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Social marginalization is associated with poor health outcomes for affected people. However, in a psychosocial study of treatment for hepatitis C infection conducted in Sydney, Australia, participants living in socially disadvantaged circumstances applied adaptive approaches learned from past experiences of drug dependence, living with symptoms of chronic illness, coping with depression and childhood sexual abuse to enable them to cope with severe treatment-related side-effects. This finding has implications for the clinical management of hepatitis C treatment; the factors and processes that facilitate adaptive coping to adversity associated with social marginalization can be assessed for their clinical contribution to coping with an arduous regimen. [ABSTRACT FROM AUTHOR]

Background: Experiences of stigma and discrimination can act as a significant barrier to testing, monitoring, and treatment for hepatitis B virus (HBV). Aboriginal and Torres Strait Islander Australians are a population disproportionately impacted by HBV and yet limited research has explored HBV-related stigma in these communities. To begin preliminary explorations of HBV-related stigma among Aboriginal and Torres Strait Islander people, we interviewed health workers about their perceptions regarding HBV infection and HBV-related stigma. Methods: Participants were recruited from staff involved in the Deadly Liver Mob (DLM) program which is a health promotion program that offers incentives for Aboriginal and Torres Strait Islander clients to be educated on viral hepatitis, recruit and educate peers, and receive screening and treatment for blood-borne viruses (BBVs) and sexually transmissible infections (STIs), and vaccination. Semi-structured interviews were conducted with 11 Aboriginal and Torres Strait Islander and non-Aboriginal or Torres Strait Islander health workers who have been involved in the development, implementation, and/or management of the DLM program within participating services in New South Wales, Australia. Results: Findings suggest that stigma is a barrier to accessing mainstream health care among Aboriginal and Torres Strait Islander clients, with stigma being complex and multi-layered. Aboriginal and Torres Strait Islander people contend with multiple and intersecting layers of stigma and discrimination in their lives, and thus HBV is just one dimension of those experiences. Health workers perceived that stigma is fuelled by multiple factors, including poor HBV health literacy within the health workforce broadly and among Aboriginal and Torres Strait Islander clients, shame about social practices associated with viral hepatitis, and fear of unknown transmission risks and health outcomes. The DLM program was viewed as helping to resist and reject stigma, improve health literacy among both health workers and clients, and build trust and confidence in mainstream health services. Conclusions: Health promotion programs have the potential to reduce stigma by acting as a 'one stop shop' for BBVs and STIs through one-on-one support, yarning, and promotion of the HBV vaccine, monitoring for chronic HBV, and treatment (where required). [ABSTRACT FROM AUTHOR]

Issue addressed: Hepatitis B (HBV) is a major public health issue with over 250 million people chronically infected worldwide. In Australia, prevalence is higher among migrant communities and these groups may be reticent to attend health care services due to concerns about experiencing stigma and discrimination. The way health workers perceive their clients, particularly those of migrant backgrounds, may influence the way they treat these clients and the quality of care provided. This study investigated and compared the attitudes and concerns health workers and health students have towards working with clients living with HBV. Methods: Health workers (n = 551) and students (n = 199) completed an online survey which investigated attitudes towards people living with HBV, comfort with providing care for these clients and concerns they have about working with them. Results: Health students expressed less comfort (U = 47 611, z = −2.73, P =.006) and reported more concerns about working with people with HBV than qualified health workers (U = 61611.50, z = 2.64, P =.008). Students' concerns were centred around their own ability to provide care rather than issues related to clients. There were no differences in overall attitudes towards people living with HBV between health workers and students. Conclusion: To address concerns that health workers and students may have in working with people living with HBV, particularly those from migrant communities, and to ensure that health workers feel comfortable and confident, HBV workforce development should be included in undergraduate and postgraduate training programmes as well as in continuing professional education. So what?: This will assist the health workforce to develop competency in the treatment of people living with HBV, with the ultimate aim of providing best quality, non‐judgemental care to all people living with HBV. [ABSTRACT FROM AUTHOR]

In Australia, the crystalline form of methamphetamine ("crystal") is a commonly used illicit substance associated with sexual activity among gay and bisexual men. Attention to psychoactive substance use among this population is the subject of increasing global concern regarding the intentional and simultaneous combination of sex and drugs, often referred to as "chemsex". While not all gay and bisexual men who use psychoactive substances report problematic use, those who do often become representative of chemsex practices more generally, and the harms they experience become attributable to all men who use drugs for sex. The way in which these practices have been framed over the past few decades contributes to the rise of a narrow set of understandings of chemsex defined by the circumstances and behaviours presumed of drug-enhanced sexual activity. In effect, these understandings now align recognisable combinations of sexual and drug-using practices with assumed correlates of risk. The Crystal, Pleasures and Sex between Men study conducted 88 interviews with gay and bisexual men in four Australian cities between 2017 and 2018. Findings from the project revealed that men used crystal in a variety of settings and relations, which mediated their sexual practices and patterns of use. In looking at the wider context in which practices were associated with the combination of sex and drugs, we identified experiences that the contemporary discourse of chemsex-in its rhetorical proposition of at-risk behaviours and circumstances-may leave out of consideration. Our findings indicate that researchers should remain open to the variability and contingency of settings, relations and practices in gay and bisexual men's different networks when recommending public health responses to their engagement in drug-enhanced sexual activity. Accordingly, we seek to destabilise the definition of chemsex that precludes consideration of the influence of experiences beyond pre-determined risk parameters. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article titled "Health workers' perspectives of hepatitis B-related stigma among Aboriginal and Torres Strait Islander people in New South Wales, Australia" published in the Harm Reduction Journal. The correction adds a reference to the article and provides the correct citation. The original article has been corrected. The publisher, Springer Nature, remains neutral in terms of jurisdictional claims and institutional affiliations. The authors of the article are Elena Cama, Mitch Beadman, Kim Beadman, Max Hopwood, and Carla Treloar. [Extracted from the article]

Background: Internalised stigma experienced by people who inject drugs (PWID) is known to have negative health consequences. Research has explored factors that may protect or buffer individuals from the negative consequences of internalised stigma. Community attachment, or perceived connection to a community of like people, can have numerous health-related benefits. However, this relationship may be complex for PWID; being part of a social network of PWID may provide opportunity for more frequent drug use and equipment sharing. This study investigated the relationships between community attachment, internalised stigma, and wellbeing among PWID, while also addressing potential health risks associated with PWID community attachment.Methods: PWID (n=603) were recruited through nine peer-based drug user organisations across Australia with assistance from the peak consumer organisation. Participants completed a survey measuring community attachment, internalised stigma, personal wellbeing, injecting frequency, and equipment sharing.Results: Greater attachment to a PWID community was associated with lower internalised stigma, but also with sharing of injecting equipment and increased frequency of injecting behaviour. The relationship between community attachment and personal wellbeing was mediated by internalised stigma, however this was only the case for PWID who reported no sharing of injecting equipment.Conclusions: This research highlights the significance of community attachment for PWID while also noting the complexity of this relationship and the potential negative consequences. It is important to view networks of PWID communities as sources of positive social capital, where norms about health behaviours and harm reduction can be promoted and which can buffer community members from the harms associated with stigma. [ABSTRACT FROM AUTHOR]

This paper explores the perceptions of 35 key informants (KIs) in a range of relevant health and community sectors regarding the stigmatisation of GBM's crystal methamphetamine use and sexual practice with view to informing stigma reduction efforts. A modified social ecological model was used to guide analysis and interpretation. At the individual level, KI participants indicated that crystal methamphetamine was used by some GBM to reduce the effects of internalised stigma. At the network level, KIs thought that some drugs and types of use could attract more stigma and that this could erode support from GBM networks for men who use crystal. KIs felt that few "mainstream" organisations could provide appropriate services for GBM who use crystal and furthermore, that there was significant work to "undo" misperceptions of the harms of crystal use. At the policy level, mass media anti-drug campaigns were seen to be a significant generator of stigma with irrelevant and patronising messages that lacked useful information. Efforts to reduce stigma about crystal methamphetamine use amongst GBM must address individual, network, organisation and policy issues and be underpinned by understandings of social power in relation to sex, sexuality, drug use, infectious status and sexual minorities., Competing Interests: Declarations of Interest Carla Treloar has received speakers’ fees from Abbive and Gilead and research funding from Merck. Max Hopwood has received research funding from Merck., (Copyright © 2021. Published by Elsevier B.V.)

Background and Aims: Interferon-free, direct-acting antivirals (DAAs) for hepatitis C virus (HCV) offer much promise to achieve World Health Organization targets by 2030. However, impediments at the practitioner and health-system level will continue to obstruct the scale-up of DAAs worldwide unless identified and acted upon. Applying a diffusion of innovations framework, the aim of this study was to identify structural factors impacting practitioner experiences of managing HCV treatment., Methods: In-depth, semi-structured, telephone interviews took place between September 2018 and April 2019 to investigate barriers and facilitators for engaging in HCV management and DAA therapy amongst general practitioners (GPs) who prescribe opioid agonist therapy and drug and alcohol specialists in Australia. Interviews were transcribed verbatim, de-identified, and coded, and data were analysed with iterative categorisation and thematic analysis using Everett Rogers's diffusion of innovation framework., Results: amongst 30 participants (12 GPs, 18 drug and alcohol specialists), several structural factors were reported to impede practitioner efforts to deliver optimal HCV care. Two primary themes were explored: contextual factors for the diffusion of DAA therapies, including attempts by participants to shift clinic culture and respond to siloed health structures, and adopter factors. Some participants chose to 'rock the boat' by circumventing clinic protocol and HCV guidelines to treat more clients, effectively shifting adopter categories to become greater advocates in HCV care. Also, while a role for GPs as the 'new adopters' in HCV management was discussed, many participants expressed uncertainty as to how much GPs should become involved in the diffusion of DAA therapies more widely., Conclusions: Reducing the global burden of HCV infection will not be possible without the widespread delivery of HCV treatment amongst practitioners. Practitioners and health workers require leadership and resources from health authorities so that the individual and population-level benefits of DAA therapy are realised., Competing Interests: Declarations of Interests ADM has nothing to declare. M Hopwood has received grant funding from Merck. JG has received research grants, speaker fees, and participated in advisory boards for Abbvie, Cepheid, Gilead Sciences, Hologic, Indivior, and Merck., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The mental health of gay and bisexual men in mixed-orientation marriages is poorly understood. In this article, the authors explore the development of anxiety and depression among gay and bisexual men in heterosexual marriages. Sixteen men, living in the Australian states of New South Wales, Queensland, Victoria, and Tasmania were interviewed throughout 2016 and 2017. An analysis of interviews identified four main themes, namely, compulsory heterosexuality, existential distress, compartmentalization, and integration and resolution. Participants reported experiencing anxiety and depression, which were exacerbated by the stigmatization of same-sex attraction and by an overwhelming distress from feelings of shame and guilt regarding their marital infidelity. Findings indicate that gay and bisexual men in mixed-orientation marriages develop anxiety and depression in response to the exigencies of compulsory heterosexuality and the compartmentalizing of same-sex attraction and identity during heterosexual marriage. Coming-out as same-sex attracted resolved men's distress by facilitating an integrative self-structure.

Much research concerning drug use in the context of sexual activity among gay and bisexual men derives from public health scholarship. In this paper, we critically examine how the relationship between methamphetamine use and sexual risk practice is treated and understood in this body of research. While public health has made important contributions to establishing the link between methamphetamine use and sexual risk-taking, the precise nature of the relationship is not well defined. This creates space for ungrounded assumptions about methamphetamine use to take hold. We outline what appear to be two dominant interpretations of the methamphetamine/sexual practice relationship: the first proposes that methamphetamine has specific pharmacological properties which lead to sexual disinhibition, risky behaviour and poor health outcomes; the second proposes that methamphetamine attracts men who are already inclined toward highly sexualised interactions and risky practice, and that such men are likely to engage in these practices with or without drugs. We suggest that both interpretations are problematic in that they individualise and cast drug and sex practices as inherently risky and biopsychologically determined. We outline a more historically, socially and politically engaged way to understand methamphetamine use in the context of sexual activity by drawing on the concept of sex-based sociality and the ways in which gay and bisexual men may use methamphetamine and sex as social resources around which to build identities, establish relationships, participate in gay communities, and maximise pleasure while protecting themselves and others from harm., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Introduction: Previous investigation has shown that the health sector is a main source of discrimination against people with hepatitis C. This paper examines the perceptions and experiences of people with hepatitis C of their interactions with healthcare workers, particularly examining the implementation of infection control precautions. We contend that rather than applying infection control precautions universally, health care workers make judgements about individual patients and the likelihood that they are infected with hepatitis C. Thus, infection control practices can be used as a tool to discriminate against people with hepatitis C. Social identity theory is used to illustrate these insights and to propose recommendations for education of health care workers., Method: Semi-structured interviews with 19 people who had hepatitis C were conducted. The analysis examines issues of diagnosis, discrimination and disclosure in relation to healthcare workers' use of infection control procedures during clinical interactions., Results: Participants described non-compliance with infection control guidelines by healthcare workers in a range of settings. In some instances, participants expressed disapproval of non-compliance, at other times participants felt vulnerable and discriminated against. Participants felt obliged to disclose their infections, but some decided against future disclosure because of negative reactions from healthcare workers. Infection control procedures were used as a tool to discriminate against some participants., Discussion: Non-compliance with infection control guidelines persists among healthcare workers and can be identified by patients. A minority of workers use infection control as a discriminatory tool against those with hepatitis C. Further intervention is required to ensure infection control guidelines are enacted in the manner intended.