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The politics of place(ment): Problematising the provision of hepatitis C treatment within opiate substitution clinics

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  • Rance, Jake
  • Newland, Jamee
  • Hopwood, Max
  • Treloar, Carla

Abstract

The hepatitis C virus (HCV) epidemic is a significant public health challenge in Australia. Current initiatives to expand access to HCV treatment focus on opiate substitution therapy (OST) settings where the prevalence of hepatitis C among clients is high. In Australia, the provision of OST for many clients is via large clinics, with an estimated median of 150 clients per service. Conceptually informed by the work of Michel Foucault, our analysis of the proposed integrated treatment model focuses on the critical but overlooked question of organisational culture and power operating within OST. We argue that the specific context of OST not merely reflects but actively participates in the political economy of social exclusion via which the socio-spatial segregation and stigmatisation of the service user as ‘drug user’ is enacted. This paper analyses data collected from two samples during 2008/9: OST clients living in New South Wales, Australia and a range of OST health professionals working in Australian settings. In total, 27 interviews were conducted with current OST clients; 19 by phone and 8 face-to-face. One focus group and 16 telephone interviews were conducted with OST health professionals. Our analysis of key themes emerging from the interview data suggests that the successful introduction of HCV treatment within the OST clinic is not a given. We are concerned that particular areas of tension, if not explicit contradiction, have been overlooked in current research and debates informing the proposed combination treatment model. We question the appropriateness of co-locating a notoriously arduous, exacting treatment (HCV) within the highly surveillant and regulatory environment of OST. While applauding the intention to improve access to HCV care and treatment for people who inject drugs we caution against a treatment model that risks further entrenching (socio-spatial) stigmatisation amongst those already experiencing significant marginalisation.

Suggested Citation

  • Rance, Jake & Newland, Jamee & Hopwood, Max & Treloar, Carla, 2012. "The politics of place(ment): Problematising the provision of hepatitis C treatment within opiate substitution clinics," Social Science & Medicine, Elsevier, vol. 74(2), pages 245-253.
    • Handle: RePEc:eee:socmed:v:74:y:2012:i:2:p:245-253
    DOI: 10.1016/j.socscimed.2011.10.003
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    References listed on IDEAS

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    1. Radcliffe, Polly & Stevens, Alex, 2008. "Are drug treatment services only for 'thieving junkie scumbags'? Drug users and the management of stigmatised identities," Social Science & Medicine, Elsevier, vol. 67(7), pages 1065-1073, October.
    2. Parker, Richard & Aggleton, Peter, 2003. "HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action," Social Science & Medicine, Elsevier, vol. 57(1), pages 13-24, July.
    3. Takahashi, Lois M., 1997. "The socio-spatial stigmatization of homelessness and HIV/AIDS: Toward an explanation of the NIMBY syndrome," Social Science & Medicine, Elsevier, vol. 45(6), pages 903-914, September.
    4. Smith, Christopher B.R., 2010. "Socio-spatial stigmatization and the contested space of addiction treatment: Remapping strategies of opposition to the disorder of drugs," Social Science & Medicine, Elsevier, vol. 70(6), pages 859-866, March.
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    1. Harris, Magdalena & Rhodes, Tim & Martin, Anthea, 2013. "Taming systems to create enabling environments for HCV treatment: Negotiating trust in the drug and alcohol setting," Social Science & Medicine, Elsevier, vol. 83(C), pages 19-26.

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