title: Hepatitis C and its risk management among drug injectors in London: renewing harm reduction in the context of uncertainty.
abstract: OBJECTIVE
  Recognizing the dearth of qualitative research on hepatitis C virus (HCV) infection associated with injecting drug use in the UK, this paper summarizes qualitative insights from a study exploring the social relations of HCV risk management among drug injectors in London.
  
  
  METHODS
  Adopting an inductive approach to data collection and analysis, 59 depth tape-recorded qualitative interviews were undertaken in 2001 with drug injectors recruited via drug user networks.
  
  
  RESULTS
  While access to injecting equipment was reportedly good, needle and syringe sharing continued in exceptional circumstances and in the context of 'trust relationships'. Analyses of drug injectors' accounts of variations of 'I never share' showed that this construction denoted less a descriptor of actual risk behaviour than presentation of perceived risk status. Paraphernalia sharing, including spoons and filters, was common. There was much confusion and uncertainty concerning HCV knowledge, including its medical and transmission risks. Injectors were aware of the provisionality and partiality of their HCV knowledge. Confusion also surrounded the meaning of HCV antibody test results, with some feeling that their positive diagnosis had been 'trivialized' by their experiences of HCV testing. Injectors tended to make sense of HCV risk in relation to HIV. With most viewing HCV prevalence as high and HCV transmission as an inevitable consequence of injecting, HCV risk was perceived as ubiquitous and unavoidable.
  
  
  CONCLUSIONS
  There is an urgent need to renew UK policies of harm reduction in order to support perceptions that HCV is avoidable and preventable.
authors.affiliation: Centre for Research on Drugs and Health Behaviour, Department of Social Science and Medicine, Imperial College London, University of London, London, UK. t.rhodes@imperial.ac.uk
authors.forename: Tim
authors.initials: T
authors.lastname: Rhodes
authors.forename: Mark
authors.initials: M
authors.lastname: Davis
authors.forename: Ali
authors.initials: A
authors.lastname: Judd
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006526:Hepatitis C / Q000517:prevention & control* / Q000635:transmission; D018937:Hepatitis C Antibodies / Q000032:analysis; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing / Q000009:adverse effects; D018671:Needle-Exchange Programs / Q000458:organization & administration; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications*
chemical_list: D018937:Hepatitis C Antibodies