Capítulo IV: Evaluación Interna
4.1 Análisis Interno AMOFHIT
4.1.3 Operaciones y logística. Infraestructura (O)
Total time required: 60 minutes
Lecture: Hepatitis B and C 30 minutes
¾ PowerPoint: Slides 20-30
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During the lecture be as interactive as possible by asking questions frequently, e.g. start the lecture by asking participants what they know about the disease hepatitis.What is hepatitis?
x Hepatitis is a general term meaning inflammation of the liver.
x In most cases, it is a viral infection that attacks the liver.
x Viral hepatitis can be caused by a variety of different viruses such as hepatitis A, B, C, D and E.
x Each type of hepatitis is transmitted and treated differently.
x Hepatitis affects the liver and negatively influences its function with sometimes serious health consequences such as liver cirrhosis and liver cancer.
x A common symptom of liver diseases is when the skin turns yellow and the whites of the eyes become bright yellow-orange (jaundice).
Hepatitis B and C
x Viral hepatitis B and C are highly prevalent among injecting drug users across Europe.
x The prevalence of both diseases is significantly higher for prisoners.
x In Germany for example, rates of Hepatitis C for prisoners are 50 times higher than in the general population.
x Hepatitis B and C are mainly transmitted via blood (e.g. by sharing injection equipment) or by unprotected sexual contact.
Hepatitis can be both acute and chronic:
x Acute means that the disease starts suddenly, showing symptoms and sometimes disappears after this stage.
x Chronic means that the disease (sometimes after an acute stage) lasts over a long period of time and gradually worsens.
Acute and chronic hepatitis display the following characteristics:
x 50 to 90% of hepatitis C infected people develop a chronic hepatitis C infection.
x Chronic hepatitis C can lead to liver cirrhosis and liver cancer.
x Hepatitis B is generally an acute disease.
x Only around 5% of the hepatitis-B infected develop a chronic form of the disease (with compa-rably serious health consequences to a chronic hepatitis C infection).
The first symptoms of a hepatitis B infection are usually more intense than those of a hepatitis C infec-tion. Unspecific symptoms such as an altered general state, weariness, muscle and joint pain, low fever, nausea, lack of appetite, the whites of the eyes turn yellow (jaundice), light colour stools and/or dark coloured urine may occur.
Many HCV-infected persons do not show any specific symptoms after infection. Most infected persons suffer from unspecific symptoms similar to that of a minor flu-like infection.
Transmission
x Hepatitis B and C are transmitted via contact with blood and other body fluids.
x Hepatitis B and C are highly infectious, i.e. only a small amount of infected blood or other in-fected body fluids needs to come into contact with cuts or other breaks in the skin or the mu-cous membrane in order to transmit the disease.
x The risk of transmission via sexual contact is especially high for hepatitis B whereas the risk for hepatitis C in this case is lower.
x Whereas the hepatitis C virus is mainly found in the blood of an infected person, hepatitis B vi-ruses are also found in the saliva, semen, vaginal secretion and breast milk.
x The hepatitis B and C viruses can survive outside the body for several days. During that time, the virus can still cause infection if it enters the body of a person who is not infected.
The most common ways in which hepatitis is transmitted are as follows:
x Unprotected sexual contact
x Sharing of injecting equipment by drug users x Sharing tattooing/piercing equipment
x Using contaminated and non-sterilized medical instruments
x Sharing objects used for personal hygiene, like razors, nail files, but also toothbrushes that might be infected with blood from small wounds in the mouth
Transmission during pregnancy to the foetus does not occur. Mother-to-baby transmission during birth is uncommon for hepatitis C, but very common for hepatitis B. Vaccinating a new born child of a hepa-titis B-positive mother within the first 12 hours after birth can reduce the risk of an infection by 95%.
Activities without risk of transmission of the infection include:
x Use of toilets x Coughing x Sneezing x Hugging
x Sharing eating utensils or drinking glasses x Shaking hands
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3.2
x Caresses
x There is a small risk of transmission of hepatitis B by kissing
Diagnosis and testing
x The symptoms of hepatitis are similar to those of other diseases; as a consequence, the pres-ence or abspres-ence of symptoms is not an indicator for an infection.
x Only a medical test can diagnose infection with hepatitis.
x At present, a simple blood test is used to detect a hepatitis infection.
x The test identifies hepatitis antibodies (the special cells produced by the body’s defence sys-tem) in the blood.
x The test will show if the person:
is infected at the time,
was infected in the past and was cured,
is immune to the virus at the time (due to vaccination or prior exposure),
suffers from a chronic form of the disease.
Treatment
x Prevention is the most efficient way of not becoming infected with hepatitis.
x There is only symptomatic treatment of nausea, vomiting, and other symptoms for acute hepa-titis B infection.
x For the chronic form of hepatitis B and C an interferon therapy may be indicated.
x Alcohol consumption should be avoided because it aggravates hepatitis and increases the risk of liver cirrhosis.
Vaccination
x A vaccination is an injection that helps a person’s immune system fight a certain infection or disease.
x There only exist vaccinations for certain diseases.
x The vaccine increases resistance of the person to a certain disease for a number of years or for life.
At present there is no vaccination to ensure protection against hepatitis C. However, there is a vacci-nation against hepatitis B which
x prevents the transmission of the virus of hepatitis B, x protects against an infection with hepatitis B, x offers immunity for at least 12 years.
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Emphasize that even for people who are vaccinated it is important to use protective meas-ures, as hepatitis B is just one of the parenterally and sexually transmitted infections.Activity: Hepatitis infection 30 minutes
¾ PowerPoint: Slide 31
Materials needed:
Flipchart, flipchart paper, markers, paper, pencils
Method:
Provide each participant with paper and pencils. Ask participants to write down one or more situations where they were at risk of getting infected with hepatitis B and/or C inside as well as outside prison.
Ask participants to read out what they have written down. Take notes on the flipchart and discuss with the group on the different situations that are listed, Ask participants to range the different situations from high risk to low risk.
Conclusion (questions and comments)
Total time required: 10 minutes
x Injecting drug use is a major contributor to the spread of infectious diseases such as HIV/AIDS and hepatitis B and C.
x The proportion of people suffering from these diseases is significantly higher in prison than in the community.
x Addressing the problem of infectious diseases in prison is essential as prisoners form part of our society, living in the community prior to imprisonment and returning to it after release
Evaluation
Total time required: 10 minutes
MENTAL HEALTH AND DRUG USE
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