Multiple stigmas, shame and historical trauma compound the experience of Aboriginal Australians living with hepatitis C

Treloar, Carla; Jackson, Leanne; Gray, Rebecca; Newland, Jamee; Wilson, Hannah; Saunders, Veronica; Johnson, Priscilla; Brener, Loren

doi:10.1080/14461242.2015.1126187

Cited by 46 publications

(47 citation statements)

References 46 publications

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“…Another woman described an incident when an initially cheerful receptionist made her feel so uncomfortable after becoming aware of her HCV status that she fled the surgery before seeing the doctor. These accounts support ongoing research that stigma encountered within health settings, along with perceived fears of potential stigma, may inhibit people with HCV from accessing healthcare 1–2 7–8 15 39 41…”

Section: Data and Discussionsupporting

confidence: 59%

“…While those who experience stigma might vacillate between ‘cowering’ and ‘bravado’,30 participants encountering stigma in health settings frequently recounted shame, citing feelings of uncertainty and diminished worthiness 15 51–54. Consequently, alternate strategies were engaged to avoid being stigmatised, often with important implications for the quality of healthcare they received.…”

Section: Data and Discussionmentioning

confidence: 99%

“…Globally, WHO estimates 8–12 billion injections are administered annually, but deem 50% of that number to be unsafe, particularly in sub-Saharan Africa and Asia. In contrast, within high-income countries, HCV is transmitted most commonly by IDU, a privately initiated, illegal behaviour associated with deviance and depravity 14 15. In addition, its prevalence in Australia is disproportionately higher in socioeconomically disadvantaged groups, notably Aboriginal and Torres Strait Islander populations15 and those in custodial settings,16 17 social groups already burdened with manifold stigmas.…”

Section: Introductionmentioning

confidence: 99%

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A dirty little secret: stigma, shame and hepatitis C in the health setting

Northrop

2017

Med Humanities

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While recent medical innovation shows great promise in treating hepatitis C (HCV), it remains a condition associated with profound stigma. HCV is a bloodborne virus (BBV) most commonly transmitted in high-income countries by injecting drug use, and it is the stigmatising association between the two which is deeply problematic for those with HCV. A qualitative study undertaken in 2002 found that disclosure in health settings places those with HCV in positions of pronounced vulnerability. Disclosure is a primal scene, an interface, where the stigma of HCV, replete with connotations of disease and deviance, potentially transforms those affected into shamed subjects. Standard precautions protect health workers and minimise the transmission of contagion, measures which, in theory, also mitigate the requirement of those with BBVs to unnecessarily disclose their blood status. However, questions on pre-employment health checks, concerns that health treatments might adversely affect the liver and an ethical need to pre-emptively inform healthcare professionals undertaking exposure prone procedures are occasions when those with HCV confront the decision to disclose their blood status. This paper employs Goffman's model of actual and virtual social identities, along with Douglas' notion of dirt and pollution, to examine the dilemmas around disclosure those with HCV negotiate within the health setting. Discriminatory responses by healthcare professionals elucidate the stigmatising potential HCV carries. The subsequent reticence by those with HCV to disclose their blood status risks less than optimum healthcare. Recent studies indicate that stigma occurring in health settings remains a perennial concern for those with HCV.

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Section: Data and Discussionsupporting

confidence: 59%

Section: Data and Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A dirty little secret: stigma, shame and hepatitis C in the health setting

Northrop

2017

Med Humanities

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“…For example, HIV and hepatitis C are both prevalent in the DTES and have been linked to compounded stigma in healthcare settings among Indigenous peoples. In Australia, study participants reported similar broader societal assumptions, which caused ‘automatic’ expectations linking Aboriginal peoples to hepatitis C and other stigmatized diseases (58, 59). It is such racialized stereotypes that reveal how racism intersects with stigmatizing identities to contribute to the marginalization of Aboriginal peoples in healthcare settings leading to unsafe care and poorer access to healthcare services.…”

Section: Discussionmentioning

confidence: 90%

“They treated me like crap and I know it was because I was Native”: The healthcare experiences of Aboriginal peoples living in Vancouver's inner city

Goodman

Fleming

Markwick

et al. 2017

Social Science & Medicine

180

158

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There is growing evidence that Aboriginal peoples often experience healthcare inequalities due to racism. However, research exploring the healthcare experiences of Aboriginal peoples who use illicit substances is limited, and research rarely accounts for how multiple accounts of stigma intersect and contribute to the experiences of marginalized populations. Our research aimed to explore the healthcare experiences of Aboriginal peoples who use illicit drugs and or illicit alcohol (APWUID/A) living in Vancouver’s inner city. Using Indigenous methodologies, a community research team comprised of APWUID/A led the study design, data collection and analysis. Peer-facilitated talking circles explored community members’ experiences accessing healthcare services and patient-provider encounters. Using an intersectionality framework, our research demonstrated how healthcare inequalities among Aboriginal peoples are perpetuated by systemic racism and discrimination. Stigmatizing racial stereotypes were perceived to negatively influence individual attitudes and clinical practice. Participants’ experiences of medical dismissal often resulted in disengagement from care or delay in care. The findings suggest healthcare providers must understand the structural and historical forces that influence racial disparities in healthcare and personal attitudes in clinical practice. Adequate clinical protocols for pain management within the context of illicit substance use are urgently needed. The valuation of Aboriginal peoples and cultures within healthcare is paramount to addressing the health gap between Aboriginal and non-Aboriginal Canadians.

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“…To date, only three articles focused on the lived experience of HCV have used qualitative data collected during the interferon‐free DAA era. One of these articles focused exclusively on the Aboriginal community in Australia (Treloar et al., ), one on the experience of taking interferon‐free treatment (Whiteley, Whittaker, Elliott, & Cunningham‐Burley, ) and the other was limited to an examination of HCV‐related fatigue (Zalai et al., ). A broader contemporary understanding of how HCV is being experienced and perceived is therefore currently absent.…”

Section: Introductionmentioning

confidence: 99%