Social Theory & Health

, Volume 14, Issue 1, pp 44–65 | Cite as

Hepatitis C health promotion and the anomalous sexual subject

Original Article

Abstract

Research shows that diagnosis with the blood-borne liver disease hepatitis C can lead to significant changes in intimate relationships, including a reduction in sexual contact and avoidance of new relationships. This article examines hepatitis C health promotion materials and their treatment of sexuality and sexual transmission. The article analyses 21 Australian hepatitis C health promotion resources collected as part of research degree project exploring the interrelationships between hepatitis C, injecting drug use, HIV and the body. It uses the work of theorist Margrit Shildrick on the ‘anomalous’ body, and a discourse analysis method, to understand these interrelationships and their metaphorical and symbolic implications. Our analysis shows that health promotion materials regularly present information about sexual transmission in ways likely to add to confusion and uncertainty about risk. Despite regular acknowledgements that hepatitis C is not a sexually transmissible infection, some resources place an inappropriately heavy focus on the possibility of hepatitis C transmission via heterosexual activity. Others contain mixed messages about the possibility for disease transmission through sex, at the same time enjoining hepatitis C positive readers to practise safe sex. We argue that these injunctions are linked to the ways that the resources figure people living with hepatitis C as intrinsically anomalous. In doing so, the resources run the risk of inadvertently naturalising stigma, anxiety and fear surrounding intimate contact. The article concludes by noting that agencies responsible for the delivery of health promotion need to carefully examine the messages they produce if they are to avoid creating uncertainty and anxiety about the implications of hepatitis C for sexuality and intimacy.

Keywords

hepatitis C health promotion sexual transmission anomalous bodies gender 

Notes

Acknowledgements

The interviews referred to in this article were conducted as part of an Australian Research Council-funded study entitled ‘Under construction: The social and cultural politics of hepatitis C’ (DP0877944) and a Masters Project. The former was conducted at Monash University in partnership with the National Drug Research Institute and the National Centre in HIV Social Research. Chief investigators for the project ‘Under construction’ were Suzanne Fraser, Carla Treloar and David Moore. The authors would like to extend their thanks to the organisations that assisted in recruitment for the study, and most importantly of all, to the study participants who gave so generously of their time.

References

  1. Boonyard, V. et al (2003) Interspousal transmission of hepatitis C in Thailand. Journal of Gastroenterology 38 (2): 1053–1059.CrossRefGoogle Scholar
  2. Brook, H. and Stringer, R. (2005) Users, using, used: A beginners guide to deconstructing drugs discourse. International Journal of Drug Policy 16 (5): 316–325.CrossRefGoogle Scholar
  3. Bunton, R. (1992) More than a woolly jumper: Health promotion as social regulation. Critical Public Health 3 (2): 4–11.CrossRefGoogle Scholar
  4. Conrad, S., Garrett, L., Cooksley, W., Dunne, M. and Macdonald, G. (2006) Living with chronic hepatitis C means ‘you just haven’t got a normal life anymore’. Chronic Illness 2 (2): 121–131.Google Scholar
  5. Crofts, N., Campbell, A. and Kaldor, J. (1999) The force of numbers: Why hepatitis C is spreading among Australian injecting drug users while HIV is not. Medical Journal of Australia 170 (5): 220–221.Google Scholar
  6. Davies, B. and Harre, R. (2001) Positioning: The discursive production of selves. In: M. Wetherell, S. Taylor and S. Yates (eds.) Discourse Theory and Practice: A Reader. Los Angeles, CA: SAGE Publications, pp. 261–271.Google Scholar
  7. Davis, M. and Rhodes, T. (2004a) Managing seen and unseen blood associated with drug injecting: Implications for theorising harm reduction for viral risk. International Journal of Drug Policy 15 (6): 377–384.CrossRefGoogle Scholar
  8. Davis, M. and Rhodes, T. (2004b) Beyond prevention? Injecting drug user narratives about hepatitis C. International Journal of Drug Policy 15 (2): 123–131.CrossRefGoogle Scholar
  9. Dore, G. (2001) Natural history of hepatitis C virus infection. In: N. Crofts, G. Dore and S. Locarnini (eds.) Hepatitis C: An Australian Perspective. Melbourne, Australia: IP Communications, pp. 82–116.Google Scholar
  10. Douglas, M. (1966) Purity and Danger: An Analysis of the Concepts of Pollution and Taboo. London: Routledge.CrossRefGoogle Scholar
  11. Dwyer, R., Fraser, S. and Treloar, C. (2011) Doing things together?:Analysis of health promotion materials to inform hepatitis C prevention among couples. Addiction Research & Theory 9 (4): 352–361.CrossRefGoogle Scholar
  12. Faye, B. and Irurita, V. (2003) Balancing perspective: The response to feelings of being condemned with the hepatitis C virus. Journal of Substance Use 8 (2): 92–103.CrossRefGoogle Scholar
  13. Fraser, S. (2004) ‘It’s your life!’: Injecting drug users, individual responsibility and hepatitis C prevention. Health 8 (2): 199–221.Google Scholar
  14. Fraser, H. (2008) In the Name of Love: Women's Narratives of Love and Abuse. Toronto, Canada: Women's Press.Google Scholar
  15. Fraser, S. and Seear, K. (2011) Making Disease, Making Citizens: The Politics of Hepatitis C. Surrey, UK: Ashgate Publishing Limited.Google Scholar
  16. Fraser, S. and Treloar, C. (2006) 'Spoiled identity' in hepatitis C infection: The binary logic of despair. Critical Public Health 16 (2): 99–110.CrossRefGoogle Scholar
  17. Fraser, S., Treloar, C., Bryant, J. and Rhodes, T. (2014) Hepatitis C prevention education needs to be grounded in social relationships. Drugs, Education, Prevention and Policy 21 (1): 88–92.CrossRefGoogle Scholar
  18. Fraser, S.M. and Valentine, K. (2006) ‘Making blood flow’: Materializing blood in body modification and blood-borne virus prevention. Body & Society 12 (1): 97–119.CrossRefGoogle Scholar
  19. Grosz, E. (1994) Volatile Bodies: Toward a Corporeal Feminism. Bloomington, IN: Indiana University Press.Google Scholar
  20. Hahn, J. (2007) Sex, drugs and hepatitis C virus: Editorial commentary. The Journal of Infectious Diseases 195 (1): 1556–1559.CrossRefGoogle Scholar
  21. Harris, M. (2009) Injecting, infection, illness: Abjection and hepatitis C stigma. Body and Society 15 (33): 33–51.CrossRefGoogle Scholar
  22. Harris, M. and Rhodes, T. (2013) Injecting practices in sexual partnerships: Hepatitis C transmission potentials in a 'risk equivalence' framework. Drug and Alcohol Dependence 132 (3): 617–623.CrossRefGoogle Scholar
  23. Hepatitis Australia. (2007a) Contact: Post – Test Information for Hepatitis C. ACT: Hepatitis Australia.Google Scholar
  24. Hepatitis Australia. (2007b) Women and Hepatitis C: A Resource for Women with Hepatitis. ACT: Hepatitis Australia.Google Scholar
  25. Hepatitis Australia. (2010) Hepatitis C Testing Information. ACT: Hepatitis Australia.Google Scholar
  26. Hepatitis NSW. ([2008] 2011) Hep C Factsheets: Sex and Hepatitis C Transmission. NSW, Australia: Hepatitis NSW.Google Scholar
  27. Hepatitis NSW. ([2009a] 2013) What You Need to Know: A Guide to Hepatitis C. NSW, Australia: Hepatitis NSW.Google Scholar
  28. Hepatitis NSW. ([2009b] 2011) Hepatitis C: A Brief Introduction. NSW, Australia: Hepatitis NSW.Google Scholar
  29. Hepatitis Queensland. (2009) Sexual Transmission and Hepatitis C (Factsheet 29). Queensland, Australia: Hepatitis Queensland.Google Scholar
  30. Hepatitis South Australia. (2008a) Hep C is Not an STI! Australia: Hepatitis South Australia.Google Scholar
  31. Hepatitis South Australia. (2008b) Hepatitis C: Information for Family and Friends. Australia: Hepatitis South Australia.Google Scholar
  32. Hepatitis Victoria. (2008) Impact: Information About Hepatitis C. Victoria, Canada: Hepatitis Victoria.Google Scholar
  33. Hepatitis Victoria. (2009) Is Hepatitis C sexually Transmitted?. (factsheet) Victoria, Canada: Hepatitis Victoria.Google Scholar
  34. Hepatitis Western Australia. (2007a) Relationships and Problem-Solving (factsheet). WA: Hepatitis WA.Google Scholar
  35. Hepatitis Western Australia. (2007b) Hepatitis C and Sexual Transmission: Does it Occur? (Factsheet) WA: Hepatitis WA.Google Scholar
  36. Hepworth, H. and Krug, G. (1999) Hepatitis C: A socio-cultural perspective on the effects of a new virus on a community's health. Journal of Health Psychology 4 (2): 237–246.CrossRefGoogle Scholar
  37. Huggins, R. (2006) The addicts body: Embodiment, drug use, and representation. In: D. Waskul and P. Vannini (eds.) Body/Embodiment: Symbolic Interaction anf the Sociology of the Body. Hampshire, UK: Ashgate Publishing Limited, pp. 165–182.Google Scholar
  38. Kao, J. et al (1996) Transmission of hepatitis C virus between spouses: The important role of exposure duration. American Journal of Gastroenterology 91 (10): 2087–2090.Google Scholar
  39. Keane, H. (2002) What’s Wrong with Addiction? Carlton, Australia: Melbourne University Press.Google Scholar
  40. Keane, H. (2004) Disorders of desire: Addiction and problems of intimacy. Journal of Medical Humanities 25 (3): 189–204.CrossRefGoogle Scholar
  41. Krug, G. (1995) Hepatitis C: Discursive domains and epistemic chasms. Journal of Contemporary Ethnography 24 (3): 299–322.CrossRefGoogle Scholar
  42. Lenton, E. (2011) Anomalous bodies: Sexuality and intimate relationships in Australian health promotion materials and interviews with people affected by hepatitis C, Masters Thesis, Monash University, Melbourne.Google Scholar
  43. Lenton, E., Fraser, S., Moore, D. and Treloar, C. (2011) Hepatitis C, love and intimacy: Beyond the ‘anomalous body’. Drugs: Education, Prevention and Policy 18 (3): 228–236.Google Scholar
  44. Lupton, D. (1992) Discourse analysis: A new methodology for understanding the ideologies of health and illness. Australian Journal of Public Health 16 (2): 145–150.CrossRefGoogle Scholar
  45. McMahon, J., Pouget, E. and Tortu, S. (2007) Individual and couple-level risk factors for hepatitis C infection among heterosexual drug users: A multilevel dyadic analysis. Journal of Infectious Diseases 195 (11): 1572–1581.CrossRefGoogle Scholar
  46. Nettleton, S. (2006) The Sociology Of Health and Illness, 2nd edn. Cambridge: Polity Press.Google Scholar
  47. Parker, I. (1992) Discourse Dynamics: Critical Analysis for Social and Individual Psychology. London: Routledge.Google Scholar
  48. Petersen, A. and Lupton, D. (1996) The New Public Health: Health and Self in the Age of Risk. St Leonards, Australia: Allen and Unwin.Google Scholar
  49. Rhodes, T. and Stimson, G. (1994) What is the relationship between drug taking and sexual risk? Social relations and social research. Sociology of Health and Illness 16 (2): 209–228.CrossRefGoogle Scholar
  50. Seear, K., Gray, R., Fraser, S., Treloar, C., Bryant, J. and Brener, L. (2012) Rethinking safety and fidelity: The role of love and intimacy in hepatitis C transmission and prevention. Health Sociology Review 21 (3): 272–286.CrossRefGoogle Scholar
  51. Shildrick, M. (1997) Leaky Bodies and Boundaries: Feminism, Postmodernism and (Bio)ethics. London: Routledge.Google Scholar
  52. Shildrick, M. (2000) Becoming vulnerable: Contagious encounters and the ethics of risk. Journal of Medical Humanities 21 (4): 215–227.CrossRefGoogle Scholar
  53. Shildrick, M. (2002) Embodying the Monster: Encounters with the Vulnerable Self. London: Sage.Google Scholar
  54. Shildrick, M. (2007) Dangerous discourses: Anxiety, desire, and disability. Studies in Gender and Sexuality 8 (3): 221–244.CrossRefGoogle Scholar
  55. Simmons, J. and Singer, M. (2006) I love you … and heroin: Care and collusion among drug using couples. Substance Abuse Treatment, Prevention, and Policy 1 (7).Google Scholar
  56. Singer, L. (1993) Erotic Welfare: Sexual Theory and Politics in the Age of Epidemic. New York: Routledge.Google Scholar
  57. Sladden, T., Hickey, A., Dunn, T. and Beard, J. (1998) Hepatitis C virus infection: Impact on behaviour and lifestyle. Australian and New Zealand Journal of Public Health 22 (4): 509–511.CrossRefGoogle Scholar
  58. Terrault, N. (2002) Sexual activity as a risk factor for hepatitis C. Hepatology 36 (5): s99–s105.CrossRefGoogle Scholar
  59. Terrault, N. et al (2013) Sexual transmission of hepatitis C virus among monogamous heterosexual couples. Hepatology 57 (3): 881–889.CrossRefGoogle Scholar
  60. Tohme, R. and Holmberg, S. (2010) Is sexual contact a major mode of hepatitis C virus transmission? Hepatology 52 (4): 1497–1505.CrossRefGoogle Scholar
  61. Treloar, C. and Fraser, S. (2004) Hepatitis C, blood and models of the body: New directions for public health. Critical Public Health 14 (4): 377–389.CrossRefGoogle Scholar
  62. Vandelli, C. et al (2004) Lack of evidence of sexual transmission of hepatitis C among monogamous couples: Results of a 10-year prospective follow-up study. American Journal of Gastroenterology 99: 855–859, doi:10.1111/j.1572-0241.2004.04150.x.CrossRefGoogle Scholar
  63. Victoria Department of Human Services. (2006) Hepatitis C: The Facts. Victoria, Canada: DHS.Google Scholar
  64. Vitellone, N. (2003) The Syringe as a Prosthetic. Body and Society 19 (3): 37–52.CrossRefGoogle Scholar
  65. Waldby, C. (1996) AIDS and the Body Politic: Biomedicine and Sexual Difference. London: Routledge.Google Scholar
  66. Wetherell, M. (1998) Positioning and interpretative repertoires: Conversation analysis and post-structuralism in dialogue. Discourse & Societ 9: 387–412.CrossRefGoogle Scholar
  67. Winter, R., Fraser, S., Booker, N. and Treloar, C. (2011) Technical Review of Hepatitis C Health Promotion Materials. NSW, Australia: NCHSR.Google Scholar
  68. Zerubavel, E. (1991) The Fine Line: Making Distinctions in Everyday Life. New York: The Free Press.Google Scholar

Copyright information

© Palgrave Macmillan, a division of Macmillan Publishers Ltd 2015

Authors and Affiliations

  1. 1.Australian Research Centre in Sex Health and Society, La Trobe UniversityMelbourneAustralia
  2. 2.National Drug Research Institute (Melbourne Office), Curtin UniversityFitzroy VICAustralia

Personalised recommendations