MANAGING HEP C RISK

Dr Leo Kehiler's letter (July 12) drew welcome attention to the
disturbingly high prevalence of hepatitis C in the NSW prison system.
However, his claim that incidence (ie, rate of new infections) is low
is, at best, ambitious.

The truth is, we just don't know the rate at which new hepatitis C
infections take place in NSW prisons, as research in this area is only
just starting.

Studies show that almost 40 per cent of prisoners test hepatitis C
positive when they enter jail, but we know the most effective
strategies for reducing new infections among people in the broader
community who inject drugs - needle and syringe programs - are not
available in prisons. Their absence virtually encourages reuse and
sharing of injecting equipment, thus increasing the likelihood of
blood-borne infection transmission.

We commend NSW Corrective Services for being recognised by the World
Health Organisation as a world leader, among prison communities, in
having methadone programs, education programs, bleach (though there is
no certainty that bleach kills the hepatitis C virus) and condoms
(sexual transmission of hepatitis C is considered to be of low risk).

However, the benchmark of comparison should rather be how well do
facilities to maintain prisoners' health compare with facilities to
maintain the health of the general population? The answer is: not well
at all. Where prevalence of blood-borne infectious diseases is high in
a population subset, so will be the new rate of new infections of the
virus that causes that disease.

Dr Kehiler acknowledges that illicit drugs find their way into jail.
He now needs to ensure that the risk of communicable disease
transmission via shared or reused injecting equipment is reduced as
much as possible.

Stuart Loveday,
Executive Officer, Hepatitis C Council of Australia,
Darlinghurst.