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Valerio H, Marshall AD, Conway A, Treloar C, Carter L, Martinello M, Henderson C, Amin J, Read P, Silk D, Degenhardt L, Prain B, Alavi M, Dore GJ, Grebely J. Factors associated with hepatitis C testing, treatment, and current hepatitis C infection among men and women who inject drugs: The ETHOS engage study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104394. [PMID: 38608357 DOI: 10.1016/j.drugpo.2024.104394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/26/2024] [Accepted: 03/13/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Evaluating gender-specific trends in hepatitis C virus (HCV) treatment uptake among men and women who inject drugs is crucial for ensuring equitable progress towards HCV elimination. This study aimed to quantify differences in testing, treatment, and current HCV infection between men and women who inject drugs. METHOD ETHOS Engage is an observational cohort study of people who inject drugs attending drug treatment clinics and needle and syringe programs in Australia recruited from May 2018-September 2019 (wave 1) and November 2019-April 2021 (wave 2). Participants completed a questionnaire including self-reported HCV testing and treatment history and underwent point-of-care HCV RNA testing (Xpert® HCV Viral Load Fingerstick). Logistic regression was used to compare the factors associated with self-reported HCV testing and treatment and current HCV infection for men and women who inject drugs. RESULTS Among 2,395 participants enrolled in ETHOS Engage, 66% (n = 1,591) were men, 33% (n = 786) women, and <1% (n = 18) did not identify as a man or woman. HCV testing history and current infection were similar among men and women. Among men or women ever eligible for HCV treatment (ever chronic HCV) (n = 1,242), women were less likely to report a history of HCV treatment compared to men (227/352, 64% vs. 631/890, 71%; p = 0.03). Among women, those aged <45 were less likely to report HCV testing (aOR: 0.57, 95%CI: 0.36, 0.90), treatment (aOR: 0.47, 95%CI: 0.29, 0.77), and more likely to have HCV infection (aOR: 1.48, 95%CI: 1.00, 2.20) CONCLUSION: Among women, those of childbearing age (<45) were less likely to report testing and treatment and were more likely to have current HCV infection. Women <45 years old should be a priority population for HCV care. Services that interface with these women should be optimised to enhance HCV testing and treatment.
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Affiliation(s)
- Heather Valerio
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
| | - Alison D Marshall
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia; Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anna Conway
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia; Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Carter
- Hepatitis SA, Hackney, South Australia, Australia
| | - Marianne Martinello
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Janaki Amin
- Macquarie University, Sydney, New South Wales, Australia
| | - Phillip Read
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia; Kirketon Road Centre, Sydney, New South Wales, Australia
| | - David Silk
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Bianca Prain
- Population Health Strategy & Performance, NSW Health, New South Wales, Australia
| | - Maryam Alavi
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Treloar C, Lancaster K, Rhodes T, Lafferty L, Bryant J, Rance J. The 'missing' in the 'endgame' of hepatitis C elimination: A qualitative study in New South Wales, Australia. Drug Alcohol Rev 2024. [PMID: 38596845 DOI: 10.1111/dar.13845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/04/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION After a promising start in Australia, elimination efforts for hepatitis C are not on track. Following the global campaign to 'find the missing' in hepatitis C response, this qualitative study explores stakeholder perspectives on the 'missing' in the 'endgame' of hepatitis elimination in the state of New South Wales, Australia. METHOD Twenty-eight key informants working in New South Wales, elsewhere in Australia and internationally in high income countries participated in a semi-structured qualitative interview. Analysis examined key informant accounts of the 'missing' in efforts to eliminate hepatitis C. RESULTS Participants' accounts framed the missing in relation to epidemiological knowledge, making-up four population categories 'missing' or 'missed' in hepatitis C response. In turn, accounts situated the missing in relation to where and how individuals were presumed to connect, or not, with existing health-care infrastructures. This gave rise to concerns about the capacity of health services to be made available for those at risk or in need, with systems said to create opportunities for people to 'miss out' on hepatitis C services. DISCUSSION AND CONCLUSIONS The 'missing' in the 'endgame' of hepatitis C elimination effort is not simply a function of who-populations missed-but of where and how, that is, situation and context. Our findings encourage a focus on how services, systems and contexts may create situations in which people become missed or are 'made missing' from care. We therefore advocate for a systemic, and not only population-based, approach in the final push towards hepatitis C's elimination.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Kari Lancaster
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- Goldsmiths University of London, London, UK
| | - Tim Rhodes
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Lise Lafferty
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Jake Rance
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Rance J, Grebely J, Treloar C. The time of cure: hepatitis C treatment and the matter of reinfection among people who inject drugs. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2024; 33:104-118. [PMID: 38373415 DOI: 10.1080/14461242.2024.2315031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 02/01/2024] [Indexed: 02/21/2024]
Abstract
Australia has made considerable progress towards the public-health 'elimination' of the hepatitis C virus. Nonetheless, reinfection remains a key challenge, with little understanding regarding the lived complexities of post-cure life among people who inject drugs. Our analysis examines reinfection through the lens of 'time', a largely overlooked and under-utilised analytical concept within the field of hepatitis C. Drawing on qualitative data from a study examining treatment outcomes and reinfection, our analysis concentrates on three participant accounts or 'cases'. Working within a new materialist framework, we combine recent social science scholarship which, firstly, posits cure as a socio-material 'gathering', and secondly, proposes a 'futurology' of hepatitis C and its treatment. We found participant accounts troubled the neat binary of pre- and post-treatment life, instead detailing the challenges of remaining virologically safe while navigating complex, local life-worlds. Rather than a singular, post-treatment future instantiated by cure, participants described the fluid, emergent nature of what we might describe as 'lived' or 'embodied' time, including multiplicities of becoming in a perpetual present. We conclude that our understanding of reinfection needs to move beyond its current, narrow biomedical conception and organising temporal logic to honour and incorporate complexity in practice.
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Affiliation(s)
- J Rance
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - J Grebely
- The Kirby Institute, UNSW, Sydney, Australia
| | - C Treloar
- Centre for Social Research in Health, UNSW, Sydney, Australia
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Farrugia A, Lenton E, Seear K, Kagan D, Valentine K, Fraser S, Mulcahy S, Edwards M, Jeffcote D. 'We've got a present for you': Hepatitis C elimination, compromised healthcare subjects and treatment as a gift. Soc Sci Med 2024; 340:116416. [PMID: 38039771 DOI: 10.1016/j.socscimed.2023.116416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023]
Abstract
With the advent of highly effective and tolerable direct-acting antiviral treatments for hepatitis C, widespread optimism for and investment in the project of disease elimination now informs the public health response. In Australia, the Commonwealth government has invested heavily in elimination by universally subsidising treatment, promising access for all. Reflecting concerns that commonly accompany ambitious public health projects, cost for governments supporting access to the treatment and cost for individuals consuming it have emerged as central issues. Drawing on 30 interviews with people who have been cured of hepatitis C with direct-acting antivirals, this article examines how cost shapes experiences of hepatitis C treatment and cure in Australia. Drawing on Lauren Berlant's (2011) influential work on 'cruel optimism', we analyse three interconnected ways that notions of cost shape participants' views of treatment as a beneficent gift from the state: (1) understandings of treatment access as a form of 'luck'; (2) conceptions of the cost of treatment; and (3) criticisms of others who are seen to waste state resources by not taking up treatment or by re-acquiring hepatitis C. We argue that, together, these dynamics constitute people affected by hepatitis C not as citizens worthy of public investment and fundamentally entitled to care, but as second-class citizens less deserving of treatment and of the health care to which they might otherwise be considered entitled. It is within this dynamic that the compromised quality of elimination optimism takes shape, binding people affected by hepatitis C to an inequitable relationship to health care, reproduced through the very things that promise to free them of such inequality - investments in access to treatment and cure.
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Affiliation(s)
- Adrian Farrugia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; National Drug Research Institute, Curtin University, Australia.
| | - Emily Lenton
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia.
| | - Kate Seear
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia.
| | - Dion Kagan
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia.
| | - Kylie Valentine
- Social Policy Research Centre, University of New South Wales, Australia.
| | - Suzanne Fraser
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; Centre for Social Research in Health, University of New South Wales, Australia.
| | - Sean Mulcahy
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia.
| | - Michael Edwards
- Faculty of Addiction Psychiatry, Royal Australian and New Zealand College of Psychiatrists, Australia.
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Kagan D, Seear K, Lenton E, Farrugia A, Valentine K, Mulcahy S. 'I'm not hep C free': afterlives of hepatitis C in the era of cure. MEDICAL HUMANITIES 2023; 49:678-687. [PMID: 37451865 DOI: 10.1136/medhum-2023-012653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
Since the advent of more effective, new-generation treatment for hepatitis C, immense resources have been devoted to delivering cure to as many people with the virus as possible. The scale-up of treatment aims to prevent liver disease, liver cancer and onward transmission of hepatitis C, but social research shows that people also approach treatment with its social promises in mind, including the hope that it might reduce or eradicate stigma from their lives. Such hopes reflect broader ideas about medical cure, which is seen as an end point to illness and its effects, and capable of restoring the self to a (previous) state of health and well-being. But what does cure mean among people for whom treatment does not produce an end to the social effects of a heavily stigmatised disease? While new treatments promise to eliminate hepatitis C, accounts of post-cure life suggest that hepatitis C can linger in various ways. This article draws on interviews with people who have undergone treatment with direct-acting antivirals (n=30) in Australia to explore the meanings they attach to cure and their experiences of post-cure life. We argue that dominant biomedical understandings of cure as an 'ending' and a 'restoration' can foreclose insight into the social and other effects of illness that linger after medical cure, and how individuals grapple with those afterlives. Drawing on recent conceptual re-framings of cure from medical anthropology and disability studies, we suggest that thinking at the limits of 'curative reason' helps to better address the afterlives of chronic illness. In the case of hepatitis C, reconceptualising cure could inform improved and less stigmatising ways of addressing people's post-cure needs. And in the era of hepatitis C elimination, such reconceptualisation is increasingly important as the cohort of people undergoing treatment and cure expands worldwide.
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Affiliation(s)
- Dion Kagan
- Australian Research Centre for Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Kate Seear
- Australian Research Centre for Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Emily Lenton
- Australian Research Centre for Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Adrian Farrugia
- Australian Research Centre for Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Kylie Valentine
- Centre for Social Policy Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Sean Mulcahy
- Australian Research Centre for Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
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Nourse G, Farrugia A, Fraser S, Moore D, Treloar C. Optimism and eternal vigilance: Gathering disease, responsible subjects and the hope of elimination in the new hepatitis C treatment era. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104142. [PMID: 37591009 DOI: 10.1016/j.drugpo.2023.104142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/19/2023]
Abstract
The advent of direct-acting antiviral hepatitis C medications has reshaped experiences of hepatitis C treatment and cure. Positioned as a treatment revolution, the new medications mean a world without hepatitis C has become imaginable, and this optimism is reflected in Australia's commitment to the WHO's target of 'eliminating' the virus as a public health threat by 2030. Alongside optimism about new treatments, Australia's current National Hepatitis C Strategy also emphasises the importance of partnerships with, and the 'meaningful involvement' of, priority populations for elimination to be achieved. We draw on Fraser and Seear's (2011) work on hepatitis C as a 'gathering' to examine these developments, and to approach hepatitis C as a disease in-the-making. Analysing 50 interviews conducted with people affected by the virus, we identify three key articulations that combine to trouble the distinction between old and new treatments: (1) the new treatment constitutes the disease as readily curable; (2) nevertheless, those who have been cured are responsibilised against acquiring it again by managing and monitoring their conduct; and (3) in the process, hepatitis C becomes re-constituted as an ongoing threat requiring continual post-cure medical and other monitoring. We argue that while treatment experiences have dramatically improved, responsibilising people affected by hepatitis C to attain cure in the context of an elimination agenda constitutes cure as valuable as much for the greater good as for self-care. This raises pressing ethical and political questions. Overall, we shed light on how, even in a context shaped by the availability of highly effective treatment, the hepatitis C-free body is never hepatitis C-free, but must be continually reproduced through regulatory practices.
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Affiliation(s)
- Gemma Nourse
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia.
| | - Adrian Farrugia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
| | - Suzanne Fraser
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; Centre for Social Research in Health, University of New South Wales, Australia
| | - David Moore
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Australia
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Seear K, Mulcahy S. Making Rights and Realities: How Australian Human Rights Make Gender, Alcohol and Other Drugs. AUSTRALIAN FEMINIST STUDIES 2023. [DOI: 10.1080/08164649.2023.2179971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Kate Seear
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Sean Mulcahy
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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8
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Seear K, Mulcahy S, Kagan D, Lenton E, Fraser S, Valentine K, Farrugia A. Complicating cure: How Australian criminal law shapes imagined post-hepatitis C futures. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:179-195. [PMID: 36254737 PMCID: PMC10092810 DOI: 10.1111/1467-9566.13562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
In recent years, highly tolerable and effective drugs have emerged promising a radical new 'post-hepatitis C' world. Optimism about medical cure potentially overlooks discrimination and stigma associated with hepatitis C and injecting drug use. Legal frameworks are especially relevant to hepatitis futures, since the law has the potential to reinforce or alleviate stigma and discrimination. This article explores how hepatitis C figures in Australian criminal law and with what potential effects. Drawing on Bruno Latour's work on legal veridiction, Alison Kafer's work on futurity and disability and case law data collected for a major study on hepatitis C and post-cure lives, we explore how the criminal law handles hepatitis C in the age of cure. We find that law complicates cure, constituting hepatitis C as disabling despite the advent of effective cures. The law steadfastly maintains its own approach to disease, disability and illness, untouched by medical and scientific developments, in ways that might complicate straightforwardly linear imaginaries of cure, transformation and progress of the kind that dominate biomedicine. We explore the implications of these tensions between law and medicine.
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Affiliation(s)
- Kate Seear
- Australian Research Centre in Sex, Health and SocietyLa Trobe UniversityMelbourneVictoriaAustralia
| | - Sean Mulcahy
- Australian Research Centre in Sex, Health and SocietyLa Trobe UniversityMelbourneVictoriaAustralia
| | - Dion Kagan
- Australian Research Centre in Sex, Health and SocietyLa Trobe UniversityMelbourneVictoriaAustralia
| | - Emily Lenton
- Australian Research Centre in Sex, Health and SocietyLa Trobe UniversityMelbourneVictoriaAustralia
| | - Suzanne Fraser
- Australian Research Centre in Sex, Health and SocietyLa Trobe UniversityMelbourneVictoriaAustralia
| | - Kylie Valentine
- Social Policy Research CentreUniversity of New South WalesSydneyNew South WalesAustralia
| | - Adrian Farrugia
- Australian Research Centre in Sex, Health and SocietyLa Trobe UniversityMelbourneVictoriaAustralia
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Wallace J, Richmond J, Howell J, Hajarizadeh B, Power J, Treloar C, Revill PA, Cowie B, Wang S, Stoové M, Pedrana A, Hellard M. Exploring the Public Health and Social Implications of Future Curative Hepatitis B Interventions. Viruses 2022; 14:v14112542. [PMID: 36423153 PMCID: PMC9693003 DOI: 10.3390/v14112542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Hepatitis B is a significant global health issue where the 296 million people estimated to live with the infection risk liver disease or cancer without clinical intervention. The World Health Organization has committed to eliminating viral hepatitis as a public health threat by 2030, with future curative hepatitis B interventions potentially revolutionizing public health responses to hepatitis B, and being essential for viral hepatitis elimination. Understanding the social and public health implications of any cure is imperative for its successful implementation. This exploratory research, using semi-structured qualitative interviews with a broad range of professional stakeholders identifies the public health elements needed to ensure that a hepatitis B cure can be accessed by all people with hepatitis B. Issues highlighted by the experience of hepatitis C cure access include preparatory work to reorientate policy settings, develop resourcing options, and the appropriateness of health service delivery models. While the form and complexity of curative hepatitis B interventions are to be determined, addressing current disparities in cascade of care figures is imperative with implementation models needing to respond to the cultural contexts, social implications, and health needs of people with hepatitis B, with cure endpoints and discourse being contested.
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Affiliation(s)
- Jack Wallace
- Burnet Institute, Melbourne, VIC 3004, Australia
- Australian Research Centre in Sex, Health and Society, Latrobe University, Bundoora, VIC 3083, Australia
- Centre for Social Research in Health, UNSW, Sydney, NSW 2052, Australia
- Correspondence: ; Tel.: +61-432850708
| | | | - Jessica Howell
- Burnet Institute, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | | | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, Latrobe University, Bundoora, VIC 3083, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, NSW 2052, Australia
| | - Peter A. Revill
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC 3010, Australia
- Department of Microbiology and Immunology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Parkville, VIC 3010, Australia
| | - Su Wang
- Center for Asian Health, Saint Barnabas Medical Center, RWJBarnabas-Rutgers Medical Group, Florham Park, NJ 07039, USA
| | - Mark Stoové
- Burnet Institute, Melbourne, VIC 3004, Australia
| | | | - Margaret Hellard
- Burnet Institute, Melbourne, VIC 3004, Australia
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, VIC 3004, Australia
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Fraser S, Moore D, Farrugia A, Fomiatti R, Edwards M, Birbilis E, Treloar C. Exhausted practical sovereignty and lateral agency: Non-uptake of treatment for hepatitis C in the antiviral era. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 107:103771. [PMID: 35952605 DOI: 10.1016/j.drugpo.2022.103771] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022]
Abstract
With the advent of highly effective antiviral treatment for hepatitis C, many people have undergone treatment and been cured. Others, however, have not undergone treatment, even where it is free and readily available. Australia's aim of eliminating the disease by 2030 means this group is of concern to researchers, health professionals and policymakers. This article draws on 50 interviews conducted for a research project on treatment experiences to examine treatment non-uptake in Australia. Informed by Berlant's (2007) work on 'slow death', it analyses experiences of non-uptake to explain the dynamics at work in such outcomes. The analysis is divided into three parts. First, participant Cal describes a lifetime in which hepatitis C, homelessness and prison have shaped his outlook and opportunities. Second, Evan describes intergenerational drug consumption, family contact with the prison system and an equally long history with hepatitis C. Finally, Rose also describes a long history of hepatitis C, complex struggles to improve life and contact with the prison system. All three accounts illuminate the dynamics shaping treatment decisions, calling to mind Berlant's slow death as a process of being 'worn out by the activity of reproducing life' under conditions that both demand self-management, and work against it. In concluding, the article points to Berlant's distinction between 'epidemics' and 'endemics', arguing that its politics apply directly to hepatitis C. In doing so, it highlights the need to address the criminalising, pathologising, capitalist context of 'attrition' (Berlant) that wears out lives even as it fetishises autonomy, responsibility and choice.
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Affiliation(s)
- Suzanne Fraser
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; Centre for Social Research in Health and Social Policy Research Centre, University of New South Wales.
| | - David Moore
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
| | - Adrian Farrugia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
| | - Renae Fomiatti
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; School of Humanities and Social Sciences, Deakin University, Australia
| | - Michael Edwards
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | | | - Carla Treloar
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; Centre for Social Research in Health and Social Policy Research Centre, University of New South Wales
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