Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; Centre for Social Research in Health and Social Policy Research Centre, University of New South Wales.
Australian Research Centre in Sex, Health and Society, La Trobe University, Australia.
Int J Drug Policy. 2022 Sep;107:103771. doi: 10.1016/j.drugpo.2022.103771. Epub 2022 Aug 8.
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.
随着丙型肝炎高效抗病毒治疗的出现，许多人已经接受了治疗并被治愈。然而，其他人即使有免费且易得的治疗机会，也没有接受治疗。澳大利亚到 2030 年消除这种疾病的目标意味着，这一群体令研究人员、卫生专业人员和政策制定者感到担忧。本文借鉴了一项关于治疗经验的研究项目中进行的 50 次访谈，以研究澳大利亚治疗不接受的情况。本研究借鉴了 Berlant（2007）关于“慢性死亡”的研究，分析了不接受治疗的经历，以解释导致这种结果的动态因素。分析分为三个部分。首先，参与者卡尔描述了他的一生，丙型肝炎、无家可归和监禁塑造了他的人生观和机会。其次，埃文描述了代际吸毒、与监狱系统的家庭接触以及同样长的丙型肝炎病史。最后，罗斯也描述了长期的丙型肝炎、改善生活的复杂斗争和与监狱系统的接触。这三个案例都阐明了影响治疗决策的动态因素，让人联想到 Berlant 的慢性死亡是一个在既要求自我管理又与之相悖的条件下，“因再生产生命的活动而疲惫不堪”的过程。在结论中，本文指出了 Berlant 对“流行”和“地方病”的区分，并认为其政治观点直接适用于丙型肝炎。通过这样做，它强调了需要解决使生命疲惫不堪的定罪、病理化、资本主义的“损耗”（Berlant）背景，即使它崇拜自主、责任和选择。
