Hepatitis C prevention and convenience: why do people who inject drugs in sexual partnerships ‘run out’ of sterile equipment?

Abstract

Rates of hepatitis C virus transmission among people who inject drugs in Australia remain high despite decades of prevention education. A key site of transmission is the sharing of injecting equipment within sexual partnerships. Responsibility for avoiding transmission has long been understood individually, as have the measures designed to help individuals fulfil this responsibility, such as the distribution of sterile injecting equipment. This individualising tendency has been criticised for placing an unfair level of responsibility on poorly resourced, marginalised people and ignoring the social nature of injecting drug use and related health care. Likewise, although research has demonstrated that injecting drug use is gendered, gender and sexual partnerships remain marginal to health promotion efforts. In this article, we address these weaknesses, drawing on a qualitative, interview-based project that explored equipment sharing within (hetero)sexual partnerships. In conducting our analysis, we explore a key theme that emerged in discussions about accessing and sharing injecting equipment, that of convenience, using critical marketing theory to understand this theme. In particular, we investigate the issues of convenience that affect the use of sterile injecting equipment, the many factors that shape convenience itself, and the aspects of equipment use that go beyond convenience and into the realm of intimacy and meaning. We conclude that injecting equipment needs to be both meaningful and convenient if sharing within partnerships is to be reduced further.

Keywords:

• consumption
• sociology of health
• drugs
• sterile injecting equipment

Acknowledgements

The authors thank the participants in this study and the anonymous reviewers for CPH.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Nine participants were in part or full-time employment, with nearly all receiving some form of social welfare (n = 71) (one participant depended on his partner’s income and two participants declined to answer). Over half the participants identified as ‘Anglo-Australian’ and nearly a quarter as Aboriginal or Torres Strait Islander (n = 17). While the majority of the remaining participants identified as having broadly European heritage, 10% (n = 8) comprised a diverse cross-section of ethnicities (Filipino, Armenian, Vietnamese, Indian, Lebanese and Chinese). Serostatus was determined by self-report only and in several cases participants offered conflicting accounts of each other’s or their own serostatus. HCV serostatus was fairly evenly shared amongst participants, with 35 reporting to be HCV-negative and 45 HCV-positive. Of the dataset’s 41 couples, 24 were HCV concordant (11 HCV-negative and 13 HCV-positive) and 17 HCV discordant (10 HCV-positive men and seven HCV-positive women).

Additional information

Funding

The research project reported on here was funded by the National Health and Medical Research Council (Australia) (APP1023437). The National Drug Research Institute at Curtin University is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvement Grants Fund. The first author (SF) is supported by an Australian Research Council Future Fellowship (FT120100215). The Centre for Social Research in Health is supported by a grant from the Australian Government Department of Health.