Joanne Bryant

The gendered context of initiation to injecting drug use: evidence for women as active initiates

This paper explores differences between womens and mens first experience of injecting in relation to socio-demographic context, drug use, and the role of others. We collected cross-sectional retrospective data from 334 recently initiated (<or=5 years) injecting drug users in New South Wales and Queensland, Australia using a structured questionnaire in face-to-face interviews. Logistic regression was used to estimate crude and adjusted odds ratios (OR). Findings from the adjusted analysis show that women had a shorter duration of illicit drug use prior to initiation (adjusted OR 0.84, 95%CI: 0.74 - 0.94), and were more likely to have their romantic-sexual partner facilitate the initiation by paying for the drugs (adjusted OR 4.64, 95%CI: 1.21 - 17.73). Women also reported a greater likelihood of being initiated in groups of other women (adjusted OR 2.87, 95%CI: 1.24 - 6.67), suggesting that some women play an active role in their initiation experience rather than relying on, or being lead by, a romantic-sexual partner. These findings demonstrate the crucial role that romantic-sexual partners play in womens initiation experience, but also provide evidence for the way that women can be active participants in their own initiation and in initiating other women.

Factors associated with specialist assessment and treatment for hepatitis C virus infection in New South Wales, Australia

Summary.  Assessment and treatment for hepatitis C virus (HCV) in the community remains low. We evaluated factors associated with HCV specialist assessment and treatment in a cross‐sectional study to evaluate treatment considerations in a sample of 634 participants with self‐reported HCV infection in New South Wales, Australia. Participants having received HCV specialist assessment (n = 294, 46%) were more likely to be have been older (vs <35 years; 35–44 OR 1.64, P = 0.117; 45–54 OR 2.00, P = 0.024; ≥55 OR 5.43, P = 0.002), have greater social support (vs low; medium OR 3.07, P = 0.004; high OR 4.31, P < 0.001), HCV‐related/attributed symptoms (vs none; 1–10 OR 3.89, P = 0.032; 10–21 OR 5.01, P = 0.010), a diagnosis of cirrhosis (OR 2.40, P = 0.030), have asked for treatment information (OR 1.91, P = 0.020), have greater HCV knowledge (OR 2.49, P = 0.001), have been told by a doctor to go onto treatment (OR 3.00, P < 0.001), and less likely to be receiving opiate substitution therapy (OR 0.10, P < 0.001) and never to have seen a general practitioner (OR 0.24, P < 0.001). Participants having received HCV treatment (n = 154, 24%) were more likely to have greater fibrosis (vs no biopsy; none/minimal OR 3.45, P = 0.001; moderate OR 11.47, P < 0.001; severe, OR 19.51, P < 0.001), greater HCV knowledge (OR 2.57; P = 0.004), know someone who has died from HCV (OR 2.57, P = 0.004), been told by a doctor to go onto treatment (OR 3.49, P < 0.001), were less likely to have been female (OR 0.39, P = 0.002), have recently injected (OR 0.42, P = 0.002) and be receiving opiate substitution therapy (OR 0.22, P < 0.001). These data identify modifiable patient‐, provider‐ and systems‐level barriers associated with HCV assessment and treatment in the community that could be addressed by targeted interventions.

Hepatitis C and injecting-related discrimination in New South Wales, Australia

Hepatitis C-related discrimination is reportedly common, however few studies have investigated this phenomenon. This paper presents findings from a cross-sectional study of people with self-reported hepatitis C virus (HCV) infection (N = 504) conducted in New South Wales (NSW), Australia throughout 2001 and 2002. Participants completed a self-administered questionnaire enquiring into their experience of living with HCV. Over a half of the participants (57.5%, n = 290) reported that they had acquired their infection from injecting drug use. Discrimination was reported by 64.7% (n = 326) of participants and healthcare was the most commonly reported site where discrimination occurred. A logistic regression identified the predictors of any discrimination as: knowing many other people with HCV infection; feeling tired due to HCV symptoms; and being younger (<51 years). Predictors of higher levels of discrimination were: knowing many other people with HCV infection; being limited in the time spent with family, friends, neighbours and groups due to HCV; and feeling pessimistic about HCV treatment and the future because of HCV-related ill health. Although discrimination occurred in a range of social domains, effort is needed to improve healthcare workers’ service delivery to people with HCV. Continued discrimination may inhibit people from seeking a range of health services and impede efforts to contain the epidemic.

Factors associated with hepatitis C knowledge among a sample of treatment naive people who inject drugs

BACKGROUND Assessment and uptake of treatment for hepatitis C among people who inject drugs (PWID) is low and strategies to enhance hepatitis C care in this group are needed. Knowledge of hepatitis C and its treatment is one precursor to decisions about treatment. METHODS We conducted a cross-section study designed to evaluate treatment considerations in participants with self-reported hepatitis C infection in New South Wales, Australia. Participants were recruited from needle and syringe programs, opiate substitution clinics, pharmacies that dispensed opiate substitution treatment and from the mailing list of a community-based hepatitis C organisation and completed a self-administered survey. Knowledge of hepatitis C was assessed by a 48-item scale addressing the natural history and treatment of hepatitis C. Factors associated with knowledge were assessed by ordinal regression. RESULTS Among the 997 participants recruited, 407 self-reported acquiring hepatitis C through injecting drug use and had never received hepatitis C treatment. Knowledge about hepatitis C was overall poor and the effects of the long term consequences of hepatitis C were over-estimated. Higher knowledge scores were associated with recruitment site, higher education levels and recent contact with a general practitioner. One-third of participants indicated that they did not intend to have treatment and one-fifth did not answer this question. CONCLUSION Knowledge is a precursor to informed decisions about hepatitis C treatment. These results indicate that efforts to support those less engaged with hepatitis C care (and specifically those on opiate substitution treatment) and those with lower literacy are required.

Feminine sexual subjectivities : Bodies, agency and life history

The relationship between discourse, sex and the body has attracted sustained interest from scholars in sociology and cultural studies over the last 20 years. It is only recently, however, that sociological analyses of sexuality have begun to explore the specificity of the body and its relationship to human agency. This work suggests that, far from serving as a passive surface upon which sexual scripts are inscribed, the body in sexual action is itself a dynamic force in generating sexual subjectivities. This is related to the way in which the praxeological aspects of sex are always corporeal and that corporeality is indivisibly related to individual agency. The specific configuration of sexual practices is central to the making of sexual identities. Indeed, it is through such a configuration that the sexual subject is brought into being. Yet human agency is a central feature of the process, rendering it a project that develops over time. Such an idea is particularly relevant to feminists who are concerned with the way that feminine sexual subjectivity can be theorized as active and desiring. This paper explores the way in which the body is implicated in sex practice and the making of active feminine sexual subjectivities. In doing so, it draws on qualitative data collected from life history interviews with 18 women.

Consumer participation in the planning and delivery of drug treatment services: the current arrangements

INTRODUCTION AND AIMS Consumer participation in decision-making about service planning is common in certain health services in Australia but is thought to be largely underdeveloped in drug treatment services. This paper (1) describes the current practices within Australian drug treatment services that aim to include consumers in service planning and provision; and (2) determines how much consumers know about the existing opportunities for involvement. DESIGN AND METHOD Sixty-four randomly selected service providers (representing 64 separate services) completed interviews about the current arrangements for consumer participation within their services (response rate = 82%). A total of 179 consumers completed interviews assessing their knowledge of the consumer participation activities available at the service they attended. RESULTS Consumer participation activities were not uncommon in drug treatment services, although the existing activities were concerned largely with providing information to or receiving information from consumers. Activities that included consumers in higher forms of involvement, such as those in which consumers took part in decision-making, were largely uncommon. Consumers had a considerable lack of knowledge about the participation activities available to them, revealing a lack of communication between providers and consumers. CONCLUSIONS While service providers were making efforts to engage consumers in service planning and provision (despite the general lack of State or Commonwealth policy directives and extra funding to do so), these appear ineffectual because of poor communication between providers and consumers. As a starting point, a critical part of any meaningful consumer participation initiative must include systems to ensure that consumers know about available opportunities.

Rethinking safety and fidelity: The role of love and intimacy in Hepatitis C transmission and prevention

Abstract Hepatitis C (HCV) is a disease of the liver with a range of potentially debilitating symptoms, the severity of which differ from person to person. HCV is a major public health challenge. Globally an estimated one in 12 persons is affected by the virus, and substantial new transmissions occur each year. The vast majority of new transmissions occur among people who inject drugs, particularly through practices such as sharing of needles, syringes and other injecting equipment. Behavioural surveillance data suggest that the majority of equipment sharing occurs between intimate partners. Despite this, very little research has focussed on intimate partnerships as a site of hepatitis C transmission or prevention. This is in part because people who inject drugs are conventionally represented as lacking capacity for romantic love and intimacy; also, drug ‘addiction’ is produced as the antithesis of voluntarity, autonomy and authenticity, all of which feature strongly in Western understandings of romantic love. This study aims to fill existing gaps in the literature about the relationship between romantic love and injecting drug use (IDU) and to explore injecting drug practices among partners in intimate relationships. Fifteen people who inject drugs, currently in long-term heterosexual relationships, were recruited for in-depth interviews, which were recorded, transcribed verbatim and analysed thematically. The main findings of this study are that romantic love and intimacy figure prominently in the lives of people who inject drugs, and that romantic notions such as commitment, trust, care and support shape how individuals who inject drugs talk about serostatus with their partners and how they account for injecting practices. Moreover, injecting practices are co-produced within intimate relationships, shaped by perceptions of risk within and outside the relationship, ideas of intimacy, and the specific levels of skill and expertise within these relationships. These findings have important implications for harm reduction strategies, which, we suggest, have largely failed to take into account the intimate relationship as a source of practice. We conclude with suggestions for future work in this area.

Is point of access to needles and syringes related to needle sharing? Comparing data collected from pharmacies and needle and syringe programs in south-east Sydney

INTRODUCTION AND AIMS The comprehensive needle and syringe distribution system in New South Wales is partly based on the premise that different points of access to injecting equipment may attract different groups of injecting drug users. This paper examines patterns of equipment acquisition and risk for blood-borne virus transmission among injecting drug users who use pharmacies and needle and syringe programs (NSP) in south-east Sydney. DESIGN AND METHODS Clients obtaining injecting equipment from four NSP (n = 147) and eight pharmacies (n = 227) in 2006 voluntarily completed a self-administered questionnaire. Respondents were grouped into three categories based on their needle and syringe acquisition patterns: exclusive use of NSP, exclusive use of pharmacies and use of both. RESULTS Although it was common for respondents to report using both pharmacies and NSP to obtain needles and syringes (57%), a proportion reported exclusive use of pharmacies (17%) and NSP (14%). Exclusive pharmacy users were more likely to have never received treatment for their drug use and the least likely to have had a recent test for hepatitis C. Compared with respondents who exclusively used NSP, respondents who exclusively used pharmacies were more likely to report receptive sharing of injecting equipment (adjusted odds ratio 5.9, 95% confidence interval 2.02-17.14), as were respondents who reported using both sources (adjusted odds ratio 5.8, 95% confidence interval 2.35-14.40). DISCUSSION AND CONCLUSIONS The high prevalence of receptive equipment sharing among pharmacy clients indicates a need to improve access to needles and syringes and ancillary equipment, possibly by including ancillary equipment at no cost in existing pre-packaged pharmacy products.

Secondary exchange of sterile injecting equipment in a high distribution environment: A mixed method analysis in south east Sydney, Australia

BACKGROUND In Australia, sterile needles are distributed to people who inject drugs through formal services for the purposes of limiting the transmission of blood borne viruses (BBV). Secondary exchange (SE) involves people acquiring needles from formal services and redistributing them to others. This paper describes the extent, patterns and contexts of SE in south east Sydney, Australia and examines whether SE is independently associated with BBV risk practices. METHODS Quantitative and qualitative data were collected through a cross-sectional study using surveys and in-depth interviews. Respondents were people using community-based pharmacies to obtain sterile needles and syringes. RESULTS Data were collected from 229 survey respondents, over half of whom (54%) reported SE in the previous month. Of these, 40% engaged in distribution only, 25% in receipt only and 36% in both. Respondents reported passing on 21.7% of their needles to others in the last month, most commonly to friends (51.6%) and partners (27.4%). Recipients of SE were four times more likely than non-secondary exchangers to report borrowing used syringes in the last month. Respondents reported supplying sterile equipment to others to prevent reuse and to reduce risks associated with unplanned drug use. CONCLUSION SE is a common activity in south east Sydney but does not appear to be highly organised, usually taking place in small networks of friends and/or partners for altruistic reasons. Harm reduction programs could capitalise on the prevalence of SE to reach injecting drug users who do not use formal distribution services.

Syringe coverage in an Australian setting: does a high level of syringe coverage moderate syringe sharing behaviour?

We examined individual-level syringe coverage among 417 people who inject drugs who were recruited from pharmacies in New South Wales in 2009. There was a U-shaped distribution of syringe coverage with many people having very high (51%) or very low (23%) coverage. Overall, two-thirds of respondents (63%) reported adequate coverage (≥100%). Respondents who had not used a needle and syringe program in the previous month were more likely to report inadequate coverage (AOR 2.25, 95% CI 1.25–4.05) as were those who reported daily or more frequent injecting (AOR 3.69, 95% CI 2.00–6.81). Inadequate syringe coverage was not independently associated with receptive needle sharing. The level of syringe coverage was high among this sample, and met targets set out by UNAIDS and other organisations. We found that inadequate syringe coverage was not independently correlated with receptive needle sharing, possibly because coverage is sufficient to diminish the relationship between syringe availability and sharing behaviours.