Notions of Injecting Drug Users' Candidacy for Hepatitis C Treatment: Conflicting Provider, Patient, and Public Health Perspectives

Abstract

Uptake of hepatitis C treatment by injecting drug users (IDUs) remains low and little is known about factors influencing treatmentuptake by ethnic minority groups. The influence of notions of "candidacy" on "accomplishing" access to antiviral treatment are explored using data from an ethnographic study. Fieldwork and in-depth interviews were conducted with 72 Indo-Chinese IDUs. Cultural contexts, everyday realities of drug use and marginalization, and disengagement from the health system produced notions of candidacy in participants' local worlds. Among the minority assessed for treatment, adjudications of candidacy were perceived to be influenced by power dynamics. Demonstrating abstinence from drug use was understood to be central to establishing legitimate claims for candidacy, suggesting conflicting provider, patient, and public health perspectives. Further research Contemporary Drug Problems 37/Winter 2010

Managing expense and expectation in a treatment revolution: Problematizing prioritisation through an exploration of hepatitis C treatment ‘benefit’

“…Accounts emphasising perseverance and/or the promise of rehabilitation are common to the qualitative HCV treatment literature (Clark & Gifford, 2015;Rance & Treloar, 2014;Rhodes et al, 2013) and intertwine in study participant narratives. Taking on a difficult interferonbased treatment now, as opposed to an easier DAA therapy later, accords with cultural scripts of redemption through personal trial (Clark & Gifford, 2015;Coupland & Maher, 2010) and demonstrates an active responsible citizenship (Rhodes et al, 2013). This demonstration aligns with the forms of subjectivity accepted and performed by treatment systems (Fraser & Seear, 2011) where most treating clinicians favour individuals who are perceived to be responsible and stable, particularly in terms of recovery from drug use.…”

Illness perceptions and explanatory models of viral hepatitis B & C among immigrants and refugees: a narrative systematic review

“…Qualitative studies (Additional file 1 : Table S4) used various methods: combination of open-ended interviews and focus groups [ 51 , 58 , 95 ]; focus group [ 50 , 55 , 68 , 78 , 91 ]; semi-structured and in-depth interviews [ 56 ]; observational and in-depth interviews [ 65 ]; and ethnography [ 61 ]. A mixed methods study used both survey questionnaires based on Health Behaviour Framework and in-depth-interviews [ 69 ] (Additional file 1 : Table S5).…”

“…Some immigrants knew that HCV infection could be transmitted vertically through child birth and breast feeding [ 62 , 66 ], or horizontally through sex [ 62 , 63 ], blood transfusion [ 62 , 63 , 66 ], intact skin contact (such as hugging and shaking hands [ 62 , 66 ]), non-intact skin contact (such as bites or wounds [ 65 ] and open mouth ulcer [ 65 ]), tattooing and body piercing [ 61 , 62 , 66 , 77 ], razors and shaving blades [ 61 , 62 , 66 ], sharing of contaminated drug injecting paraphernalia [ 61 , 62 , 65 , 77 ], sharing toothbrush [ 62 , 66 ], and traditional healing practices (such coin rubbing, cupping, moxibustion, and acupuncture) [ 62 ]. Some immigrants also believed that HCV could be transmitted through ingestion of contaminated food [ 62 ], water [ 62 , 68 ], sharing of utensils [ 62 , 66 ] and saliva [ 65 ].…”

“…Some studies suggests that the framing of the transmission of HBV infection within a broader issue of sexually transmitted disease [ 49 , 55 , 65 , 78 , 91 , 95 ], and injecting drug use [ 61 , 65 , 95 ] contributed to its association with shame and stigma.…”

“…As such awareness about the knowledge of the existence of vaccines for HBV did not translate into acceptance that vaccination should be used as the primary means of preventing HBV infection among this Chinese group [ 56 ]. However, some south East Asian participants were found to perceive vaccination positively following active recommendations by doctors and healthcare providers [ 59 , 61 , 64 , 71 , 72 , 76 , 87 , 90 , 97 ], family or friends or if it was compulsory for employment or school admission [ 58 , 67 , 90 ]. In addition, some participants from Chinese, Pacific Islanders, and Vietnamese immigrants indicated that targeting the whole family for intervention might positively influence uptake of screening and vaccination [ 79 , 80 , 87 ].…”