Hepatitis C prevention and convenience: why do people who inject drugs in sexual partnerships ‘run out’ of sterile equipment?

Rates of hepatitis C virus transmission among people who inject drugs in Australia remain high despite decades of prevention education. A key site of transmission is the sharing of injecting equipment within sexual partnerships. Responsibility for avoiding transmission has long been understood individually, as have the measures designed to help individuals fulfil this responsibility, such as the distribution of sterile injecting equipment. This individualising tendency has been criticised for placing an unfair level of responsibility on poorly resourced, marginalised people and ignoring the social nature of injecting drug use and related health care. Likewise, although research has demonstrated that injecting drug use is gendered, gender and sexual partnerships remain marginal to health promotion efforts. In this article, we address these weaknesses, drawing on a qualitative, interview-based project that explored equipment sharing within (hetero)sexual partnerships. In conducting our analysis, we explore a key theme that emerged in discussions about accessing and sharing injecting equipment, that of convenience, using critical marketing theory to understand this theme. In particular, we investigate the issues of convenience that affect the use of sterile injecting equipment, the many factors that shape convenience itself, and the aspects of equipment use that go beyond convenience and into the realm of intimacy and meaning. We conclude that injecting equipment needs to be both meaningful and convenient if sharing within partnerships is to be reduced further

Authenticity and Diversity: Enhancing Australian Hepatitis C Prevention Messages

Despite two decades of prevention activities and education, rates of hepatitis C infection remain high among people who inject drugs. In this article we draw on the findings of an extensive review of the content of print hepatitis C prevention materials circulating in Australia, examining these data in light of Petraglia’s (2009) theory of “authenticity” in social marketing. We identify three main areas in which resources could be redesigned: closer attention to language and terminology, a critical engagement with common concepts of the individual, and more acknowledgement of the role of social and structural factors in shaping injecting practice. To achieve a stronger sense of authenticity, and in turn become more equitable and efficient, future resources could address these issues using insights from social marketing literature

Hepatitis C prevention education needs to be grounded in social relationships

Most hepatitis C transmission occurs through the sharing of equipment used for injecting drugs, and in many settings, the majority of equipment sharing occurs between sexual partners. Despite this, few health promotion materials directly address sexual partnerships, couples or social relationships in general. This blindspot is one example of the ways in which prevention education in the area of drug use would benefit from careful rethinking. Focusing on the case of Australia, we argue that hepatitis C prevention education insufficiently acknowledges or mobilize social relationships, social dynamics and social contexts in its efforts to prevent hepatitis C transmission. This can lead it to reproduce the conditions for the very problems it seeks to solve. We further argue that hepatitis C prevention education is insufficiently attentive to its own social location, drawing too little on stakeholder expertise. Its effectiveness relies upon its social context, including the collaborative input and engagement of affected communities and other stakeholders. Better recognizing this would produce a stronger foundation for developing prevention strategies. As we conclude, this social foundation for hepatitis C prevention could be articulated into national, collaboratively developed guidelines on effective communication in hepatitis C and injecting drug use risk

Changes in Maternal Gene Expression in Olfactory Circuits in the Immediate Postpartum Period

Regulation of maternal behavior in the immediate postpartum period involves neural circuits in reward and homeostasis systems responding to cues from the newborn. Our aim was to assess one specific regulatory mechanism: the role that olfaction plays in the onset and modulation of parenting behavior. We focused on changes in gene expression in olfactory brain regions, examining nine genes found in previous knockout studies to be necessary for maternal behavior. Using a quantitative PCR (qPCR)-based approach, we assessed changes in gene expression in response to exposure to pups in 11 microdissected olfactory brain regions. Over the first postpartum days, all nine genes were detected in all 11 regions (at differing levels) and their expression changed in response to pup exposure. As a general trend, five genes (Dbh, Esr1, FosB, Foxb1, and Oxtr) were found to decrease their expression in most of the olfactory regions examined, while two genes (Mest and Prlr) were found to increase expression. Nos1 and Peg3 levels remained relatively stable except in the accessory olfactory bulb (AOB), where greater than fourfold increases in expression were observed. The largest magnitude expression changes in this study were found in the AOB, which mediates a variety of olfactory cues that elicit stereotypic behaviors such as mating and aggression as well as some non-pheromone odors. Previous analyses of null mice for the nine genes assessed here have rarely examined olfactory function. Our data suggest that there may be olfactory effects in these null mice which contribute to the observed maternal behavioral phenotypes. Collectively, these data support the hypothesis that olfactory processing is an important sensory regulator of maternal behavior

"Don't think I'm going to leave you over it": Accounts of changing hepatitis C status among couples who inject drugs.

While the health-related benefits of intimate partnership are well documented, little attention has been paid to couples exposed to high levels of social stigma and exclusion. In this project we investigated an important site of stigma for partnerships by collecting accounts of changing hepatitis C (HCV) status ("sero-change") among couples that inject drugs. We explored what these accounts reveal about the meaning of HCV for these couples, and how this understanding contributes to our collective efforts at prevention and care. Drawing from a large dataset of qualitative interviews with couples, we focussed on those containing reports of sero-change. By adopting a methodology that positioned partnerships rather than individuals as the primary unit of analysis, we addressed the commonplace tendency to either overlook or discount as dysfunctional, the sexual relationships of people who inject drugs. While some couples sought greater biomedical understanding as a means of coming to terms with sero-change, others drew on alternative logics or "rationalities" that sat firmly outside conventional biomedical discourse (privileging notions of kinship, for example). Regardless of which explanatory framework they drew on, participants ultimately prioritised the security of their relationship over the dangers of viral infection. Effectively engaging couples in HCV prevention and care requires acknowledging and working with the competing priorities and complex realities of such partnerships beyond simply the identification of viral risk. The "new era" of direct acting antiviral treatments will provide ongoing opportunities to learn to integrate biomedical information within more socially sophisticated, relationally aware approaches

At the intersection of marginalised identities: Lesbian, gay, bisexual and transgender people’s experiences of injecting drug use and hepatitis C seroconversion

While the levels of injecting drug use among lesbian, gay, bisexual and transgender (LGBT) populations are high we know little about their experiences of injecting drugs or living with hepatitis C virus (HCV) infection. The loss of traditional family and cultural ties means connection to community is important to the wellbeing of LGBT populations. While some kinds of drug-use are normalised within many LGBT communities, injecting drug use continues to be stigmatised. This exploratory qualitative study of people with newly acquired HCV used semi-structured interviews to explore participants’ understandings and awareness of HCV, seroconversion, testing, diagnosis and treatment. We present a secondary thematic analysis of eight LGBT participants of the experience of injecting drugs, living with HCV and having a marginalised sexual or gender identity. Community was central to the participants’ accounts. Drug-use facilitated connection to a chosen community by suppressing sexual or gender desires allows them to fit in to the mainstream; enacting LGBT community norms of behaviour; and connection through shared drug-use. Participants also described feeling afraid to come out about their drug-use to LGBT peers because of the associated stigma of HCV. They described a similar stigma associated with HIV within the PWID community. Thus the combination of being LBGT/living with HIV (a “gay” disease) and injecting drugs/living with HCV (a “junkie’s” disease) left them in a kind of no man’s land. Health professionals working in drug and HCV care services need to develop capacity in providing culturally appropriate health care for LGBT people who inject drugs. Key words: Hepatitis C; HIV; Drug Use; Sexuality; Culturally-appropriate; health car

History Memorized and Recalled upon Glass Transition

The memory effect upon glassification is studied in the glass to rubber transition of vulcanized rubber with the strain as a controlling parameter. A phenomenological model is proposed taking the history of the temperature and the strain into account, by which the experimental results are interpreted. The data and the model demonstrate that the glassy state memorizes the time-course of strain upon glassification, not as a single parameter but as the history itself. The data also show that the effect of irreversible deformation in the glassy state is beyond the scope of the present model. Authors' remark: The title of the paper in the accepted version is above. The title appeared in PRL is the one changed by a Senior Assistant Editor after acceptance of the paper. The recovery of the title was rejected in the correction process.Comment: 4 pages, 4 figure

Making sense of ‘side effects’: Counterpublic health in the era of direct-acting antivirals

Direct-Acting Antiviral (DAA) treatments for hepatitis C have been widely promoted by health promotion professionals and medical clinicians as being ‘side-effect free’. In this paper, we draw on data that troubles this approach. We used a mixed method design to collect data from people who inject drugs, and who were DAA treatment naïve, in New South Wales, Australia. We describe knowledge about and perceptions of DAA treatment. We found that concerns about side effects were commonplace – for example, one-third (37%) of participants who had not taken up treatment worried “a lot” about ‘side effects’ – and that these concerns were underpinned by a general distrust and suspicion of medical institutions and their technologies, including widespread negative associations linked to interferon treatment. In trying to make sense of this, we draw on the concept of counterpublic health and its recognition that the everyday health needs, knowledges and aspirations of subordinated citizens frequently contradict the normative frameworks governing public health interventions. We suggest that failing to engage with concerns about ‘side effects’ could hinder elimination efforts. Our analysis suggests that addressing the issue of ‘side effects’ within the ‘public’ discourse of DAAs will not dampen or damage elimination efforts, as some might fear, but rather it will legitimate the concerns of people who inject, decrease their suspicion of medical interventions, and better support the uptake of DAA treatments

Smectic-C tilt under shear in Smectic-A elastomers

Stenull and Lubensky [Phys. Rev. E {\bf 76}, 011706 (2007)] have argued that shear strain and tilt of the director relative to the layer normal are coupled in smectic elastomers and that the imposition of one necessarily leads to the development of the other. This means, in particular, that a Smectic-A elastomer subjected to a simple shear will develop Smectic-C-like tilt of the director. Recently, Kramer and Finkelmann [arXiv:0708.2024, Phys. Rev. E {\bf 78}, 021704 (2008)] performed shear experiments on Smectic-A elastomers using two different shear geometries. One of the experiments, which implements simple shear, produces clear evidence for the development of Smectic-C-like tilt. Here, we generalize a model for smectic elastomers introduced by Adams and Warner [Phys. Rev. E {\bf 71}, 021708 (2005)] and use it to study the magnitude of Smectic-C-like tilt under shear for the two geometries investigated by Kramer and Finkelmann. Using reasonable estimates of model parameters, we estimate the tilt angle for both geometries, and we compare our estimates to the experimental results. The other shear geometry is problematic since it introduces additional in-plane compressions in a sheet-like sample, thus inducing instabilities that we discuss.Comment: 8 pages, 5 figure