Academic journal article Health Sociology Review

Multiple Stigmas, Shame and Historical Trauma Compound the Experience of Aboriginal Australians Living with Hepatitis C

Academic journal article Health Sociology Review

Multiple Stigmas, Shame and Historical Trauma Compound the Experience of Aboriginal Australians Living with Hepatitis C

Article excerpt

Introduction

It is well established that stigma contributes to the burden associated with an illness or health condition (Earnshaw & Quinn, 2012) and to shaping inequalities in health outcomes (Hatzenbuehler, Phelan, & Link, 2013). Previous writers have emphasised the importance of considering relational and structural elements in the study of healthrelated stigma. These authors argue that individualistic notions of stigma, focusing on the beliefs and attitudes of those who stigmatise others, obscure the social processes of power and control that lie behind the marking of individuals or groups for social exclusion (Parker & Aggleton, 2003; Scambler, 2006). Examining the experience of minority populations in living with a stigmatised condition brings to the foreground notions of stigma as a multi-level construct (Cook, Purdie-Vaughns, Meyer, & Busch, 2014). In this study of Aboriginal and Torres Strait Islander Australians (hereafter referred to as Aboriginal Australians) living with hepatitis C (HCV) in New South Wales (NSW), it is clear that a conceptualisation of stigma that incorporates social, cultural and historical forces is required when considering the experience of a minority community living with a socially maligned infectious disease that is associated with a criminal activity (injecting illegal drugs).

HCV is a major public health challenge. HCV is transmitted via blood to blood contact, hence practices which penetrate the skin such as unsterile medical procedures, tattooing and piercing can lead to transmission of the virus. In Australia, approximately 90% of new infections are associated with the use of unsterile equipment for injecting drugs (Gidding et al., 2009). Chronic infection occurs in approximately 75% of those exposed to the virus (Gidding et al., 2009). A smaller proportion, less than 10% of those chronically infected, will go on to develop serious advanced liver disease, cirrhosis or liver cancer (Grebely & Dore, 2012).

Aboriginal Australians are identified as a key priority group for national efforts to address HCV. The Australian Aboriginal population is over-represented in both the prevalence of HCV and incidence of newly reported HCV infections. In 2008, approximately 16,000 Aboriginal Australians were estimated to be living with chronic HCV infection, representing around 8.3% of the total Australian population living with chronic HCV at the time (National Centre in HIV Epidemiology and Clinical Research, 2008); Aboriginal Australians comprise approximately 3% of the population (Australian Bureau of Statistics, 2012a). In 2011, there were 652 new cases of HCV infection reported among the Aboriginal population representing 6.4% of all new infections (Kirby Institute, 2012). Additionally, the rate of HCV diagnosis in 2011 for Aboriginal Australians was more than six times higher than the rate in 15-19 and 20-29 age groups compared with nonAboriginal populations. These data parallel infection rates among Canadian Inuit and First Nations populations who have similar patterns of colonisation and socio-economic disadvantage (Rempel & Uhanova, 2012; Wu et al., 2007).

Epidemiological research and surveillance data show that Aboriginal Australians are over-represented in groups most at risk of HCV. Aboriginal Australians comprise approximately 11-12% of the sample collected in annual, national surveillance studies of more than 2000 participants conducted in Needle and Syringe Programs (Iversen & Maher, 2013) and 15-20% among participants recruited from pharmacies in NSW that distributed equipment for injecting drug use (Bryant, Wilson, Hull, & Treloar, 2010). Aboriginal people constitute approximately 27% of the Australian prison population (Australian Bureau of Statistics, 2012b). Australian data show HCV rates of 50% among adult prison inmates with a history of injecting drug use (49% for men and 68% for women) (Butler, Lim, & Callander, 2011) and HCV rates of 7. …

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