High intensity hep C testing in NSW prisons
Friday, 28 June, 2024.
Prisoner art from 2017-18 Justice Health poster competition. Artist unknown.
“It’s great you guys (NUAA) are here. You treat us like we’re humans, you treat us like we matter.”
The fight against hepatitis C has been a longstanding priority for NUAA and builds on the important work carried out by people who inject drugs in averting the HIV epidemic. The good news is that efforts to eliminate hep C in Australia, particularly in NSW, are overall a success story. The not so good news is there is one setting where transmission of hep C remains stubbornly high: prisons.
The NSW prison system has previously led the state in providing hep C treatments to people in custody. However, testing and treatment uptake has slowed in recent years. Treatment for people in custody is increasing as a proportion of hepatitis C treatment nationally however, this is not because the rate of treatment is increasing in prisons. The rate of treatment in custody is declining in real terms, just at a slower rate than in the community.
Hep C prevention in prison comes with challenges. While hep C treatment has remained free and accessible to people in custody, the provision of harm reduction services in prisons is limited and underwhelming. People in custody do not have access to sterile injecting equipment and other evidence-based harm reduction strategies. Consequently, the rates of reinfection in custody are high.
Elimination requires preventing transmission. If we are serious about hep C elimination we must recognise the necessity of prevention, alongside testing and treatment. Despite negative societal views perpetuated by stigma and discrimination, people in jail are part of the community and will at some point be released. So, if hep C transmission is still occurring in jails, elimination will be impossible to achieve both on the inside and outside. Health promotion without discrimination needs to become a policy priority at all levels. If this is achieved, the global countdown to hep C elimination will be easier to attain.
To support hep C testing and treatment uptake in prisons, NUAA works closely with key stakeholders including Justice Health NSW, Corrective Services and the Kirby Institute, to provide hep c testing, peer education and support to people in custody who may be at risk of hep C infection.
This year, NUAA outreach workers have participated in 2 successful high-intensity testing campaigns in NSW Correctional Centres. In April, the HITC crew were in Nowra at the South Coast Correctional Centre where over 90% of the population received a hep C test. This was followed by another successful event at the Bathurst Correctional Centre in June.
Our team were extremely grateful for the warm reception from the Justice Health NSW team and are excited for the next campaign as we continue to provide healthcare and support to people in custody.
The purpose of high-intensity testing campaigns is to:
Raise awareness, reduce stigma and provide support around hepatitis C in prisons
Deliver peer education on hep C transmission, testing, treatment and prevention to people in custody
Provide hep C RNA testing under the national point-of-care testing program
The high intensity testing model aims to ensure every person in custody receives a hepatitis C test. Targeting people at risk of hep C can lead to earlier identification of infection or reinfection, earlier treatment intervention, and enhanced cure determination.
The Federal Government’s Sixth National Hepatitis C Strategy 2023–2030 has identified jails as an obstacle to federal and state governments’ hep C elimination plans. While incarcerated people do not have access to safe injecting equipment HCV transmission will continue, the report said. The report also supported law reform that would stop people being sent to jail simply for using or possessing drugs.
Unfortunately, state elections — in NSW and other Australian states — tend to be dominated by non-evidence-based tabloid scare campaigns promoting “tough on crime” politics. For this reason, the major parties tend to steer clear of policies like decriminalisation of injecting drug use and allowing NSPs in jail, even when such policies are recommended by the government’s own research.
Serious law reform is needed. But in the meantime, through programs such as HITC, hep C can be kept in check in jails through a continual focus on screening and treatment.