Hygiene and uncertainty in qualitative accounts of hepatitis C transmission among drug injectors in Serbia.

Hepatitis C virus (HCV) infection is a significant cause of mortality and morbidity related to injecting drug use. In Serbia, recent estimates suggest that approximately a third of drug injectors are hepatitis C positive. We undertook the first qualitative study of drug injecting in Serbia with a focus on exploring drug injectors' accounts of hepatitis C risk. Drawing upon 67 qualitative interviews with drug injectors in Belgrade, we explore accounts of hepatitis C risk and its transmission. We find that accounts portray a social context of pervasive risk in relation to hepatitis C. Hepatitis C is characterised as ubiquitous among drug injectors, and as a hardy virus with immense transmission potential. Narratives of hygiene emerge as core to accounts of transmission, in which the virus is linked to dirt, including dirty environments, dirty drugs and dirty injecting equipment. These hygiene narratives not only have symbolic function but also appear to stem from ambiguities in accounts wherein hepatitis C is conflated with the signs, symptoms and transmission routes of hepatitis A. In addition, accounts portrayed hepatitis C risk management as a responsibility of individuals in the absence of secure trust or certainty in knowledge about risk, including in relation to others' disclosed antibody status. Hygiene narratives are a core and symbolic feature of injectors' accounts of hepatitis C transmission. There is an urgent need for health promotion fostering hepatitis C risk awareness and risk avoidance among drug injectors in Serbia.