Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

This was a very informative inquiry and the report highlights some very important issues in relation to hepatitis C. Hep C is one of those silent conditions that people do not know whether a person is suffering from and living with. It is a disease that has a lot of stigma attached to it, and that stigma really impacts on so many different aspects of treatment and the lives of people living with hep C. The terms of reference for the inquiry including examining the prevalence of the disease and the testing and treatment options available through primary care, acute care, Aboriginal medical services and prisons—and I will spend a fair amount of my contribution to this debate talking about prisons. The inquiry looked at the cost of treatment of the short-term and long-term impacts of hep C, and methods to improve prevention. Public health awareness and prevention and non-government organisations were also addressed.

There are a number of recommendations that were made in relation to this inquiry. Of course, as with all recommendations of the health committee, they were unanimous. This was a report and an issue that everybody embraced and, at the end of the day, we came up with 10 very strong and good recommendations. They covered things like the overview of hep C in Australia, living with hep C, testing and treatment, and reaching populations at high risk. This was one of the areas that the committee really homed in—looking at people coming from migrant backgrounds, Aboriginal and Torres Strait Islander populations and, of course, corrections centres and how you handle hep C and prevent the spread of hep C within the prison population. Recommendation 10 is that the Australian government raise the issue of hep C in prisons and establish a national standard in prison health delivery as part of the COAG and health council processes. I think that is a recommendation that is of vital importance.

In relation to people in custodial settings, Professor Michael Levy AM, Clinical Director of Justice Health Services ACT, describes the prison environment as a perfect storm for hep C because of a number of factors. There is a concentration of hep C individuals within those institutions. There is fighting. There is barbering, tattooing and body piercing. There is boredom and, of course, illicit drugs are available in those jails.

An issue that I found particularly troubling is that, when people serve a custodial sentence and are put into a jail, the testing of that individual and the knowledge of whether a person has hep C is very ad hoc. They are asked, 'Do you have hep C?' If a person identifies as having hep C then they are taken into a little group and given a little bit of counselling and some special treatments. To my way of thinking, that is not good enough, because you have a population within a very confined area where a number of people have hep C. In the report it was noted that there is no national surveillance system for hep C infection in prison facilities, and I find that very troubling because, once a person has served their custodial sentence, they go out into the community.

There was a study of 114 prisoners with a history of injecting drugs who tested negative to hep C at the start of their sentence; that was upon entering the prison. Thirteen of those prisoners subsequently tested positive. During the time that they were in prison, they contracted hep C. To my way of thinking, that is not good enough.

Thirty-three per cent of prisoners continue to use injecting drugs whilst incarcerated, 90 per cent of whom are sharing injecting equipment. That is really unsafe behaviour. I do not think our present system is addressing it properly. I think we need to get more data. There is a lack of data and a lack of any consistent data around this. There is a lack of national surveillance data. I mentioned the small sample of 114 with the 13, but that is unique. That does not happen all the time.

Remember what I said a moment ago: people are asked when they enter a jail whether or not they have hep C and it is left to that. As the member for Calwell said, 'How would they know?' Well, a lot of people do not know, and if they do they do not feel inclined to disclose the fact that they have hep C.

The Australian Institute of Health and Welfare reported that Australian prisoners who are injecting are at least eight times more likely to contract hep C while they are in prison than non-injecting prisoners—eight times more likely! The Kirby Institute reported that 31 per cent of prison entrants were hep C antibody positive, and this represented an increase of 22 per cent since 2010. So it is increasing.

A very significant proportion of the population in jails have hep C, and I do not think the system is actually working properly to keep and follow the data. Then, when a person is released from prison, I do not think that the proper plans and processes are put in place so that they do not subsequently infect other people.

There are a number of strategies that were talked about. The most controversial is the needle exchange program within prisons. I can understand why that is quite controversial for prison officers: (A) they feel at risk, because prisoners would have needles; and (B) as prison officers, they are supposed to make sure that illegal behaviour does not take place, and injecting illegal drugs is an illegal behaviour. There are only 60 prisons around the world that use needle exchange programs. In Spain, there was a decrease from 40 per cent to 26 per cent of prevalence in jails because of that program.

But there are other ways, too. The Prison Officers Association talked about education, and about making sure that tattooing could be made available within jails because data indicated that 39 per cent of men and 20 per cent of women in prison get tattoos and 14 per cent of women reportedly have piercing done whilst they are in prison.

This is a really complex situation. It is a very good report that I would recommend to everybody. It is an issue that is of great importance. It is an issue not only about prison populations; it is about people in the community, it is about containing the spread of the hep C infection and it is also about putting in place proper education so that the spread of hep C stops. (Time expired)

Debate adjourned.