Letter to HIV Prevention Providers

Dear HIV Prevention Provider:

We are writing to share information about resources for helping to make sure that persons at risk for hepatitis A and B are aware of their risk and know that vaccines to prevent hepatitis A and B infection are available. Due to shared modes of transmission and populations at risk, hepatitis A, B and C are common among persons at risk for or living with HIV. Chronic hepatitis C, along with chronic and acute hepatitis B may be life-threatening and they are the leading cause of chronic liver disease. Hepatitis A can also have serious consequences, especially for people living with hepatitis C. Hepatitis A and B can be prevented through vaccination. Currently there is not a vaccination for hepatitis C, however, the CDC recommends that individuals chronically infected with hepatitis C be vaccinated against hepatitis A and those with risk factors should be vaccinated against hepatitis B to prevent further liver damage.

Individuals at high risk for hepatitis A for whom vaccination is recommended include men who have sex with men (MSM) and injection drug users (IDUs). Hepatitis B vaccine is recommended for MSM, IDUs, persons who are HIV-infected, sex contacts of persons who are infected with hepatitis B, and those who have multiple sex partners. The CDC recommends that all MSM get vaccinated against both hepatitis A and B. Despite safe and effective vaccines against hepatitis A and B, studies have shown that vaccination rates are low among MSM. Men infected with both chronic hepatitis B and HIV have been found to have extremely high liver-related mortality rates.

Availability of Vaccine for Hepatitis A and/or B Vaccination for hepatitis A and/or B is available at many doctors' offices, health care clinics and STD clinics. Often, an individual's health insurance covers costs associated with hepatitis A and B screening and vaccination for high-risk adults. Persons enrolled in Medicaid or the AIDS Drug Assistance Program (ADAP) are covered for both the antigen screening tests, and the hepatitis A and B vaccines are part of comprehensive primary care visits.

The NYS Department of Health Immunization Program provides free hepatitis A, B and Twinrix (combination hepatitis A & B) vaccine to local health departments in most upstate counties. The vaccine is targeted for high risk adults and adolescents seeking services through the local health department, including STD clinics and HIV counseling and testing programs. In areas of the state outside of New York City (NYC), call your local health department for information about how to refer individuals at risk for free vaccination.

In NYC, the NYC Department of Health and Mental Hygiene (NYCDOHMH) makes free vaccine available at certain STD clinics. These sites are identified on the attached listing. Hepatitis B vaccine is available to anyone. Hepatitis A vaccine is limited to MSM, IDU and persons living with HIV and/or liver disease. The NYCDOHMH also distributes hepatitis vaccine to some HIV prevention programs. To explore access to vaccines for your organization, you can call Dr. Stephen Friedman at (212) 676-2256 or Dr. Jane Zucker at (212) 676-2248.

We encourage you to reach out to the NYCDOHMH or to your local health department, to obtain specific information about how individuals can access free vaccines.

Free Materials and Training about Hepatitis A and B Attached are reference sheets that highlight how to access free materials and training about hepatitis A and B and access to free vaccines within NYC.

Action Steps It is important for MDM, IDUs, individuals with HIV, individuals with hepatitis C, and other persons at high risk for hepatitis A and B to be aware of their risk and to be informed of the availability of antigen screening and vaccine against Hepatitis A and B. Please consider ways in which you can incorporate information about hepatitis A and B into your programs and services. For example:

  • Offer clients clear information about how to avoid exposure to viral hepatitis as part of prevention counseling.
  • Incorporate information about hepatitis A and B into their risk reduction presentations, especially in/at venues where high risk populations gather;
  • Make brochures and information about hepatitis A and B available to clients;
  • Educate active IDUs and MSM about vaccination;
  • Refer active IDUs to syringe exchange programs and/or ESAP pharmacies for clean injection equipment;
  • Provide information about free vaccines available from local health departments;
  • Provide HIV-infected individuals and their partners information about hepatitis A and B and referrals, where appropriate, as part of case management; and
  • Use materials about hepatitis A and B as part of a discussion on maintaining health behaviors in MDM support groups and support groups for HIV-infected individuals.

We appreciate your assistance in informing individuals about hepatitis A and B, helping them assess their risk(s) and aiding them in accessing vaccines.

Sincerely,

Susan J. Klein, M.S.
Director, Division of HIV Prevention
AIDS Institute

Elizabeth J. Herlihy, R.N., M.S.
Hepatitis B Coordinator
Immunization Program

Additional Resources: Materials and Training Related to Hepatitis A and B

Free Materials about Hepatitis A and B A variety of print materials about hepatitis A and B are available in camera ready format and copyright free from the Immunization Action Coalition. The Immunization Action Coalition maintains a web site at: www.immunize.org . Materials suitable for use with adults who may be at risk include the following items:

  • Item # P4035
    • Title: Immunizations...Not Just Kids' Stuff
  • Item # P4041
    • Title: Shots for Adults with HIV
  • Item # P4080
    • Title: Hepatitis A is a Serious Liver Disease: Should you be Vaccinated?
  • Item # P4112
    • Title: Every Week Thousands of Sexually Active People Are Infected with Hepatitis B: Get Protected! Get Vaccinated!
  • Item # P4115
    • Title: Hepatitis B: 100 Times Easier to Catch than HIV!
  • Item # P4116
    • Title: You Don't Have to Go All the Way to Get Hepatitis A: Get Vaccinated!

The Gay and Lesbian Medical Association provides information about hepatitis A and B, as well as resources for creating a safe clinical environment for LGBT clients at: www.glma.org.

The NYS Department of Health Immunization Program recently established a Viral Hepatitis Web Site. To access it, visit: http://www.nyhealth.gov/diseases/communicable/hepatitis/.

The NYS Department of Health AIDS Institute offers a brochure, "Diseases that Can be Spread During Sex" (publication 3805), that highlights risks, symptoms and recommendations for hepatitis B vaccination. This brochure is available in English and Spanish and can be obtained through the HIV/AIDS Consumer Educational Materials Order Form, available by calling (518) 474-9866 or by e-mail directed to: hivpubs@health.state.ny.us.

The Centers for Disease Control and Prevention offers fact sheets for hepatitis A and B on-line at:

http://www.cdc.gov/ncidod/diseases/hepatitis/a/fact.htm

http://www.cdc.gov/ncidod/diseases/hepatitis/b/fact.htm

Training for Staff The AIDS Institute offers a free, half-day training entitled "The ABC's of Hepatitis and HIV". To view the Statewide Calendar of HIV/AIDS Trainings, go to:

http://www.health.state.ny.us/nysdoh/aids/training.htm

Hepatitis A and B Vaccine, Materials and Training Available Through the New York City Department of Health and Mental Hygiene

Free Hepatitis A and B vaccine: Free hepatitis A and B vaccine is available at the three NYCDOHMH STD clinics listed below. Hepatitis B vaccine is available to anyone. Hepatitis A vaccine is limited to men who have sex with men, people who inject drugs, and people with HIV and/or liver disease.

  • Riverside STD Clinic
    160 West 100th Street, 1st Floor
    Manhattan
    (212) 865-1951
  • Morrisania STD Clinic
    1309 Fulton Avenue, 2nd Floor
    Bronx
    (718) 901-6564
  • Crown Heights STD Clinic
    1218 Prospect Place, 2nd Floor
    Brooklyn
    (718) 735-0580

Gay men/men who have sex with men can also get hepatitis A vaccine at the Chelsea STD clinic and hepatitis B vaccine from the Chelsea immunization clinic, open Monday and Friday. The Chelsea STD clinic is located at 303 9th Avenue, 2nd Floor (at W. 28th Street). Call (212) 239-1718 for details.

Free Promotional Materials: Free fact cards that list NYCDOHMH STD clinics where hepatitis A and B vaccination and hepatitis C testing are offered and provide basic information on hepatitis A, B and C can be ordered by calling (212) 427-5120.

Training for Staff: The HIV Training Institute offers a free full-day training entitled "Hepatitis C: A Training for Service Providers". Call (212) 341-9810 or e-mail to: losborne@health.nyc.gov to obtain a schedule or to register.

For Further Information about Hepatitis C in New York City: Please contact:

Karen Schlanger, M.P.H.
Director, Hepatitis C Program
NYC Department of Health and Mental Hygiene
125 Worth Street, CN-22, Room 326
New York, NY 10013
Telephone: (212) 227-6021