Health Report

by Dash Gray

(The Gender Centre advise that this article may not be current and as such certain content, including but not limited to persons, contact details and dates may not apply. Where legal authority or medical related matters are cited, responsibility lies with the reader to obtain the most current relevant legal authority and/or medical publication.)

Hi and thanks for reading Polare and the following Health Report. Some you may have met me already, for others my name is Dash and I am the Gender Centre's new Outreach Worker. I work Mondays so please feel welcome to call me at the Centre on Mondays to discuss any issues related to outreach or any queries you might have relating to these health reports.

Thankfully we have all survived Christmas and the New Year - having said that, the holiday period can be a time of stress and sadness for many who find themselves alone or who suffer lost or strained relationships.

I recently read this summary of feelings and how they can affect us:

• Anger can give you power to take care of yourself;
• Guilt can help you change your behaviour;
• Pain can help you grow stronger;
• Fear can help you protect yourself.

Feelings need expression:

• Anger kept inside too long becomes rage;
• Guilt kept inside too long becomes shame;
• Pain kept inside too long becomes helplessness;
• Fear kept inside too long becomes panic.

Our behaviours are affected by our thoughts and feelings. Behaviour based on rage, shame, helplessness or panic are likely to be negative and possibly self-harming or harming to others.

If you are having a difficult time finding support and acceptance for your feelings seek help. There are a broad range of services and support options out there.

Gay and Lesbian Counselling Service of New South Wales

L.G.B.T. support line 5:30pm - 10:30pm Monday to Sunday
Phone: (02) 8594 9596 or outside Sydney call 1800 184 527
Website: http://www.glcsnsw.org.au

ACON Counselling Service

Contact intake and assessment officer 11:00am to 1:00pm Monday to Friday
Phone: (02) 9206 2000

LifeLine

Phone: 13 11 14

Websites

Reach Out
Beyond Blue
Grow

At the back of Polare we list a range of support services and contacts. The Gender Centre has a counsellor available by appointment, who can also help you find appropriate support or services or who can work with you on specific issues.

The basics of injecting

For those who know the Gender Centre's layout, you will know that the Outreach Office is the room out the back of the building. You may also know that this is where the Gender Centre's Needle and Syringe Program (NSP) operates.

The Needle and Syringe Program provides new injecting equipment to anyone injecting hormones or other drugs. We do this to minimise the risks of H.I.V. and other Blood Borne Viruses like hepatitis C and hepatitis B.

Whether you are injecting hormones or other drugs you need to get new and clean equipment. You can get a supply of needles, syringes, swabs, filters and water from the Gender Centre's N.S.P.

Hormone drugs designed to be injected usually come in an oily solution and because they need to be absorbed into the body slowly should be injected intramuscularly, i.e. into muscles. Most commonly the muscles involved here are either the buttocks or the thighs. Anyone who knows photography and Loren Cameron's work may recall a beautiful self portrait of Loren Cameron self injecting into the buttock.

We would always advise getting hormones medically prescribed. This way you know exactly what you are getting and you can be monitored and advised by your doctor. If you are taking hormones by intramuscular injection a doctor can administer the injection or in consultation with your doctor you may self-inject. If you intend to self-inject get your doctor to show you how and make sure you are confident in the process before doing it by yourself. Needles for injecting into muscles are longer in length and have a larger gauge than the needles used for intravenous injections so follow the advice from your doctor about what best suits your needs.

The diagrams below (in the hard-copy of Polare) show the intramuscular injection sites in the buttock and thigh. It is generally recommended that you alternate injecting sites, i.e. if you inject into the thigh alternate between the left and right thigh each injection and avoid injecting into the exact same place as last time. This gives the tissue you are injecting into adequate time to repair. When you are injecting into muscle you should not see any blood in the syringe on drawback. If you do it means you probably have hit a vein and need to withdraw the needle and either inject a centimetre back or start again (Remember don't use needles more than once as they blunt with the first injection) If there is pain or difficulty with the injection don't push through or ignore it, but get advice.

If you are injecting drugs like speed, ice or heroin then you are most likely to be doing so intravenously i.e. into veins. With any illicit drug you can never be exactly sure what you are getting so caution and care are necessary. The most common site of injecting intravenously is between the forearm and upper arm but veins are delicate structures and continued injecting will often cause damage. Once again, rotating injection sites is a good idea but it is generally recommended to avoid injecting into the neck, groin or the hands or feet. You can get advice about injecting and vein care from any Needle Syringe Program (NSP), inc1uding the Gender Centre. N.U.A.A., the New South Wales Users group is also a good place for information and advice (listed in service directory at the back of Polare).

Whether injecting intramuscularly or intravenously here are some general tips:

• Find a safe, secure spot where you are not likely to be disturbed;
• Get all your new equipment ready
• Have the right equipment
• Wash your hands before and after injecting
• Take your time, try not to rush
• Dispose of your equipment safely (yellow sharps disposal bins can be picked up from your nearest N.S.P. or take your used equipment to your N.S.P. to place in their sharps bin)

Intramuscular Injection

( from www.PharmaEurope.com )

Check the label on the bottle.

Remove the cap from the bottle. Clean the top of the bottle with an alcohol pad. Do not touch the top of the bottle after it has been cleaned.

Attach and / or tighten the needle onto the syringe.

Take the needle cap off the needle.

Pull back on the end of the plunger, draw air equal to the amount of liquid to be injected into the syringe. Do not touch the plunger or the needle.

Insert the needle into the rubber stopper in the bottle.

Push down the plunger to push the air into the bottle. Leave the syringe in the bottle. Invert the bottle and syringe so the bottle is on top. Pull down on the plunger allowing the medicine to fill the syringe. Stop when the desired amount has been transferred to syringe. Check for bubbles in the syringe. If bubbles are present, tap the barrel of the syringe with your finger to move any bubbles to the top of the syringe, push the plunger slightly to move air bubbles out of the syringe. Pull down on the plunger again to fill the syringe with the correct dosage. Check again for air bubbles and repeat above steps if necessary. Remove the needle from the bottle. Replace needle cap.

Selecting the site.

Avoid major blood vessels and nerves. Use different sites in turn to prevent repeated injections in the same area. Do not use areas that are bruised, swollen, tender, or scarred. Ask someone qualified to help you find the site.

Buttock (Gluteus Medius)

Find the trochanter (the knobby top portion of the long bone in your upper leg (femur)). Find the posterior iliac crest. Draw an imaginary line between the bone landmarks. From the centre of the line find a point one inch up from the line. This (X) is where the needle goes in. Stretch the skin tight. Hold the syringe like a dart and insert at a right angle to the skin. You can use up to 3ml (cc) of fluid in this site.

Hip (Ventrogluteal)

Find the trochanter (see above). Find the anterior iliac crest. Place the palm of your hand over the trochanter. Point your first finger toward the anterior iliac crest. Spread the second (middle finger) towards the back. Inject between the knuckles of your first and middle finger. Stretch the skin tight. Hold the syringe like a dart. Insert at right angles to the skin. You may give up to 3ml (cc) of fluid at this point.

Leg (Vastus Lateralus)

To find the thigh injection site you will be making an imaginary box on your upper leg. Find the groin. One hand width below the groin becomes the upper border of the box. Find the top of the knee. One hand width above the top of the knee becomes the lower border of the box. The centre of the top of your leg becomes the left corner of the box. The centre of the side of your leg becomes the right border of the box. The best areas to use for injection are in the middle of this imaginary box. The sites are marked with X's. Stretch the skin to make it tight. Insert the needle at a right angle to the skin. You may give up to 2ml (cc) of fluid into this site.

Polare is published in Australia by The Gender Centre Inc. which is funded by the Department of Community Services under the S.A.A.P. Program and supported by the N.S.W. Health Department through the AIDS and Infectious Diseases Branch. Polare provides a forum for discussion and debate on gender issues. Advertisers are advised that all advertising is their responsibility under the Trade Practices Act. Unsolicited contributions are welcome, though no guarantee is made by the Editor that they will be published, nor any discussion entered into. The editor reserves the right to edit such contributions without notification. Any submission which appears in Polare may be published on our internet site. Opinions expressed in this publication do not necessarily reflect those of the Editor, The Gender Centre Inc.I, the Department of Community Services or the N.S.W. Department of Health.