The time of cure: hepatitis C treatment and the matter of reinfection among people who inject drugs

ABSTRACT

Australia has made considerable progress towards the public-health ‘elimination’ of the hepatitis C virus. Nonetheless, reinfection remains a key challenge, with little understanding regarding the lived complexities of post-cure life among people who inject drugs. Our analysis examines reinfection through the lens of ‘time’, a largely overlooked and under-utilised analytical concept within the field of hepatitis C. Drawing on qualitative data from a study examining treatment outcomes and reinfection, our analysis concentrates on three participant accounts or ‘cases’. Working within a new materialist framework, we combine recent social science scholarship which, firstly, posits cure as a socio-material ‘gathering’, and secondly, proposes a ‘futurology’ of hepatitis C and its treatment. We found participant accounts troubled the neat binary of pre- and post-treatment life, instead detailing the challenges of remaining virologically safe while navigating complex, local life-worlds. Rather than a singular, post-treatment future instantiated by cure, participants described the fluid, emergent nature of what we might describe as ‘lived’ or ‘embodied’ time, including multiplicities of becoming in a perpetual present. We conclude that our understanding of reinfection needs to move beyond its current, narrow biomedical conception and organising temporal logic to honour and incorporate complexity in practice.

KEYWORDS:

• Hepatitis C
• cure
• reinfection
• time
• futurology
• new materialism

Acknowledgements

The authors would like to thank the study participants for their generous contribution to the research, as well as service staff who helped facilitate the interviews. Thank you also to the two anonymous reviewers for their thoughtful and considered comments on an earlier draft.

Disclosure statement

JG is a consultant/advisor and has received research grants from Abbvie, Abbott, Biolytical, Camurus, Cepheid, Gilead Sciences, Hologic, and Indivior. CT has received speaker fees from Abbvie and Gilead, and grants from Merck.

Additional information

Funding

This study was supported through a National Health and Medical Research Council Project [grant number 1128886]. The Kirby Institute is funded by the Australian Government Department of Health and Ageing. The views expressed in this publication do not necessarily represent the position of the Australian Government. JG is supported by a National Health and Medical Research Council Investigator [grant number 1176131].