Bad Seed - Roland S Howard & Hep C

Weighing 60kg, he barely made a bump under the blankets but a dapper suit helped him conceal his swollen abdomen, puffy legs and the rash over his dysfunctional liver. Dosed with anti-nausea medication, he warned the audience of goths and hipsters that he was feeling queasy and could vomit. The signature Lark cigarette that dangled from his lips when he burst on to the ’70s punk scene with Nick Cave in The Boys Next Door was missing. So too was the heroin that had laced his veins on and off until 2004.

He swigged from a bottle of Pepsi at the Prince that night, playing his trademark Fender Jaguar, performing songs from his new solo album Pop Crimes as well as classics the fans knew by heart. Standing several feet from the front of the stage, gig reviewer Greg Moskovitch tried to reconcile the room’s thumping mood with the painful signs of Howard’s physical decay.

Halfway through the last song, Exit Everything, he noticed something spill from Howard’s lips. He thought it was sweat or saliva. But when Howard wiped his mouth his fingers were covered in blood; it dripped on to the microphone and down to the floor. “I’m not sure if I’ve ever knowingly been this close to a dying man,” Moskovitch later recounted in an article lauding this gaunt, talented, underappreciated songwriter, who like it or not had made heroin chic. Eight weeks later, on December 30, Howard let go of life. He was 50.

Liver cancer had dealt the knock-out punch to a body cannibalised by the Hepatitis C virus (HCV), which few Australians could identify as our most common notifiable blood-borne disease. It has been estimated that 212,000 people have chronic HCV, numbers that dwarf those for headline-grabbers such as HIV (17,500). Yet there are no pink, red or yellow lapel ribbons drawing attention to their plight because the stigma surrounding infection silences news of the epidemic’s spread. Transmission occurs through blood. People can catch it from tattooing, unhygienic health procedures, or transfusions that occurred prior to screening, but most HCV cases in Western countries come from sharing needles during intravenous drug use. Studies indicate that 80 per cent contract the disease through shooting up. One jab with a contaminated needle is all it takes.

Those infected with HCV may be like two friends of mine who wish to remain anonymous. They used heroin with borrowed equipment a couple of times over 20 years ago. They now have young children, careers and lead healthy lives - keeping their fingers crossed. Just as bushfires raze one house and leave the next untouched, some individuals (up to 25 per cent) may clear HCV spontaneously while others will experience debilitating fatigue, “brain fog”, headaches, anxiety, nausea and pain.

Unchecked and untreated HCV can be a ticking time-bomb that gradually ravages the liver. That’s why it’s sometimes called “the 25-year disease”, for this is the time lag between infection and the potential development of deadly conditions such as cirrhosis or cancer.

Highly successful cures are available but take-up rates remain abysmal. Treatment requires self-injection for up to 48 weeks, depending on the HCV strain, which can leave patients suffering nasty side-effects including severe depression. This gruelling regime discourages recruits already shy of owning up to illicit drug use. Inhaling might be something US presidents admit to, but injecting is a darker demon, conjuring up junkies, back alleys and the menace of hardcore addiction, or what a former HCV carrier dubs “the yuck factor”. One Melbourne nurse says people will tell strangers on the tram about their sister’s hysterectomy but “Hepatitis C is a condition that is kept quiet”.

In this hushed-up climate the disease casts a lengthening shadow over an ageing population. Without early intervention, those suffering chronic HCV face the lottery of a liver transplant as a last alternative to death. Demand for livers in Australia is expected to triple by 2020 as the disease stalks a generation who dabbled in recreational intravenous drug use, swapping needles without fully comprehending the risks.

“Hepatitis C is an epidemic,” confirms Dr Paul Gow, a senior hepatologist at Melbourne’s Austin Hospital, the nation’s liver transplant centre, where a third of the transplants are HCV-related. “And it’s going to get worse.” He rattles off epidemiological modelling that predicts complications from the virus will increase threefold in the next decade. “The gap between the waiting list and available organs is going to widen unless something changes.”

An image problem
Organs are precious. media tycoon Kerry Packer scored a kidney from his helicopter pilot. Some believe Apple chief Steve Jobs jumped the queue last year for a new liver because he owns a private jet that could fly him to collect one wherever a donor next appeared. Many die waiting.

Australia has one of the lowest organ-donor rates in the developed world and the Rudd Government launched a nationwide campaign in 2008 to try to reverse this trend. My initial approach to the Austin Hospital exposed sensitivities surrounding organ donation. A spokesman indicated there was anxiety lest this article feed perceptions that organs are being harvested for “deadbeats from punk bands with only themselves to blame”. Certainly the Prime Minister preferred the sad story of a young girl born with a genetic liver disease to launch the appeal over a 50-year-old former heroin user, brilliant or not.

Yet Rowland S. Howard’s cultural tribe will be lining up for livers, over-represented in the list of patients seeking medical reprieve. On December 23, seven days before Howard’s death, guitarist Mick Cocks of Rose Tattoo succumbed to the same fate. There’s an abundance of rock celebrities who could serve as pin-ups for HCV in an age when health campaigns jostle for high-profile patrons.

Paul Stewart of the Melbourne band Painters and Dockers, who got a new liver at the Austin, jokes that the hospital’s liver unit “is like a rock’n’roll catch-up house”. Hepatitis Australia has trouble persuading some to risk recording contracts and sales by adopting the cause. But older musicians who’ve gained a second wind from transplants are keener converts: Criston Barker (ex Air Supply), Shane Laffy (ex Man Friday) and Stewart spruik for the cause. Last May Barker hooked up with Russell Coleman (ex AC/DC) in The Melbourne Hep Cats, while Stewart and Laffy formed The Transplants for a Federation Square concert to draw attention to HCV.

Activists say they often encounter a nasty puritanical streak, perhaps heightened by “compassion fatigue”, which reserves pity for more deserving “innocent” victims of illness and disaster. Lindy Morrison (ex The Go-Betweens), who helps run Support Act Ltd for musicians in strife, was informed by a colleague that “several big names” had withdrawn assistance after “finding that many of those who are in need of ‘charity’ had done the drugs/rock’n’roll thing and their money ‘went up their nose’, so to speak”.

“I can’t stand this amazing judgmental attitude from people who should know better,” Morrison snaps. This hardening, even in the industry’s backyard, makes carriers reluctant to report for treatment and sabotages efforts to use prominent people as lightning rods who could encourage public debate.

Executives at Hepatitis C Victoria had thought of enlisting Rowland S. Howard’s help before his condition deteriorated. The idea surprises his closest friend, Genevieve McGuckin. “He was disarmingly honest, and generous of spirit, but quite a private person,” she says, adding: “Who knows what he’d have done after a successful transplant … he’d have been so happy and grateful.” Howard secured a place on the Austin’s liver list but it was too late. He’d been told in 2003, when he was 44, that his liver was shattered with end-stage cirrhosis. Doctors compared it to the liver of a 74-year-old alcoholic. He didn’t undergo HCV treatment until 2006.

There’s no point searching for a scapegoat in his medical history. “He really hated having Hep C,” says McGuckin. “It’s such a horrible disease. But he never complained, ‘Why me?’ He hated victimhood. He was never the sort of person who glossed over what he did.” And whatever he did, she did too. “I ate the same food. I did the same things. I gave up drugs six years earlier than him.” McGuckin contracted HCV, too, but her treatment did wonders whereas his respite was brief. “I don’t know why my liver’s fine,” she says. His story is her story, only she has endured.

For 26 years they lived together here and in London. They collaborated musically. She plays keyboards. They shared houses, a love of mythical beasts, jokes, memories, books, needles and a virus that plagued them both. They met in St Kilda in 1977. She remembers seeing him at a gig in his leopard-print shirt. “The first time we ever did anything there were six of us. We all shared the same needle,” she remembers. “We didn’t start doing it all the time; usually after a gig, or with people.” Sudden death from an accidental overdose was thought to be the worst that could happen. Pre AIDS, there were no needle-exchange programs, chemists closed early, and the “bleach, don’t boil” campaign hadn’t been conceived. McGuckin recalls syringes that had been handled so often that the measurement inscriptions had worn off.

Patients presenting with symptoms at health clinics were often misdiagnosed as the virus was not identified and publicised in the medical community until 1990. “In those early decades there was no concept of getting a disease,” says Criston Barker, who recalls going into a tent at a music festival and sharing a needle with strangers. These stories chill you. Rick Grossman (ex Divinyls) tells of rifling through his garbage for second-hand needles. He got a bout of Hepatitis B and later tested positive for HCV but it cleared from his system. Now drug-free and playing with the Hoodoo Gurus, he says needle-sharing was rife in the ’80s. “When the few chemists selling syringes closed, people resorted to old ones,” he explains.

“Everyone was doing it” is the chorus line repeated in conversations I have with musicians, artists and their followers who were congregating in pubs and alternative venues in Melbourne and Sydney in the ’70s and ’80s. The tangle of intertwined relationships between people who played, worked and partied together led to easy, swift transmission. “Heroin was pretty common around the traps,” says Paul Stewart. “I did it stupidly, the first time drunkenly with a friend. I’m really embarrassed to say that everyone else was doing it and if they’d been wearing red shoes I’d have bought a pair too.”

Even those who didn’t succumb to peer pressure or curiosity witnessed friends or band members injecting. “I was fortunate,” says Lindy Morrison, who thanks her father, a doctor, for scaring her off ever using needles. “The whole creative milieu was tied up with experimenting, taking risks, living in the moment. There was no authority spelling out the danger. People didn’t have any information. They were ignorant; I know, I was there. There was a really naïve attitude to drug taking – almost cavalier.” How cavalier is clear from writer Meera Atkinson’s memory of catching HCV. “I was infected when I was 20, the second time I injected heroin, shot up by an anonymous junkie I never saw again. Some weeks later I noticed my eyes looked yellow,” she revealed in an essay for Griffith Review.

Junkie chic
Heroin developed an allure, according to musician Dave Graney, who in the ’80s played with The Moodists. “We were hardcore boozers,” he says, “but there was a glamour around the junkie myth. People loved scoring as much as shooting up. They loved the ritual as much as the drug.” The Moodists went to London in the ’80s around the same time as Howard and Nick Cave decamped there and The Boys Next Door became The Birthday Party. Graney shared a squat with Howard briefly. In her eulogy at Howard’s funeral, McGuckin recalled: “Our time together in London was liberally laced with self-destruction … but we had so much fun.” Bass guitarist Tracy Pew, who died in 1986 of an epileptic seizure, drew caricatures of the band in London on a card for a friend. Howard has a syringe hanging out of his neck while a thought-balloon from Pew’s mouth asks: “Wot song is it?”

Howard described the substances sucked down between sound-checks and shows at a gig in London, in an essay on rock as performance for World Art magazine. “When stage time arrives, three-fifths of the band, myself included, are wasted men. The memories grow hazy at this point. Is it shame or adrenalin?”

Art commentator Ashley Crawford, who commissioned Howard’s reflections, moved in the same avant-garde circles around Melbourne in the early’ 80s. “Art student Nick Cave had become something of a shuffling icon along the then decrepit Chapel Street in Prahran, crossing paths with artist Howard Arkley, both no doubt on a quest for substances,” he wrote in a memoir of the period. Howard Arkley died of a heroin overdose in 1999. “He must have had Hep C too,” Crawford concludes when we speak in the weeks after Howard’s funeral. “I have another friend who died recently of liver cancer from Hep C,” he says, referring to Melbourne artist Peter Walsh. “Peter and Rowland were both 50, so very young.”

Nick Cave was “unavailable to comment” on his HCV status. He didn’t attend Howard’s funeral in January but his co-operation is being sought in 2011 to drag the disease into the spotlight.

Like Anzac veterans counting fallen comrades, musicians now aged 50-plus count colleagues with HCV, some of them since buried, along with contemporaries struck down by cancer. Paul Stewart was waiting for his liver transplant when he attended a 2006 benefit concert for guitarist Lobby Loyde, who died a year later from lung cancer. “I was in a semicircle of five guys. Three of them are now dead and I’ve had a liver transplant and Jimmy Barnes has had heart surgery,” he says. “To tell you the truth I feel blessed. Rowland Howard died. I didn’t. I feel obliged to tell people to take care of themselves.”

Health professionals say there’s a deficit of public knowledge about HCV compared to the hyper-awareness of AIDS. They point to the “grim reaper” shock tactics adopted in 1987 TV ads that galvanised the population into a preventative, proactive mindset. Stuart Loveday, president of Hepatitis Australia, calls for “a measured, factual, well-funded, broad-based media campaign to alert the Australian community to what you can do, where you can go for effective treatment. That’s the best way to make a great big dent in the Hep C epidemic”.

“We need to stop the leap in people dying,” says Helen McNeill of Hepatitis C Victoria. “We need to double the rates of people being treated and we need to reduce the numbers of new infections.” Sixty-five per cent of people with HIV receive treatment, while only 3 per cent of HCV sufferers put themselves through the combination therapy of pegylated interferon and ribavirin for a period determined by which genotype they carry. The blood is cleared in up to 80 per cent of genotype 3 infections and 50 per cent of genotype 1, the two most common HCV strains in Australia. “The treatment can make people terribly sick,” McNeill concedes. “They often lose weight and look terrible which means they may have to disclose their condition to family and friends and employers. The stigma is so great that some people prefer to lie and say they’re having chemotherapy.”

Genevieve McGuckin says Howard got so thin and pale during his treatment that many suspected he was back on heroin. She looked after him. Gradually his health and outlook brightened. He began writing songs, getting about town, playing gigs again. He encouraged others with HCV to try and rid their body of the disease. When McGuckin followed suit, Howard helped her through. Then his tiredness returned. “He got diagnosed with liver cancer while I was on interferon,” she says. The tumours were tenacious, growing back after radiofrequency ablations to burn them off. “He was hanging on for dear life. He just wanted to get a new liver,” McGuckin says. A friend had told him: “You wake up in intensive care feeling like a teenager again.”

McGuckin confirms the disapproval directed at people with HCV. “It really does exist, in social life, amongst some nurses, doctors, and other health professionals, and of course in the workplace. There’s a distinction between ‘innocent victims of disease’ and people who are deemed to have only their behaviour to blame. It’s very discouraging.” After all, she points out, nobody complains when we spend millions to rescue risk-takers from oceans and mountain ledges. Howard didn’t delude himself as to the role he played in his own downfall. “He said [drugs] had cost him everything,” she says.

A lot of their friends have HCV. When we talked she referred to people she knew who were managing the disease as best they could. Later she sent me an email: “Please don’t mention […] in any way at all! It doesn’t add to anything and I will be lynched … it’s not public knowledge. […]  is a sensitive private person with a job, a partner and children.”

Her warning reinforces the vicious circle we are caught in. For as long as people are frightened or embarrassed to speak out there will be silence and shame. Rowland S. Howard didn’t have the energy or the temperament to proselytise on behalf of his colleagues and contemporaries, but his death screams the loudest warning.