What's in a virus? Folk understandings of hepatitis C infection and infectiousness among injecting drug users in Kings Cross, Sydney

BACKGROUND: To explore folk understandings of blood borne virus infection and infectiousness among injecting drug users in Kings Cross, Sydney. METHODS: Observational fieldwork was conducted in Kings Cross over a four month period. In-depth interviews with 24 current injectors and 4 key informants recruited from King Cross were undertaken. RESULTS: Hepatitis C (HCV) generated different meanings from HIV. HIV was considered "the dreaded" and generated fear of infection and dire disease progression. Whereas HCV was considered non-desirable but less threatening than HIV. The risks of transmitting HCV through sharing injecting paraphernalia was poorly understood. Some believed HCV infection was linked to poor hygiene and dirty water. Jaundice was mistakenly thought to indicate HCV infection and was used to gauge infectiousness. Many were confused about their current hepatitis C serostatus. Some participants thought they had a "dormant antibody" or that they had a "mild case" of infection. Participants were unsure what this meant for their own health or for their potential to infect others. CONCLUSION: Participants displayed confusion about transmission risks for hepatitis C, conflating blood awareness and hygiene health promotion messages. Participants' reliance on the symptom of jaundice to gauge serostatus places them at risk of transmitting and contracting HCV. Participants were confused about what a positive HCV diagnosis meant for their own health and their ability to infect others. Education is needed to debunk misconceptions about jaundice and clarify medical terms such as 'antibody' at the time of diagnosis. Further clarification of messages about injecting hygiene and blood awareness are also required

Needle and syringe distribution trends in Western Australia, 1990 to 2009

Introduction and Aims To describe needle and syringe distribution trends of needle and syringe programs (NSP) between 1990 and 2009 in Western Australia, and explore contributing factors within the national and state strategic and legislative environment. Design and Methods The number of needles and syringes distributed by each of the four NSP types [needle and syringe exchange program (NSEP); health service; pharmacy; vending machine] between 1990 and 2009 were stratified by time period and geographic location using Microsoft Excel. Results Total needle and syringe distribution over the 20-year period increased by eight-fold. Regional areas experienced the highest growth: 20-fold increase compared with seven-fold increase in metropolitan areas. The proportion of needles and syringes distributed through NSEPs increased from 33% to 62% between 1990 and 2009, and through health services increased from 3% to 8% between 1994 and 2009. The proportion distributed through pharmacies decreased from 67% to 28% between 1990 and 2009, and through vending machines from 7% to 1.3% between 1992 and 2009. National and state HIV and hepatitis C strategies guided NSP provision at an early stage, and expedited legislative amendments to allow for the operation of approved NSPs. Discussion and Conclusions The majority of growth occurred through the NSEPs and health service NSPs, which are publicly funded NSPs and provide injecting equipment either on ‘exchange’ or free-of-charge respectively. The Health Department of Western Australia recognises the increasing reliance on publicly funded NSPs and the need to continue this cost-effective public health program