Exploring the contingent reality of biomedicine: Injecting drug users, hepatitis C virus and risk1

Abstract

Hepatitis C is an emerging theme of contemporary public health discourses related to illicit drug injection practices. Such discourses differentiate injecting from non-injecting users in an actuarial risk logic, targeting drug-injecting users as a population in need of support in the management of risks attributed to their practices. Public health strategies suppose, among other things, that injecting drug users adopt a homogeneous vision of hepatitis C, and of its risk, that is compatible with the reality produced by biomedicine. The majority of studies conducted on hepatitis-related risks in the context of harm reduction strategies are interested in socio-demographic factors to understand the behavioural variations within this targeted population. The meaning given to the virus and to its risk has remained marginal and the diversity of areas of construction of meaning tends to be ignored in the academic literature. Attention to this diversity indicates a complex tissue of social and communicational relations and the contingency of the symbolic instruments that people manipulate in their relation with their body and towards others; a complex tissue in which the reality of biomedicine is one among many alternative realities.

Views and experiences of hepatitis C testing and diagnosis among people who inject drugs: Systematic review of qualitative research

“…140) Responses to a positive diagnosis depended on individual circumstances (Craine, Walker, Carnwath & Klee, 2004) but feelings of unconcern or denial among some PWID were commonly underpinned by a lack of knowledge. In many studies PWID had experienced difficulties in obtaining reliable information following testing, regardless of whether they received a positive or negative diagnosis Carrier, LaPlante, & Bruneau, 2005;Copeland, 2004;Lally et al, 2008;Rhodes et al, 2004).…”

“…PWID perceived themselves as never being completely safe from, or in control of HCV transmission despite their intentions and actions to reduce risk (Carrier et al, 2005;Davis, Rhodes, & Martin, 2004;Harris, 2009b;Rhodes, Davis, & Judd, 2004;Roy, Nonn, Haley, & Cox, 2007;Sutton & Treloar, 2007;Swan et al, 2010;Wozniak, Prakash, Taylor, & Wild, 2007). However, there were exceptions, with studies noting that the extent to which PWID participated in the 'normalised discourse' was influenced by their situation, social context and personal relationships (Wozniak et al, 2007;Roy et al, 2007;Harris, 2009b).…”

“…However, injecting behaviour was also a motivation for testing with PWID citing social or personal responsibility to others, such as those within their injecting networks (Craine et al, 2004;Khaw et al, 2007;Roy et al, 2007). For those with concerns about a positive diagnosis, anxiety over the impact of HCV on the chances of finding a long term partner, sexual relations, starting a family and the possibility of transmission predominated (Carrier et al, 2005;Harris, 2009b;Temple-Smith et al, 2004;Tompkins et al, 2005;. A positive diagnosis led some 10 PWID to re-evaluate their lives and make the first steps towards a life away from their drug use (Roy et al, 2007;Sutton & Treloar, 2007;Swan et al, 2010) or towards adopting a healthier lifestyle, such as eating more healthily and reducing alcohol and drug use (Cullen et al, 2005;Faye & Irurita, 2003;Khaw et al, 2007;Roy et al, 2007;Sutton & Treloar, 2007;Wozniak et al, 2007;Wright et al, 2005).…”

“…) HCV was often understood relative to HIV; a product of joint testing procedures, a bias towards HIV services in practice, the relative trivialisation in comparison to HIV by others (including health professionals) and the social dominance of popular HIV discourse since the 1980's Harris, 2009a;Khaw et al, 2007;Munoz-Plaza et al, 2010;Rhodes et al, 2004). Studies that described the trivialisation of a positive HCV diagnosis, relating both to those delivering and those receiving the diagnosis (Roy et al, 2007;Copeland, 2004;Carrier et al, 2005;Cullen et al, 2005), noted that this trivialisation tended to be relative and in comparison to a HIV diagnosis.…”

Penser et percevoir autrement les personnes qui font usage de drogues par injection

“…C'est d'ailleurs le « danger » qui est souvent sous-entendu dans les messages de santé publique portant sur les risques biomédicaux liés aux infections transmissibles telles le VIH ou le VHC, par le biais du partage de matériel d'injection contaminé (Carrier, Laplante et Bruneau, 2005 ;Rhodes et Quirk, 1998). Ainsi, le terme « toxicomane » a été remplacé par un terme sanitaire se voulant dénué de connotation morale, celui d' « utilisateurs de drogues par injection » ou d'UDI qui sert surtout à identifier le facteur de danger: l'injection, et à cibler les personnes « dangereuses » : les injecteurs.…”