Reinforced biographies among women living with hepatitis C

In a growing body of social research it is suggested that hepatitis C virus (HCV) infection is a low priority for people who inject drugs. We expand on the evidence to explore the link between identity and health using biographical adaptation theories. We examined experiences of HCV infection and illness among women who inject drugs, women who are no longer injecting drugs, and women who have never injected drugs. We investigated the relationship between identity and illness experience and found that illness does not simply dislocate one's biographical trajectory. For women who used drugs the shared symbolism of HCV infection was understood and accepted via a self-identity linked to poverty and experience of injecting drugs. Rather than disrupting their expected life trajectory, the narratives of most women incorporated the disease experience within their life story, confirming their identity as a person who injected drugs and as someone with constant and serious life stressors

Internal or Infernal Devices: Experiences of Contraception Among Australian Women Living With Hepatitis C

In this article we seek to delineate the experiences of contraceptive use by Australian women living with hepatitis C. Using semi-structured, in-depth interviews, 109 women with hepatitis C from two cities in Australia, Melbourne (Victoria) and Canberra (the Australian Capital Territory), were interviewed about their alcohol and other drug use, their contraceptive history, and their experiences of hepatitis C. We aimed to understand why such a high proportion of women living with hepatitis C (66%) had previously reported that they were not currently using contraception. Many women had used contraception at some stage of their lives but were no longer using it because they had experienced contraceptive failure or uncomfortable side effects. Others were concerned about the impact of contraception on their fertility, were planning to get pregnant or considered themselves to be celibate. Hepatitis C appeared to have little impact on their contraceptive practices, but some women's illicit drug use had an important influence. Illicit drug use was, for some, an encouragement to seek long-term forms of contraception that reduced their chances of pregnancy while for others drug taking hampered their contraceptive use. In compliance with health promotion campaigns of the last two decades, women were generally more concerned about preventing sexually transmissible infections than pregnancies, particularly with new or casual partners

Aged care services for Indigenous people in the Australian Capital Territory and surrounds: analysing needs and implementing change

Objective: To ascertain and meet current and anticipated needs for residential care and other services by older Indigenous people in the Australian Capital Territory (ACT) and region. Methods: With advice from a reference group, qualitative and quantitative data were gathered from 98 older (45 years and over) Indigenous people in the ACT and region during 1999/2000. Indigenous and non-indigenous researchers worked closely throughout all phases of the research. We helped participants with immediate problems identified during the interviews and worked directly with the Government funding body to implement the findings. Results: No one expressed a current need for residential services. In terms of future needs, 50% of respondents favoured an arrangement where an existing mainstream provider of aged care accommodated a cluster of Indigenous people in the same facility as non-Indigenous people. Thirty-two per cent preferred an Indigenous-run organisation. Our study also revealed a broad range of health problems and needs. Assessment using the Resident Classification Scale showed that 70% required a low level of care and 4% needed a high level of care. Conclusion: The research identified the needs and provided a health profile of older Indigenous people in the ACT and region. This then provided policymakers with evidence on which they acted to provide appropriate aged care services. Implications: Collaboration between Indigenous and non-Indigenous researchers can access high-quality information, and partnership between researchers and policymakers can improve Indigenous services

Positive health beliefs and behaviours in the midst of difficult lives: Women who inject drugs

Background: It is assumed that people who inject drugs (PWID) care little about their health. This emerges from social and moral perceptions of PWID and is framed by research that focuses on their morbidity and mortality. Drawing on the narratives of Australian women who inject drugs, we examined the salience of health for our participants and the contexts that structure their descriptions of health and wellbeing. Methods: We conducted qualitative interviews with 83 women who inject drugs and live with hepatitis C virus (HCV) to explore their experiences of health and health care seeking. Findings: Although the interviews focused on HCV, women discussed their health within broader contexts of drug dependence, unstable housing, unemployment, financial strain, other health issues and relationships. Concern about HCV was less pronounced than concerns about other health problems and socio-economic circumstances. Broadening the focus of health beyond drug use alone, women's narratives strongly suggest that PWID can and do care about their health. Conclusions: Whilst research and policy often focus on health problems and barriers to health amongst PWID, the women in our sample maintained positive health beliefs and behaviours. Much like other members of society, their health priorities are contextualised by cultural, economic and political factors. This suggests that health interventions aimed at women who inject drugs could build upon the salience of a range of health priorities as well as integrating these with structural interventions designed to improve housing and economic status

Walan Girri: developing a culturally mediated case management model for problematic alcohol use among urban Indigenous people

OBJECTIVE. To describe the design and implementation of a culturally mediated case management model at Winnunga Nimmityjah Aboriginal Health Service (Winnunga) for Indigenous clients who consume alcohol at problematic levels. METHODS. Our research took place from March 2008 to March 2010 in the Australian Capital Territory and built on previous research partnerships between Winnunga and The Australian National University’s National Centre for Epidemiology and Population Health. We conducted a review of existing models to determine elements for consideration in the community controlled setting, and conducted staff surveys to assess current levels of skill and confidence around alcohol screening, brief intervention and care planning. Using the information from the review and staff surveys, we then undertook staff capacity building to build confidence and skills in conducting alcohol screening, brief intervention and care planning. This process was driven by Winnunga’s social health team. To meet Medicare benefits schedule requirements, and frame the study within the Aboriginal and Torres Strait Islander Chronic Disease Package framework, we included team care arrangements, care planning and health checks. RESULTS. Elements of case management were suggested by staff and incorporated into the final model. Forty staff in the health service participated in identifying training needs for the development of the case management model and undertook a range of training before the model was implemented. Staff working within the social health team decided that the focus of the case management was to build a stronger future for their clients, hence the name of the case management model ‘Walan Girri’ (Wiradjuri language for strong future). The model included a package of screening instruments and brief intervention, related polices and discussion of ‘mob’ and ‘country.’ Changes in Winnunga management and staff, the composition of the research team and the way Walan Girri evolved led to protracted development and implementation. CONCLUSIONS. This project highlights considerations for implementing a case management model in a dynamic health service environment. Capacity building for Winnunga staff and for an Indigenous PhD scholar were part of the process and were integral in maintaining momentum in the project.The original research was funded by the DoHA. The first author’s PhD research was initially made possible by an NHMRC scholarship and then by an Indigenous Visiting Research Fellowship at the Australian Institute of Aboriginal and Torres Strait Islander Studies. NCEPH provided additional funding for salary and for community outreach activities

Where's your country?' New approaches for working with problematic alcohol use among Indigenous Australians in an urban setting

Conversations between Indigenous Australians meeting each other for the first time often include the question, ‘Where’s your country?’. ‘Country’ is used by Indigenous Australians to refer to land which for them has historical and cultural significance. The association between Indigenous Australians and country and emerging literature on the importance to wellbeing of maintaining that association suggests that dislocation from country may have significance for treatment and rehabilitation of problematic alcohol drinking. Our paper has two parts: it describes a project conducted between 2008 and 2009 that evolved into a PhD commencing late 2009 (RL undertaking, PD and JG supervisory panel members); it then describes the PhD, which hypothesises that some people may be living on country from which they may not derive Indigenous cultural identity and that problematic alcohol use is associated with that dislocation

Alcohol, other drug use, and gambling among Australian Capital Territory (ACT) workers in the building and related industries

Aims: To describe the prevalence of alcohol, drug, and gambling problems among building and related workers in the ACT. Methods: Workers at 9 major construction and maintenance sites in the ACT received self-administered questionnaires, which they completed on site and returned to researchers. Findings: Workers returned 254 usable questionnaires. Response rates varied by location but were between 70 and 80% on larger sites. They reported high levels of tobacco, cannabis and amphetamine use and 19% reported self-diagnosed alcohol problems, 11.5% gambling problems and 18% problems in their family life. Conclusions: This study found high levels of alcohol, and other drug use among building and related workers and high levels of self-diagnosed problems associated with this use and with gambling. While an existing union-led program aims to reduce harm on the worksite, the levels of self-reported family and gambling problems found in this study suggest that more needs to be done for workers and their families off worksites