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National Drug Alcohol
Research Centre
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NDARC Technical Report No. 262 (2007)

EXECUTIVE SUMMARY

Most Australians who have hepatitis C contracted the virus through the shared use of drug injecting equipment. Further, the prevalence and incidence of hepatitis C virus (HCV) are high among Australian injecting drug users (IDUs), around 50 to 60 percent and 15 percent respectively. The task, therefore, of controlling the spread of hepatitis C depends largely on controlling transmission among IDUs. Although there is a considerable body of research describing hepatitis C epidemiology and infection risk factors, very little research has examined IDUs’ understanding of hepatitis C. The aim of the current study, therefore, was to examine IDUs’ knowledge of hepatitis C, their understanding of virus transmission, the clinical markers and symptoms of the virus, and treatment in particular. How IDUs prioritise hepatitis C relative to other life areas was also examined.

A cross-sectional survey, using an interviewer administered, structured questionnaire, was conducted across inner-city, suburban and regional sites of New South Wales. Participants were recruited through advertisements at needle and syringe programs (NSPs), methadone clinics, and snowballing (word-of-mouth) techniques. Participation was not determined by hepatitis C status.

One hundred and forty nine IDUs were interviewed. The median age of the sample was 34 years and approximately two-thirds were male. The median age of first drug injection was 17 years, with the most commonly reported illicit drugs injected in the last month being amphetamine (62%) and heroin (61%). Over half of the sample (62%) was in treatment for drug use at the time of interview, with the majority in a methadone or buprenorphine program. Over half the sample rated their knowledge and understanding of hepatitis C as either ‘good’ (30%) or ‘very good’ (23%).

Testing for hepatitis C was common among the sample, with all but one participant tested for hepatitis C in their lifetime, and the majority (74%) tested one or more times in the past 12 months. ‘Routine screening’ was the main reason selected for their last test (39%), followed by ‘mandatory testing’ (13%) and then ‘risky behaviour’ (12%). Seventy six percent of the sample believed they had hepatitis C at the time of interview. Despite most participants reporting recent and often multiple testing, a number of IDUs were clearly confused about the results of the various tests. Only about 40 percent of those tested during or after 2000 reported receiving pre- and post-test counselling.

Significant gaps in IDUs’ knowledge of hepatitis C were uncovered in the study, with respect to transmission risks, symptoms, clinical markers and treatment. For instance, substantial proportions of participants believed it was possible to contract hepatitis C by re-using their own needle (48%), or from dirt (17%). Forty-two percent of participants believed antibodies to hepatitis C gave protection against acquiring the virus (42%), and over one-third (35%) believed that some people are immune to hepatitis C. IDUs’ understanding of their own hepatitis C infection was similarly confused, with one in five participants who reported having hepatitis C believing they could not infect others (19%), and that they were immune to hepatitis C (19%). One in three participants stated they did not have antibodies for hepatitis C, and an even greater number were unsure, despite reporting themselves to have hepatitis C.

Very few IDUs were found to prioritise hepatitis C highly relative to other life areas. For many IDUs, hepatitis C appears to be a relatively low priority compared with the numerous health, welfare and social concerns that exist among this often economically and socially marginalised group. However, health was frequently selected as one of the most important life areas determining quality of life, which may incorporate symptoms and sequelae resulting from hepatitis C impacting on day-to-day life.

Given the high prevalence and incidence of hepatitis C among Australian IDUs, and that many continue to share injecting equipment, the findings of this study are of great concern. The fundamental misconceptions held about hepatitis C, particularly regarding ‘antibodies’ and their perceived role in providing immunity, place IDUs at serious risk of transmitting and contracting hepatitis C. These findings warrant further development of, and research into, strategies to improve IDUs’ understanding of hepatitis C.

Citation: O'Brien, S., Day, C. Black, E., Thetford, C. and Dolan, K. (2007) Sydney: National Drug and Alcohol Research Centre.

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In order to be eligible, costs of goods needs to be incurred during the Action and be necessary. This implies that the relating results foreseen in the proposal need to be achieved within the duration of the implementation period of the Action.

If despite achieving the result, the partner has remaining goods at the end of the implementation period, the following steps - in order - will be taken depending on the volume of the remaining goods:

To request a no-cost extension via an NIKE Womens InSeason TR 6 Cross Training Shoe Black/White/Stealth/Cool Grey yNTfA
to give more time to distribute the remaining goods, provided that the no-cost extension is still possible and that the distribution meets the needs of the beneficiaries. In order to avoid risk of double funding in the event of an overlap of actions/activities, a no-cost extension is possible only if there is no follow-up Action or when the follow-up Action does not focus on addressing the same needs. (i.e. there is no overlap in the activities/results)
To transfer or donate the goods taking into consideration the conditions mentioned below.
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If the no-cost extension is not possible, and when the Action’s results are achieved and the remaining amount of goods does not result from procurement excessive to the needs, the goods can be transferred to a follow-up ECHO-funded Action. This applies when ECHO is the single largest donor and the quantity to be transferred is a marginal quantity. What is considered as marginal is to be defined in the light of all the goods of a similar type purchased within a given Action. ECHO considers as marginal a quantity up to 5% of the goods of similar type purchased in the Action. Per type of goods purchased, we can consider, for example, drugs, food, NFI kits. In some circumstances, due to the complex humanitarian situation, the quantity might be higher. In such cases, the partners should revert to ECHO to request a derogation to transfer a bigger quantity of remaining goods.

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If there is no follow-up Action , the goods can be donated. When ECHO is the single largest donor and provided the results were achieved, the partner may donate goods left over at the end of the Action, of a marginal quantity, that were not used or distributed to beneficiaries to the following recipients

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