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Research has documented the negative impact of stigma on health outcomes for people living with HIV (PLHIV). How central HIV is to the identity of the individual may increase the negative effects of stigma, including greater psychological distress, while having strong social supports may play a buffering role. This study aimed to establish whether internalised stigma mediates the relationship between the centrality of HIV identity and psychological distress, while also assessing the role of social support as a moderator. PLHIV (n = 181) responded to a survey assessing experiences of living with HIV focussed on centrality of HIV identity, internalised stigma, and wellbeing. After controlling for age and education, findings from the mediation analysis show that the more central HIV is to an individual's identity, the more stigma is internalised and the greater the negative impact on psychological wellbeing. However, this is only the case for people with low levels of social support. Regardless of how central HIV is to identity, social support appears to act as a buffer and promote positive wellbeing. For those working with PLHIV, promoting the importance of good social support systems may be one way to address some of the negative impacts of stigma. [ABSTRACT FROM AUTHOR]

Complex lifestyle issues associated with injecting drug use may make it difficult to provide care to people who inject drugs (PWID). Negative attitudes towards PWID can undermine the provision of good quality care, hence, it is important to explore the impact of health workers' attitudes in the delivery of care to PWID. An online survey was administered to 336 health workers assessing contact with and attitudes towards PWID, concerns about these clients as well as whether health workers feel stigmatised by working with PWID. Health workers were also asked whether they supported the discriminatory behaviour of a colleague in a series of hypothetical scenarios about working with PWID. In correlational analyses, negative attitudes towards PWID, greater concerns about the behaviour of PWID, not feeling stigmatised by colleagues and seeing fewer clients who inject were associated with greater support for discriminatory actions in the hypothetical scenarios. Multiple regression analysis results showed that only attitudes towards PWID and concerns about the behaviour of injecting clients remain independent predictors of participant support for the hypothetical scenarios. This research highlights the role of attitudes toward PWID in understanding health workers' decisions, practices and potential behaviour. [ABSTRACT FROM AUTHOR]

This study compared attitudes towards homosexuality of 164 students from two faculties at a rural Australian university. Eighty-two percent of participants were aged from 18-24 years, 65% percent of the sample were female with 58% of participants enrolled in a humanities course and 42% in a business course. A cross-sectional design using the Heterosexual Attitudes to Homosexuals (H.A.T.H.) and Fear of HIV/AIDS questionnaires found that for the total sample the major predictors of homophobia were fear of HIV/AIDS, gender, religiosity, and academic major. Business majors were significantly more homophobic than humanities majors. The findings imply that homophobia may be prevalent among university faculties and that staff and student programs need to be implemented to address homophobia, especially among business majors and lecturers. [ABSTRACT FROM AUTHOR]

Expansion of Needle and Syringe Programs (NSPs) to non-specialised sites requires an NSP workforce with skills in engaging stakeholders who may have different opinions of NSP. This study examined the strategies used by NSP workers to develop and maintain NSP services and the emotional labour involved in performing this work. Qualitative interviews were undertaken with 12 staff of a NSP network in metropolitan Sydney, Australia. Participants had undertaken a range of activities to expand NSP sites, often in unwelcoming environments in which NSP was viewed as a “cowboy” service. Participants’ strategies included building positive, ongoing inter-group contact, being visible in external services, and maintaining their professionalism to promote NSP as a legitimate service and themselves as legitimate health workers. Some participants employed strategies which were at odds with their personal and professional values. Participants relied on cohesion within the NSP team to support and encourage each other. Dealing with external services to establish and maintain NSPs was a source of significant emotional labour for NSP workers and was grounded in the stigma attached to injecting drug use. NSP policies and procedures should account for this additional work undertaken by NSP staff and leadership is required to address stigmatisation of NSPs. [ABSTRACT FROM PUBLISHER]

Adherence to treatment for hepatitis C virus (HCV) infection is associated with the successful eradication of infection. However, patients often have difficulty adhering to HCV treatment because of factors such as the psychiatric side effects of regimens and social disadvantage. Commonly, health professionals including specialist physicians, nurses, social workers and psychologists work together under a multidisciplinary model of shared-care to support patients’ adherence to HCV treatment. In some HCV treatment clinics, shared-care is not always available, or only partially implemented and this has implications for patient adherence. To explore the facilitators of adherence, an interview-based study was conducted in 2012 with a purposive sample of Australian physicians and nurses (N = 20). The findings reveal that when comprehensive shared-care was limited or unavailable, physicians and nurses filled in the gaps by assuming roles outside of their expertise to help patients adhere to HCV treatment. Physicians and nurses applied instrumental support strategies based on psychosocial interventions, namely patient advocacy, pragmatic problem-solving, treatment engagement and emotional support. These strategies were provided by dedicated physicians and nurses to address shortfalls in multidisciplinary shared-care. Although these interventions were reported to assist adherence, there is an increased risk of complications when physicians and nurses move beyond the bounds of their disciplinary training, for example, to assess and manage patients’ psychiatric side effects or advocate on their behalf for social services. Future research should measure the effectiveness of instrumental support strategies on HCV treatment adherence, and explore the costs associated with physicians and nurses providing instrumental support in the absence of comprehensive multidisciplinary shared-care. [ABSTRACT FROM PUBLISHER]

Research indicates that patients treated with interferon-based regimens can experience persistent neurotoxicity after treatment ceases and new symptoms attributable to the regimens can emerge post-treatment. To explore post-hepatitis C virus (HCV) treatment outcomes, in-depth interviews were conducted with a self-selected sample of people from two Australian states who had completed an interferon-based regimen at least 24-weeks prior to being interviewed. Participants comprised almost equal numbers of men and women aged from 26 to 57 years, who were treated for HCV genotypes 1 through to 4, and included treatment responders, non-responders and those who had relapsed after treatment. Of 27 participants who volunteered to be part of this study, 25 reported persistent physical and psychological side-effects after treatment. Participants perceived a direct causal link between the treatment regimen and their ongoing symptoms. Reportedly, recovery from treatment was inhibited by an absence of a follow-up protocol that identified and addressed patients’ post-treatment needs, including medical care for persistent side-effects, referral, and information and advice about lifestyle issues. Although the study’s sample was not representative of all people treated for HCV, it is likely that persistent side-effects and their impact can affect other patients following completion of HCV treatments. Further prospective studies of HCV treatment outcomes are needed. In the meantime, the systematic implementation of a follow-up protocol in liver clinics might expedite recovery in patients who experience ongoing adverse health. [ABSTRACT FROM PUBLISHER]

Aim: A cross-sectional study was conducted to explore knowledge of viral hepatitis among attendees of an Australian metropolitan university. Method: A short survey enquiring into viral hepatitis A, B and C (HAV, HBV and HCV, respectively) was administered to a convenience sample of people at a campus in Sydney, Australia during September 2011. Results: A total of 340 participants completed the survey. Among this sample, the risks for transmission of viral hepatitis, particularly HCV, were generally well understood; however, there were substantial gaps in knowledge about the hepatitis vaccines and treatments. Univariate analyzes indicated that participants who reported religion as unimportant to them had better overall knowledge about HBV and HCV than people for whom religion was reportedly important. Similarly, participants without children had better knowledge of HCV than participants who had children. Conclusions: Although the sample was not representative, these findings suggest that among Australians more work is needed to promote knowledge of HAV and HBV vaccines and HBV and HCV treatments. It is prudent to educate young people about the risks for viral hepatitis before they are sexually active, engaging in injecting drug use or planning body modification. [ABSTRACT FROM AUTHOR]

Background: Little is known about the factors that influence injecting drug users’ (IDUs) choice of outlet, and in particular why some IDUs might prefer to use pharmacies. Greater understanding of the influences on this choice will contribute to more sophisticated policy and programme responses for blood-borne virus prevention and for health and wellbeing programmes for people who inject drugs. Method: In-depth interviews were conducted with 15 IDUs about their experiences of accessing injecting equipment from pharmacies that participated in the government-sponsored pharmacy needle and syringe scheme. Results: A range of factors influenced participants’ decisions about equipment access. The advantages of the pharmacy scheme access included convenience, relative anonymity, increased positive feelings of self-worth when accessing equipment from pharmacies where they had a good relationship with staff, less police surveillance and access to a greater range of equipment than available in publicly funded Needle and Syringe Programmes. The disadvantages of pharmacy access included the cost of equipment and complications related to methadone dosing and equipment access. Conclusion: Pharmacy access to injecting equipment is highly valued by IDUs. The results of this study direct attention to several elements of programme and policy in the area that would increase access to equipment from pharmacies relating to cost, need for exchange, police surveillance practices, out-of-hours access and anonymity. [ABSTRACT FROM AUTHOR]

Hepatitis C treatment is known to produce significant physical and psychiatric side-effects. Healthcare workers in hepatitis C treatment clinics focus on preparing people to cope with these side-effects. Unrealistic optimism, or judging oneself to be at low risk of negative events, has been implicated in contributing to practices that place health at risk and to delays in seeking help or facilitating coping with negative events. In the context of hepatitis C treatment, patients with overly optimistic expectations of their ability to cope with treatment-related side-effects are less prepared for their impact and therefore may be more likely to discontinue treatment. In this exploratory qualitative study, data from semi-structured interviews with 20 people undergoing hepatitis C treatment and six healthcare workers at three hepatitis C treatment clinics in Sydney, Australia were explored for the presence of unrealistic optimism and also the impact that this had on patients' processing of information pre-treatment and management of side-effects during treatment. The concept of unrealistic optimism was evident in both patients' and healthcare workers' interview transcripts. Patients' descriptions of their preparation for hepatitis C treatment included references to delays in seeking help for depressive symptoms attributable to unrealistic optimism. Healthcare workers also discussed their observations of the effects of unrealistic optimism on patients' coping strategies. Data from this study contribute to an understanding of unrealistic optimism and its impact on the experience of hepatitis C treatment side-effects, patients' coping styles and potential for delays in seeking help. Unrealistic optimism should be explored as part of pre-treatment assessments for hepatitis C treatment and considered throughout treatment to avoid delays in help seeking. [ABSTRACT FROM AUTHOR]

Hepatitis C-related discrimination is reportedly common, however few studies have investigated this phenomenon. This paper presents findings from a cross-sectional study of people with self-reported hepatitis C virus (HCV) infection ( N ?=?504) conducted in New South Wales (NSW), Australia throughout 2001 and 2002. Participants completed a self-administered questionnaire enquiring into their experience of living with HCV. Over a half of the participants (57.5%, n ?=?290) reported that they had acquired their infection from injecting drug use. Discrimination was reported by 64.7% ( n ?=?326) of participants and healthcare was the most commonly reported site where discrimination occurred. A logistic regression identified the predictors of any discrimination as: knowing many other people with HCV infection; feeling tired due to HCV symptoms; and being younger ( [ABSTRACT FROM AUTHOR]

The term "needle fixation" is increasingly used by researchers and health professionals to explain a range of drug injecting attitudes and practices. This article employs an innovative discourse analysis approach to consider this notion of needle fixation. Foucault's theories of power, knowledge and discourse are taken up in examining a recent literature review of material considered to support the idea of needle fixation, and in conducting a secondary analysis of transcripts of interviews with people who inject methadone. Some correspondence in definitions of needle fixation was found between the literature and the interview subjects, but significant differences, both within and between literature and interviews were also observed. We argue that needle fixation can be understood as a product of discourse, and as such, as both fact and fiction. Considering that the term encompasses very different behaviours, is in some ways limiting, and has negative connotations, careful consideration should be given to it before it is accepted as a useful diagnostic and therapeutic tool. [ABSTRACT FROM AUTHOR]

This paper reviews international and Australian literature related to living with hepatitis C infection. At present scholarly research into this worldwide epidemic focuses on medical and scientific understandings of the virus and its effects on people's health-related quality of life. Exploration of the sociocultural impact of hepatitis C infection is for the most part absent from this literature. However, a nascent academic inquiry into living with hepatitis C infection points to a complex range of concerns regarding diagnosis, disclosure, stigmatization and discrimination against people with hepatitis C. The increasing association of hepatitis C infection with injecting drug use and the medicalization of those affected by the virus suggests a need for further social research. For example, injecting drug users' access to healthcare and information on reducing transmission are two important areas that are poorly understood. In this paper the authors argue for an expanded sociocultural understanding of hepatitis C to account for the material effects of medicalization, stigmatization and discrimination, and the sociocultural impact of treatment on the lives of people with hepatitis C infection. The article concludes with suggestions for future directions in social research to address the silence surrounding living with hepatitis C infection. [ABSTRACT FROM AUTHOR]

This article presents a reply to Andrew McBride and Richard Pates' riposte to the critique of their articles on needle fixation. It is important that a term which has garnered a degree of currency is examined for the implications of its use. This is particularly important if the term is used further to generate a pejorative category of deviance and/or to act as a catalyst for treatment to fix that deviance. There are a number of ways in which this examination can be undertaken. While particular questions of power, language and meaning inherent in the discourses of needle fixation drew us to a Foucauldian analysis, there are many other theoretical or epistemological positions from which to examine this issue. Another point of agreement between ourselves and McBride and Pates: we too seek to enjoy our work as researchers. We also seek to work within the injecting drug user sector as responsible, respectful and reflexive practitioners of research.

A correction to the article "Hepatitis C and Injecting-Related Discrimination in New South Wales, Australia," by Max Hopwood, Carla Treloar, and Joanne Bryant is presented.

Recent surveys have found antigay attitudes and behavior to be commonplace. In this article, we use contact theory to explain these prejudicial attitudes. We contribute to the literature on contact and prejudice by expanding contact to include not only whether the heterosexual knows any gay men or lesbians, but also how many, for how long, and in what ways. To these, we add a new and unique measure of contact: a person's contact with the gay community. The data are from a survey of 956 undergraduate students at a large urban university in the southeastern United States. Ordinary least squares (OLS) regression analyses find that contact with gay men and lesbians significantly reduces prejudice toward them; although, only as contact with gay friends or the gay community. Contact has stronger effects on women's prejudice than men's prejudice; however, the attitudes of African Americans toward lesbians and gay men are unaffected by gay contact. The results suggest that contact intervenes between prejudice and sex, race, religiosity, and gender attitudes. [ABSTRACT FROM AUTHOR]