Hepatitis C meanings and preventive strategies among street-involved young injection drug users in Montréal.

OBJECTIVE: To examine what hepatitis C virus (HCV) infection means to street-involved young IDUs (SYIDUs) and how this impacts on their health behaviours, based on social contexts in which they live.
METHODS: Thirty-nine SYIDUs with HCV infection participated in in-depth interviews. A typology was built founded on SYIDUs' street life and drug use experiences. The meanings given to hepatitis C and resulting health behaviours were examined through these experiences.
RESULTS: In Montréal, "total" experience is characterised by an exclusive social relationship with the street milieu and by intensive drug consumption. In this milieu, where most injectors are HCV-infected but asymptomatic, getting infected is considered trivial. Compared to other more immediate threats, HCV infection and its long-term consequences are lesser concerns. Efforts to inject safely are made to avoid HIV. When these SYIDUs learn they are HCV-infected, they do not make important lifestyle changes. However, since they worry about transmitting the infection to others, they notify their injection partners that they are infected. SYIDUs living a "controlled" experience preserve some stability in their lives and control their consumption. They maintain relationships within mainstream society and have beliefs reflecting these links. They view HCV infection as a serious disease and make significant efforts to avoid sharing their injection equipment and thus remain healthy. When they learn they are HCV-infected, they engage in "liver friendly" behaviours but are not ready to stop injecting. The "disengaging" experience is that of youth who start to disengage from drug injection. They leave the drug milieu and develop new relationships within mainstream society. They adopt new values regarding health. HCV infection is viewed as requiring significant changes in strategies aimed at protecting themselves and others.
CONCLUSION: This research sheds light on the fundamentally social nature of hepatitis C. SYIDUs' HCV experiences, which evolve in parallel with their street life and consumption trajectories, provide numerous occasions where they can be exposed to prevention messages.