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Although new hepatitis C treatments are a vast improvement on older, interferon-based regimens, there are those who have not taken up treatment, as well as those who have begun but not completed treatment. In this article, we analyse 50 interviews conducted for an Australian research project on treatment uptake. We draw on Berlant's (2007, Critical Inquiry, 33) work on 'slow death' to analyse so-called 'non-compliant' cases, that is, those who begin but do not complete treatment or who do not take antiviral treatment as directed. Approached from a biomedical perspective, such activity does not align with the neoliberal values of progress, self-improvement and rational accumulation that pervade health discourses. However, we argue that it is more illuminating to understand them as cases in which sovereignty and agency are neither simplistically individualised nor denied, and where 'modes of incoherence, distractedness, and habituation' are understood to co-exist alongside 'deliberate and deliberative activity […] in the reproduction of predictable life' (Berlant, 2007, p. 754). The analysed accounts highlight multiple direct and indirect forces of attrition and powerfully demonstrate the socially produced character of agency, a capacity that takes shape through the constraining and exhausting dynamics of life in conditions of significant disadvantage., (© 2023 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

With the advent of highly effective and tolerable direct-acting antiviral treatments for hepatitis C, widespread optimism for and investment in the project of disease elimination now informs the public health response. In Australia, the Commonwealth government has invested heavily in elimination by universally subsidising treatment, promising access for all. Reflecting concerns that commonly accompany ambitious public health projects, cost for governments supporting access to the treatment and cost for individuals consuming it have emerged as central issues. Drawing on 30 interviews with people who have been cured of hepatitis C with direct-acting antivirals, this article examines how cost shapes experiences of hepatitis C treatment and cure in Australia. Drawing on Lauren Berlant's (2011) influential work on 'cruel optimism', we analyse three interconnected ways that notions of cost shape participants' views of treatment as a beneficent gift from the state: (1) understandings of treatment access as a form of 'luck'; (2) conceptions of the cost of treatment; and (3) criticisms of others who are seen to waste state resources by not taking up treatment or by re-acquiring hepatitis C. We argue that, together, these dynamics constitute people affected by hepatitis C not as citizens worthy of public investment and fundamentally entitled to care, but as second-class citizens less deserving of treatment and of the health care to which they might otherwise be considered entitled. It is within this dynamic that the compromised quality of elimination optimism takes shape, binding people affected by hepatitis C to an inequitable relationship to health care, reproduced through the very things that promise to free them of such inequality - investments in access to treatment and cure., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Modern health-care systems have customarily approached hepatitis C in ways that resemble the public health approach to HIV/AIDS known as 'HIV exceptionalism'. HIV exceptionalism describes the unusual emphasis on privacy, confidentiality and consent in approaches to HIV and was partly developed to address HIV/AIDS-related stigma. In the case of hepatitis C, exceptionalist approaches have included diagnosis and treatment by specialist physicians and other 'boutique' public health strategies. The recent availability of highly effective, direct-acting antivirals alongside goals to eliminate hepatitis C have heralded dramatic changes to hepatitis C health care, including calls for its 'normalisation'. The corollary to exceptionalism, normalisation aims to bring hepatitis C into routine, mainstream health care. This article draws on interviews with stakeholders (n = 30) who work with hepatitis C-affected communities in policy, community, legal and advocacy settings in Australia, alongside Fraser et al.'s (2017, International Journal of Drug Policy, 44, 192-201) theorisation of stigma, and Rosenbrock et al.'s (1999, The AIDS policy cycle in Western Europe: from exceptionalism to normalisation. WZB Discussion Paper, No. P 99-202) critique of normalisation to consider the perceived effects of hepatitis C normalisation. Stakeholders described normalisation as a stigma-reducing process. However, they also expressed concerns about the ongoing stigma and discrimination that is not ameliorated by normalisation. We suggest that in centring normalisation, changes in health care may exaggerate the power of technological solutions to transform the meanings of hepatitis C., (© 2023 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

The advent of direct-acting antiviral hepatitis C medications has reshaped experiences of hepatitis C treatment and cure. Positioned as a treatment revolution, the new medications mean a world without hepatitis C has become imaginable, and this optimism is reflected in Australia's commitment to the WHO's target of 'eliminating' the virus as a public health threat by 2030. Alongside optimism about new treatments, Australia's current National Hepatitis C Strategy also emphasises the importance of partnerships with, and the 'meaningful involvement' of, priority populations for elimination to be achieved. We draw on Fraser and Seear's (2011) work on hepatitis C as a 'gathering' to examine these developments, and to approach hepatitis C as a disease in-the-making. Analysing 50 interviews conducted with people affected by the virus, we identify three key articulations that combine to trouble the distinction between old and new treatments: (1) the new treatment constitutes the disease as readily curable; (2) nevertheless, those who have been cured are responsibilised against acquiring it again by managing and monitoring their conduct; and (3) in the process, hepatitis C becomes re-constituted as an ongoing threat requiring continual post-cure medical and other monitoring. We argue that while treatment experiences have dramatically improved, responsibilising people affected by hepatitis C to attain cure in the context of an elimination agenda constitutes cure as valuable as much for the greater good as for self-care. This raises pressing ethical and political questions. Overall, we shed light on how, even in a context shaped by the availability of highly effective treatment, the hepatitis C-free body is never hepatitis C-free, but must be continually reproduced through regulatory practices., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

In recent years, highly tolerable and effective drugs have emerged promising a radical new 'post-hepatitis C' world. Optimism about medical cure potentially overlooks discrimination and stigma associated with hepatitis C and injecting drug use. Legal frameworks are especially relevant to hepatitis futures, since the law has the potential to reinforce or alleviate stigma and discrimination. This article explores how hepatitis C figures in Australian criminal law and with what potential effects. Drawing on Bruno Latour's work on legal veridiction, Alison Kafer's work on futurity and disability and case law data collected for a major study on hepatitis C and post-cure lives, we explore how the criminal law handles hepatitis C in the age of cure. We find that law complicates cure, constituting hepatitis C as disabling despite the advent of effective cures. The law steadfastly maintains its own approach to disease, disability and illness, untouched by medical and scientific developments, in ways that might complicate straightforwardly linear imaginaries of cure, transformation and progress of the kind that dominate biomedicine. We explore the implications of these tensions between law and medicine., (© 2022 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

During the COVID-19 pandemic, telehealth has played a prominent role in the treatment of hepatitis C. As part of a qualitative study on the accessibility and effectiveness of telehealth for hepatitis C treatment during this period in Australia, this article considers how health-care practitioners and patients experience and manage their proximity to each other in telehealth encounters of care. Comparisons between telehealth and in-person health-care tend to focus on measures of patient satisfaction rather than qualitative changes in treatment relationships. Media scholar Silverstone (Digital media revisited: Theoretical and conceptual innovations in digital domains, MIT Press, 2003) uses the term 'proper distance' to theorise how ethical relationships are mediated by technology. Drawing on this concept, we explore how patients and health-care practitioners understand telehealth as affecting distance and proximity. We find that both groups express some ambivalence about the impact of telehealth on relationships, on the one hand expecting and privileging simple, transactional relationships, and on the other hand, expressing concerns about the loss of more intimate relationships in health care and about 'missing something' while providing health care. Given that proximity is important to the development of ethical relationships in health care, we conclude with some considerations for establishing and sustaining attentive and responsive relationships in telehealth., (© 2022 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

While the use of telehealth was common in hepatitis C healthcare in Australia in remote and regional areas prior to the COVID-19 pandemic, it has been used more broadly to improve access to hepatitis C heathcare during the pandemic. Despite its widespread uptake, little research has explored how telehealth shapes hepatitis C healthcare. In this article, we draw on the concept of affordances (Latour, 2002) and interviews with 25 healthcare practitioners to explore the emergent possibilities for hepatitis C care that take shape through telehealth. Despite suggestions that telehealth is comparable to in-person care, healthcare practitioners' accounts suggest that telehealth significantly changes the nature of their experience of providing healthcare for hepatitis C. According to these service practitioners, while it increased access to hepatitis C healthcare during the pandemic, it also afforded narrower, less personal healthcare encounters, with a focus on simple and singular issues, and reduced opportunities for communication and rapport. These affordances also discouraged the use of interpreters and by extension the inclusion of patients from non-English speaking backgrounds. However, the data collected also suggest that telehealth has the potential to afford more informal and relaxed healthcare environments and dispositions between healthcare practitioners and patients, potentially disrupting classic practitioner-patient power dynamics. In concluding, the article considers how telehealth models of care might better afford quality hepatitis C healthcare and care beyond COVID-19 pandemic conditions., Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier B.V.)

With the advent of highly effective antiviral treatment for hepatitis C, many people have undergone treatment and been cured. Others, however, have not undergone treatment, even where it is free and readily available. Australia's aim of eliminating the disease by 2030 means this group is of concern to researchers, health professionals and policymakers. This article draws on 50 interviews conducted for a research project on treatment experiences to examine treatment non-uptake in Australia. Informed by Berlant's (2007) work on 'slow death', it analyses experiences of non-uptake to explain the dynamics at work in such outcomes. The analysis is divided into three parts. First, participant Cal describes a lifetime in which hepatitis C, homelessness and prison have shaped his outlook and opportunities. Second, Evan describes intergenerational drug consumption, family contact with the prison system and an equally long history with hepatitis C. Finally, Rose also describes a long history of hepatitis C, complex struggles to improve life and contact with the prison system. All three accounts illuminate the dynamics shaping treatment decisions, calling to mind Berlant's slow death as a process of being 'worn out by the activity of reproducing life' under conditions that both demand self-management, and work against it. In concluding, the article points to Berlant's distinction between 'epidemics' and 'endemics', arguing that its politics apply directly to hepatitis C. In doing so, it highlights the need to address the criminalising, pathologising, capitalist context of 'attrition' (Berlant) that wears out lives even as it fetishises autonomy, responsibility and choice., Competing Interests: Declarations of Interest Suzanne Fraser: No declarations; David Moore: No declarations; Adrian Farrugia: No declarations; Renae Fomiatti: No declarations; Michael Edwards: No declarations; Elizabeth Birbilis: No declarations; Carla Treloar: CT has received speaker's fees from Abbvie and Gilead, and research funds from Merck for unrelated research., (Copyright © 2022. Published by Elsevier B.V.)

Since the advent of direct-acting antiviral hepatitis C treatments, widespread enthusiasm about disease elimination has emerged. This article examines experiences of hepatitis C treatment and cure in this period. Mobilising Fraser and Seear's (Making disease, making citizens: The politics of hepatitis C, Ashgate, 2011) approach to hepatitis C as a 'gathering', we analyse cure not as a biomedical phenomenon but as a social and material event. To do so, we take a Science and Technology Studies-inspired approach to analyse three complementary cases drawn from an Australian project on experiences of hepatitis C, treatment and cure. First, we analyse the ways a friendship between two women combines with adjustments to treatment access to produce a gathering that makes cure possible. Second, we analyse the forces that gather and distribute responsibility when a cure does not occur in a context shaped by oversimplified treatment logics. Third, we analyse a gathering of relations in which hepatitis C lingers, thereby limiting the cure's possible transformative effects. We argue that, even in an era defined by highly effective medicines, the hepatitis C cure is not necessarily straightforward, but an unpredictable gathering constituted by a fragile coalescing of social and material forces., (© 2022 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL (SHIL).)

Australia's recent investment in, and optimism about, direct-acting antivirals to treat hepatitis C brings with it the promise of new drug futures, including the possibility of a post-hepatitis C world and a revolution in the lives of people affected by the disease. But is the situation more complicated than we might assume? What expectations are being produced about post-cure lives? And what is being overlooked along the way? We argue that hepatitis C policy, practice and research can instantiate a problematic orientation towards medicine and 'the future' and explore ways of moving beyond these orientations. The essay then proceeds into two main stages. First, combining critiques from existing research with preliminary insights from a new study on hepatitis C 'post-cure' lives, we outline some of the key logics regarding cure and post-cure, and explain why such logics are problematic. We argue against the assumption that the availability of a medical cure will alone reverse the entrenched social, political and structural dynamics that drive infections and limit service access. To do so, we note, is to overlook the net of meanings and power relations that co-constitute hepatitis C and injecting drug use and render those associated with them marginalised and disenfranchised. Such optimism erases the legacy of laws and policies devised in a pre-cure world, and their role in generating and limiting new ways of being. Second, we introduce new ideas to the field and articulate a vision for what we call a 'futurology' of hepatitis C, designed to counter these assumptions and take us beyond problematic temporal logics. Our futurology is inspired by the work of Cuevas-Hewitt (2011) on the 'futurology of the present'. Cuevas-Hewitt's approach discards linear temporalities, expectations of revolution and reform, and instead pays attention to multiplicities of becoming in the perpetual present. Taking up ideas from Cuevas-Hewitt, we introduce our own sketches for a 'futurology of hepatitis C'. This is a set of practices for thinking, researching, writing about and otherwise engaging with hepatitis C, characterised by attention not to what an imagined, singular future might look like, or to assumptions about treatment as revolutionary, but to what Cuevas-Hewitt (2011) calls the multiple 'perpetual presents' already with us, and aims to foment hope for change., Competing Interests: Declarations of Interest The authors declare no conflicts of interest., (Copyright © 2020. Published by Elsevier B.V.)

Australia's ambitious aim to 'eliminate' hepatitis C as a public health concern by 2030 requires researchers, policy makers and health practitioners to engage with populations rarely identified as a priority. Men who inject performance and image-enhancing drugs (PIEDs) are one such population, yet research suggests they have low rates of knowledge about hepatitis C. Although rates of needle-sharing in this group are thought to be low, other risks of blood-to-blood contact exist due to the use of large-gauge needles, intramuscular injecting, hard-to-reach injection sites, repeated injecting and peer-to-peer injecting. How should health initiatives engage people who might not customarily consider themselves vulnerable to hepatitis C? Drawing on the work of body theorist Margrit Shildrick, this article considers how men who inject PIEDs understand their bodies, with a particular focus on injecting practices, blood awareness and infection control, in order to inform hepatitis C prevention efforts. In our analysis, we draw on qualitative interviews with 60 men who inject PIEDs, which we conducted for an Australian Research Council-funded project focused on better understanding PIED injecting to improve health and minimise hepatitis C transmission. The interviews suggest that men who inject PIEDs closely monitor potential external infection risks, such as dirt and bacteria that might intrude upon the 'purity and security' of the body. However, less attention appears to be paid to what might be transferred out of the body and potentially to others, such as blood. Notions of trust and cleanliness, and normative perceptions of intravenous drug use, also shaped injecting practices and cursory attention to blood management. While environmental transmission poses a smaller transmission risk than needle-sharing, educating PIED consumers about it is nevertheless warranted. Focusing targeted health promotion materials on environmental blood as a potential route of hepatitis C transmission may help engage this population in prevention, and encourage more frequent hepatitis C testing., (Crown Copyright © 2019. Published by Elsevier B.V. All rights reserved.)

Despite the majority of needle-syringe sharing occurring between sexual partners, the intimate partnerships of people who inject drugs have been largely overlooked as key sites of both hepatitis C virus prevention and transmission, and risk management more generally. Drawing on interviews with 34 couples living in inner-city Australia, this article focuses on participants' accounts of 'sharing'. While health promotion discourses and conventional epidemiology have tended to interpret the practice of sharing (like the absence of condom use) in terms of 'noncompliance', we are interested in participants' socially and relationally situated 'rationalities'. Focussing on participants' lived experiences of partnership, we endeavour to make sense of risk and safety as the participants themselves do.How did these couples engage with biomedical knowledge around hepatitis C virus and incorporate it into their everyday lives and practices? Revisiting and refashioning the concept of 'negotiated safety' from its origins in gay men's HIV prevention practice, we explore participants' risk and safety practices in relation to multiple and alternative framings, including those which resist or challenge mainstream epidemiological or health promotion positions. Participant accounts revealed the extent to which negotiating safety was a complex and at times contradictory process, involving the balancing or prioritising of multifarious, often competing, risks. We argue that our positioning of participants' partnerships as the primary unit of analysis represents a novel and instructive way of thinking about not only hepatitis C virus transmission and prevention, but the complexities and contradictions of risk production and its negotiation more broadly.

Background: In the West, hepatitis C is predominantly transmitted via the sharing of contaminated drug-injecting equipment. Although the majority of this sharing occurs between sexual partners, the responsibility for avoiding transmission has long been conceived as an individual responsibility, with prevention measures such as the distribution of sterile injecting equipment such as injecting packs ('fitpacks') aimed at individuals without regard for the social contexts of injecting. In this article we draw on the work of Bruno Latour to reconceptualise the fitpack. We argue that the fitpack is not inert or neutral in its meaning or effects, that instead it 'affords' particular meanings and actions, for example, that injecting is an individual practice and safety an individual responsibility., Method: To challenge these affordances, we developed a new fitpack prototype aimed at couples, along with related health promotion messages. We asked 13 couples who inject drugs to examine and reflect on these new objects and messages., Results: Overall, we found a high level of support for the broad idea of couples-oriented materials, as well as for our prototype and associated materials. Participants identified opportunities for improving the materials and commented on implications of the symbols and language used. Together the interviews demonstrated ways in which the new fitpacks and messages could afford couples-oriented safe injecting, and better recognition of relationships that are often dismissed by researchers and health care providers as insincere., Conclusions: These findings demonstrate that first, there is a need and desire for a greater range in harm reduction resources. Second, it is essential to find ways of better acknowledging the validity and value of relationships between people who inject. Third, and more broadly, recognition must be given to the role of technological objects in materialising meanings and, as Latour might put it, 'moralities', and in turn to interrogating these meanings and moralities., (Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.)

Background: 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., Methods: 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., Results: 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., Conclusions: 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., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Aims: Despite injecting-equipment sharing between sexual partners leaving them at increased risk of hepatitis C (HCV), there is scant literature available to guide harm reduction workers in their encounters with couples who inject drugs. This article explored workers' understandings of such couples and their accounts of working with them in relation to HCV prevention., Method: Semi-structured interviews were conducted with 22 staff of harm reduction services located in Sydney and Melbourne, Australia., Results: Overall, staff represented couples as either absent from the service or as presenting with needs indiscernible from those of individual clients. Responses to questions about HCV and couples were framed primarily in terms of risk. Staff participants questioned 'genuineness' of clients' intimate relationships, instead characterising them as inauthentic and drug-driven. Working with couples was seen to present a number of organisational and clinical challenges. The benefits of recognising and working with such partnerships received scant acknowledgement. Rather, staff tended to perceive couples as being 'impenetrable' to health promotion messaging., Discussion: The framing and delivery of harm reduction in Australia remains an individualising enterprise with little capacity to recognise the intimate partnerships, including addressing the HCV risks specific to them. More effective harm reduction strategies may be achieved by transitioning to a practice framework that addresses the social context of injecting, including the experience of couples. This would require direct involvement of couples who inject drugs., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

In the West, most hepatitis C transmission occurs through the sharing of equipment used for injecting drugs, and most sharing occurs between sexual partners. Despite this, little is known about how injecting practice, including equipment use, is managed in these partnerships. This article draws on science studies theorist Bruno Latour's work on technology and ethics (2002), and preliminary data collected for a research project on sexual partners who inject together, to illuminate these issues. Responsibility for avoiding transmission has long been conceived individually, as have measures intended to aid individuals in fulfilling this responsibility, such as the distribution of sterile injecting equipment. This individualising tendency has been criticised for inequitably responsibilising disadvantaged people. This article aims to exceed this individualising approach by proposing a different understanding of agency and a new mode of prevention. Rather than treating hepatitis C in conventional terms, as a bounded, ontologically stable object that pre-exists its encounter with individuals and the material objects they use in injecting, it formulates it as made in its enfolding with other phenomena, including social relationships and technological objects. In turn it sees transmission in new terms; as a question of social relationships and of object design. The article goes on to discuss a new Australian research project that takes this approach as its starting point, aiming to develop two key prevention innovations: (1) new messages aimed at partnerships rather than individuals, and (2) a new injecting pack or 'fitpack' that treats the partnership as a primary unit of resourcing. The article concludes by considering the politics of this shift to an ethics of technology, social relationships and objects., (Copyright © 2013 Elsevier B.V. All rights reserved.)

In Western countries, people who inject drugs experience a disproportionate burden of hepatitis C as a result of effective transmission of the virus via the sharing of used injection equipment. With a hepatitis C prevalence of 60% and higher in many areas, previous and current prevention efforts focusing on the availability of sterile injecting equipment along with education, have had only limited effect on incidence rate. Little attention has been paid to the broader social and political positions that drug use and people who use drugs hold in these societies. Insights from social research provide opportunities to broaden the possibilities for prevention efforts. We will review the social inclusion literature to provide some examples of how hepatitis C prevention may be approached in innovative ways.

Issues: In an effort to increase the number of people undergoing hepatitis C treatment, a range of initiatives are planned or underway to provide treatment in non-specialist services, such as opioid pharmacotherapy treatment (OPT) clinics., Approach: This commentary considers the implications of this new approach to treatment delivery, taking account of individual-level issues generally discussed in the literature, such as knowledge of treatment and concerns about side effects. In addition, because less visible organisational and structural factors would equally influence the successful implementation of hepatitis C treatment in OPT services, these are also explored., Key Findings: Provision of hepatitis C treatment in OPT services raises a broad range of pressing questions, from individual knowledge and concern about treatment, to workforce issues, such as discrimination, and tensions between the need for supportive care during hepatitis C treatment and the surveillant, regulatory nature of OPT clinic operations., Implications: A thorough critical examination of the structure and delivery of all services involved is necessary. Social research can play a unique role in this assessment because of its ability to generate detailed insights into lived experience and make use of social theories that allow previously invisible operations of power to become visible., Conclusion: The success of hepatitis C treatment in new sectors, such as OPT clinics, is not a given. Close attention needs to be paid to the context and culture in which OPT is delivered. In turn, this needs to be considered alongside the context and culture necessary for successful hepatitis C treatment delivery.

Clinical medicine and biotechnology increasingly utilise and transform human bodily tissues in novel ways. Today more and more tissues--blood, whole organs, ova, embryos, sperm, skin, bone, heart valves, cellular material, bone marrow and corneas--can be transferred between donors and recipients. Hence more and more people in developed nations have the experience of giving a fragment of their body to another, or receiving such a fragment as part of some kind of therapy. These systems for the circulation of tissues raise the question of what we have termed 'bioidentity'. Bioidentity describes our common-sense understanding of our bodies as 'ours', as both supporting and being included in our social and subjective identities. Within this framework, how are we to understand the status of detachable bodily fragments like blood, ova or organs? As parts of our bodies do they retain a trace of our identity after donation, or are they detachable things? What is our relationship, if any, to the patient who receives our tissues as part of their treatment? This paper investigates the specific case of blood transfusion and donation. It draws upon in depth interviews with 55 people who have specific experience with blood. They either have hepatitis C (are HCV+) acquired by transfusion or intravenous drug use, or have donated blood or received a blood transfusion but are free of hepatitis C (are HCV-). We analyse this material according to the themes--Donated Blood as 'Self', Blood as Alienable, Blood as Communal Substance, and Contaminated Gifts and the Blood of Strangers. We find that, generally speaking the HCV+ and HCV- groups share very similar ideas about blood donation and transfusion. For a minority of both groups, blood was understood as a decisive site of self irrespective of location, but for the remainder donated blood was either ambiguous with regard to identity, a shared substance, or not considered to have any lingering relationship to the self once given. However both groups regarded blood as strongly imbued with 'risk identity'. In particular the HCV+ interviewees regarded their blood as a dangerous personal attribute, one that they must be careful to withhold from circulation, whereas the blood donors felt obliged to donate their blood precisely because they considered it clean and risk free.

Health promotion materials on hepatitis C prevention and safe injecting enjoin injecting drug users to produce ethical selves through relatively rigid social and hygiene-related conduct. This article examines a sample of safe injecting and hepatitis C prevention health promotion materials, and interview data gathered from injecting drug users, to consider the ways in which the notion of individual responsibility functions within them. I argue that the primacy of the individual in western culture is indeed reflected in hepatitis C and safe injecting materials and, that for a range of reasons, injecting drug users also make use of notions of individual responsibility. The article concludes by considering the social and health implications of this individualist approach to injecting drug use and health promotion, and by suggesting ways in which effective materials which do not focus solely on the individual can be created.

The World Health Organization's goal of achieving hepatitis C elimination by 2030 is inspiring the use of novel methods to find, diagnose and treat people living with the virus. Globally, rates of hepatitis C treatment uptake have declined. Data-driven public health approaches, including case finding, notification and contact tracing, are being developed and implemented to reach the elimination goal. Drawing on interviews with policymakers, lawyers, peers and others who work with people with hepatitis C, we analyse perceptions of the use of data-driven interventions to achieve elimination, and concerns about risks. While interviewees expressed some enthusiasm for data-driven interventions, they were apprehensive about the possible effects of data collection processes and systems and/or believed that people with hepatitis C were. They noted concerns about the sharing of people's health data without active consent, and worried that data-driven approaches could perpetuate hepatitis C-related stigma and discrimination. We explore these concerns through the concept of data justice, which helps to account for complexities, risks, and challenges. We argue that data-driven interventions to increase access to treatment will be effective and beneficial only if they also address, or at least do not increase, the barriers to treatment caused by stigma, criminalisation and structural inequities faced by many people with hepatitis C. Such interventions should also be designed to mitigate the limitations of the most usual models of data collection and use. [ABSTRACT FROM AUTHOR]

New drugs with the potential to cure hepatitis C have emerged. There is great optimism within medicine about the transformative potential of cure, but this overlooks the entrenched discrimination and stigma associated with both hepatitis C and injecting drug use and the role of law in re/producing it. Drawing on interviews with key stakeholders such as policymakers, lawyers, and representatives from peer organisations (N = 30), Latour's (2013) work on legal veridiction, Fraser and Seear's (2011) conceptualisation of hepatitis C as a 'gathering', and Mol's (2021) work on being, this paper explores the possibility that legal processes complicate the linear trajectory of progress and transformation cure promises. Our participants' identify various legal processes that allow hepatitis C to echo or linger in people's lives after treatment. These processes are remaking hepatitis C, and making perpetual hepatitis C subjects. We argue that we must grapple with these forces in the era of cure. [ABSTRACT FROM AUTHOR]

Until the recent introduction of direct-acting antiviral (DAA) medications, the only available hepatitis C treatments were lengthy and onerous interferon-based therapies, with relatively weak success rates. While experiences of interferon-based treatment have been well documented, there is a need to better understand how the experiences of the 'old' treatments shape contemporary treatment experiences. This article uses the concept of 'post-crisis' developed in critical scholarship on HIV/AIDS, and recent theorisations of 'curative time', to explore the relationship between contemporary treatment experiences and the legacies of interferon-based therapies. In mobilising these concepts, we trouble linear temporal logics that take for granted distinctions between the past and present, old and new, and cure and post-cure, and draw attention to the fluidity of time and the overlapping co-constitutive terrains of meaning that shape treatment experiences. Drawing on 50 interviews with people affected by hepatitis C, we argue that the curative imaginary of DAA treatments – that is, the temporal framing applied to hepatitis C in which cure is expected and assumed – is shaped by the logic of crisis. Here, knowledge of and the possibilities for the new treatments and living with hepatitis C remain tethered to crisis accounts of interferon. Unlike HIV/AIDS, in which the disease itself was figured as crisis, many participants described interferon-based treatments as the crisis: as worse than living with hepatitis C. While the new treatments were widely described as simple and easy, we argue that treatment is not so straightforward and that the crisis/post-crisis relation is central to this complexity. We conclude by considering the significance of these post-crisis enactments for understanding the recent plateauing of DAA treatment uptake, and reflect on how post-crisis futures of hepatitis C 'cure' need to address the ongoing constitutive effects of interferon-based treatments. [ABSTRACT FROM AUTHOR]

Despite the majority of needle–syringe sharing occurring between sexual partners, the intimate partnerships of people who inject drugs have been largely overlooked as key sites of both hepatitis C virus prevention and transmission, and risk management more generally. Drawing on interviews with 34 couples living in inner-city Australia, this article focuses on participants’ accounts of ‘sharing’. While health promotion discourses and conventional epidemiology have tended to interpret the practice of sharing (like the absence of condom use) in terms of ‘noncompliance’, we are interested in participants’ socially and relationally situated ‘rationalities’. Focussing on participants’ lived experiences of partnership, we endeavour to make sense of risk and safety as the participants themselves do.How did these couples engage with biomedical knowledge around hepatitis C virus and incorporate it into their everyday lives and practices? Revisiting and refashioning the concept of ‘negotiated safety’ from its origins in gay men’s HIV prevention practice, we explore participants’ risk and safety practices in relation to multiple and alternative framings, including those which resist or challenge mainstream epidemiological or health promotion positions. Participant accounts revealed the extent to which negotiating safety was a complex and at times contradictory process, involving the balancing or prioritising of multifarious, often competing, risks. We argue that our positioning of participants’ partnerships as the primary unit of analysis represents a novel and instructive way of thinking about not only hepatitis C virus transmission and prevention, but the complexities and contradictions of risk production and its negotiation more broadly. [ABSTRACT FROM AUTHOR]

In recent years, several studies have suggested that the use of performance and image enhancing drugs via injection is increasing in Australia, with anabolic steroids appearing to be the most commonly used of these drugs. Traditionally the domain of elite athletes and recreational bodybuilders, steroid use may be extending to other groups, including adolescents, gym attendees, professionals and students. Like other forms of injecting drug use, steroid injecting can allow transmission of blood-borne viruses, especially hepatitis C, but little is known about how steroid injecting takes place and how such transmission might occur. Crucially, Australia’s existing harm reduction framework appears ill-equipped to deal with this emerging trend, and is underprepared to meet the challenges that it may pose. In this commentary, we outline key areas where more research into steroid use in Australia is needed. Improved understandings of the practices and experiences of individuals, who inject steroids, and the possibilities for targeted harm reduction responses, are needed if Australia is to respond to the increase in steroid use effectively. [ABSTRACT FROM PUBLISHER]

Abstract Direct-acting antiviral (DAA) treatment for the blood-borne virus hepatitis C has shifted conceptions of the disease from a chronic infection – and, in some legal contexts, a “disability” – towards a non-permanent impairment capable of “cure”. The shift in treatment has also led to a shift in law. This paper explores the shift in Australian social security and migration judgments by drawing from performance studies research on disability and recovery. It examines legal performances before and after the introduction of DAA treatment to track the way in which “disability” is performed in earlier cases and to problematise “cure” in later cases. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Hepatitis C (HCV) is a disease of the liver with a range of potentially debilitating symptoms, the severity of which differ from person to person. HCV is a major public health challenge. Globally an estimated one in 12 persons is affected by the virus, and substantial new transmissions occur each year. The vast majority of new transmissions occur among people who inject drugs, particularly through practices such as sharing of needles, syringes and other injecting equipment. Behavioural surveillance data suggest that the majority of equipment sharing occurs between intimate partners. Despite this, very little research has focussed on intimate partnerships as a site of hepatitis C transmission or prevention. This is in part because people who inject drugs are conventionally represented as lacking capacity for romantic love and intimacy; also, drug 'addiction' is produced as the antithesis of voluntarity, autonomy and authenticity, all of which feature strongly in Western understandings of romantic love. This study aims to fill existing gaps in the literature about the relationship between romantic love and injecting drug use (IDU) and to explore injecting drug practices among partners in intimate relationships. Fifteen people who inject drugs, currently in long-term heterosexual relationships, were recruited for in-depth interviews, which were recorded, transcribed verbatim and analysed thematically. The main findings of this study are that romantic love and intimacy figure prominently in the lives of people who inject drugs, and that romantic notions such as commitment, trust, care and support shape how individuals who inject drugs talk about serostatus with their partners and how they account for injecting practices. Moreover, injecting practices are co-produced within intimate relationships, shaped by perceptions of risk within and outside the relationship, ideas of intimacy, and the specific levels of skill and expertise within these relationships. These findings have important implications for harm reduction strategies, which, we suggest, have largely failed to take into account the intimate relationship as a source of practice. We conclude with suggestions for future work in this area. [ABSTRACT FROM AUTHOR]

In 2010, the International Conference on the Reduction of Drug Related Harm shared its 21st birthday with one of its most constant companions: hepatitis C. The co-occurrence of these significant anniversaries provides an opportunity to reflect critically on the formative role played by hepatitis C, and on our responses to it, in the development of harm reduction. The commentary takes an interdisciplinary approach to analyse the implications of a foundational aspect of harm reduction and the response to hepatitis C: medicalisation. It draws on a range of literature and research disciplines to highlight a set of issues poorly visible from within medical expertise. This commentary highlights two trends, both of which emerge from hepatitis C's place as a thoroughly medicalised object. First, hepatitis C has contributed to an increasing emphasis on individual responsibility in prevention initiatives, and second, it has contributed to the homogenisation of affected individuals in relation to treatment.While acknowledging the benefits for injecting drug users that have flowed from the medicalisation of hepatitis C, we note that insufficient attention is sometimes paid to the impact of medical and public health imperatives on the goals and values of harm reduction. We conclude by considering some key ethical and political challenges that harm reduction must confront as it continues to place the status and well-being of drug users at the centre of its rationale and work. [ABSTRACT FROM AUTHOR]

Considerable effort has been expended in developing health education materials and programmes aimed at reducing transmission of hepatitis C virus (HCV) among people who inject drugs. Health education is considered more likely to be effective when it is targeted to defined segments of the population and when people actively identify with the messages presented. In this context, it is important to understand the health messages on offer in these materials. This article conducts a discourse analysis of an extensive corpus of Australian heath education literature on HCV to explore the kinds of messages these materials attempt to present. It questions the unexamined assumptions they include and it considers how effectively these materials address the social context of HCV transmission. It focuses on issues of individual and group conduct: in particular, because HCV transmission occurs commonly between sexual partners, on the place of couples who inject together in prevention education. The article concludes by arguing that these materials pay insufficient attention to couples, relying almost without exception, and despite a longstanding critique recommending new approaches, on the individual as the core unit of agency in HCV transmission and in turn prevention. [ABSTRACT FROM AUTHOR]

Background: Many of the effects of hepatitis C are now well-documented. There are reports of a reduction in sexual contact, social withdrawal and feelings of contamination and contagion following diagnosis. However, on some of the more intimate aspects of living with hepatitis C, such as those relating to sexuality, love and intimacy, research is yet to be undertaken. Method: In this article, we draw on 30 interviews conducted with hepatitis C positive people in Melbourne, Australia. Interviews were recorded and transcribed verbatim, and then coded and organized thematically. This article draws on three case studies to illustrate its findings. Results: Contracting hepatitis C significantly limited access to love and intimacy for some participants, affecting existing relationships and ruling out new ones. The task of managing both health and relationships was undertaken by women much more commonly than by men. Finding love and becoming a desirable partner, sometimes engaged people in new ways with their health. Conclusions: This article concludes with two key observations. First, ideas of love, intimacy, health and purity all rely on each other for meaning. Second, within this constellation of meanings, disease and intimacy figure as paradoxical. Together these observations indicate the need to challenge ideas about disease, sexuality and romance. [ABSTRACT FROM AUTHOR]

People who inject drugs access information about hepatitis C in a range of ways. For some, diagnosis is a key point at which information is encountered. This information is considered in public health circles to be important for initiating or enhancing safe injecting practice and self-care. Yet, not all of those diagnosed with hepatitis C continue to stay informed about the disease or about their health in general, preferring to postpone engagement with these issues. In this article, I draw on Nikolas Rose's idea of biological citizenship and interview material gathered from people who inject drugs, who have been diagnosed with hepatitis C to conduct an analysis of this deferral. Drawing on the empirical material, I note that in some cases, pursuing knowledge is sometimes overshadowed by more pressing material concerns such as homelessness. In other cases, the desire to acknowledge or confront the implications of the infection is absent to the point that ‘keeping up’ is not regarded as desirable. In other cases still, the information imparted at diagnosis is so incomplete that the merits of seeking further medical input are seen to be doubtful. Drawing on the theoretical material, the article asks, what kind of medical subjects, or biological citizens, are these interview participants, given their parallel status as hepatitis C patients and subjects of discourses of addiction? I conclude by considering the effectiveness of the medicalisation of addiction. [ABSTRACT FROM AUTHOR]

Knowledge about disease and illness usually emerges as a result of complex social negotiations among those with a stake in the outcomes of this knowledge. These negotiations can involve a range of agents and discursive avenues, some of which are contradictory and paradoxical. This is especially true for the blood-borne virus hepatitis C, the medical, social and political features of which – associations with injecting drug use, ‘tainted blood’ scandals and HIV – render it a controversial disease involving a range of highly motivated stakeholders. In this paper I analyse one such set of agents in the process of disease knowledge negotiation: self-help books on hepatitis C. In conducting this analysis I offer insights into the content of the books and the way they construct hepatitis C and those who have it. I do this by mapping three key issues helping to shape the way hepatitis C is constituted in these books: HIV, injecting drug use and iatrogenic (medically caused) transmission, and by exploring the implications of the themes of emotion, risk and guilt that arise in the playing out of these issues. In the process I aim to make sense of the complexity of disease, its social constitution and its role in shaping social phenomena such as stigma. [ABSTRACT FROM AUTHOR]

Hepatitis C is a potentially debilitating disease of the liver, the impact of and prognosis for which vary significantly from person to person. Although the health consequences of contracting hepatitis C are extremely diverse, becoming infected with the disease is sometimes experienced in terms of an absolute shift from healthy to sick, clean to contaminated, good to bad. In this paper, we use interview material derived from a study on hepatitis C and blood awareness to look at one rarely discussed response to diagnosis with hepatitis C: a sense of despair and absolute contamination, leading to a belief that contraction of other blood-borne viruses is of no consequence. By considering the effects of hepatitis C diagnosis in light of Goffman's theory of stigma, and by linking stigmatization to the binary logic common to thinking about infection, health and identity, we offer a starting point for designing health-promotion materials that minimize despairing responses to infection. [ABSTRACT FROM AUTHOR]

Hepatitis C is a major public health challenge, and efforts to reduce the transmission of hepatitis C among people who inject drugs (IDU) have had limited success. From within a harm minimization perspective, this study sought to examine the models of blood and the body used in health promotion materials designed to encourage safer injecting practice, and aspects of the body emphasized in interviews with 32 IDU. Of particular interest were the unstated, implicit models of blood and the body evoked in metaphors, language and symbols used to describe blood and the body. Health promotion messages relied heavily on fortress models of the body, that is, rigid definitions of bodily boundaries that define outside or foreign substances as hostile. Descriptions of blood by IDU were more complex including strong views of blood as both vital and fatal to life. Blood was seen as generally life saving and, at the societal level in terms of blood banking, in need of protection. An alternative model of education was, therefore, developed to highlight the multi-level responsibilities in caring for blood, to position blood as a shared social resource and to acknowledge the positive value in sharing resources. This model has the potential to reduce harm within the context of hepatitis C prevention without contributing to the further stigmatization of IDU. [ABSTRACT FROM AUTHOR]

Health promotion materials on hepatitis C prevention and safe injecting enjoin injecting drug users to produce ethical selves through relatively rigid social and hygiene-related conduct. This article examines a sample of safe injecting and hepatitis C prevention health promotion materials, and interview data gathered from injecting drug users, to consider the ways in which the notion of individual responsibility functions within them. I argue that the primacy of the individual in western culture is indeed reflected in hepatitis C and safe injecting materials and, that for a range of reasons, injecting drug users also make use of notions of individual responsibility. The article concludes by considering the social and health implications of this individualist approach to injecting drug use and health promotion, and by suggesting ways in which effective materials which do not focus solely on the individual can be created. [ABSTRACT FROM AUTHOR]