“Don’t think I’m going to leave you over it”: Accounts of changing hepatitis C status among couples who inject drugs

Abstract

a b s t r a c tBackground: While the health-related benefits of intimate partnership are well documented, little attention has been paid to couples exposed to high levels of social stigma and exclusion. In this project we investigated an important site of stigma for partnerships by collecting accounts of changing hepatitis C (HCV) status ("sero-change") among couples that inject drugs. We explored what these accounts reveal about the meaning of HCV for these couples, and how this understanding contributes to our collective efforts at prevention and care. Methods: Drawing from a large dataset of qualitative interviews with couples, we focussed on those containing reports of sero-change. By adopting a methodology that positioned partnerships rather than individuals as the primary unit of analysis, we addressed the commonplace tendency to either overlook or discount as dysfunctional, the sexual relationships of people who inject drugs. Results: While some couples sought greater biomedical understanding as a means of coming to terms with sero-change, others drew on alternative logics or "rationalities" that sat firmly outside conventional biomedical discourse (privileging notions of kinship, for example). Regardless of which explanatory framework they drew on, participants ultimately prioritised the security of their relationship over the dangers of viral infection. Conclusions: Effectively engaging couples in HCV prevention and care requires acknowledging and working with the competing priorities and complex realities of such partnerships beyond simply the identification of viral risk. The "new era" of direct acting antiviral treatments will provide ongoing opportunities to learn to integrate biomedical information within more socially sophisticated, relationally aware approaches.

Change in injecting behaviour among people treated for hepatitis C virus: The role of intimate partnerships

“…Those who had a partner who used drugs were more likely to reduce their injecting frequency, a reduction difference of more than nine injections a week. This finding was surprising, as previous literature associated having a partner who uses drugs, in particular those injecting, with increased frequency of injecting and of sharing of injecting equipment . A variety of papers have been published on the power imbalance and social inequalities that drive injecting risk behaviour in heterosexual couples, in particular in women who inject drugs, who often rely on their male partner to acquire, prepare and inject the drugs .…”

“…A variety of papers have been published on the power imbalance and social inequalities that drive injecting risk behaviour in heterosexual couples, in particular in women who inject drugs, who often rely on their male partner to acquire, prepare and inject the drugs . Disregard of injecting risk occurs as a consequence of emotional closeness, intimacy, trust and commitment . Given the high level of sero‐concordance in people who inject drugs in intimate partnerships, the study team identified patients in dyadic intimate partnerships who had both been enrolled on the Eradicate‐C trial.…”

“…Disregard of injecting risk occurs as a consequence of emotional closeness, intimacy, trust and commitment . Given the high level of sero‐concordance in people who inject drugs in intimate partnerships, the study team identified patients in dyadic intimate partnerships who had both been enrolled on the Eradicate‐C trial. The trial nurses identified 22 participants in couples.…”

“…In the general population, the health benefits of being married or in a committed intimate relationship are well documented . People in romantic partnerships tend to be healthier, engage with healthcare services and show a longer lifespan .…”

“…Yet, historically, close relationships with other PWID, such as romantic partnerships and living with other drug users, are among the factors most strongly linked to continued injecting risk behaviour . A possible explanation of these polar effects could be that in a hostile environment where the behaviours of vulnerable adults are influenced negatively by partners, a positive sense of acceptance, belonging and self‐worth can stem from these partnerships . Integrated models of behaviour change attempt to explain how couple dynamics can influence risk and health behaviours …”