Amid calls for stigma reduction approaches that go beyond one condition, identity or practice and growing evidence of stigma as a common experience in the general population, we explored the possibility of a “universal precautions” approach. That is, that all people who attend for health care should be considered as worried about how they might be judged. To further develop this approach, semi-structured interviews were conducted with 30 health workers in clinical and non-clinical roles in Australia. Participants were generally supportive of a “universal” approach to stigma reduction (“there’s 1000 s of stigmas out there”) and wanted opportunity for all workers to participate in any programs. Participants were typically aware of the impact of stigma and drew on their own experience or that of family or friends to explain the long legacy of stigma for people’s interactions with health care systems. An element of misconception around stigma (what it looks like and why it can be damaging) was apparent in relation to practices that health workers engage in an effort to protect or care for their colleagues through communications that include irrelevant or judgemental information about patients. Health worker values of non-judgemental care and reflective practice were seen as important to draw upon to frame stigma reduction interventions which needed organisational support and leadership. Using quality standards and accreditation systems to drive further action on stigma reduction was also highlighted. These data will contribute to scoping potential approaches and limitations of a “universal precautions” approach to stigma reduction in health care.

This commentary outlines the development of an Inclusion Collaborative in a large health district in Sydney, New South Wales Australia. The Collaborative grew out of ongoing efforts to reduce stigma associated with blood borne viruses while recognising that there are many health conditions and situations where people feel judged when attending services for health care. The formation of the Collaborative drew in health workers in other sectors to create a critical mass of voices calling for stigma reduction, move beyond siloed responses to stigma and to reframe conversations about stigma to a more positive description of “inclusion”. The involvement of consumer representatives (paid for their time) was a key principle of the Collaborative. The members of the Collaborative identified the common experience of their clients being ‘othered’ by the mainstream services and that services can be unwelcoming or not supportive of difference, and therefore create a significant barrier to accessing healthcare. The group considered ways to highlight these issues among colleagues from mainstream services and community members who were not ‘othered’. The Collaborative designed and carried out a range of activities including a Festival of Inclusion, a series of seeding grants for staff and consumer-focused initiatives, promotion of diversity days and an audit of compliance with strategic priorities. The Inclusion Collaborative is an example of a structured approach for efforts to reducing stigma that draws on the ambitions of many parts of a large, complex public health service to deliver better outcomes for its staff and consumers.

Background Aboriginal and Torres Strait Islander Australians are disproportionately impacted by blood-borne viruses (BBVs) and sexually transmissible infections (STIs). Stigma remains one of the key barriers to testing and treatment for BBVs and STIs, particularly among Aboriginal and Torres Strait Islander people. The Deadly Liver Mob (DLM) is a peer-delivered incentivised health promotion program by and for Aboriginal and Torres Strait Islander Australians. The program aims to increase access to BBV and STI education, screening, treatment, and vaccination for Aboriginal and Torres Strait Islander Australians in recognition of the systemic barriers for First Nations people to primary care, including BBV- and STI-related stigma, and institutional racism. This paper presents routinely collected data across nine sites on the 'cascade of care' progression of Aboriginal and Torres Strait Islander clients through the DLM program: hepatitis C education, screening, returning for results, and recruitment of peers. Methods Routinely collected data were collated from each of the DLM sites, including date of attendance, basic demographic characteristics, eligibility for the program, recruitment of others, and engagement in the cascade of care. Results Between 2013 and 2020, a total of 1787 Aboriginal and Torres Strait Islander clients were educated as part of DLM, of which 74% went on to be screened and 42% (or 57% of those screened) returned to receive their results. The total monetary investment of the cascade of care progression was approximately $56,220. Data highlight the positive impacts of the DLM program for engagement in screening, highlighting the need for culturally sensitive, and safe programs led by and for Aboriginal and Torres Strait Islander people. However, the data also indicate the points at which clients 'fall off' the cascade, underscoring the need to address any remaining barriers to care. Conclusions The DLM program shows promise in acting as a 'one stop shop' in addressing the needs of Aboriginal and Torres Strait Islander people in relation to BBVs and STIs. Future implementation could focus on addressing any potential barriers to participation in the program, such as co-location of services and transportation.

The Deadly Liver Mob (DLM) is a peer-delivered incentivised health promotion program by and for Aboriginal and Torres Strait Islander Australians, and was introduced in response to the disproportionate number of Aboriginal and Torres Strait Islander Australians who are impacted by blood borne viruses (BBVs) and sexually transmitted infections (STIs). The goal of the program is to increase access to BBV and STI education, screening, treatment, and vaccination in recognition and response to the systemic barriers that Aboriginal and Torres Strait Islander peoples face in accessing health care. This commentary introduces a series of papers that report on various aspects of the evaluation of the Deadly Liver Mob (DLM) program. In this paper, we explain what DLM is and how we constructed an evaluation framework for this complex health promotion intervention.

Historic models of hepatitis C treatment have not been suitably adapted for people who inject drugs (PWIDs). With the availability of highly effective direct acting antivirals (DAAs) and the possibility to eliminate hepatitis C as a public health threat, there is an urgency to improve treatment provision and uptake among PWID. This commentary explores the role of needle and syringe programs (NSPs) in providing hepatitis C treatment to PWID through an exploration of Positively Hep, a peer-referral, incentive-based project in Sydney, Australia. Positively Hep uses peer-networks to engage clients and introduce them to hepatitis C education, screening, and treatment. Within the first 26 months of operation, Positively Hep has provided education about hepatitis C and DAA treatments to 326 individuals, and has tested 145 people, 44% (n = 64) of whom have tested positive. Of these individuals, 21 (33%) have begun treatment, and 18 (28%) have successfully completed treatment. Positively Hep highlights the benefits of having trustworthy, timely, convenient, and client-friendly services to engage PWID and support them throughout hepatitis C treatment. This commentary is intended to prompt discussion about incorporating hepatitis C treatment into NSP service delivery, which could increase treatment uptake among PWID and support progress toward elimination targets.

Introduction: A review of Peripheral Intravenous Cannula (PIVC) and Central Venous Access Device (CVAD) needleless valve products was undertaken in 2016 by the Vascular Access Working Group (VAWG) at Nepean Blue Mountains Local Health District (NBMLHD). Needleless valve devices have been in use for many years in healthcare and the current devices used across NBMLHD needed to be reviewed and change.

AIM:Prevention of hepatitis C (HCV) remains a public health challenge. A new body of work is emerging seeking to explore and exploit "symbiotic goals" of people who inject drugs (PWID). That is, strategies used by PWID to achieve other goals may be doubly useful in facilitating the same behaviours (use of sterile injecting equipment) required to prevent HCV. This project developed and trialled new HCV prevention messages based on the notion of symbiotic messages.METHOD:New HCV prevention messages were developed in a series of 12 posters after consultation with staff from needle and syringe programs (NSPs) and a drug user organisation. Two posters were displayed each week for a 6-week period within one NSP. NSP staff and clients were invited to focus groups to discuss their responses to the posters.RESULTS:A total of four focus groups were conducted; one group of seven staff members and three groups of clients with a total of 21 participants. Responses to each of the posters were mixed. Staff and clients interpreted messages in literal ways rather than as dependent on context, with staff concerned that not all HCV prevention information was included in any one message; while clients felt that some messages were misleading in relation to the expectations of pleasure. Clients appreciated the efforts to use bright imagery and messages that included acknowledgement of pleasure. Clients were not aware of some harm reduction information contained in the messages (such as "shoot to the heart"), and this generated potential for misunderstanding of the intended message. Clients felt that any message provided by the NSP could be trusted and did not require visible endorsement by health departments.CONCLUSIONS:While the logic of symbiotic messages is appealing, it is challenging to produce eye-catching, brief messages that provide sufficient information to cover the breadth of HCV prevention. Incorporation of symbiotic messages in conversations or activities between staff and clients may provide opportunities for these messages to be related to the clients' needs and priorities and for staff to provide HCV prevention information in accord with their professional ethos.