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Hepatitis C and Initiation into injecting drug
use in a rural setting
NEWS
FLASH
Download Final
Report, Hepatitis C in a Regional Setting (1 Mb)
Download Fact Sheet,
Hepatitis C in a Regional Setting (80kb)
Download Recommendations,
Hepatitis C in a Regional Setting (80Kb)
This additional study has been funded by the
Department of Human Services (DHS) through a Public Health Research
Project Grant (Communicable Disease Research).
Introduction
This is a 12 month in-depth study of hepatitis C (HCV) risk and
the initiation into injecting drug use in a rural setting. The DHS-funded
study has taken advantage of the established presence of the research
team in Bendigo through the My Body My Drugs My World study and
has provided resources for a more in-depth analysis of the emergent
issues in this regional setting. Contact with young people, families
and service providers in Bendigo has enabled access to the experiences
of young people in the first year of injecting a drug for the first
time.
The focus of the study
This is a qualitative study using non-probabilistic (social network)
sampling. Two key research strategies have been used, ethnographic
research (using fieldwork observation and in-depth interviews) and
group discussions. These methods are particularly well suited to
investigating drug use in sensitive social contexts.
Methodological considerations
Ethnographic research produces in-depth understandings in specific
social contexts. This style of research is inherently inductive
in the strategy of inquiry, i.e. the study does not set out to test
hypotheses, rather it produces further questions and gathers data
in order to document the social lives of the people in the ethnographic
fieldsite. Ethnography also produces evidence of its activity through
the "writing of culture", or stories from the field. As
a consequence, stories are the central output from the study.
As the quality of ethnography is determined by
the quality of the relationships developed during fieldwork, ethnographic
research is dependent on time spent in the "fieldsite",
getting to know drug users and participating in the lives of the
subjects of the research over an extended period of time.
DHS project funding, enabled time to be spent
in the fieldsite and to produce more in-depth understandings of
HCV risk for young injecting drug users.
As more in-depth understandings were developed,
interviews and group discussions were conducted in the latter half
of 2003 with affected community leaders (1 focus group), young drug
users (3 focus groups) and parents of drug users (1 group). The
fieldsite is well developed and mature relationships have been established
in a sensitive social context.
Ethnographic fieldwork
Observations and semi-structured interviews of 1-2 hours duration
have been conducted. The criterion for inclusion into the study
is that a drug user must have injected for the first time in the
previous 12 months. In addition to interviews with injecting drug
users, the research team has consulted with parents of drug users
and elders from the Indigenous community.
Recruitment of study participants has been through
word-of-mouth in social and drug using networks. The study already
has approval from the University of Melbourne Human Research Ethics
Committee.
Interviews and group discussions were audiotaped,
and subsequent theme analysis conducted using a coding scheme developed
in the course of data collection. The software package Annotape
(v.2, RoseHill Software Ltd, 1999) has been used for data management.
Group discussions
Two types of small group discussions have been conducted with drug
users in Bendigo. The first was conducted with a small friendship
network of young injecting drug users. Discussions are conducted
in drug users' own homes. This was a particularly productive setting
as discussion is embedded in everyday interactions. This has prompted
an exploration of the particular character of sociality for injecting
drug users.
Facilitated group discussions held in a private
room in a Bendigo hotel provided a traditional space for drug users
to reflect on issues of hepatitis C risk, identity and sociality.
Emerging from this discussion was a focus on the impact of rural
setting in the development of stigma. Sociality was found to revolve
around a dynamic set of relations between drug users and dealers
in a social "fishbowl". In this setting small drug-using
networks reflect on the ways they negotiate risk both individually
and as a group. After conducting group discussions ins drug user's
house we have developed some important understandings of sociality
for young injecting drug users.
The group discussion approach has identified
areas for further exploration in the sociality of drug-using networks.
This will be developed further in the remainder of the study.
Findings
The following are preliminary findings of importance
to Hepatitis C risk.
(1) Risk settings
Times and places and social conditions that involve the risk of
hepatitis C (HCV) transmission.
- HCV social risk settings
Rather than conceptualising the risk of HCV spread through individual
behaviours, we have noted that small networks are important units
for understanding risk. The independent functioning of small drug-using
networks allows HCV risk practices to propagate by virtue of the
sociality of drug using experience. Poor HCV knowledge and complex
sociality contribute to small networks as a key mechanism for
HCV transmission.
- Knowledge of HCV risk in the community
Service providers, families and drug users are not fully aware
of the extent of HCV in their own community. There is poor understanding
of data sources on HCV transmission in Bendigo. A prevailing view
is that 90% of drug users in Bendigo have HCV. There is no evidence
that this is the case. However, injecting drug use has become
synonymous with HCV infection and it has become inevitable that
a new injector will become HCV positive. This is an important
impediment to HCV prevention strategies if the community believes
that HCV infection is inevitable.
- Belonging in Bendigo
There are specific features of growing up and becoming an injecting
drug user in Bendigo. There is a history to cultural life in Bendigo
that gives priority to conservative social values. This creates
a set of social expectations about what it means to belong in
Bendigo. Drug users reported a strong sense of belonging in Bendigo
compared to living often anonymously in Melbourne. There was however
a price to this belonging. Belonging in Bendigo, when recognised
as a drug user meant experiencing significant stigma and disadvantage.
Therefore maintaining anonymity either in Melbourne or in Bendigo
use carries with it an economy of belonging.
(2) ) Initiation to Injecting and Identity
Becoming an injecting drug user is often conceptualised as an epidemiological
event, through the movement of a drug user from one risk category
to another. We use ethnographic description to document the relationships
that form the process of initiation.
The description traces several ethnographic fragments
in the initiation experience of one injecting drug user. Initiation
to injecting drug use is best understood as a relational experience
between Body, Self and Other. Specific relationships are explored,
such as the relationship between user and dealer, the user and their
own body and a transformation in the sense of self. When understood
through a relational lens, the new drug user is particularly amenable
to new social and corporeal re-configurations. The pleasure and
risk of transformation is central to the initiation experience,
and is shaped by the drug users' relationship with their own body
in the experience. It is suggested that initiation to injecting
drug use is as much about drug effect, as it is about social and
corporeal transformation.
Story #1 - Kylie's
Initiation
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