Are We Leaving Women Who Inject Drugs Behind on the ‘Road to Hepatitis C Elimination’? A Qualitative Exploration to Minimise Inequalities in Health.

Author: Alison Marshall Jake Rance Greg Dore Jason Grebely Carla Treloar

Theme: Social Science & Policy Research Year: 2022

Background: In Australia, research has indicated that women who inject drugs are less likely to
initiate hepatitis C virus (HCV) treatment than men who inject drugs. On the ‘road to HCV
elimination’, concerted efforts are needed to minimise inequalities in care. The study aim was to
explore experiences of HCV-related care among women ‘across the HCV care cascade’ to better
understand ‘why’ and ‘how’ this phenomenon is occurring.
Methods: Participants were sampled from the ETHOS Engage cohort (n=1,443). Inclusion criteria
were informed consent, aged >18 years, history of injection drug use, and persons who injected in
the prior six months or were currently receiving opioid agonist therapy (OAT). Participants who
identified as women and were enrolled in ETHOS Engage were invited to participate in a semistructured interview. Data was analysed with the Stigma and Substance Use Process Model.
Results: 21 women were interviewed (mean age 42 years, 5 are Aboriginal, 11 received HCV
treatment) of which the majority received financial assistance, were currently receiving OAT, and
over half injected drugs in the past month. Participants highlighted several incidents of ‘double
stigma’ when receiving HCV care, i.e., perceived to be judged more harshly by health services due to
their gender and injection drug use. When HCV care and gender-based care overlapped (e.g., HCV
diagnosis during pregnancy) participants were mostly dissatisfied with the care received and/or
expected to be reprimanded based on past stigmatising experiences. Participants who had not
received HCV treatment spoke of intimate partners who were also not treated and a lack of support
networks. Participants who received treatment identified the support of ‘champion’ workers to
overcome barriers.
Conclusion: Findings move beyond sex disaggregation data to reinforce the complexities of ‘double
stigma’ for women in HCV care, underscoring the need for services to recognise and work towards
countering its impact.
Disclosure of Interest Statement: ADM has nothing to declare. JR has nothing to declare. GJD is a
consultant/advisor and has received research grants from Abbvie, Abbot Diagnostics, Bristol Myers
Squibb, Cepheid, Gilead, GlaxoSmithKline, Merck, Janssen and Roche. JG is a consultant/advisor and
has received research grants from AbbVie, Cepheid, Gilead, and Merck outside the submitted work.
CT has received speaker fees from Abbvie and Gilead and grant funding from Merck.

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