Hepatitis C and Aboriginal and Torres Strait Islander people: closing the gap

HIV Australia | Vol. 14 No. 1 | March 2016

By Heather McCormack

When we talk about closing the gap in relation to Aboriginal and Torres Strait Islander people, we often have very siloed ideas of what that means: there’s over-incarceration, the health gap and the education gap, for example. But viral hepatitis, and particularly hepatitis C, is one of those areas where it all links together in a horrible cycle that ends up disproportionately affecting Aboriginal people’s health.

The over-incarceration of Aboriginal people means that more of us are in an environment where there are very high rates of hepatitis C.

We’re more likely to inject drugs and share equipment when we do inject drugs, and our historic disconnection from the health sector means that people aren’t getting treatment and aren’t being monitored. We’re also often disconnected from health messages that educate drug users to inject safely, due to educational disparity and geographical distance.

Colonialism and racism play a big role, too. Even today people claim that over-incarceration occurs because Aboriginal people commit more crimes. That is wrong. The evidence suggests Aboriginal people are more likely to be searched for drugs, more likely to be arrested if they do have drugs on them, and more likely to be sent to prison if they are arrested.

Conservative estimates state that 30–50% of people in the criminal justice system at any one time have, or have had, hepatitis C.^{1 2}Ex-prisoners tell stories of one needle being shared between 10 to 20 people again and again and again.

If you were trying to design the ideal environment for hepatitis C transmission, you would come up with something that looks a lot like our prison system – a high number of people incarcerated for drug-related crimes, who currently inject drugs but who are then denied access to sterile injecting equipment.

About 90% of new hepatitis C infections come from shared injecting equipment.³ A lot of people now understand not to share needles, but hepatitis C is a startlingly infectious disease and can be passed on by traces of blood on things like tourniquets and swabs. So if people don’t know not to share absolutely anything related to injecting, they can still transmit the disease.

In that remaining 10%, things like backyard tattooing and piercing and prison tattooing – which we know happens frequently in the Aboriginal community – are a big risk factor.

There is a persistent myth that Aboriginal people share injecting equipment because of the culture of sharing. That is just not the case. The real reason is a combination of lack of access to sterile equipment and low health literacy.

We know when people are given the information and capacity to look after their own health they do, and Aboriginal people aren’t any different to that.

Anecdotal evidence suggests that Aboriginal people using drugs are more heavily policed than non-Aboriginal drug users. We have heard of people accessing needle syringe programs (NSPs) and being targeted by police doing that, even though that’s not supposed to be a thing that police do.

We also know that a lot of Aboriginal people are reluctant to access NSPs where they may be recognised by members of their communities as someone who uses drugs. There are some places, especially regional and remote areas, where there just aren’t NSPs.

Aboriginal medical services that have implemented NSPs find that some people don’t access it because that’s where they get all their healthcare needs met and they don’t want their healthcare providers to know they use drugs.

Some of the services are countering this by putting vending machines in places where they can’t be seen but there is still more work to be done.

I cannot be any clearer that the single easiest way to reduce hepatitis C transmission would be to introduce needle and syringe programs in prisons. The statistics for hepatitis C in prisons are staggering. People don’t stop injecting when they go into prison, and they don’t stop injecting when they come out of prison.

We know that some people actually start injecting when they go into prison. While prisoners are no more or less valuable than any other member of the community, it is also a way of passing that infection into the general population.

Owing to myriad complex factors, we tend to cycle people through prison in repeated short sentences, and that includes a number of marginalised people not being offered bail. Drug treatment programs in NSW, however, are only available to prisoners who are incarcerated for a minimum of six months.

In practice, this means we are effectively imprisoning many people for using substances illicitly, but telling them they’re not in prison long enough to be treated for dependency on those substances. With no NSPs in prisons, this puts inmates at huge risk of hepatitis C transmission.

This article was originally published by The Guardian on 27 July 2015 in partnership with IndigenousX, as part of Hepatitis Awareness Week. The original article is available at: https://bit.ly/1EBd5ri

References

1 Black, E., Dolan, K., Wodak, A. (2004). Supply, Demand and Harm Reduction Strategies in Australian Prisons. Australian National Council on Drugs: Research Paper No 9. Australian National Council on Drugs, Canberra.

2 Butler, T., Boonwaat, L., Hailstone, S. (2005). National Prisons Entrants’ Blood Borne Virus Survey Report, 2004. Centre for Health Research in Criminal Justice and National Centre for HIV Epidemiology and Clinical Research, University of NSW, Sydney.

3 Hepatitis NSW. (2015, 6 May). Factsheet: Preventing Hep C Transmission. Hepatitis NSW, Sydney. Retrieved from: www.hep.org.au

Heather McCormack is Project Officer Information and Communications at Hepatitis NSW. She was a host of Indigenous X from 27 July to 3 August 2015.