Treating hepatitis C in prison: Understanding the social and behavioural implications of risk, prevention, and treatment





1. Please give a summary of your research

My research highlights the ongoing social, behavioural, structural, environmental, and policy issues which continue to hinder efforts to eliminate hepatitis C virus (HCV) infection in Australia. As a social health researcher in the prison setting, my research focuses on the social and behavioural components underpinning HCV risk, prevention, treatment, and reinfection among people who inject drugs whilst incarcerated.

HCV is predominantly transmitted through shared injecting equipment and is highly prevalent in the prisoner population do to the mass incarceration of people who inject drugs. Over half of Australian prisoners have a history of injecting drug use, with many people in prison continuing to inject drugs during their incarceration. However, a lack of access to sterile injecting equipment combined with high HCV prevalence creates an injecting culture in which transmission risks may be superseded by drug consumption.

My work explores the social negotiations which occur among injecting networks as people who inject drugs in prison navigate drug dependence and likelihood of HCV exposure. HCV is often perceived as inevitable among people who inject drugs in the prison setting.

A majority of people released from prison to the community will return to prison. Although prison is a high prevalent setting for blood borne viruses, such as HCV, it can be an ideal setting for testing and treating people living with HCV. Through my work, prisoners have identified the perceived benefits of undergoing HCV treatment in prison (compared with in the community) as prison provides opportunity for self-improvement (including health), as well as proximity to healthcare (on-site versus across town), and few other competing priorities which can hinder healthcare access in the community (e.g., employment, childcare). The interviews I have conducted, and subsequent analyses, have identified modifiable barriers to enhance HCV care thereby informing health promotion and service delivery within the prison setting. 

2. Please include any additional details you would like to share

Undertaking research with people in prisons requires unique skill sets to overcome the innate power dynamic of researcher-prisoner, as well as navigating the multitude of relationships to even be granted access into the prisons. Once inside, developing rapport with people who inject drugs whilst incarcerated requires sensitivity and knowledge of prisoner vulnerabilities in speaking with a researcher (both for fear of being exposed to correctional officers for their illicit drug use, as well as being perceived as “snitching” by fellow prisoners).Correctional officers, who are involved in direct access to both the prison as well as prisoner participants, may be opposed to the research itself, or the involvement of prisoners within the research study (through elevated sense of self of participants during the course of data collection). Liaising with correctional officers to ensure support of the study is necessary for access to participants, and possibly participant acceptance of the research through officer-prisoner dialogue during escort to the interview room (or at other times). 

To address these challenges, I have developed extensive skills in liaising with key stakeholders from correctional services to gain support for prison-based qualitative studies, ensuring greater participant response as well as ease of access to correctional centres during data collection periods. Prior to commencing data collection in prison, I met with former prisoners to learn about rapport building in the prison setting and creating trust with prospective participants. Throughout my experience of prison-based interviewing, I have learned from participants and supportive correctional officers about strategies to ensure participant safety and confidentiality which I communicate to all prospective participants before commencing any interview. This creates a safe space for participants to discuss their illicit drug use in the context of HCV risk exposure without concern of breach of confidentiality.  



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