title: "Don't think I'm going to leave you over it": Accounts of changing hepatitis C status among couples who inject drugs.
abstract: While the health-related benefits of intimate partnership are well documented, little attention has been paid to couples exposed to high levels of social stigma and exclusion. In this project we investigated an important site of stigma for partnerships by collecting accounts of changing hepatitis C (HCV) status ("sero-change") among couples that inject drugs. We explored what these accounts reveal about the meaning of HCV for these couples, and how this understanding contributes to our collective efforts at prevention and care.
  
  
  
  Drawing from a large dataset of qualitative interviews with couples, we focussed on those containing reports of sero-change. By adopting a methodology that positioned partnerships rather than individuals as the primary unit of analysis, we addressed the commonplace tendency to either overlook or discount as dysfunctional, the sexual relationships of people who inject drugs.
  
  
  
  While some couples sought greater biomedical understanding as a means of coming to terms with sero-change, others drew on alternative logics or "rationalities" that sat firmly outside conventional biomedical discourse (privileging notions of kinship, for example). Regardless of which explanatory framework they drew on, participants ultimately prioritised the security of their relationship over the dangers of viral infection.
  
  
  
  Effectively engaging couples in HCV prevention and care requires acknowledging and working with the competing priorities and complex realities of such partnerships beyond simply the identification of viral risk. The "new era" of direct acting antiviral treatments will provide ongoing opportunities to learn to integrate biomedical information within more socially sophisticated, relationally aware approaches.
authors.affiliation: Centre for Social Research in Health, UNSW Australia, Sydney NSW 2052 Australia. Electronic address: jake.rance@unsw.edu.au.
authors.forename: Jake
authors.initials: J
authors.lastname: Rance
authors.affiliation: Centre for Social Research in Health, UNSW Australia, Sydney NSW 2052 Australia. Electronic address: c.treloar@unsw.edu.au.
authors.forename: Carla
authors.initials: C
authors.lastname: Treloar
authors.affiliation: National Drug Research Institute, 19-35 Gertrude Street, Victoria 3065, Australia. Electronic address: Suzanne.fraser@curtin.edu.au.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Fraser
authors.affiliation: Centre for Social Research in Health, UNSW Australia, Sydney NSW 2052 Australia. Electronic address: j.bryant@unsw.edu.au.
authors.forename: Joanne
authors.initials: J
authors.lastname: Bryant
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Electronic address: Tim.Rhodes@Ishtm.ac.uk.
authors.forename: Tim
authors.initials: T
authors.lastname: Rhodes
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D016174:Hepacivirus; D006526:Hepatitis C / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D012747:Sexual Partners; D015819:Substance Abuse, Intravenous / Q000150:complications*; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: Australia; Dyadic analysis; Hepatitis C; Injecting drug use; Qualitative research; Sexual partnerships