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It always seems a bit daft to me not to treat people in prison to the max
because these are high-risk individuals,
they're the individuals who will go on to have liver failure and liver cancer
and all the rest of it.
It's a never-ending story, which incidentally is why I work here,
because if you want to see clinical medicine,
there's nowhere else like a prison for the diversity of what you see.
I think one of the benefits of people being in prison,
and I do say this - I love a captive audience.
They can't get away.
We run a very good vaccination program.
As I said again, we get the herd immunity.
With any of these viruses,
what I find really important is that you work with somebody.
Doing the - 'You shouldn't drink alcohol' or 'You shouldn't do this'
actually defeats the purpose.
Health professionals really need to be mindful
that as soon as you say, 'Don't do something,'
people find that really difficult.
Hepatitis B, just ways to protect yourself -
how transmissions happen so easily through ridiculous things.
One of the issues I didn't know was, don't touch injection sites.
So common, but it's never mentioned.
All the tools and the blood crosses are mentioned,
but you pull a needle out of somebody's arm,
you put your thumb on it straightaway.
Everybody seems to do it.
It's stupid when you think about it, but I never thought of it before.
The process, when people are coming to jail,
they are offered what we call an admissions screen. That's pathology.
Within that admissions screen is a hep-B, hep-C screening.
When the results come back, the medical officer, Chris Wake,
then refers to one of us immunisers.
There are three of us currently here.
We are responsible for booking and overseeing the hepatitis B vaccinations.
Hepatitis, both in Australia and in the prison system,
appears to be on the increase.
We're certainly diagnosing more of it.
We recognise nowadays that there are probably about 200,000 Australians
living with chronic hepatitis B.
In the prison system,
the risk groups that we tend to see are people in the immigrant population
and their children in the second generation,
men who have sex with men, people who inject drugs,
people who have multiple *** partners.
Basically, in the prison system,
hepatitis B tends to be a facet of the lifestyle of young men
who perhaps have an irregular lifestyle, in general terms.
It's interesting that
the last national prison-entrance, blood-borne virus survey
showed that only 40% of prisoners
who tell you that they've been immunised for hepatitis B are actually immune.
That's very low, isn't it?
These are people who say, 'Yes, I've had my three injections for hepatitis B,'
but when you test them for immunity, only 40% are immune.
Clearly, people are not really clear about how many injections they've had,
about the spacing time-wise of those injections
or even, in many cases, what they're having injections for.
So imparting that information is really very important.
CHRISTINE CASTLES: We have three schedules.
We have the 21-day schedule, which has to be medically prescribed
because it's not in the immunisation schedule.
We have a three-month schedule, which is also a fast track,
and we have the regular six-month schedule.
When the inmates come up to the clinic, we explain what we're doing,
we give them an appointment card that I developed.
They are then responsible to make sure that they let us know
if they don't get to their appointment.
It's difficult to get three injections into a person who's in prison
because it involves a cast of thousands.
It involves people who prescribe, people who administer.
It involves prison officers who have to bring the person to have the injection.
It involves prisoners getting out of bed when they might not want to.
It literally involves a cast of thousands.
We've found that you have to make sure
that the cast of thousands understands what's going on,
and, most importantly, the person who's having the immunisations.
Today we're going to give you your hepatitis B vaccination.
That's a series of three injections.
I'll give you the three dates. Today we're doing the first one.
You're being vaccinated under an accelerated schedule. Alright?
That's your second date, that's your third date.
Because you're being accelerated,
you need to have another vaccination within 4 to 12 months.
The impact of the hepatitis B vaccination program
within a correctional setting gives us a herd immunity of over 70%.
That protects the unvaccinated people.
Certainly over the years here,
more and more inmates want to be vaccinated.
They hear from other people. Now that we're able to do the fast track here,
we capture a lot more of the population.
The rates that we see, about 25% of people coming into the prison,
have had wild hepatitis B.
They've had hepatitis B.
We know that because they have a core-antibody positivity,
which is the marker of the natural infection.
That indicates that there is a significant rate of hepatitis B
happening in Tasmania which we probably don't know about
because the first time we find out about it is when we test these people.
We're talking about 500 individuals coming into the prison
who are testing positive for wild hepatitis B.
In terms of acute hepatitis B, we don't see a great deal of that in the prison -
about two cases a year.
This is diagnosed in the early stage of disease,
typically in the first weeks and months.
Almost invariably, that is associated with
intravenous drug use within the prison.
I'm an intravenous drug user, have been for a lot of years.
I have no blood-borne diseases
but I have a big interest in blood-borne diseases.
I need to be able to protect myself
and the people around me from such incidents.
I've been an intravenous drug user since the early 1980s.
When I started,
chemist shops used to have
ten-packs of new syringes.
They were always so easy to get.
$6, they were charging
for ten brand-new needles with a black box.
It was very easy to get, and I always went and got some.
It was always nice to have one buried somewhere
that you can go and dig up if you need to.
I never really shared.
I never got into a group situation where we were six of us,
and if we did, we always knew... it just makes everything work.
AIDS was very pushy on the TV.
There was a lot of ad campaigns
happening around that issue at that time.
It was one of the things that worried people.
But like I said, there are still things I don't know,
like, don't touch injection sites,
little bits of knowledge you pick up along the way.
OK. Thanks for coming along again
this afternoon, guys.
Last week we did hepatitis C.
Today we're going to cover hepatitis B.
I'm not sure how much any of you know
about hepatitis B, but I thought we'd do a brainstorm
and see what you already know.
I educate all of the correctional officers
around blood-borne viruses
in relation to standard precautions
and infection control,
assist with workforce development
in terms of our nursing staff,
work with the clinical director
around coordinating the hepatitis C treatment program
and do various types of education with inmates,
education prior to hepatitis C treatment, for example.
But I also run specialist education programs
around blood-borne viruses and health literacy.
Who else do you think?
That's right - Aboriginal and Torres Strait Islander communities
are one of the at-risk groups.
MAN: IV drug users.
So, people who are injecting drug users.
What other major group of people, thinking not just about the actual...
MAN1: ***, I suppose. MAN2: Gay.
DEBORAH SIDDALL: No, they're not.
What we'd be looking at is migrant and immigrant communities
are particularly at risk.
Correctional Primary Health formed a partnership
with the Prisoner Education and Training Unit.
One of their peer-tutor coordinators, when she's been working with inmates,
identified the need to address some of these health issues
which are ongoing within the prison in a health-literacy type of way -
recognising that she works with peer tutors at a certain level
and that they can then reinterpret health messages
for people with much lower literacy.
We know that about 30% of people living with chronic hepatitis B
are actually undiagnosed.
So they don't have it.
And of course, if you don't know that you have something,
it's really hard to prevent transmission
and/or maintain your health and get the proper health checks you need.
So far the evaluation has been really good.
I think they probably get just as frustrated as we do
in a sense of some of the barriers
when you're working within a prison to the provision of health care.
These guys have nominated to do it. They do it in their own time.
They're not paid to do it.
Generally, it's really well accepted.
A lot of them want to do it because they've got young people in their lives
that they want to provide good health information to and keep them safe.
I don't think that's any risk, because normally,
before you get the utensils, you'd like to think they'd been washed.
I had my hep B shots in the late '90s, so I've been immune to it.
I don't get into using drugs intravenously.
I don't get backyard tattoos.
I've never worried too much about it.
But given the prison environment,
you've got to be careful of any blood-borne virus, especially in prison.
Within the prison, everyone has always been scared of a blood spill.
But unless you roll around in it, blood means nothing.
You've just got to treat it with respect and not worry too much about it.
I've learned lots about different aspects
that can help me within the prison, to stay away and stay clean.
If I leave at the end of the day knowing that I've provided information
that's been understood, that's a good day for me.
You have to take small wins when you work in such a complex environment.
We know in Tasmania that we have about 6,000 people
who have blood-borne virus positivity.
We know from federal numbers that about 5,000 are either injecting
or have injected.
The number we actually treat for drug and alcohol problems in the community
is measured in hundreds.
So there is a disconnect of many thousands.
Those are the people who keep coming into this prison every year.
80% of them, that's 80% of 2,000, come through this prison every year.
Really, until we alter the systems that we use
to both treat, screen and organise,
we're not actually doing a very good job.
Again, it comes down to resources.
What are we going to treat, are we going to treat diabetes?
Are we going to treat heart disease? Are we going to treat blood-borne viruses?
That's why vaccination is so important.
It really is one of the most significant
public-health interventions that we can make.
Captions by CSI Australia