Harm reduction workers and the challenge of engaging couples who inject drugs in hepatitis C prevention.
Despite injecting-equipment sharing between sexual partners leaving them at increased risk of hepatitis C (HCV), there is scant literature available to guide harm reduction workers in their encounters with couples who inject drugs. This article explored workers' understandings of such couples and their accounts of working with them in relation to HCV prevention.



Semi-structured interviews were conducted with 22 staff of harm reduction services located in Sydney and Melbourne, Australia.



Overall, staff represented couples as either absent from the service or as presenting with needs indiscernible from those of individual clients. Responses to questions about HCV and couples were framed primarily in terms of risk. Staff participants questioned 'genuineness' of clients' intimate relationships, instead characterising them as inauthentic and drug-driven. Working with couples was seen to present a number of organisational and clinical challenges. The benefits of recognising and working with such partnerships received scant acknowledgement. Rather, staff tended to perceive couples as being 'impenetrable' to health promotion messaging.



The framing and delivery of harm reduction in Australia remains an individualising enterprise with little capacity to recognise the intimate partnerships, including addressing the HCV risks specific to them. More effective harm reduction strategies may be achieved by transitioning to a practice framework that addresses the social context of injecting, including the experience of couples. This would require direct involvement of couples who inject drugs.
Centre for Social Research in Health, UNSW Australia, 2052, Australia. Electronic address: c.treloar@unsw.edu.au.
Carla
C
Treloar
Centre for Social Research in Health, UNSW Australia, 2052, Australia.
Jake
J
Rance
Centre for Social Research in Health, UNSW Australia, 2052, Australia.
Joanne
J
Bryant
National Drug Research Institute, Curtin University, Suite 6, 19-35 Gertrude Street, Fitzroy, VIC 3065, Australia.
Suzanne
S
Fraser
D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D005260:Female; D040261:Harm Reduction; D016174:Hepacivirus; D006526:Hepatitis C / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D012309:Risk-Taking; D012747:Sexual Partners; D015819:Substance Abuse, Intravenous / Q000150:complications*
Couples; Hepatitis C; Injecting drug use; Needle and syringe exchange; Prevention; Qualitative research; Relationships