BBV & STIs in Victorian Prisons

1. BBV & STIs in Victorian Prisons Kim Messieh Sexual Health/BBV Nurse Victorian Prisoner Initiative Melbourne Sexual Health Centre

2. 13 Adult Prisons

3. Studies into BBV/STIs in Victorian Prisons

4. Studies in Victorian Prisons • Hepatitis C virus among inmates in Victorian Correctional facilities • Corrections Victoria & Burnet Institute, 2002 • Victorian Prisoner Health Study • Corrections Victoria & Burnet Institute, 2003 • Survey of Harms in Victorian Prisons • Corrections Victoria & Burnet Institute, 2003 • Women’s Hepatitis B Pilot Project • Devine, Karvelas & Sundararajan, 2007

5. Studies cont’d… • National Prison Entrants’ Bloodborne Virus & Risk Behaviour Survey Report • National Drug Research Institute 2004 & 2007 • National Hepatitis B Needs Assessment • La Trobe University/ARCSHS 2007 • Chlamydia Study • Lyn Pierce, 2006 (unpublished) • Hepatitis Summary Plan Study • Kim Messieh, 2008 (unpublished)

6. Overview of BBV/STIstudy results

7. HIV

8. HIV • Victorian Prisoner Health Study, 2003 • 1% 3 (297) tested positive • NPEBV&RBS Report, 2007 • Victoria 0% 0 (117) No one tested positive • Nationally 0.4% 4 (586) tested positive

9. Chlamydia

10. Chlamydia • Victorian Prisoner Health Study, 2003 • Males & females tested • 0.9% 4 (455) had Chlamydia • Chlamydia Study, 2006 (Lyn Pierce) • 100 male new receptions tested • 3% 3 (100) had Chlamydia

11. Hepatitis B

12. National Hepatitis B Needs Assessment Jack Wallace, Stephen McNally & Jacqui Richmond 2007

13. Communities most affected …by chronic hepatitis B • People born in Asia & the Pacific Islands, Africa, Middle East & the Mediterranean • Indigenous Australians • People who inject drugs • Men who have sex with men (MSM) • People in custodial settings

14. Why Prisons? • High proportion of people who inject • No needle exchange • Over representation of Indigenous Australians • 5.6% (220 of 3,936 men) • 7% (18 of 257 women) • People from overseas • Men • 17.7% overall in Vic • 4.7% Vietnamese; 3.1% Europe – other • Women • 12.5% overall in Vic • 5.4% Vietnamese; 2.3% Europe – other

15. Prevalence of Hepatitis B • Number of people living with chronic hepatitis B in Australia is between 0.5 - 0.8% • Prevalence in Australian prisons described between 1.8 – 3.2% • Exposure rates to hepatitis B infection is 30 – 40% Wallace, McNally & Richmond (2007)

16. National Prison Entrants’ Bloodborne Virus & Risk Behaviour Survey Report National Drug Research Institute 2004 & 2007

17. Hepatitis Bcab Prevalence • Nationally 21% - 120 (566) • Victoria 23% - 27 (115) • Men 25 (105) -45% tested positive • IDU 23 (56) -41% • Non-IDU 2 (49) -4% • Women 2 (10) -33% tested positive • IDU 2 (6) -33% • Non–IDU 0 (4) -0% NPEBV&RBS Report, 2007

18. Hepatitis B immune status Victorian statistics (national %) • No Immunity 59% (50) • Vaccine Immunity 16% (28) • Natural Immunity 22% (20) • Carrier 3% (2) NPEBV&RBS Report, 2007

19. Women’s Hep B Pilot Project 391 women participated • No Immunity 54.8% • Vaccine Immunity 25% • Naturally Immune 19.4% • Carrier 0.8% Devine, Karvelas & Sundararajan, 2007

20. Hepatitis C

21. Current prisoners Hepatitis C Virus Among Inmates in Victorian Correctional Facilities, 2002 • 57.5% total • IDU 79.1%; Non-IDU 11.2% • Males 55.2%; Females 66.7% Victorian Prisoner Health Study, 2003 • Males 52% • Females 60%

22. Prison Entrants’ • Nationally 35% - 208 (589) • Victoria 41% - 49 (119) • Men 42 (108) tested positive • IDU 40 (59) -68% • Non-IDU 2 (49) -4% • Women 7 (11) tested positive • IDU 6 (7) -86% • Non–IDU 1 (4) -25% • NPEBV&RBS Report, 2007 NPEBV&RBS Report, 2007

23. Response to these issues

24. Victorian Prisoner Initiative • Joint collaborative project between • Department Human Services • Justice Health (DoJ) • St Vincent’s Correctional Health Service • Pacific Shores Healthcare • The GEO Group • Melbourne Sexual Health Centre

25. Public Health Project • Commenced December 2005 as a 2½ year project • Has now been refunded for 3 (-4)years July 2008 – June 2011 • Started with • Lyn at MAP; Kim at DPFC • Expanded to include PPP and MRC • Leading to covering all 13 prisons in Victoria • Nyree Chung • Developed Clinical Practice Guidelines • Took on Nurse Immuniser role at PPP

26. Aim To improve the screening & management of BBV/STIs & increase vaccinations, especially for Hepatitis B, in the Victorian prison system

27. Leading & Managing Change Work alongside 3 health service providers • Looking at systems & processes • Recognising need for on the job training as well as for external accredited courses for staff • Pre & Post Test HIV & Hep C Counselling Course • Nurse Immuniser Program • Facilitate BBV/STI & Immunisation clinics for prisoners • Feedback to Advisory Committee

28. Hepatitis B Vaccination • Vaccination programs in prisons extremely important • From commencement of project DHS has given vaccines free to all prisoners • This will continue until June 2010 • Schedule has been revised to 0,1 & 3 months (that is, 3rd dose 2 – 5 months after 2nd) • This is to increase number of prisoners completing course whilst in prison

29. Improved documentation • 3 different health providers • High movement of prisoners between prisons • High rate of recidivism …Therefore we decided to pilot revising the Hepatitis Summary Plan • This form captures hepatitis A, B & C information as well as LFTs • and kept in the most current file

30. Hepatitis C Treatment • Currently available only for men • Running several years through PPP • About 10 per year • Commenced a pilot at regional prison 2008 • Currently about 10 on treatment • If ‘successful’ will be replicated at other prisons • Plans to include women too

31. Thank you.. Kim Messieh T: 9341 6229 kmessieh@mshc.org.au Lyn Pierce T: 9341 6258 lpierce@mshc.org.au