Report on the SRDC's Program of Social and Behavioural ...
Report on the SRDC’s Program of Social and Behavioural
Research into Hepatitis C
The National Health and Medical Research Council
The National Health and Medical Research Council is a statutory body that provides advice
on all aspects of health and health care delivery in Australia, from health and medical
research to ethical issues. In accordance with its statutory obligations, the NHMRC has
responsibilities ranging from basic medical and public health research and training to the
provision of comprehensive advice on the most complex and important matters affecting the
The Strategic Research Development Committee
Until the 1997-2000 triennium, the NHMRC relied on researchers to determine the direction
of the research it funded. While this generally produced a balanced coverage of research
fields, it became increasingly apparent that Australia needed to improve its ability to respond
more effectively to health and medical research issues that may not have been addressed as
adequately, effectively or expeditiously as desired.
To address this the Strategic Research Development Committee (SRDC) was established as a
principal committee of the NHMRC in April 1997. The stated objective of the SRDC is to
develop strategic research in specific areas where there is potential for improved health
outcomes, within a reasonable timeframe. To fulfil its aims, the SRDC was specifically
constituted to have a wide perspective and range of expertise. Its membership covers many
different disciplines – not only from the biomedical community, but also economics, business
and the media.
Besides providing a useful mechanism by which the NHMRC is able to target research
funding, the SRDC, through its own small budget, has the capacity to determine broad areas
needing a strategic research focus. The SRDC is able to commission work in these areas.
One area that the SRDC identified as important was social and behavioural research into
The Social and Behavioural Research into Hepatitis C Program
Funding of $1 million for social and behavioural research into hepatitis C was announced by
the then Federal Minister for Health and Family Services, Dr Michael Wooldridge, in
February 1998, following its identification as a priority by the Australian National Council
for AIDs and Related Diseases (ANCARD). The program was administered by the SRDC
using funds from within its budget. Priority areas for research were determined by a joint
SRDC/ANCARD Working Committee set up to identify the research priorities and to oversee
the subsequently funded research. The Working Committee comprised:
Ms Genevieve Cantwell (Chair, SRDC member, public health consultant)
Emeritus Professor Lois Bryson (Royal Melbourne Institute of Technology)
Professor John Finlay-Jones (Flinders University of SA)
Ms Michele Kosky (Consumer’s Health Forum of Australia)
Dr Ian Anderson (SRDC member to 2000)
Part of the Working Committee’s role was to ensure that the specific needs and issues of the
wider community, including women, people from diverse language and cultural backgrounds,
youth, injecting drug users and gay men were considered.
The aim of the SRDC’s program in hepatitis C research was to:
· make a difference in reducing the spread of hepatitis C; or
· improve the quality of life for people with hepatitis C by minimising the personal and
social impact of the disease.
In July 1998, a call for research was advertised nationally. Sixty-eight expressions of interest
were received, of which 31 were short-listed. Full applications were assessed by a minimum
of three external assessors based on the relevance of the proposal to the objectives of the
program, scientific merit, track record of the investigators and collaborating agencies as well
as the balance of research effort across areas. Twelve projects were funded from March
The projects recommended for funding are outlined in Appendix A. They included a focus
on a range of data collection methodologies, the development of appropriate interventions for
specific target groups and educational approaches appropriate for the client groups and
health professionals, including general practitioners. Two-thirds of the projects involved
research with injecting drug users and aimed to explore behaviours that may reduce
The Social and Behavioural Research into Hepatitis C Workshop
The SRDC hosted a workshop on social and behavioural research into hepatitis C at the
Melbourne Business School, University of Melbourne on 9 November 2001. The aim of the
workshop was to provide an opportunity for the SRDC to evaluate the success of its Program
of Social and Behavioural Research into Hepatitis C.
The purpose of the workshop was to evaluate what each project had accomplished and to
assess the relevance of the findings for public policy. It was envisaged that the SRDC could
incorporate the lessons learnt from conducting the program to improve its processes. Social
and behavioural research broadens the traditional focus of NHMRC funded research, so the
SRDC is particularly interested in the most effective ways to conduct effective sociological
and behavioural health research.
The workshop comprised a series of presentations from chief investigators of the funded
projects, small group discussion and a final plenary session that provided an opportunity to
reflect on the implications for social and behavioural research into hepatitis C. The remainder
of this paper considers the deliberations of the workshop and subsequent discussion of the
outcomes by the SRDC’s Hepatitis C Working Committee on 19 November 2001.
Findings of the Research Program
Living with hepatitis C
The Program of Social and Behavioural Research into Hepatitis C was groundbreaking
because it is the first time that the psychosocial aspects of living with hepatitis C have been
targeted. Previous studies of the quality of life of people living with hepatitis C have tended
to reflect the clinician’s perspective on hepatitis C issues. Symptoms such as fatigue, nausea
and muscle/joint pain are well known in association with hepatitis C infection. What has not
been identified before, however, is the occurrence of ‘hep C attacks’ – clusters or ‘episodes’
of multiple symptoms, typically comprising overwhelming fatigue, hypersensitivity,
irritability, pain and depression/mood swings.
Exploring the experiences of people living with chronic hepatitis C infection, Michael Dunne
(Queensland University of Technology) found that over half the people he interviewed for his
study experienced ‘hep C attacks’. They varied widely in the time of onset and duration.
However, apart from fatty foods and alcohol (which induce nausea and abdominal pain) no
triggers were identified. These ‘hep C attacks’ had a major effect on the quality of life for
people living with hepatitis C because of the uncertainty caused by not being able to predict
their onset or severity. Other factors contributing to this feeling of uncertainty were
heightened by doubt about the origin of symptoms, fear that the illness is a long term
disability or will shorten life, and lack of social acceptance.
Pyschosocial factors such as these feelings of uncertainty and depression experienced by
many people living with hepatitis C need to be taken into account by health professionals
working with people who have hepatitis C. “Although general practitioners are confident
about the clinical management of hepatitis C, they are somewhat less confident about the
psychosocial aspects of care,” said Leena Gupta (Central Sydney Area Health Service). Dr
Gupta conducted a national survey of the needs, outcomes and patterns of care for general
practitioners in diagnosing and managing hepatitis C. Almost one-third of general
practitioners reported that they would like to acquire better skills in pre- and post-test
counselling for hepatitis C.
Sadly, despite its importance where the test result is positive and although testing services
report that they offer pre- and post-test counselling, many people living with hepatitis C
report that they do not receive either. A study conducted by Wendy Loxley (Curtin
University of Technology) found that three-quarters of injecting drug users attending a testing
service in Western Australia said they had not received any pre-test counselling and less than
20% had post-test counselling. This was despite the testing services stating that they provide
pre- and post-counselling. A similar picture was found among Victorian women living with
hepatitis C where Sandy Gifford (Deakin University) found that 77% of women did not
receive any pre-test counselling and 51% of women did not receive any post-test counselling
at time of diagnosis. Almost one quarter of women participating in the study did not know
that there is treatment available for hepatitis C. [A more detailed article on Sandy Gifford's
work appears in Australian Hepatitis Council Chronicle - Issue 8.]
Interestingly, the same study found that levels of satisfaction with the way they were told
about their diagnosis were strongly associated with the length of consultation time rather than
the person, place or way that the results were given. Pre- and post-test discussion is vitally
important for people living with hepatitis C.
Professor Gifford’s study also found that current -injecting drug users were more likely to
report negative treatment by health professionals. In many cases this led to confusion about
hepatitis C and issues around pregnancy/breast feeding and, in some cases, women were
advised not to go ahead with pregnancy because of their diagnosis. In other cases, sharing
their positive hepatitis C status threatened custody or access to their children. The study
concluded that the physical, mental, emotional and social impact of living with hepatitis C
has been underestimated and, in keeping with Wendy Loxley’s findings, there is a need to
improve information, support and referral before and after testing and at the time of
diagnosis. Stigmatisation, relating to both the infectiousness of hepatitis C infection and its
association with intravenous drug use, was also the most enduring aspect of living with
hepatitis C infection found in Michael Dunne’s study.
Stopping the spread of hepatitis C
Access to hepatitis C testing and counselling services is essential to reduce the social and
economic costs of hepatitis C infection. A study conducted by Nick Crofts and Michael
Kerger (Centre for Harm Reduction, Macfarlane Burnet Centre) showed that injecting drug
users are comfortable being tested and counselled by a peer in a familiar and convenient
environment. Educational counselling received from a credible and empathetic peer was
highly likely to be acted upon. “Needle and Syringe Programs need to be resourced to
employ and train an extra staff member to deliver testing and counselling for hepatitis C and
other blood-borne viruses and to deal with overdoses,” said Michael Kerger. “Such a
development would be a useful initial step towards improved primary health care for drug
users, and generate further information about modes of delivering service to this marginalised
Although most people injecting drugs are aware of the danger of contracting hepatitis C
through shared needles and most actively avoided doing so, the Australian blood borne virus
and injecting drug use study conducted by Craig Fry (Turning Point Drug and Alcohol
Centre, Melbourne) found that more than one-third of participants regularly engage in
practices, such as being assisted with injecting by someone who had just injected themselves.
Such practices provide opportunities for contact with another person’s blood. Mr Fry found
that injecting in a public place was a key determinant of higher risk practices because access
to necessary facilities is limited and the injection itself occurs in hurried conditions. Other
determinants included buying and using drugs in a group and being in a relationship where
injection equipment was shared as an expression of trust.
The study conducted by Erica Southgate (University of New South Wales) found that
injecting drug users who knew their hepatitis C status had a better knowledge of the risk
factors involved in hepatitis C transmission compared to those who did not know their
hepatitis C status or are untested. However, those who knew their status also have higher
levels of sharing fits and other equipment than those who did not know their status or were
untested. It was suggested that this could be because they did not think that the messages
applied to them as a group.
The Southgate study also found that ‘speed’ users have riskier injecting practices than heroin
users. Heroin use has been extensively studied and a shift to other injecting drugs due to the
heroin drought has been noted. A profile for speed users compared to heroin is currently
being developed by the research team.
A common theme emerging from the research was that there is a lack of culturally and
contextually appropriate information available for injecting drug users. “Injecting drug users
access different sources of health information to other people in the community,” Sandy
Lack of creative, culturally informed resources for injecting drug users of Vietnamese
ethnicity led a team headed by Nick Crofts and Peter Higgs (Centre for Harm Reduction,
Macfarlane Burnet Centre) to develop resources for harm reduction in collaboration with
Vietnamese injecting drug users. These resources included the development of activities
including role-plays, discussions, agency visits, videos and guest facilitators.
Similarly, lack of appropriate information about the transmission of blood borne viruses for
high risk young people, led Susan Sawyer (Royal Children’s Hospital Research Institute,
Victoria) to design and pilot a peer education strategy about hepatitis C for young injecting
drug users aged 15 to 22 years, using a dynamic approach to recruitment. Young people
attending a needle and syringe program over a 12-week period were given one-to-one
education focussing on areas of knowledge of risk minimisation that are often misconstrued.
Participants were invited to attend a follow up session during which they were invited to
recruit and educate peers. Interested people were briefed on how to do this.
On the other hand, a study of injecting drug use in Melbourne’s gay male community
conducted by Gary Dowsett (Australian Research Centre in Sex, Health and Society, LaTrobe
University) found that injecting drugs is not regarded by many in the gay community as an
approved pastime. As a result, gay men in the community who inject drugs recreationally
tend to do so in private or with a small circle of friends.
Many gay men who inject have developed techniques to maintain safety in their injecting
practices in relation to HIV but whose knowledge of hepatitis C transmission is patchy. No
single pattern of injecting drug use was observed. It is important that gay men be included in
the development of educational materials about hepatitis C prevention.
A different approach was taken by Alex Wodax and his team from the National Drug and
Alcohol Research Centre at the University of New South Wales. This study aimed to
minimise risk of spreading hepatitis C and improve the quality of life of injecting drug users
by shifting from injecting to non-injecting routes of administration (smoking, snorting, oral
ingestion and shafting) using cognitive behaviour therapy. Although only small numbers
were followed up, these participants showed a shift in route of administration with some
participants no longer using heroin or amphetamines.
Of course injecting drug use is not the only way that hepatitis C spreads. Any practice that
involves “contact” with blood can transfer the hepatitis C virus. For this reason, each State
has developed guidelines for use by operators involved in skin penetration. One of the
projects funded under the Program looked at the knowledge and attitudes about safe skin
penetration practices among tattooists, beauticians and hairdressers in New South Wales.
A team from the University of Newcastle led by John Wiggers interviewed tattooists,
beauticians and hairdressers to find out whether they had a copy of the guidelines and, if so,
what their knowledge of the guidelines was. A second strand to the project was to assess the
knowledge of the environmental health officers employed by local councils and public health
units in administering the New South Wales guidelines.
The study found that only 82% of tattooists, 56% of beauty therapists and 32% of
hairdressers had received them. Although all environmental health officers had a copy of the
guidelines, they had only a moderate knowledge of their contents. Of the three groups of
operators, tattooists had the best overall knowledge of safe practices to prevent spreading
hepatitis C and were more likely to comply with the guidelines.
As you can see, the Program covered a wide range of topic areas relating to living with
hepatitis C and stopping the spread of hepatitis C. One objective of strategic research is to
inform policy and practice, although in reality policy and practice are not always informed by
research evidence. Similarly, much research endeavour is completely unrelated to the policy
or practice environments, either as a means of creating a policy agenda or validating an
existing policy or practice strategy - although it may be good science!
One objective of the SRDC is to close this gap.
In developing the Program, the SRDC sought to ensure that there was interaction between the
researchers and the policy and practice environment. However, for research to successfully
influence the policy and/or practice environments, the research outcomes must be sustainable
outside a research setting and perhaps ideally transferable to other settings and conditions.
The challenge before you, as consumers and service providers, is to implement the findings
of this research program into policy and practice.
Summary of the projects funded by the Social and Behavioural Research
into Hepatitis C Program
1. An intervention to improve compliance with skin penetration guidelines in tattooists,
beauty therapists and hairdressers
Chief investigator: Dr Jill Cockburn, Hunter Centre for Health Advancement,
The purpose of this project was to assess knowledge and attitudes regarding skin penetration
practices among tattooists, body piercers, beauty therapists and hairdressers following the
distribution of disease prevention guidelines. Environmental health officers (EHOs), from
local councils and public health units, have responsibility for ensuring premises involved in
skin penetration services comply with the prevention guidelines, and therefore improve
infection control in the premises of the target group.
Despite the introduction of guidelines, the study found that there is a continuing need to
improve knowledge and skills regarding the prevention of blood-borne disease among
tattooists, body piercers, beauty therapists, and hairdressers. Further research is required to
identify improved methods of achieving this. There is a need to improve the knowledge and
skills of EHOs involved in skin penetration inspections.
2. A pilot peer-based Hepatitis C counselling and testing service at a needle and syringe
Chief Investigator: Dr Nick Crofts, Centre for Harm Reduction, McFarlane Burnet
Over 200,000 Australians are estimated to have been infected Hepatitis. Many people who
inject drugs have not been tested and counselled for Hepatitis C infection, despite being at
very high risk. The objective of this research was to trial delivery of Hepatitis C testing and
counselling services to injecting drug users by a trained peer counsellor located at a needle
and syringe program. The researchers hypothesised that this mode of service would be
favourably received by injecting drug users, be effective in reaching people previously
untested for Hepatitis C exposure, and that meaningful behaviour change could be effected
The findings of the research suggest that a demand exists for Hepatitis C testing and
counselling of injecting drug users in Melbourne’s western suburbs (and plausibly, elsewhere
in Victoria and Australia), that testing and counselling improve injecting drug users’ ability to
avoid harm, and that delivery of these services by a trained and experienced peer located at
an NSP is an appropriate and effective model.
3. Prevention of HCV Infection amongst intravenous drug users of Vietnamese
Chief investigator : Dr Nick Crofts, Centre for Harm Reduction, MacFarlane Burnet
The idea for the project came not only from the agencies that implemented it (The Centre for
Harm Reduction and the School of Medical Education at UNSW), but also from Vietnamese
welfare groups, the justice sector, youth based organisations and generic health and welfare
agencies. Initial consultations in the project revealed that many workers in the field saw a
great need to do more than just casework with their clients. Workers lamented the lack of
creative, culturally informed resources for engaging young people around their drug use.
Young people complained about the lack of connection between existing information and
their daily lives. The idea of utilising the medium of the Internet and developing a Website by
and for ethnic Vietnamese drug users was warmly received by workers and young people
Young people were recruited in both Sydney (Cabramatta) and Melbourne (Footscray). The
researchers collected stories from heroin users from South East Asian backgrounds to
generate interest in the project and the concept of storytelling as a way of educating young
people about drug use. Participants were introduced to the principals of harm reduction
through a series of activities, including role-plays, discussions, agency visits, videos and
guest facilitators. Young women in the Cabragirlz.com group were also asked to keep a
journal and, during weekly sessions, participants were allowed to describe their experiences
and relate their stories to each other. The two groups met weekly for about twelve months.
During the course of the project the researchers noticed that participants dropped in and out
of the weekly sessions, reflecting the often chaotic lifestyles many lead. The development
and administration of the project was not predictable or smooth - but nor were the lives of the
participants. Flexibility was crucial. The researchers learned to accept that people will come
and go and that ‘our’ expectations are not always the same as participants' expectations. If
we are to deliver the best possible outcomes for ethnic Vietnamese heroin users then these
people need to feel that projects belong to them and that they have a say in the projects
4. Hepatitis C prevention among gay men who inject drugs in Melbourne’s gay
Chief Investigator: Associate Professor Gary W. Dowsett, Australian Research Centre
in Sex, Health and Society, LaTrobe University
The design of the project required that the major celebration period in the gay community in
Melbourne be the period in which the ethnographic fieldwork be undertaken. The fieldwork
was designed to include large summer celebratory events such as the Midsumma Festival and
its Red Raw dance party, the annual street festival and Gay Pride parade in Melbourne,
culminating in the Gay and Lesbian Mardi Gras in Sydney in early March. The Mardi Gras is
the focus of national gay community celebrations each year. These celebrations also include
a high level of drug-taking.
The project was successful in terms of its design and process, and the partnership with the
Victorian AIDS Council/Gay Men’s Health Centre was very productive. The research
assistant position on the project was filled in sequence by two seconded educators from the
community partner and from the Prostitutes Collective of Victoria. The project was thereby
able to offer a training possibility for community Hepatitis C educators in research methods
and feedback more awareness about social research, its processes and potential to community
partners. This strengthened the research and the acceptability of the project and its findings
as a resource for the Victorian AIDS Council/Gay Men’s Health Centre to develop evidence-
led prevention strategies for Hepatitis C among injecting users in Australia.
5. Quality of life among people living with chronic Hepatitis C infection
Chief Investigator: Dr Michael Dunne, Centre for Public Health Research, Queensland
University of Technology
The aim of this research was to explore the subjective experiences of people living with
chronic Hepatitis C infection. Semi-structured interviews were conducted with 22
individuals and 12 focus groups (total N=70). Participants were recruited from Hepatology
clinics, Hepatitis-related community agencies (including a blood disorders support group), a
sexual health clinic, a prison, a drug dependence treatment agency, and through community
The unifying theme emerging from the data was uncertainty. This permeated most aspects of
life, including personal relationships, work, and subjective physical and mental health. Many
participants reported a complex range of symptoms and social problems, and a sense that they
had lost control over their lives. Some people reported severe illness episodes of
unpredictable onset and duration. Labelled “hep C attacks”, they were described as bouts of
severe fatigue, nausea, headaches and pain. Uncertainty regarding transmissibility to loved
ones was a major concern, and was not assuaged by factual information about low risks. The
researchers are working with the Queensland Hepatitis C Council to translate the findings
into practical resources for dissemination to community groups and professionals.
6. Identifying the social, personal and health needs of women living with Hepatitis C
Chief Investigators: Professor Sandra Gifford, School of Health Services, Deakin
The overall aim of this study was to collect baseline data on the specific social and health
concerns of women affected with Hepatitis C virus (HCV) and to identify gender specific
needs for medical and social support services. The specific objectives were:
§ To assess the social and personal impact of HCV on women, their partners and their
§ To identify the health, medical and social support needs of women living with HCV;
§ To identify the impact of HCV on parenting and families with specific reference to
women and their adolescent children;
§ To identify specific needs in accessing appropriate treatment of HCV;
§ To identify the needs and concerns of women in relation to their reproductive health with
specific reference to pregnancy and decisions concerning having children;
§ To examine the self-reported incidence and risk factors and health impacts for Hep A and
Hep B; and
§ To identify particular issues of stigma relating to HCV diagnosis that impact on women,
with a specific reference to access to health care, parenting and paid employment.
Most of the women in this study experienced social or economic disadvantage and this makes
it more difficult for them to meet the cost of treatment and care for their HCV. The majority
of women did not receive adequate, if any, pre (71%) and post (49%) counselling at the time
of diagnosis. Almost half (46%) of the women in our study described their health as fair to
poor. A little more than half (54%) of the women surveyed were satisfied with their current
level of medical care in relation to their Hepatitis C. Thirty-two percent of women were
living in households with dependent children and the majority of these women had concerns
about the risk of HCV transmission to their children. About a third of women reported ever
experiencing less favourable treatment from doctors, dentists, pharmacists or nurses because
of their HCV. Of these women, those who were current injecting drug users (IDUs) were at
least twice as likely to be treated worse than women who had never injected drugs or who
were past IDUs, when it came to nurses, pharmacists and dentists.
7. National survey of general practitioners about needs, outcomes and patterns of care
Chief Investigator: Dr Leena Gupta, Central Sydney Area Health Service
This project is a national survey of general practitioners to determine their quality of care,
education needs and suggestions for support and research to improve outcomes for patients
with Hepatitis C. As this project is still underway, an interim report will be made at the
8. Risks for Hepatitis C: transition and initiation to injecting drug use among youth in a
range of drug user networks
Chief Investigator: Professor Susan Kippax, National Centre in HIV Social Research,
University of New South Wales
This study focused on the history of initiation and transition to injecting drug use amongst a
range of current injectors aged 25 years and under. It aimed to document risk practices and
influences associated with the initial injecting episode, including age of initiation, role of the
initiator; reasons for injecting; context of first injection and sources of information. It also
aimed to explore the influence of a range of variables on initial and current risk practice. As
such, the study focused on contextualising risk practice, examining the importance of
different histories of transition and initiation and assessing the relationship between initial
risk and current risk practice. It also looked at knowledge of HCV and HIV transmission and
the relationship between these and current risk practices.
The study combined qualitative and quantitative measures in order to provide contextual and
in-depth information on initiation to injecting and injecting cultures among young people. A
closed structured questionnaire was designed addressing the following topics - drug use
history prior to injecting; first injecting experience, nature of the network prior to and
including initiation to injecting, factors associated with initial injecting; sharing, re-use and
passing on of fits and injecting equipment; sexual history; health issues related to injecting;
knowledge of HCV and HIV/AIDS transmission; current patterns of drug use and injecting
The researchers examined the relationship between variables such as age of initiation; gender;
location; HCV status; level of dependency; frequency of use; and current risk practices.
9. Exploring testing injecting drug users for Hepatitis and HIV/AIDS
Chief Investigator: Dr Wendy Loxley, National Drug Research Centre, University of
Australian injecting drug users are commonly tested for Hepatitis C, Hepatitis B and
HIV/AIDS. While a considerable literature exists in relation to human factors involved in
testing for HIV/AIDS, there appears to be little or no literature related to human factors in
testing for Hepatitis C and B, or vaccinating against Hepatitis B. Some studies suggest that
being tested is not necessarily a valuable or useful experience for individuals and/or that
failure to take account of the complex human factors involved in testing can either deter
individuals from presenting for testing, or render testing ineffectual for both the those tested
and her/his community.
This study examined clinical and practical difficulties with the NHMRC Guidelines. It aimed
to deepen knowledge about the process of testing injectors for Hepatitis C and other blood
borne viral infections, and to develop recommendations for changes to the testing process.
The project was informed at every stage by consultants drawn from a range of relevant
organisations. The data collection methodology was primarily qualitative, using a number of
different techniques (interviews, focus groups, and consultations) to develop a total data set
upon which conclusions and recommendations were based.
The findings have led the researchers to the conclusion that a test event is a not only a
medical but also a psychosocial intervention to prevent risk behaviour. Both injectors and
TSPs need to have the expectation that a test event is an opportunity for them to discuss why
the injector could be infected and how further risk to the individual and the community could
10. National survey of Hepatitis C risk practices among injecting drug users
Chief Investigator: Dr Craig Fry, Turning Point Alcohol and Drug Centre
Despite the magnitude of the public health problem associated with the continuing spread of
the Hepatitis C virus (HCV) among people who inject drugs in Australia, we currently have
little knowledge of the extent to which these individuals are participating in practices that
contribute to the spread of Hepatitis C. The Australian Blood borne virus and Injecting Drug
Use Study (ABRIDUS) was a national study conducted to explore Hepatitis C risk practices
among people who inject drugs.
The aims of the study were:
1. To improve the current understanding of the extent to which individuals who inject drugs
engage in a range of specific practices that may lead to the transmission of the Hepatitis C
2. To explore the social and environmental context of identified HCV risk practices.
3. To disseminate and apply the findings of this research extensively to inform national
prevention and education initiatives currently underway in Australia.
A key contextual determinant of risk practices emerging from the survey was injecting in
public where access to necessary facilities was limited and where the injection itself occurred
in hurried conditions. Other determinants were buying and using drugs in a group, being
helped to inject by other people and being in a relationship where injection equipment was
often shared as an expression of trust.
Despite the broadening of blood borne virus (BBV) prevention messages to cover sharing of
all injection paraphernalia as well as blood awareness, this study has shown evidence of
persistent levels of BBV risk practices among people who inject drugs. This was consistent
across the three states. The study also identified key social and environmental contextual
determinants of these risk practices. HCV prevention initiatives need to incorporate an
understanding of these contextual determinants if they are to be effective in reducing the
prevalence of practices that may result in the transmission of blood-borne viruses among
people who inject drugs.
11. Reducing transmission of Hepatitis C virus in high-risk young people – a peer
Chief Investigator: Dr S Sawyer, Centre for Adolescent Health, Murdoch Children’s
Our experience with young injecting drug users is that much of the information available
about blood awareness is inappropriate for this group. The aim of this project was to design
and pilot a peer education strategy about HCV for young injecting drug users aged 15 to 22
years, using a dynamic approach to recruitment.
Sixty-five young people (mean age 19.8 years) were recruited from a local needle exchange
over a 12 week period (primary recruitment). A brief questionnaire identified demographics,
risk taking behaviour, HCV status and HCV knowledge - focussing on infection, transmission
and harm minimisation (pre-intervention testing). One-to-one education was then provided
that focused on misconceptions and areas of poor knowledge, using interactive approaches
based on real life situations. Participants were asked to return for a follow-up appointment
(post-education testing). At the end of the session, participants were asked if they would be
interested in recruiting and educating their peers (secondary recruitment). Interested young
people were given three ‘Teach Sheets’ and were briefed on how to use these as an aid to
educating their peers about HCV.
Twenty-seven participants returned for follow-up appointments, 13 of whom had been
secondarily recruited. Only one did not try to recruit anyone to the project. All but one young
person reported they had learnt something new and changed some aspect of their behaviour.
Being a peer educator had a significantly greater effect on knowledge than being educated by
a peer. This pilot project is of particular interest in its innovative approach to recruitment
(which promotes access to hidden groups), method of education, costs and sustainability.
12. A feasibility study of non-injecting routes of administration among intravenous drug
Chief Investigator Dr Alex Wodak, St Vincent’s Hospital, Sydney
The Non-Injecting Routes of Administration (NIROA) intervention was feasible and
beneficial. When asked 'How much do you feel your injecting behaviour has changed?', 12 of
21 subjects stated 'somewhat' to 'very much'. At six months, the number of subjects
abstaining from drugs had increased from nil at baseline to three; the number of subjects
using drugs more than once a week by NIROA increased from one to five and the number
who had never tried NIROA decreased from nine to one. Fifteen out of 30 subjects beginning
treatment completed four or more sessions. NIROA was adopted by subjects and introduced
to other injecting drug users.
Interventions were generally well received by the subjects of this study. The research design
underestimated the potential benefits for injecting drug users. Modification of the
intervention will be necessary if widespread implementation is to occur. Recruitment was
slow. No negative unintended consequences were detected. There is a need for further
education of IDUs regarding the benefits of NIROA.