UNSW Sydney, Australia.
London School of Hygiene and Tropical Medicine, UK.
Health (London). 2022 Nov;26(6):736-752. doi: 10.1177/1363459320988887. Epub 2021 Jan 28.
Until recently, the only medical treatment available for the hepatitis C virus (HCV) was interferon-based therapy, a notoriously long and arduous treatment with limited success. However, in December 2015, the Australian Government announced a scheme of 'universal access' to new, highly effective direct-acting antiviral therapies (DAAs). This article draws on in-depth interviews with community actors engaged in national and state-based drug user and viral hepatitis advocacy to trace how universal access to curative medicines affords revised notions of citizenship and social inclusion among people who inject drugs and others affected by HCV. To inform our analysis, we draw on and combine critical perspectives from the biological citizenship literature, particularly pharmaceutical citizenship, along with work on the concepts of 'publics and counterpublics'. We ask: what kinds of emergent HCV communities or are being enacted through our participant accounts in response to the new DAA-era of universal access, and what forms of citizenship and inclusion (or non-citizenship and exclusion) do they postulate? Some accounts indeed enacted treatment as an individual, sometimes collective, 'good': a citizenship potential. However, a number of accounts enacted situated limits to a straightforward actualisation of this potential, performing a model of public health governance that prioritised viral cure whilst rendering injecting drug use and its attendant social disadvantages an absent presence. Reconceptualising HCV treatment within a counterpublic health sensibility would, by engaging with the everyday health needs and aspirations of people living with HCV in conditions of social disadvantage, create space for new social inclusions and citizenships.
直到最近，针对丙型肝炎病毒（HCV）的唯一医学治疗方法是基于干扰素的治疗，这种治疗方法非常漫长和艰巨，成功率有限。然而，2015 年 12 月，澳大利亚政府宣布了一项新的、高度有效的直接作用抗病毒疗法（DAAs）的“全民普及”计划。本文通过对参与国家和州一级的吸毒者和病毒性肝炎宣传的社区行为者的深入访谈，追踪了全民获得治疗药物如何为注射毒品者和其他受 HCV 影响的人群提供了公民身份和社会包容的新概念。为了进行分析，我们借鉴并结合了生物公民身份文献中的批判观点，特别是药物公民身份，以及关于“公众和反公众”概念的研究。我们提出以下问题：通过我们的参与者的叙述，在新的 DAA 全民普及时代，出现了哪些新的 HCV 群体或身份，以及它们提出了哪些形式的公民身份和包容（或非公民身份和排斥）？一些说法确实将治疗视为一种个人的、有时是集体的“好处”：一种公民身份的潜力。然而，一些说法却对这种潜力的直接实现设定了具体的限制，执行了一种公共卫生治理模式，该模式优先考虑病毒的治愈，同时使吸毒和随之而来的社会劣势成为缺席。通过在反公共卫生意识中重新构想 HCV 治疗，可以在社会劣势条件下，满足和关注 HCV 感染者的日常健康需求和愿望，为新的社会包容和公民身份创造空间。
