People in prison who inject drugs: who is trusted when it comes to information about hepatitis C?

Abstract

Background

Prisons are complex environments where there is a high risk of transmission of blood borne viruses, including hepatitis C (HCV). Providing trustworthy information in such settings can be challenging. This article presents the findings from a qualitative study examining interpersonal trust between people in prison and other individuals from whom they access information regarding HCV (health professionals, custodial officers, and peers).

Methods

In-depth semi-structured interviews were conducted across 12 prisons in New South Wales, Australia, with 30 participants that had a history of injecting drug use. Questions addressed topics including awareness of HCV and harm reduction information sources. Data analysis was guided by two frameworks examining the affective and cognitive determinants of trust and the domains of fidelity, competence, honesty, confidentiality, and global trust.

Results

In general, health professionals were seen as trustworthy, while custodial officers were seen as untrustworthy. In contrast, the trustworthiness of peers was dependent on the individuals and the context. Peers were trusted if they had previous experience with HCV or were considered an ‘elder’ of their group, whereas others were not trusted due to a perceived lack of competence or fidelity.

Conclusions

Information about HCV must come through trusted sources such as health professionals, selected peers, and, typically, not custodial officers. Affective and cognitive determinants of trust, as well as the domains of fidelity, competence, honesty, confidentiality, and global trust, are evident and should be leveraged to develop harm reduction interventions that will be trusted and adopted by people in prison.

Keywords:

• Harm reduction
• healthcare
• hepatitis C
• injecting drug use
• inmates
• prison
• trust

Acknowledgements

The HITS-p investigators include: Andrew Lloyd, Kate Dolan, Paul Haber, William Rawlinson, Carla Treloar, Greg Dore, Lisa Maher, and Fabio Luciani.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The HITS-p cohort has been supported by grants from NHMRC [Nos. 222887 and 1016351] including NSW Health, the Justice Health & Forensic Mental Health Network, Corrective Services NSW, and Hepatitis NSW as partners. ARL is supported by NHMRC Fellowship [APP1043067]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We also would like to thank Luke McCredie who conducted all the interviews for this project.