Academic journal article Australian Journal of Social Issues

Understanding the Context of Risk Practices among Injecting Drug Users: Implications for Hepatitis C Prevention

Academic journal article Australian Journal of Social Issues

Understanding the Context of Risk Practices among Injecting Drug Users: Implications for Hepatitis C Prevention

Article excerpt

Introduction

`Risk' has become a keyword in recent sociological studies of health and related behaviour (Gabe 1995; Lupton 1993; Hayes 1992; Rayner 1992; Douglas 1986), particularly in discourses about HIV/AIDS (Habib et al. 2000-2001; Rhodes 1997; Bloor 1995a, 1995b; Schiller et al. 1994; Connors 1992; Pollak et al. 1992). This keyword is also considered central to the study of the social aspects of hepatitis C (HCV) and to mapping its determinants. The reason for this is that HCV is a behavioural disease which progresses mostly throughout an injecting drug-using population via different interacting patterns and social relationships. As with HIV, the HCV epidemic and associated risk behaviour are of profound sociological significance, not only because of the threat to public health, but also because the onset and course of the disease are interrelated to social behaviour.

The risk of HCV infection among injecting drug users (IDUs) has been the subject of inquiry among behavioural and social scientists, and epidemiologists for many years (MacDonald et al. 2000; Loxley 2000, 1998). Research up until the present has found that high rates of needle sharing have been a common problem for some IDUs (Crofts et al. 1997). It is now well known that sharing injecting equipment puts IDUs at risk of HCV via the transmission of contaminated blood. It is apparent that when the virus is introduced into a community of IDUs, it spreads rapidly and infects a large proportion of individuals who inject drugs. Furthermore, many investigators see IDUs as the epidemiological bridge to other people because of the various mixing patterns within a population.

The context of risk behaviours is important to understanding continued risky injecting practices among drug users (Rhodes 2002, 1995). Previous research shows that sharing injecting equipment occurs most often among people in a relationship or social network; whether family, partner or close friend--wherever members are, at least potentially, mutually oriented to one another and may influence each other's behaviour (Koester 1996; Bloor 1995b; Barnard 1993; Harding and Zinberg 1977). These dynamics of the HCV epidemic among IDUs highlight the importance of a basic knowledge about the context of drug use and risk practices, as well as of the interaction of drug users in their naturally occurring social contexts.

With respect to behavioural change in risk practices, numerous epidemiological studies have been undertaken in the areas of injecting drug use in response to HCV prevention in Australia (MacDonald et al. 2000; Loxley et al. 1997; Crofts et al. 1997). These studies related to the onset of HCV appear too frequently to allow us to ignore the social aetiology of factors that are recognised as more immediately relevant. If changes in risk behaviour influence the course of HCV, it is important to understand the factors that influence behavioural change in general and the onset of risk behaviour in particular. In the absence of efficacious vaccines against this virus, all health promotion strategies to prevent the further spread of HCV infection should focus on changing human behaviour, more specifically injecting behaviour.

No social studies so far have addressed IDUs' risk practices in relation to HCV transmission in Australia, nor the contexts and constraints preventing safer behaviour. This paper investigates the context of HCV-related risk behaviour among IDUs and discusses the behavioural and social determinants of such practices. The aim is to examine how risk is constructed in the context of the everyday lives of IDUs. Although the social `efficiency' of different interacting patterns within the IDU population is not highlighted here, a focus has been placed on regular partners to shed light on the ways in which individuals behave in a risky fashion.

Method

This paper is based on a self-administered survey, conducted by the author between January and June 1998. …

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