Safety in the silence: Hepatitis C risk and prevention in three networks of Australians who inject drugs

Abstract

Hepatitis C is a significant public health issue in Australia, as it is in many countries around the world. In the last few years, the field of social research on hepatitis C has expanded to more explicitly acknowledge and address the broad range of factors that influence health and risk in the context of hepatitis C transmission. Rhodes (2002, 2009) risk environment framework has been particularly influential in this regard, identifying policy, economic, physical and social environments that operate at micro- and macro-levels of influence. However, little research has explored in detail the micro-social dimensions of hepatitis C risk and prevention. Employing a social network analysis design, combining qualitative interviews and participatory social network mapping, this study generated new insights into how social network factors influenced the sharing and reuse of injecting equipment within particular networks of people who inject drugs. The networks were recruited from three geographically and socially diverse settings in Australia. The first network was located in inner city Sydney, an area with a demographically diverse population; the second in outer suburban Sydney, in an area with high numbers of Vietnamese migrant Australians; and the third in a regional city in New South Wales, in an area with high numbers of economically marginalised young people. The analysis focused on exploring the different perspectives shared by network members regarding hepatitis C-related knowledge, communication and network dynamics. A pervasive silence was observed in all networks regarding hepatitis C, accompanied by remarkable variation in knowledge of hepatitis C between network members. However, despite this range in knowledge and restriction in communication, evidence was also found of network members actively working to prevent hepatitis C transmission in their networks, particularly through peer distribution of sterile injecting equipment. Nonetheless, the normalisation of hepatitis C within these networks of people who inject drugs did not necessarily result in a reduction in hepatitis C-related stigma. Further research is needed to consider how these related social network-level factors influence hepatitis C transmission in a diverse range of other networks of people who inject drugs, to strengthen the potential for harm reduction approaches to acknowledge and learn from these informal responses to hepatitis C risk.