Rhodes Tim, Zikic Bojan, Prodanović Ana, Kuneski Elena, Bernays Sarah
Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK.
Soc Sci Med. 2008 Mar;66(6):1437-47. doi: 10.1016/j.socscimed.2007.11.009. Epub 2008 Jan 16.
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.
丙型肝炎病毒（HCV）感染是与注射吸毒相关的死亡率和发病率的一个重要原因。在塞尔维亚，最近的估计表明，大约三分之一的吸毒者丙型肝炎呈阳性。我们开展了塞尔维亚首次关于注射吸毒的定性研究，重点是探究吸毒者对丙型肝炎风险的描述。基于对贝尔格莱德吸毒者的67次定性访谈，我们探讨了丙型肝炎风险及其传播的描述。我们发现，这些描述描绘了一个与丙型肝炎相关的普遍风险的社会背景。丙型肝炎在吸毒者中被描述为无处不在，是一种具有巨大传播潜力的顽强病毒。卫生叙述成为传播描述的核心，在这些叙述中，病毒与污垢联系在一起，包括肮脏的环境、肮脏的毒品和肮脏的注射设备。这些卫生叙述不仅具有象征功能，而且似乎源于描述中的模糊性，即丙型肝炎与甲型肝炎的体征、症状和传播途径混为一谈。此外，在缺乏对风险的可靠信任或对风险知识的确信（包括关于他人披露的抗体状况）的情况下，描述将丙型肝炎风险管理视为个人的责任。卫生叙述是注射吸毒者对丙型肝炎传播描述的核心和象征特征。迫切需要在塞尔维亚开展健康促进活动，以提高吸毒者对丙型肝炎风险的认识并避免风险。
