(03) 9865 6700 and speak to a Regional Support Officer (RSO).
An initial assessment will be made over the phone. If eligibility is probable then an appointment will be made for a formal assessment.
If appropriate a Care Team Coordinator will be assigned who will then discuss your support needs, and develop a care plan.
All client records are maintained confidentially, and the program is non-discriminatory. Services are targeted to those PLWHAs most in need. Straight Arrows has always found the service to be a boon to HIV+ people, and the RSO's friendly and approachable.

Positive Women
This is a State-wide service in Victoria offering confidential information and support group for women with HIV/AIDS. Positive Women offer:
• one-to-one contact in person or by phone
• group support
• a monthly newsletter
• a drop-in centre 5 days a week
• information and referrals
• retreats and social events
• hospital and home visits on request.

Positive Women also:
• advocates and lobbies for the rights of women with HIV/AIDS
• provides speakers for educational purposes in the wider community and networks with other women’s and AIDS groups in Australia and overseas.

Fairfield House
Alfred Hospital
Moubray Street
Prahran 3181
Tel: (03) 9276 6918
Fax: (03) 9276 6092
Email: info@positivewomen.org.au
Web site: http://www.positivewomen.org.au

AIDS, Hepatitis and Sexual Health Line
Originally known as AIDSLINE and formed in 1985 in response to the HIV/AIDS epidemic. The name was changed in 1998 to reflect the fact that as well as dealing with sexually transmitted diseases other than HIV, they also offer services on viral hepatitis, in particular hepatitis C.
AH&SHL offers anonymous, free and extended hours telephone help. The service is staffed by trained staff and volunteers, and has been a backbone of HIV information services since its inception.
AIDSLINE: (03) 9347 6099 or Freecall 1800 133 392
HEP C Helpline: (03) 9349 111 or Freecall 1800 00 241
Vietnamese infoline on Hep C Freecall 1800 456 007
Email: info@aidshep.org.au
Web: http://www.aidshep.org.au

National Association for Loss and Grief (Vic)
NALAG can assist with information and referral to accredited Loss & Grief Practitioners (Counselors, Educators, Supervisors, Care and Support workers), Support Groups and Self Help Groups and services available. For further information:
National Assoc Loss & Grief (Vic)
PO Box 214 Essendon 3040
Tel: (03) 9351 0358
Fax: (03) 9351 0802
Email: Info@nalagvic.org.au
Web: http://www.nalagvic.org.au

Lifeline Australia
This is a telephone counseling service that is available 24 hours a day, 365 days a year.
Calls are connected automatically to the nearest available Lifeline centre for the cost of a local call, from anywhere in Australia.
Tel: 13 11 14
Web: http://www.lifeline.org.au

Country AIDS Network (CAN)
CAN is a statewide organisation which represents regional and rural interests.
Its aim is to be a resource for people affected or infected by HIV/AIDS or other blood borne diseases, and it can be accessed by agencies or individuals across Victoria.
CAN also acts as a facilitator for education, training and events, support and care to be run by local communities for local communities in rural Victoria.
Tel: (03) 5443 835
Email: ewe2@can.org.au
Web: http://www.can.org.au

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HOUSING

Access to appropriate and safe housing is an extremely important link in the management of HIV. Housing authorities recognise this and HIV+ people can apply for priority if they are eligible for public housing.
Housing options can also include private rental, share accommodation and community housing.

Additionally, there are full residential services available for HIV+ men and women, particularly for respite, and temporary accommodation such as after hospital admission. Straight Arrows, or any of the other support services can arrange referral to these.
The principal housing service for HIV+ people is AHAG:

AIDS Housing Action Group Vic. Inc.
365 Hoddle Street, Collingwood, 3066
(Collingwood Community Health Centre, Cnr Sackville & Hoddle St's)
Tel: (03) 9531 2722
Email: ihspahag@vicnet.net.au
Web: http://home.vicnet.net.au/~ahag/

Public Transport:
Tram 86, Stop 17 Smith Street
Train – Victoria Park Station
Buses – 246 (Hoddle Street)
200,201,203,205,207,257-262,264-266,276- 281,299,300 (Johnston Street)

Wheelchair Access: Yes
Appointments: Yes, there is no drop in facility.

Services are for those with HIV/AIDS include:

Housing Advice and Referral
Staff are able to discuss housing options, including assistance for private rental may include information regarding Housing Establishment Funds (HEF) for rent in advance and the Bond Loan Scheme (Office of Housing).
Referrals to other housing agencies will also be arranged where appropriate.

Transitional Support Program
This program supports those that are homeless or at risk of becoming homeless. People will need to be assessed by staff as suitable for the program and be willing to receive support whilst in the program.

John R Stroop Housing Program
This community-housing program provides long-term housing for People Living With HIV/AIDS.

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LEGAL ISSUES AND DISCRIMINATION

Over the years, particularly early in the epidemic, people with HIV have faced some significant hurdles. One of these has been in relation to discrimination, and other legal areas where their status has been an issue.

There is Federal and State legislation dealing with equal opportunity and discrimination generally. PLWHA (Vic), Positive Women and the Victorian Law Foundation have produced a guide, “Don’t Just Take It”, which is very helpful.

In Victoria, the Equal Opportunity Act (1995) makes it unlawful to discriminate directly or indirectly against someone because of their:
• Age
• Carer status
• Disability
• Lawful sexual activity/orientation
• Personal association with a person who could be discriminated against
• Physical features
• Political or industrial activity or beliefs
• Pregnancy, parental or marital status
• Race
• Sex

In particular, this means it is unlawful to discriminate against a person who is living with HIV, assumed to be living with HIV, or is an associate of a person living with or assumed to be living with HIV. (This also applies to Hepatitis C)

It is unlawful to discriminate against a person with HIV in the areas of :

Accommodation
including buying, renting, providing temporary or permanent accommodation such as business premises, a house, flat, hotel or motel room, boarding house or hostel, caravan, mobile home or campsite.

Clubs
covering social recreational sporting or community service clubs that are located on Crown Land, or receive any financial assistance from the State Government or a municipal council.

Employment and Sport

Goods & Services & Disposal of Land
which includes refusing to supply a person with goods and services, or on less favourable terms. It does not matter if the goods and services are provided for money or not.

Discriminatory requests for Information
If you feel you have been discriminated against, you can:
Contact an HIV Support Service or HALC

Contact the Victorian Equal Opportunity Commission
Level 3 380 Lonsdale St Melbourne
Tel: (03) 9281 7100
Fax: (03) 92817171
Web: http://www.eoc.vic.gov.au

HIV/AIDS Legal Centre (HALC)
What is HALC?
The HIV/AIDS Legal Centre (Victoria) is a community legal centre, providing legal advice and referral to people infected by HIV/AIDS.
The aims of HALC include:
• To provide free legal services to people living with and affected by HIV/AIDS
• To involve people living with and affected by HIV/AIDS in the recognition, understanding and solution of their own legal problems.
• To take part in the process of laws related to HIV/AIDS that are unjust or difficult to understand.
• To raise awareness of the laws and processes that affect PLWHA through information and education
• To encourage participation in running the Centre by people living with HIV/AIDS

Who can use the HALC?
HALC provides free legal advice and assistance to all people living with HIV/AIDS. It also provides free legal advice and assistance to partners, carers, family and close friends of people living with HIV/AIDS, where their legal problems relate to HIV/AIDS.

What types of problems does HALC assist with?
HALC can assist with legal problems, including:
• Making a will
• Medical and Enduring Powers of Attorney
• Immigration and travel
• Tenancy disputes
• Social security
• Family law
• Superannuation and insurance
• Discrimination of all types
• Police charges
• Debt
• Employment

When can I see a lawyer?
HALC is open for appointments every Wednesday night from 7 pm to 9 pm.

You need an appointment to see a lawyer. Appointments can be made by contacting the Positive Living Centre on (03) 9863 0444

Is it confidential?
All staff at the centre are specifically trained so that they understand the need for confidentiality. Confidentiality is our PRIORITY.
The centre has special facilities so that your file and all personal details are secure and can not be assessed by anyone except HALC staff.

HIV/AIDS Legal Centre Victoria
6 Claremont Street, South Yarra 3141
Tel: (03) 9525 4455
Fax: (03) 9534 2708

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THINGS THAT GO BUMP IN THE NIGHT

Everyone has things sometimes that seem to spin around in their minds keeping them from sleeping. And, in the middle of the night, things can also feel overwhelming. Often, in daylight hours, we can take some positive action to fix these worries, but we often put them off only to have them return and keep us awake.

The things can cause us concerns often relate to what may happen many years from now – things like the need for a Will, finding out what continuing care is available if needed, etc.
These sheets will look at some of the things that can be done making it easier to just get on and live life with fewer sleepless nights! The funny thing is, everybody should have a grip on these issues, not just people with HIV. If you deal with them, whatever your situation, they are done with and you can get on with life.

Making a Will
Everybody needs a will! If a person dies without a Will, their assets are divided up according to a statutory formula. If you want a choice in what happens to your assets, you need to make one.
There are many ways to organise this. Most of them simple!
1. Contact your local AIDS Council for free legal assistance
2. Speak with any private lawyer/solicitor who will usually be able to prepare a Will for less than $100.
3. Attend a local Community Legal Centre who will assist you for a small fee.
4. The Public Trustee or State Trustee will prepare your Will for free as long as they are appointed as your Executor. They deduct fees from estates for carrying out the duties of the Executor.

POWERS OF ATTORNEY

What are they?
There are 3 types of Power of Attorney:
• A general power of attorney
• An enduring power of attorney
• An enduring power of attorney for medical treatment

To ensure that any Power of Attorney is prepared and witnessed correctly it is best to follow the guidelines for advice and preparation given previously under the ‘Wills’ section of this document.

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CHILD CARE

There may be times when your circumstances mean that a sudden and unexpected need for childcare arises. The following are some guidelines as to who to approach at these times:

Straight Arrows
Straight Arrows has limited financial resources available for emergency care of children. That is, when circumstances arise other than regular arrangements. An example of this would be when you are required to attend a medical appointment at short notice, or if requiring admission, again at short notice, whilst you make firmer arrangements.
Straight Arrows also endeavours to assist with childcare when running an adult function.
Phone: (03) 9276 3792 or Anytime Arrowline: (03) 8302 7222

Victorian AIDS Council
The Council has a Child Care policy that states its commitment to:
• Facilitating the access of parents and guardians to the processes and services of VAC, and also to
• Providing parents and guardians who have HIV/AIDS, or whose children have HIV/AIDS with access to occasional respite child care.

Requests for childcare will be assessed on a case-by-case basis with reference to the level of demands on the service.
Phone: (03) 9865 6700

Hospital
The Social Work department of your treating hospital may be able to help with arrangements through local councils, etc, and at times infants have been accommodated in the hospital with a parent. You might want to make enquiries at the hospital to plan for such a contingency.

Remember, you can contact Straight Arrows at almost anytime to discuss possibilities.

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FINANCE

Good financial planning, and knowledge of the resources available, can provide a sense of security for anyone, and particularly people with HIV. The planning needs of HIV+ people depend on their personal circumstances, their current resources, and future needs. A person working full time, for example, has different resources and planning needs to a person who is unwell and unemployed. People can also have circumstances which can include periods of employment mixed with periods of inactivity:

Long Term
For people who are well and/or working, particularly those with children, there is the issue of medium to long term savings and planning.

Cash
Usually cash, such as a bank account, is considered to be a very short term investment. The interest rates paid on savings accounts and the like is extremely low, and term deposits, whilst having a better rate, lock money up for a fixed period. On the other hand, cash in accounts is readily available.

There is an alternative to these, however – Cash Management Trusts. These are usually run by large investment companies, and offer a reasonable rate together with good access to funds, including cheque access. The catchs with CMTs are they often require a minimum deposit, or a minimum balance. If you have some savings they are a good place to park money with a 12 month to 2 year horizon.

Shares and the stock market
The roller coaster ride. The stock market can offer good returns in the medium to long term if you pick a good company or portfolio of companies. The market has two factors affecting your investments – risk and volatility. Risk is the possibility of your investment going belly up, like some of the new technology companies. Volatility, on the other hand, relates to the rise and fall of the market, and, providing there is a general upward movement in your investment, not such an issue for medium to long term investors.

One way of investing in shares, or property for that matter, is to spread your investments not just by number, but also within individual investments through managed unit trusts. There is a multitude of these unit trusts, offering a diverse range of investment options, such as Australian and International Equities, and with a variety of outlooks, including bias towards income or capital growth, lower or higher risk and volatility, etc. The investment company employs professionals to manage these investments, and their performance history can be assessed from a prospectus.

The best way of accessing these products is to find an experienced and reputable investment advisor. In particular look for an independent advisor, and one who discloses the initial and trailing commissions they receive, or an advisor who charges a consultation fee only. The Victorian AIDS Council has produced an excellent guide on managing finances, “the Positive way to stay afloat”. You can obtain a copy from Straight Arrows or directly from the VAC

Centrelink
At various times, many of us need to access the social security system.
For advice as to Benefits to which you or members of your family are entitled it is best to directly contact Centrelink. Centrelink staff also visit the Alfred Hospital twice a week providing a very discrete link to the social security system.
The following are central numbers – Australia-wide – for the designated Benefits:

131021
To make an appointment to see someone in your local office

132717
Disability, Sickness and Carers benefits

136150
Family/Parenting Payments

131202
For information in other languages

132850
Employment Services

132490
Youth Allowance

132490
Austudy Payment

Freecall 1800 810 586

Teletypewriter Service
A TTY service for hearing and speech impaired people. A TTY phone is required to use this service.

Depending on your situation the following Benefits may well apply at various times:
• Disability Support Pension
• Mobility Allowance – not means tested
• Child Care benefit
• Parenting Payment
• Carer Allowance
• Sickness Allowance
• Telephone Allowance

David Williams Fund - Project of the HIV Services Unit of Victorian AIDS Council
This fund was established in 1987 by the friends and family of David Williams, and provides emergency financial assistance and relief to HIV+ people experiencing hardship.
To be eligible for financial assistance through the David Williams Fund you must:
• Provide proof of your HIV status
• Demonstrate that you are in receipt of a Social Security Benefit or Pension
• Demonstrate financial hardship, and
• Be a resident of Victoria for the previous 3 months.

David Williams Fund Application forms are available from:
•The Victorian AIDS Council, 6 Claremont Street, South Yarra
• The Social Work Department of the Alfred Hospital, Prahran
• Straight Arrows

Straight Arrows
Straight Arrows provides a limited amount of emergency financial relief to people within our service category: HIV+ parents and HIV+ heterosexuals and their families. This is usually by way of voucher or utility assistance.

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LIVING WITH CHANGE AND TRANSITION (and dealing with Loss and Grief)

Every person’s life contains change and transition. From our earliest months we experience (whether we are conscious of it or not) massive changes - physically, emotionally and mentally. Sometimes there is resistance to change and it is often expressed through crying. Any who have witnessed a small child being put to bed against their will understands this very well!

As we grow older we often feel the same emotions when faced with changes and transitions, but we have learned what is ‘appropriate’ or ‘inappropriate’ behaviour in our society at such times. However, we do still respond, despite what our public face shows.
Very often we don’t recognise the changes as being a cause of grief in our lives. We perhaps, although incorrectly, think that humans only grieve when a death occurs. Of course it is true that we do grieve when bereaved. However, there are many other changes and transitions that can arouse similar emotional and other responses.

Some common changes and transitions are:
• Finishing school
• Leaving home
• Breakdown in a relationship
• Lost dreams/hopes
• Divorce
• Loss of friendship
• Unemployment
• Ill health
• Infertility
• Loss of accommodation
• Loss of financial security
• Changes in role and sense of identity

One of the realities of life is that we are all individuals with our own unique way of feeling and expressing ourselves. While responding to change and transition is a universal experience the way in which we respond is almost inevitably different to anyone else. Even when a similar change is experienced the responses may differ enormously.

So what are the various factors that help to create these different responses within us?
• Our age and previous experience in dealing with change and transition
• Our gender - with all the social pressures to conform to ‘male’ or ‘female’ ways of showing emotion.
• Our cultural background
• Our ethnicity
• Our belief system (religious and spiritual values)
• Our sense of personal identity
• Our current health situation
• Our current financial situation
• Our support systems
• Access to information that can assist us
• Our relationship with the person or thing that has been lost to us

So how do we express our response to change and transition?
It is helpful to recognise the impact on our lives in all aspects of our experience, ie in the physical, emotional, sexual, economic, social, psychological and spiritual spheres. And so we may respond with tears, or we may not. We may experience physical aches and pains, headaches, digestive problems. We may withdraw socially or become hyperactive in our activities. We may feel abandoned by God, or may seek out spiritual support. We may seek casual and anonymous sexual encounters or we may long for a committed relationship. We may experience poverty for the first time and be ashamed or embarrassed to admit our needs.

Some strategies for coping with change and transition.
• Do not carry the burden alone. Find a trustworthy person with whom you can share your feelings.
• Seek out information to assist you with your specific needs. For example, financial counseling, spiritual guidance, medical attention. Whatever it is that will offer ease to anxiety and uncertainty.
• Recognise that whatever you are feeling is normal, that responding in these ways does not mean you are ‘going mad’ (which is how many people describe themselves as feeling when under stress). Your responses show you are in touch with the reality of the pain of the change.
• Utilise the phone book, the Internet and other resources to put you in touch with organisations, counselors, or other forms of support in the community. They are there to be utilised and their very existence is evidence that you are not the first to feel in need of their expertise.

Those around us grieve too.

When we are experiencing change and transition that brings with it loss and grief, then it is sometimes easy to forget that those who know us can also be feeling the impact of the changes we are experiencing. None of us lives without others in our lives. We may (or may not) have families; many have neighbours, friends, social groups, colleagues at work (ie in paid or voluntary work places), professionals who offer support and care. Any person with whom we share some sort of relationship will affect us by their attitudes and feelings just as we affect them with ours.

Experiencing grief can create feelings of isolation because we look around and see others who are behaving, acting, speaking differently to us even if they share a similar situation. But no two people are the same, and no two people’s circumstances are exactly the same.
It can be tempting to judge ourselves against others and think that we are not coping if, for instance, we shed tears and others do not. ‘Coping’ can mean that we feel angry, or cry, or feel sad, or happy. Coping is acting on our feelings. We are not coping when we hide our feelings – especially when we try to hide them from ourselves!
If you feel that you would like to access support as you work with the feelings arising from any changes and transitions in your life then contact a Social Worker/Counselor at your local HIV/AIDS service, your General Practitioner or a grief counselor.
Accredited grief counselors can be contacted through the National Association for Loss & Grief (Vic.) on (03)9351 0358 or Country Vic. Freecall 1800 100 023.

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DEPRESSION

Depression can be a common reaction to a stressful event in life, especially loss. It may also be a symptom of a chronic medical illness, or a reaction to medication. It is not uncommon for people with HIV to experience depression.

The most important aspect of depression is that it can be effectively treated.

Signs of Depression:
There are many signs associated with depression, though experiencing each of these things separately does not indicate that you have depression:
• A feeling of sadness lasting for an extended period of time
• Loss of appetite, significant weight gain or loss
• Irregular sleeping patterns and difficulty getting out of bed
• Anxiety, irritability, impulsive behaviour
• Feelings of worthlessness, helplessness or that there is no future
• Finding you do not enjoy previously pleasurable activities
• Suicidal thoughts
• Frequent crying, or inability to cry
• Difficulty concentrating and loss of interest
• Loss of sexual desire or sexual difficulties

Factors which can aggravate depression:
If you are feeling depressed, you need to be aware of things that can increase feelings of depression. Some of these are:
• Drug use
• Alcohol use
• Certain HIV medications
• Extra stress
• Social isolation
• Dwelling on the current feelings of unhappiness

Practical ways that may ease depression:
• Seek supportive company
• Try to achieve a small task each day
• Take things one day at a time
• Do something special for yourself
• Mild exercise. Eat and sleep sensibly.
• Talk to a health professional

Seeking Help:
An accurate diagnosis is important to assist in treating and monitoring your depression. There are a number of services available to do this. Many that specialise in HIV and depression will be free of charge.

Your options include:
• Seeing a GP, counselor or a social worker who will refer you to the appropriate services if extra treatment for your depression is needed
• Seeing a psychologist or a psychiatrist is an option many people choose (a referral is usually required to a psychiatrist)
• There are other services that deal with these issues indirectly, by providing ongoing support, such as peer support groups
• There is more than one option available for you.

HELPFUL RESOURCES:

The Alfred HIV Psychiatry
(03) 9276 6081

The Alfred HIV Social Work Team
(03) 9276 3026

Bouverie HIV Counseling Team
(03) 9376 9844

Melbourne Sexual Health Centre Counselor
(03) 9347 0244

Victorian AIDS Council Counseling Team
(03) 9865 6700
(provides services for a minimal cost)

The Victoria Infectious Disease Service
(Royal Melbourne Hospital) Social Worker
(03) 9342 7418

Internet site:
Beyond Blue http://www.beyondblue.org.au

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PEOPLE LIVING WITH HIV AND AIDS (PLWHA)

NAPWA
(National Assoc of PLWHA)
Darlinghurst 1300
Tel: (02) 9281 2511
Fax: (02) 9212 5322

ACT
Tel: (02) 6257 4985
Fax: (02) 6257 4838

N.S.W.
Tel: (02) 9361 6011
Fax: (02) 9360 3504

Northern Territory
Tel/Fax: (08) 8948 0810

Queensland
(Qld Positive People)
Tel: (07) 3844 1990
Fax: (07) 3846 1283

South Australia
Tel: (08) 8293 3700
Fax: (08) 8293 3900

Tasmania
(Positive People TAS)
Tel: (03) 6234 1242
Fax: (03) 6234 1630

Victoria
PLWHA
Tel: (03) 9865 6722
(03) 9804 7978

Positive Women
Prahran
Tel: (03) 9276 6918
Fax: (03) 9276 6092

Straight Arrows Inc.
Tel: 03 9276 3792
Fax: 03 9276 3817

AIDSLINE
Melbourne: (03) 9347 6099
Country Vic: 1800 133 392
TTY: 1800 032 665

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AIDS COUNCILS AND ORGANISATIONS

Aust. Federation of AIDS Orgs.
Level 4, 74 Wentworth Ave
Surry Hills 2010
Tel: (02) 9281 1999
Fax: (02) 9281 1044

AIDS Action Council of the ACT
Canberra
Tel: (02) 6257 2855
Fax: (02) 9281 1044

AIDS Council of Central Australia
119 Todd St.
Alice Springs 0871
Tel: (08) 8953 1118

AIDS Council of NSW
9 Commonwealth St
Darlinghurst 2010
Tel: (02) 9206 2000
Fax: (02) 9206 2069

AIDS Council of SA
64 Fullarton Road
Norwood 5067
Tel: (08) 8362 1611
Fax: (08) 8363 1046

N.T. AIDS Council
6 Manton St
Darwin 0800
Tel: (08) 8941 1711
Fax: (08) 8941 2590

Qld. AIDS Council
32 Peel St
Sth. Brisbane 4101
Tel: (07) 3844 1990
Fax: (07) 3844 4206

Tas. Council on AIDS & Related Diseases
319 Liverpool St
Hobart 7001
Tel: (03) 6234 1242
Fax: (03) 6234 1630

Victorian AIDS Council
6 Claremont St
South Yarra 3141
Tel: (03) 9865 6700
Fax: (03) 9826 2700

W.A. AIDS Council
664 Murray St
West Perth 6005
Tel: (08) 9429 9900
Fax: (08) 9429 9901

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TREATMENT FOR HIV

Drug treatments for HIV offer some people the chance to control the virus and stay healthy for much longer. Treatment options have had a huge impact on the lives of people with HIV and those who care for then, due to reductions in AIDS illnesses, admissions to hospital and death rates. Treatment has also enabled some people with HIV to go back to work and plan for the future, Unfortunately, the drugs do not work as well for everyone, and they also have quite a lot of side effects. Deciding whether or not to take treatment is an individual decision which you should consider carefully and discuss all of the options with your doctor.

Types of Treatment
Drug treatment is usually called “HAART” which stands for “Highly Active Anti Retroviral Therapy”. HIV is a type of virus called retrovirus, so antiretroviral drugs are drugs which work against retroviruses.
There are three main groups of drugs:
• Nucleoside reverse transcriptase inhibitors (NRTIs)
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• Protease inhibitors

Usually, three different drugs from at least two of these group are taken together, two or four times a day.

How treatment works
The drugs control the virus by stopping it from making copies of itself inside the cells of the body. The virus gets into a body cell and starts to make more copies of itself, which then spread out of that cell and into another. Drug treatments interfere with the chemicals that the virus uses to make these copies. One of these chemicals is called ‘reverse transcriptase’, and the other is called ‘protease’. So reverse transcriptase inhibitors stop reverse transcriptase from working, and protease inhibitors stop protease from working.
The virus can become resistant to the drugs, which means that they won’t work as well. The treatment may then have to be changed to a different combination of drugs.
People taking drug treatment for HIV will probably need to take it for the rest of their lives. Stopping drug treatment even for short periods of time can cause the virus to become resistant to those drugs. A lot of research is being done in this area, to see if people with HIV will be able to take short breaks from treatment without harmful effects. This may be a possibility for the future, but at the moment, it is not recommended that anyone interrupt drug treatment without medical advice.

The drugs cannot eliminate all of the virus in the body, but they can control it. People on treatment will still have HIV in their body, even when blood tests show the virus is “undetectable”. Although an “undetectable” result is good news, it means that as far as that test can tell, it can’t find virus in the blood. A more sensitive test could possibly still find some virus, and also the virus may still be found in the semen or in the lymph glands.
Treatment does not stop someone with HIV from being able to pass on the virus through unprotected sex or sharing needles.

Side Effects
Some of the most common side effects are:
• Nausea (feeling sick)
• Diarrhoea
• Tiredness
• Difficulty sleeping
• Headaches
• Peripheral neuropathy (problems with the nerves in the legs, such as pain)
• Lipodystrophy (changes in the way body fat is distributed around the body)

Side effects are a big problem with treatment, although it would be unusual for someone to get all of them at the same time. Sometimes the side effect can be controlled with other medication, or is not too severe and can be tolerated. Sometimes treatment regimes need to be altered because of side effects. There is some good advice about side effects available on the Internet from Project Inform, access through www.thebody.com
You could also talk to your doctor, the Straight Arrows Treatment Officer, Jenny McDonald, or a Treatment Officer at your State HIV/AIDS office.

Testing
The two blood tests which are used to see how well the treatment is working are the viral load test and the CD4 count.
The viral load test measures how much virus can be found in the blood. Usually, people who are just starting treatment will have high levels of the virus. One of the aims of the treatment is to reduce this level until it is ‘undetectable’, which means the test cannot fin any virus. It doesn’t actually mean that all of the virus is gone, but it does mean that it is under control.

The CD4 count measures how many of a certain type of white blood cell can be found in the blood. This is also sometimes called the ‘t-cell count’. The CD4 count is one way of seeing how well the immune system is working. The higher the CD4 count, the healthier the immune system is. This means that the risk of other infections, such as pneumonia, is much less. One of the aims of treatment is to see the CD4 count go up, showing that the immune system is getting stronger.
Some people with HIV use other types of therapy, either alone or with their treatments. (see Complementary Therapies information sheet)

For More Advice:
• A doctor who specialises in HIV
• Access Information Centre – Tel. (03) 9276 6993
• Melbourne Sexual Health Centre – Tel. (03) 9347 0244
• Straight Arrows – Tel. (03) 9276 3792
• Victorian AIDS Council – Treatment Officer – (03) 9865 6700
• Victorian HIV/AIDS Service, The Alfred, Infectious Diseases Outpatient Clinic – Tel: (03) 9276 6081
• Victorian Infectious Diseases Service, Royal Melbourne Hospital Tel: (03) 9342 7212

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CONSIDERING TREATMENTS – TREATMENT OFFICERS

Over the past decade or so there have been many changes in the way HIV is understood and managed. These changes have led to great improvements in treatments and management and have greatly increased the options available to people today with HIV.
As a consequence of these developments many people are living longer and staying well with HIV.

The changes which have led to these improvements include:
• A clearer understanding of how HIV works inside the body
• A range of antiretroviral drugs which can act in different ways against the virus and are used in combination to treat HIV
• The use of the viral load test measuring the amount of HIV circulating in your blood has become standard practice in Australia. The results of this test can help in making treatment decisions. It can also show how well the treatments are working against HIV.

Your principal source of information on treatments will be your specialist. People often find, however, that they want to discuss at length the various issues surrounding treatments, including how there lifestyle may impact on the sometimes very strict compliance required by the drugs. People are also often interested in how to deal with side effects, and other issues such as diet.

Treatment Information Officers available in the Straight Arrows/Positive Women Positive Edge Project, other HIV related organisations throughout Australia are able to discuss such issues as:
• When to start treatments
• What combinations are best for you
• Viral load
• Antiretroviral treatments
• Resistance
• Tips to help stop the development of resistance
• Compliance
• Monitoring and changing combinations
• Treatment breaks
• Tips to help manage side effects
• Nutrition
• Complementary therapies
• New developments
• Other resources and support services available

Some contacts:
Positive Edge
A Straight Arrows and Positive Women (Vic) Project
Tel: (03) 9276 3792
Mob. 0401 922 419
Fax: (03) 9276 3817

Jim Arachne
Victorian AIDS Council
Tel: (03) 9865 6700

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COMPLEMENTARY THERAPIES

What does the term ‘Complementary Therapies’ mean?
(def.) complementary …. “that which completes”
Complementary therapies are those that can be used to supplement or replace traditional medical treatments.
Complementary therapists are specifically trained practitioners who can assist you in assessing which of a wide range of therapies can be of benefit to you.

What are the most commonly used of the wide range of complementary therapies?
National surveys in recent years have highlighted the following as the most frequently utilised:
• Nutritional supplements, i.e. vitamins and minerals
• Massage
• Herbal therapies
• Meditation
• Acupuncture

Detailed information can be accessed via the internet.

COMP_THERAPIES_HIV, a free, monthly e-mail newsletter focusing on research into complementary therapies that are relevant to people with HIV/AIDS. To register for automatic delivery send a blank email to:
Comp_therapies_hiv-subscribe@yahoogroups.com
Or phone your email address to Jim Arachne - Complementary Therapies treatment Officer at Victorian AIDS Council on (03) 9865 6700.
The newsletter is produced at the Victorian AIDS Council.

WITH COMPLEMENTS. This magazine has been the only one in the world with a sole focus on complementary therapies and HIV. It was produced by the HIV Complementary Therapies Collective based in Sydney. Unfortunately, it ceased production in 2000.

DAAIR - Direct Access Alternative Information Resources.
Based in New York, this site has large amounts of information on complementary therapies and HIV - with a main focus on nutritional supplements. DAAIR’s (expensive) protocols for dealing with drugs side effects are included.
Search this site at: http://www.daair.org

Organisations
Check if your local state or territory AIDS council or PLWHA organisation has a designated person to help you with treatment queries.
Victorian AIDS Council - Jim Arachne - Tues - Fri - (03) 9865 6700
PLWHA N.S.W. - Mac McMahon - Mon and Friday, 2-6 pm - (02) 9519 6830

Books
Many books are available, however these two are highly recommended for a start:
Living With HIV/AIDS - A Practical Guide for Staying Well - Peter de Ruyter - 1996 Allen & Unwin
Peter de Ruyter has been Australia’s leading naturopath in the treatment of people with HIV since the early 1980s.

Healing HIV - How to rebuild your immune system - Dr Jon Kaiser - 1999 - Health First Press
Dr Kaiser is an American medical doctor with a large HIV practice who combines medical drugs with complementary therapy protocols.

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HIV & Hep C Coinfection - A Guide

The liver, hepatitis and viruses:
Hepatitis means inflammation of the liver, a condition where the liver gets hot, swollen, red and painful. Many different things (alcohol, drugs, viruses, bacteria, poisons) can cause inflammation of the liver.

The liver is part of the digestive system. An adult’s liver is about the size of a football and is located behind and slightly below the right side of the rib cage. Millions of liver cells do the essential work of filtering poisons (including drugs and alcohol) from the bloodstream and changing the foods we eat and drink into chemicals that the body can use for energy, maintenance and growth.

A virus is a microscopic parasite. 5 different viruses can invade and reproduce inside the liver, causing hepatitis. The different viruses that inflame the liver are called Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, Hepatitis E and Hepatitis G. All 5 hepatitis viruses infect the liver, but all are completely different from each other in terms of how each virus is spread and the long-term effects for the person who is infected.

Hepatitis C is one virus that reproduces itself inside the liver cells of infected people. If the virus infection is long term the ongoing inflammation of liver cells can cause permanent damage to the liver.

In the liver of the person who has Hepatitis C, the virus is multiplying and damaging the cells, meanwhile the body is constantly repairing itself with new cells. Chronic Hepatitis C is like a marathon race between the Hepatitis C virus and the liver, with the immune system always trying to stop the virus.

You can assist your liver to win this race by treating your body well with good low fat diet, lots of fruit and veggies, little or no alcohol and a balanced combination of exercise, rest and relaxation. Getting vaccinated against Hepatitis A and B will also be useful (because it protects your liver from other invaders).

There is also the option of Interferon based treatment which aims to clear Hepatitis C out of the body altogether. (See information on treatments).

None of these are measures guaranteed to stop the progress of Hepatitis C liver damage, but for co-infected people all are worth a try.

What does Hepatitis C do to people who are co-infected with HIV?
If Hepatitis C reproduction continues unhindered, causing continual liver inflammation the outcomes are serious. Fibrosis is the scar tissue that forms in the liver after it has been inflamed for a while. Cirrhosis occurs when the liver has been inflamed and has been forming scar fibrosis for a long time. At this stage the liver cannot filter the blood due to loss of liver cells and scarring that blocks the flow of blood between the cells.
Cancer is the end product of years of inflammation, fibrosis and cirrhosis. Surgery to remove tumours does not extend life for long.

What happens if a HIV positive person also has Hepatitis C?
HIV causes immune suppression, this allows Hepatitis C to reproduce rapidly, increasing the rate of damage to the liver. Destruction of liver cells is indicated by abnormally high levels of ALT (Amino Alaninetransferase ) in the blood (revealed on Liver Function Tests). Some destruction (and replacement ) of liver cells is normal, but raised ALT levels indicate that more than the usual numbers of cells are being destroyed. The destruction of liver cells may (or may not) be caused by Hepatitis C; Other things like drinking too much alcohol can also destroy liver cells (and even too much coffee or stress can cause raised ALT levels, so can strong medicines such as anti-retroviral medicine for HIV).

But even if ALT levels seem to be continuously high, this does not measure the level of permanent damage that has been done by inflammation. It also important to know that once the liver is severely scarred (cirrhosis) ALT levels can read “normal” even though the liver is quite damaged. People can feel very sick or fatigued with Hepatitis C but their ALT levels read “normal”; this is quite common and reflects on the shortcomings of ALT readings as a precise diagnostic tool.

Some broken liver cells would have been replaced by perfect new liver cells, others replaced by scar tissue which eventually accumulates causing blockages between liver cells and the bloodstream. Only a liver biopsy (where a tiny piece of liver is pinched off by a needle) viewed under a microscope can show exactly how much damage (fibrosis) has accumulated. Liver biopsy results are graded on a scale of 0-4. 0= no damage 1=mild fibrosis (scarring) 2=medium fibrosis 3=bridging fibrosis 4=cirrhosis fibrosis. Cirrhosis is a serious illness. At that stage the liver is struggling to perform any of its vital functions.

One of the liver’s functions is to process medicines. People who are HIV positive may require combinations of Antiretroviral drugs to keep the HIV load down allowing their CD4 count to stay high. All medicines are processed by the liver in order to have the required effect in the body. Some antiretroviral drugs are especially difficult for the liver to process. If the liver is damaged its capacity to process drugs is also damaged. A scarred liver is severely impaired and that liver may not process medicine properly (thus preventing the body from getting the full benefit of the drug). The liver may even be poisoned by a medicine that would not be poisonous to a healthy liver.

Why look after my liver when I have HIV anyway?
People who are co-infected with Hepatitis C and HIV need to keep their liver intact so that their liver will be able to process any Antiretroviral drugs that can fight HIV to keep the immune system intact. Where possible, co-infected people may wish to take the chance (through Interferon based Treatments) to eradicate Hepatitis C from their system. There is no way to cure HIV, but there is a chance of getting rid of Hepatitis C.

What are the odds of clearing Hepatitis C on Ribavirin and Pegylated Interferon?
The success rate of this treatment varies from 28% - 69 % and depends upon:
• which genotype of Hepatitis C the person has (detected by PCR blood test)
...• Genotype 1 around 28% clearance after 12 months on treatment
...• Genotype 2 or 3 around 69% clearance after 6 months.
• length of treatment for 6 or for 12 months
• amount of virus in blood before treatment (measured by PCR -low viral load is better)
• age of person (under 40 years old better outcomes)
• gender: male or female (females better outcomes)

55% of people in Australia with Hepatitis C have genotype 1.

Hepatitis C Helpline recommends that you consult with a doctor who is expert in co-infection and ask if there is any good reason why you should not be prescribed combination Pegylated Interferon with Ribavirin. If there is good reason (perhaps a heart condition or potential for bad interaction with your HIV drugs) then ask for the next most effective treatment.

Pegylated Interferon & Ribivarin
This medicinal drug treatment involves shallow injections (Interferon) once a week, as well as tablets (Ribivarin) for period of six months or a year. The success of any treatment is usually measured by the evidence of no Hepatitis C virus detectable in blood at the end of treatment and then 6 months later.

Interferon based treatments are often associated with serious side effects; up to 15% of people who commence these treatments stop taking them because of side effects. Some people experience few or no side effects. Because of the potential for severe depression, anxiety and mood swings, good clinics are ensuring that clients are not depressed before commencing treatment and monitoring patients carefully throughout the treatment.

It is highly recommended that people undergoing Interferon treatments have supports in place such as close and expert monitoring of depression, anxiety and irritability; access to good counseling and support groups for the person undergoing the treatment and also those who live with them.

Side effects of Interferon based treatment may include:
• “flu like” symptoms (fevers/chills,muscle aches, joint aches, fatigue)
• headaches
• nausea and/or vomiting,
• insomnia
• hair loss
• depression, anxiety, mood swings
• thyroid disorders
• blood disorders including serious anaemia
• heart complications related to serious anaemia
NB:-It is strongly recommended that clients (male and female) do not attempt pregnancy while on Rebetron or for 6 months afterwards because birth defects are likely to occur.

Interferon is a neurotoxic drug ; that means it is irritating of the brain. Depression, anxiety and irritability can be very serious side effects. Remember if you are freaking out on Interferon it is not you it is the drug- call the clinic or your counselor and get help immediately. If you are watching your partner freak out on interferon- get help. Side effects can be managed, but don’t try to do it alone.

Before commencing Interferon based treatments ensure that the Liver Clinic send you to a psychiatrist for expert assessment and/or treatment of depression. Even if you are assessed as “not depressed” before commencing Interferon based treatments, it important to be aware of the signs of depression in case it overtakes you during the treatment.

If you are overwhelmed by such feelings, seek help immediately.
It is important to remember that Interferon induced depression does not mean that you are losing your mind; it is a side effect of Interferon and therefore can be quickly relieved with professional assistance.

Hepatitis C Transmission
Hepatitis C is transmitted only when the blood of a person with Hepatitis C gets out of their bloodstream and into the bloodstream of another person. Even tiny specks of blood can carry Hepatitis C into the bloodstream when there is an open break in the skin.

It is perfectly safe to live with a person who has hepatitis C. Hepatitis C is not transmitted by sharing cups, glasses, food, drinks, eating utensils, bathrooms, soap or towels with people. Hepatitis C is not transmitted through hugging, kissing or touching people. Hepatitis C is not transmitted through the semen, vaginal fluids, saliva, tears or sweat of people who have the virus. Hepatitis C is transmitted only when the blood of a person with Hepatitis C gets out and into the bloodstream of another person, this requires that both people must have open wounds, because hepatitis C must enter the second person through an open break in the skin.

Hepatitis C can be passed from person to person in any of the following activities.
-Injecting with un-sterile injecting equipment for example by sharing drug injecting equipment or through an accidental needle-stick injury where the needle has just been used.
-Un-sterile tattooing, body piercing, acupuncture needles
-Receiving unscreened blood transfusion (in Australia before 1990)
-Use of un-sterile medical, surgical or dental instruments where blood is exposed.
-Ritual blood exchange, for example “blood brothers”
-Sharing razors, tooth-brushes or manicure equipment with a person who has hepatitis c
-Hepatitis C positive mother delivering baby but ONLY if mother’s blood gets under baby’s skin.

If you are co-infection with HIV and Hepatitis C, the risk of transmitting Hepatitis C greater because co-infection increases the HCV viral load in your blood.

What does this mean for sex…
-Co-infected people may pass on Hepatitis C through unprotected sexual penetration if blood gets out and into the bloodstream during sexual penetration. However HIV is the greater concern for sexual penetration. Correct condom use can prevent the spread of HIV.
If a person has both HIV and Hepatitis C, only safe sex barriers such as condoms can protect sex partners from transmission.

What does it mean for childbirth…
•A mother who is co-infected with Hepatitis C and HIV is more likely to pass HCV onto their babies during birth. While there are now are very effective drugs to prevent maternal transmission of HIV, only avoidance of breaking baby’s skin can prevent Hepatitis C transmission.

What if my baby does get Hepatitis C?
So far the evidence suggests that babies and young children who get hepatitis C usually do not get sick from it during childhood. Generally children with hepatitis c grow quite normally. Children with hepatitis c should get regular medical check-ups by expert paediatric liver doctors (most Children’s Hospitals have clinics) to make sure that the child’s liver is coping well with hepatitis c infection. There are medicines available to treat Hepatitis C but these medicines have serious side effects and are not available for children (because children are usually not sick from Hepatitis C).

Prevention –how to stop the spread of Hepatitis C.
Because Hepatitis C is only a blood-borne virus, people with Hepatitis C pose no threat to anyone in the home or workplace as long as everyone is “blood aware”. Blood awareness means always treating everyone’s blood as potentially able to cause infection:
• Cover up any open cuts and sores with band-aids.
• Do not share razors, nail files or toothbrushes with other people.
• Always wear disposable rubber gloves when giving first aid or cleaning up blood spills.
• When injecting drugs, do not share needles, syringes, swabs, tourniquets, filters, water or spoons
• When injecting, clean the table and wash your hands before and after each hit
• When you get a piercing, tattoo, acupuncture or dentistry; make sure the job is done by a professional who uses new needles, properly sterilised equipment, gloves, and (for tattoos) individual ink pots.
• Dispose of bloody needles or sharp instruments in a strong plastic sealed container such as a plastic drink bottle with a lid (or the yellow Sharps Disposal containers that are available free at the local Needle & Syringe Service)
• Dispose of soft blood stained material a leak-proof plastic bag
• Clean up blood spills with paper towel; then wash area with warm, soapy water and finally, wipe area with bleach.
• Do not share a bloody thing!

Testing for Hepatitis C- Who should get tested for Hepatitis C?
If you have :
• injected IV drugs
• received un-screened blood-transfusion ( Australian Blood Banks started screening for Hepatitis C in 1990, but in many other countries screening still does not occur)
• had un-sterile tattoo, body piercing or acupuncture
• had surgical or dental operations in un-sterile conditions
• shared razors, toothbrushes, manicure equipment with someone who has Hepatitis C

If you think you have been exposed to Hepatitis C you can have blood tests to find out for sure.
You must specifically ask for Hepatitis C blood tests. If you have HIV, it is possible that Hepatitis antibody may not show up in a blood test that looks for Hep C anti-bodies. Health care workers must use the PCR blood test for Hepatitis in order to get an accurate result.

If I have Hepatitis C can I drink alcohol?
Alcohol is toxic to liver cells and causes inflammation. If alcohol induced inflammation is continual, the ongoing damage will eventually lead to scarring of the liver.
In the liver of the Hepatitis C Positive person, the virus is slowly multiplying; this causes inflammation and eventually may do enough consistent damage to cause scarring. Partly Because Hepatitis C is slow and the liver repair is very fast, only a minority of people with chronic Hepatitis C will accumulate enough Hepatitis C related liver damage to cause life threatening illness.
Alcohol consumption damages liver cells; Hepatitis C replication damages liver cells; The combination of alcohol consumption and Hepatitis C means more liver cells are damaged (than by alcohol alone or by Hepatitis C alone) so this increases both the likelihood of and rate of serious liver damage (scarring, fibrosis and cirrhosis).
Some people need help with strategies for cutting down on alcohol or giving it up, Drug & Alcohol Helplines can refer to professionals who can help people to control their alcohol consumption.

Symptoms of Hepatitis C.
Some people with chronic Hepatitis C experience some or all of the following:
• 'flu like' symptoms (fevers/chills, muscle-aches, joint aches, fatigue)
• indigestion -difficulty digesting food especially fatty/fried food
• poor appetite, nausea or vomiting.
• pain under ribs on right side of abdomen
• 'foggy brain' and poor concentration and/or headaches
• psoriasis (patches of red, scaly flakey skin rash) and / or itchiness
• irritable bowel syndrome and / or diahorrea
• hormonal imbalances including disruption of thyroid functioning and/or menstrual cycle
• severe hang-over (disproportionate to alcohol intake)
• fatigue (severe and debilitating tiredness) which can be ongoing or occasional
• depression, mood swings
• social isolation related to labeling as “IV drug user”

Who do I need to tell about Hepatitis C?
A person with Hepatitis C is not legally obliged to tell anybody about having Hepatitis C. People with Hepatitis C do not pose any risk to their family, friends, workmates or health care workers.

Hepatitis C is a widely misunderstood condition: ignorance, fear, prejudice and discrimination are common. On Hepatitis C Helpline we hear many stories from callers who have told their employer, dentist, workmates even sometimes friends or family members only to find out later that they experience discrimination because of that disclosure. We advise callers to think very carefully before telling ANYBODY about their Hepatitis C status. Deciding who to tell or not tell can be difficult.

If you choose to confide in a trustworthy person who cares about you it is important to work out the details of HOW, WHEN and WHERE to break this often shocking news. Generally it is important to reassure the person that you pose no risk to them or to others (unless sharing injecting equipment).

Remember that many people do discriminate; so before telling anyone about having Hepatitis C, think very carefully about whether or not it will be good for you if they know.

Injecting Drug Use and Hepatitis C
People who have been injecting drugs (heroin, speed, cocaine etc) with other users and have shared fits (needles and syringes) or other injecting equipment (spoons, water, filters, swabs or tourniquets) are highly likely to have been exposed to Hepatitis C.
Hepatitis C is transmitted in the injecting process. When a people inject themselves or inject another person, invisible specks of blood end up on their fingers. From their fingers those invisible specks of blood, which may contain Hepatitis C end up :
• on the needle and syringe
• and on the mixing spoon
• and on the filter
• and in the water
• and on the tourniquet
• and on the table
• and on the alcohol swab

Once the equipment is contaminated with invisible little drops of other people’s blood containing Hepatitis C, it can to get into another person’s veins as they inject. To inject drugs withou