Blood Borne Viruses: Presentation.

I welcome Ms Jean Flanagan, Ms Naomi Glover, Ms June Colgan, Mr. Thomas Cumberton, Mr. Michael King and Ms Olivia Carr. I draw attention to the fact that while members of the committee have absolute privilege this privilege does not apply to witnesses appearing before the committee. Members are also reminded of long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the House or an official, by name or in such a way as to make him or her identifiable. I invite the delegation to make its presentation for ten minutes. We will then have an exchange of views for 30 minutes.

Ms Olivia Carr

As chairperson of Blood Borne Virus Forum I thank the Chairman for inviting us to appear at the committee meeting. Committee members will appreciate that it is difficult to condense this subject into a ten minute format but we are aware there is time available for discussion afterwards.

Ms Jean Flanagan

I will provide an explanation of what is hepatitis C, followed by an explanation of the Blood Borne Virus Forum and why we are addressing the matter of hepatitis C. I will highlight our concerns at what is happening in this regard in Ireland and make recommendations.

Hepatitis C is a viral infection and a serious condition that can affect liver health over a long period. One third of people who have hepatitis C will develop liver cirrhosis, which will lead to liver transplants as a treatment or death. Some 1% to 4% of those with liver cirrhosis will develop liver cancer. This is how serious the illness is and why we are discussing it this morning.

Hepatitis C is passed from one person to another through infected blood. The document circulated explains how this can happen. It occurs mainly through sharing drug injecting equipment, contaminated blood products used in transfusions and sharing tattooing and piercing equipment that is not sterile. That industry is not regulated in Ireland. Hepatitis C can also be passed by sharing snorting equipment for cocaine use. The committee is aware of the recent upsurge in cocaine use. The viral infection can also be passed from mother to baby during pregnancy, although there is a small chance of this. There is also a small chance that it can be passed on sexually. These means of infection affect a considerable number of groups in Ireland.

Hepatitis C can be treated but treatment is quite sickening and difficult. Not everyone is suitable because one must be stable before undergoing treatment. The success rate is variable.

The Blood Borne Virus Forum has tackled this issue because we noticed an increase in the figures for hepatitis C in Ireland. This voluntary group, which is not funded and comprises statutory, voluntary and community agencies, was established in 2001. Our idea is to promote awareness of hepatitis C in the general public, in health care settings and to politicians. We seek to promote equitable care for those with hepatitis C, irrespective of how the infection was acquired.

Much work has been done to this end. We have concentrated on awareness programmes and events in the past few years. We collaborated with the former eastern region health authority to consult with service planners, service users and those who deliver services. Services for hepatitis C in Ireland are limited and we sought to establish what should happen next. The recommendations from this influenced the development of a regional strategy for hepatitis C in 2004 and 2005 which was completed two years ago. However, it still has not seen the light of day which is quite worrying and may be due to the switch over from the health boards to the Health Service Executive. I will return to this point.

For the past year we have been involved in a public awareness campaign. We managed to get on board Antonia Leslie, a columnist at theSunday Independent who suffered from hepatitis C, was treated for it and is happy to discuss it. Due to the stigma attached, it is difficult to discuss it in the open. Through television, radio and newspaper interviews she spoke about her experience and we generated awareness. We also distributed postcards to more than 300 venues nationally during the past three months.

To put this in context, I will discuss the risk groups in Ireland. The largest risk group are those injecting drugs, people are also infected through transfusions and blood produce and prisoners are at extreme risk. A study was carried out in 2000 which showed 37% of prisoners were exposed to hepatitis C through antibodies. We noticed up to 81% prevalence in injecting drug users in prison. This is alarming because the same study showed 21% of people start injecting in prison. The rate of spread of hepatitis C in prison is alarming and we have not made a comprehensive examination of strategy or policy to manage it. Policy in prison is extremely conservative. Other risks occur in the antenatal, sexual and tattooing contexts, as already mentioned.

We highlighted three groups as being affected through blood or blood products. The first is women who received contaminated anti-D during the past number of years. Two donors, donor X and donor Y caused infection in 1,100 cases which is quite astounding. In terms of infectivity, this had many implications not only for the women and the donors but also their partners and children.

The second group is men with bleeding disorders such as haemophilia who required clotting factors originally derived from blood product. Some were infected with hepatitis C. Others were also infected with HIV and had to contend with two infections. Over ten years, a haemophiliac may be exposed to more than 10 million donors which gives an idea as to how repeatedly people were exposed to the risk.

The third group is men and women infected through blood transfusions, transplant or dialysis because procedures were not adequately controlled. We spoke to the Irish Blood Transfusion Services board this week. It stated the risk of picking up HIV or hepatitis C is one in 4 million. It has been significantly reduced. These three groups represent approximately 1,600 people and I will discuss responses for them later.

Before doing so, I will mention the final group of people infected or at risk of being infected with hepatitis C. These people either do not know how they were infected through certain risk-taking or were infected through sharing drug-use equipment. From the NACD figures, we know Dublin has approximately 14,000 drug users. Statistical projections are that between 70% and 80% will be infected with hepatitis C if they inject for longer than six months. This means approximately 10,000 people in Dublin are exposed to hepatitis C at present. Imagine what the figures are for the rest of the country. Unfortunately, we do not have definitive figures at present. From a study done in 2003, we noticed approximately 74% of people will develop chronic infection. Some people will clear it but the majority do not. This will a major burden on the State as people will become more ill as time goes on.

In response to infection of hepatitis C by blood or blood products, the State devised a comprehensive strategy. The Health Act was amended to provide wider access to service for people for the remainders of their lives. A consultative council was established to oversee the running and development of services and ensure people were cared for properly and comprehensively following infection. The patient groups are extremely active, strong and sturdy and also secured help.

Eligibility means open access to hospital facilities. Patients are not supposed to wait more than one hour in any outpatient setting or any more than two weeks to be seen by a specialist. They can be offered a five day hospital stay at the initiation of hepatitis C treatment because it is a sickening treatment. They have open and free access to dental, ophthalmic, counselling, home nursing and home help services. This is a broad-ranging response, which is excellent because it is appropriate that they are cared for.

The remaining group has the highest prevalence rate of people infected with hepatitis C in Ireland. However, until 2004, no policy or strategy was in place to deal with this. It was mentioned in the health strategy and emphasis was placed on equity of care; it was also mentioned briefly in the drugs strategy. However, no definitive policy or strategy is in place to deal with prevention and management of hepatitis C for the remaining majority. No allocated budget was made for the largest prevalence group making it difficult to develop services.

Services are available to people who become infected. They can visit hospital and see specialists. However, more definitive needs such as counselling services and community supports are not as available because no identifiable budget or strategy is in place. They use separate clinics to those infected by blood and blood produce and must wait. Usually, they are not offered admission for treatment initiation, home nursing or home support.

Our conclusion is the response to groups infected through blood and blood products, which amount to what is hoped to be a fixed number of approximately 1,600, must be comprehensive and appropriate. An excellent budget and wide-ranging services were identified to deal with the scandal of infecting people through blood. However, we await a comprehensive response, identified budget and development of services for the largest prevalence group in Ireland which amounts to more than 10,000 cases in Dublin alone. We do not seek exactly the same services because different patient groups have different needs. However, we want equitable consideration of service needs. Apart from the social burden of long-term infection, including stigma, effect on family life and ill health, we also consider the financial burden it will project on the State. Treatment of one hepatitis C patient can cost approximately €16,500. One uncomplicated transplant can cost between €28,000 and €56,000 and we envisage large numbers in the future.

Our recommendation is that we should learn from past mistakes. The heroin problem in the 1980s spiralled out of control because it was difficult to acknowledge at first. We should take a comprehensive look at the hepatitis C epidemic now. We would like to ensure equivalence of care for all people affected by hepatitis C no matter how they picked it up. We would like the committee to consider calling for a comprehensive national policy so that we can examine service development for everybody. We would appreciate if an appropriate budget were allocated to support service development. We seek the release of the regional hepatitis C strategy, which is under review again, and we would like it to be made national.

I thank Ms Flanagan for a comprehensive, clear, easy-to-understand presentation. Could people have hepatitis C and not know it? Is there a simple test to detect infection? I find it strange that there is no strategy. When does Ms Flanagan think we will have a strategy? I am sure there are infected people who unwittingly donate contaminated blood. What sort of tests are available to detect this? I am not sure if cocaine users are aware that they are at risk of contracting hepatitis C. Many students at debs dances use cocaine and I doubt they are aware of the risk. Is this risk due to snorting or injecting cocaine? Could Ms Flanagan elaborate on that?

Ms Flanagan says treatment results are variable and services are limited. How limited are those services and why is the treatment not as good as it should be? I am amazed by the one hour-two week rule in hospitals. How does that operate? If an infected person goes to hospital looking healthy he or she would not look like a person who needs treatment within the hour and or like an emergency case. How is Ms Flanagan coping with this and what are her experiences of it? She said we should learn from past mistakes with various diseases. Are we learning from them? Ms Flanagan referred to an appropriate budget. Has she estimated what would be appropriate?

I, too, thank Ms Flanagan for her comprehensive and user-friendly presentation. We were not bombarded with anything. Approximately how many people in Ireland suffer from blood-borne viruses? What are the symptoms? How does it begin? How young can a person be? Ms Flanagan said it can be transmitted from mother to baby. What kind of symptoms do people in their late teens and early 20s experience? I was surprised to hear it can be passed on through piercing, particularly when one sees so many young people with piercings, which are more prevalent than tattooing. Many young girls, particularly, have their tongues, navels or noses pierced.

While nobody would advocate or promote recreational drug taking, cocaine is the drug of choice for people. It is worrying that people are at risk of picking up an infection while engaging in something that they think is only temporary in their lives, that they will do only between the ages of 20 and 25. There should be more awareness of this. Heroin users are so addicted that the consequences do not matter to them, however we owe it to everybody to protect them and there should be a better educational programme for them regardless of how addicted they are.

It is interesting that Ms Flanagan said to care for a patient properly for 48 weeks, which is less than a year, costs €16,500 and one uncomplicated transplant costs €28,000 to €56,000. I take it that she means a liver transplant.

Ms Flanagan


Can Ms Flanagan tell us approximately how many are carried out per year? Are transplant livers readily available? I would have thought not, and that patients have to be prepared for that. Would transplants be uncomplicated? I know it would be a major operation. Ms Flanagan said she is not seeking a lot from politicians. She is correct. It is not much. We should take the three simple points on board and ask the Minister to try to do something about them. Ms Flanagan's third request is the release of the national hepatitis C strategy. Has that strategy been drawn up but not reported on? If so, when was it drawn up and by whom?

I welcome the witnesses and thank them for the presentation. I apologise for being late. We have heard mention of cocaine snorting equipment, tattoos, piercing and permanent make up. I do not understand permanent make up so Ms Flanagan had better tell me. Last weekend a lady brought up the insurance costs of a friend of hers who contracted hepatitis C from contaminated blood products. Could Ms Flanagan talk about that? It is an issue for people and they find it difficult. I would be interested in Ms Flanagan's response. I was struck by the fact that this report has not been released by the Government. Why is that?

I thank Ms Flanagan for an excellent presentation. Like Deputy Gormley and the other members I am surprised that the report was not released, although that happens sometimes. Perhaps Ms Flanagan could tell us more about that. We have been dainty about education in this area and we need to be tougher and rougher in letting people know exactly what is happening. Sometimes the advertisements are so subtle I do not follow them myself although I am aware of the issue. GPs and community workers need further education too and we politicians can try to help in this area. Although I know hepatitis C is spread by dialysis and we have a shortage of dialysis facilities, I had not realised that any Irish people had contracted hepatitis C from dialysis and I am worried about it. Perhaps Ms Flanagan could expand on that. What specific group of people affected by hepatitis C do not receive proper care? Are some groups considered more worthy than others?

I welcome the delegation from the Blood Borne Virus Forum. I support the comments of Deputy Connolly. Young, and not so young, people today think that snorting is the in thing to do but it is laden with dangers to their health. I note that public awareness meetings have been held. Would the delegation consider it worthwhile to post notices at nightclubs and discos? That would be very useful.

I am familiar with hepatitis C, as are most members of the joint committee, but I do not think people are aware that simple processes such as having tattoos and getting one's ears pierced are means of transmission and have inherent dangers. The presentation this morning has brought that into focus, which is very important.

Given the implications of hepatitis C for public health, and its adverse effects on the resources of the State in terms of hospital services, there is not enough public awareness, although that is not the fault of the witnesses before us today. I hope our friends in the media give pride of place to their efforts this morning because it is a very serious public health matter. Have the witnesses made any contact with the national director of population health in the Health Service Executive? The good doctor, the Chairman and I know him very well from our time on the Midland Health Board and the HSE must be more proactive.

I thank the witnesses and congratulate Ms Flanagan on her presentation. In answer to the final point about what politicians can do, I will certainly play my part.

In her conclusion, Ms Flanagan said there had been a comprehensive response to cases of people infected with blood products and a suitable budget identified to deal with it, which is the sort of response one would expect. She said, however, that the largest infected group was still awaiting a comprehensive response. That sub-group, comprising prisoners and heroin abusers, has received no treatment for hepatitis C and has been completely neglected. Ms Flanagan did not spell it out but effectively said its members were being ignored and that that was the reason for the problem. Throughout the presentation she said that almost everybody who had come into contact with hepatitis C had received a comprehensive response but drug users and prisoners had received none. That is the only group identifiable as being significantly at risk from hepatitis C at the moment.

Blood products imported into this country come from countries where blood donations are paid for. Ms Flanagan said the prevalence of hepatitis C within the Irish prison population is close to 40%. Those who donate blood products in other countries are usually less well off and often have had contact with the prison service in the past. They may still donate to companies producing blood products but hepatitis C and hepatitis B are very contagious viruses. They are difficult to identify and there is no comprehensive screening policy for them. The figures show that the virus will still break through, no matter how well we test for it.

To address what the delegation is calling for this morning the Department of Justice, Equality and Law Reform needs to wake up to the crisis as much as the Department of Health and Children.

Ms Flanagan

I will try to field all the questions.

Ms Flanagan may take her time. I appreciate that many questions have been put.

I apologise but I must attend the Seanad. I will watch with interest and read the report.

Ms Carr

I will introduce the panel. Ms Naomi Glover is a hepatitis C nurse with the drug treatment board. Her answers will be given in the context of the work she has done. Mr. Thomas Cumberton is a community development worker with Donore community drug team. Ms Jean Flanagan is a hepatitis C liaison nurse specialist with the HSE in north Dublin. Mr. Michael King is an addiction support worker with a rehabilitation and education project. Ms June Colgan is a hepatitis C trainer with Community Response. I am the chairperson and a drugs education co-ordinator with the canal communities local drugs task force. Each delegate will answer on his or her own field. The question of what training existed for community workers and people who had hepatitis C was asked from a number of different angles. Ms Colgan will talk about ear piercing and creating general awareness.

Ms June Colgan

I will do so to the best of my ability. Ms Debbie Mulhall and I have worked in Community Response for the past nine years. Our job is to deliver information workshops to the community on hepatitis C and HIV. Many of the people with whom we work are in recovery from drugs. The information we provide gives them a better understanding of the issues and takes the fear away. It also motivates them to go for treatment but there is not enough support for them when they do that. They require a lot of counselling but do not receive it. They do not know that blood-to-blood infection can take place as they snort cocaine.

We are the only two community workers providing this information. We are on the south side but work on the north side and in prisons because of the number of requests we receive, which come from everywhere. We leave people with a full understanding of their situation. We hold two-hourly sessions with people for four weeks and the information we provide is culturally relevant to them. We have lobbied for nine years for funding to train others in what we do but without success.

I thank Ms Colgan for giving us a very clear picture of her work. What type of support is she calling for? I do not ask for numbers to define her success rate but, in her nine years, does she feel she has been successful, given the basic level of support she receives?

I have a supplementary question. Ms Colgan said there were only two community workers on the south side. I take that to mean the city of Dublin but what about the rest of the country?

Ms Colgan

We are the only two in Dublin. Health workers give information. We are just finished in Kilbarrack, but nobody on the north side of Dublin delivers this kind of information.

What about Cork, Galway, Limerick and the rest of the country?

Ms Colgan

As far as I know there is nobody doing this work in the rest of the country because we have carried out research in this regard.

What is the referral process, how is contact made and who gives that information?

Ms Colgan

There is a community response helpline.

So there are no referrals. People make contact directly.

Ms Colgan

People find out about us through word of mouth when we complete a project in an area. We recently completed a project with Addiction Response in Crumlin, ARC, where we worked with 25 members of staff.

Where were these members of staff based?

Ms Colgan

Addiction Response in Crumlin, ARC. We worked with them to enable them to gather information from us and work with up to 350 participants in their programme.

Ms Colgan says she works with addicts, gives information, explains blood to blood disease and reassures them. Does she refer them for treatment? How does this work, is there a waiting time and who treats the addicts?

Ms Colgan

We refer them. Most of the recovering addicts with whom we work know they have hepatitis C but are very confused about how they get information. Some addicts automatically think they are vaccinated against hepatitis C because they are vaccinated against hepatitis A and hepatitis B. There is no vaccination for hepatitis C but I found inmates in prison received information in a way that they thought they were vaccinated against it.

In terms of referral, we are linked to the hepatology clinic in St. James's Hospital and would advise addicts to receive frequent blood tests and so on.

Ms Flanagan

Most people are referred through a general practitioner, GP. If a person has been tested by a GP, the GP will refer him or her for further services at specialist level. This can happen either through a community, personal or family GP or through addiction services. There are many people who do not fall into this category and have no idea that they may have put themselves at risk some years ago. This is a group we must try to reach.

Owing to the nature of addiction, many people referred to hospital fail to keep their appointments and fall through the net. It can be very difficult to get them to return. This is what we mean when we refer to specifically defined services that are fine-tuned for people with complex social needs who require a more definitive strategy. Many hospitals have a high rate of non-attendance, even for people who received referrals. There is a stigma and fear attached to the treatment of hepatitis C because it is a difficult treatment and many people are afraid of following through with a referral.

Ms Flanagan

I was going to field some of the questions on symptoms. Ms. Glover might like to refer to testing for hepatitis C.

Ms Naomi Glover

Many people do not show specific symptoms of hepatitis C and there is a concern that many people are unaware of their infections and will remain so until they get tested. Reported symptoms include tiredness and general aches and pains. It is quite unusual for people to experience acute jaundice.

I work in addiction services so testing via blood test is carried out on clients routinely. Trials were carried using mouth swabbing, which gives limited information and helps identify exposure, as a means of testing for hepatitis C. If patients are not linked to addiction services, GPs are the usual source of referrals.

Ms Flanagan

As someone pointed out a minute ago, some GPs are not very aware of the issues relating to hepatitis C and it may not be high on their lists of priorities as so many illnesses exist. As Ms Colgan would point out, patients may receive a diagnosis but may not have comprehensive information for follow-up and may not understand how chronic and serious a condition hepatitis C is. They are not receiving access to the right information.

An attendee asked if we had considered putting notices in public places as part of our campaign. We sent postcards to 300 venues nationally in the last quarter of the year, including pubs, clubs and cafes, trying to entice people to gain a greater understanding of the issue and ask more questions. We have really tried to disseminate information in our public campaign this year because health promotion is limited. People with access to addiction services and related services, including community support workers and outreach workers, will receive information. However, those using drugs who do not receive methadone treatment and those who have exposed themselves through other risks will receive a very limited amount of information.

How is the one-hour rule operating?

Ms Flanagan

There are some difficulties because, operationally, trying to see every patient within one hour of his or her arrival in a department is quite difficult. This is a factor that was outlined as an important feature for people affected through blood and blood produce. Clinics for acute services have been streamlined to help address this as best they can. Most people are quite reasonable regarding what can be achieved in that time.

Mr. Cumberton will answer questions relating to cocaine. There were many questions on the strategy, a good deal of surprise that it has not been released and we are also surprised in this respect. A great deal of work went into the strategy and it is very good as it covers education, prevention, peer support, community support, treatment, follow-up and health surveillance. In answer to an earlier question, we have been in consultation with the Director of Public Health Medicine and I believe he will help in the application of the strategy. I can only speculate that the recent restructuring of the health service, which has seen responsibilities shifted to different departments, has caused the delay in the strategy. It is now a matter of asking them to remember the strategy.

Who has Ms Flanagan dealt with in this matter, the Department or the Health Service Executive, HSE?

Ms Flanagan

The former Eastern Regional Health Authority, ERHA, drew up the strategy having invited a working party to examine the subject.

When was that completed?

Ms Flanagan

The end of 2004.

It has been ready for two years and may be almost out of date at this point. I am sure Ms Flanagan's group has made representations to find out what is happening in this regard.

Ms Flanagan

We have. The HSE and those delivering services are very concerned and would like to see the matter progress but the main concern is whether the strategy will receive the funding it requires to support service delivery.

We recognise that the organisation has met with the committee to ask for our support. Let us go the extra distance. Why has this report not been acted upon? Are there any controversies outside of the funding?

Ms Flanagan

I am sure there are controversies.

Then let us talk about that. Let us see what is controversial.

There is a point on insurance which I would like Ms Flanagan to address.

Ms Flanagan

I am aware that there are issues around health and life insurance because of the chronic nature of hepatitis C and the serious projections it has for health. Patient groups representing those who were infected through blood and blood products have been working hard to achieve a fair outcome to this situation. It affects everyone with hepatitis C irrespective of how they contracted it. Premiums are often loaded and these people are sometimes not accepted for insurance at all. It is a current issue and we look forward to its resolution.

Does the State pick up the insurance tab if it was liable?

Ms Flanagan

That is to be decided.

Let us return to the report. While this committee does not have the authority to increase or provide budgets, we can put our weight behind ensuring the report is released. Outside of the funding, are there any controversial issues involved?

Ms Flanagan

As there is such a high prevalence of hepatitis C in Ireland, managing it and reducing future infection will require quite a lot of effort from many Departments. That in itself will put a significant demand on budgets. We are looking at significant service developments. For instance, community supports and education will be important and the report examines the introduction of peer supports. It also suggests how prisons might be managed. Harm reduction programmes are always controversial.

To take up Deputy Connolly's point, the strategy Ms Flanagan is talking about refers only to the old ERHA area.

Ms Flanagan


I therefore presume there is no strategy for elsewhere.

Ms Flanagan

No. It is hoped that this will eventually be rolled out as a national strategy. I understand that is the intention.

That is where the financial concerns may lie. It may not just be for the group's package or report, but it will have implications nationwide.

Ms Flanagan


Is Ms Flanagan saying that strategies are already written?

Ms Flanagan

A strategy has been prepared.

Has that been written since 2004?

Ms Flanagan

Yes. We are still awaiting its release.

It was hardly delayed because of the establishment of the HSE; that was a reforming process that was supposed to speed things up. The delay must be because of resource issues, is it not?

Ms Flanagan

Resources definitely have a significant part to play. I can illustrate that for the committee. As it will see, there are only two formal education trainers that we know of. I work in a huge catchment area and while the job has been advertised, I do not yet have a counterpart. We are hoping that people like me will be employed soon. This is an example that could be applied to many of the services and it all boils down to resources.

Based on the figures Ms Flanagan has supplied, the strategy must focus on a comprehensive review of prison medical services. As we both know, prison medical services operate on a wing and a prayer and comprehensive services are not available to examine what she is proposing.

Ms Flanagan

One of the recommendations is to give detailed consideration to how services can be rolled out in prisons. There is momentum within the prisons for this change to occur.

Some other questions were asked. A member asked if there was a group of people who are not receiving proper care. It is not that they do not get proper care when they go to hospital. They get looked after like everyone else. The problem arises when people with a history of drug use are recommended for treatment. They may have many complex needs and these cannot often be met at hospital level as it requires more in-depth service provision. This is not currently available. One cannot commence hepatitis C treatment until one stops using drugs and drinking alcohol. One must also have social supports in place. However, it very often does not happen like this. We are seeking to develop support services to enable people to fully access treatment.

Does Ms Flanagan have any evidence that people in Ireland have got hepatitis C from dialysis? I know there is significant pressure on dialysis services.

Ms Flanagan

Yes, there are reports of people acquiring hepatitis C through dialysis. Recommendations for the management of dialysis have been put in place to prevent further transmission.

Before the witnesses leave, can they tell us what permanent make-up is?

Ms Flanagan

It is, for example, permanent eye liners, etc.

Ms Carr

It is like having eye liner and lip liner injected.

Instead of applying it every day, would someone get it done for life?

Ms Flanagan

It can be tattooed.

Thank you. I did not know what that was. I thought we might be at risk from using make-up every day.

Ms Flanagan


I am glad I asked.

Some of us do not use make-up every day.

Ms Flanagan

Mr. Cumberton wishes to say something about cocaine use.

Mr. Thomas Cumberton

There is much media attention on people using cocaine. I am a community drug worker and I come across many people who use cocaine but do not know about the risks of sharing paraphernalia, such as the straws or banknotes they use to snort the substance. People across the country are at risk of contracting hepatitis C because they are not aware of such risks. They are astounded when I make them aware of the risks because they do not see themselves as drug users. When they use cocaine only at weekends, they do not see themselves as drug users because they do not take it every day or do not inject heroin. However, they are sharing the paraphernalia in toilets in pubs and nightclubs. I feel an awareness campaign needs to be organised, or people must be trained so that they can make others aware of the risk they are putting themselves in by sharing paraphernalia.

There is much more cocaine use within the injecting community too. Many heroin addicts stopped their heroin use and became stable through using methadone. However, cocaine has taken off and these people have started using it as well as methadone. They inject cocaine because they find they get a better buzz from it. Their inhibitions are lowered when they are high on cocaine and they do not worry about sharing paraphernalia.

Someone mentioned developing a campaign that could be run in nightclubs. That is a great idea. Cocaine use is not occurring in areas that have been awash with drugs for years — it is everywhere. It is in colleges and small towns around Ireland. It is not just in drugs hotspots.

In my work I talk to people about HIV and hepatitis C. They are more worried about HIV and can be quite sanguine about having a hepatitis C infection. There must be a campaign to inform people that hepatitis C can cause many problems and can be fatal if not looked after. There is a welcome focus on HIV but hepatitis C is another virus that is hurting communities. Hepatitis C sufferers are not the only people who are affected by it. It is everybody around them — their family members and those in their community. Everybody's community is affected by it. There must be a wider campaign and money must be provided at Government level. We can do what we can regarding blood-borne viruses and communities can do what they can but unless the money is provided and a strategy put in place, we cannot do a great deal. We are all volunteers.

I must bring the presentation to a close shortly because we have other business to attend to and we have given an hour to the discussion. I am not taking from the presentation but the committee members have heard the views and it is up to this committee to make a proposal to the Minister to ensure the report is released as quickly as possible. Is that agreed? Agreed.

There is the issue also of trying to source further funding in support of what the representatives said. We will give a commitment to try to do that as well. It is not our job to work out the budgets but if we accept the views expressed in the representatives' presentation, it is up to us to ensure the report is brought forward as quickly as possible. The committee is committed to doing that. I thank the delegation for the presentation. We will do everything possible to support them.

Sitting suspended at 10.41 a.m. and resumed at 10.42 a.m.