Everybody's got it, but...: situational and strategic participation in normalized HCV discourse among injection drug users in Edmonton, Canada

Abstract

Background: The normalization thesis refers to processes whereby stigmatized individuals, groups, and activities are accommodated into everyday social life. This study explored the utility of normalization for understanding the social accommodation of HCV among street-involved injection drug users (IDUs) in a Canadian city.

Methods: In-depth semi-structured interviews (1-4 hr) were conducted with 61 drug injectors recruited through a harm reduction program and user networks in Edmonton's inner city. ANALYSES AND RESULTS: An inductive approach characterized common and unique themes across participants, using a combination of phenomenological and thematic analyses and the constant comparative method. Most respondents readily participated in a normalized discourse about HCV, wherein 'everybody's got it', transmission is unavoidable, and that being HCV+--while being less serious than HIV--is a defining characteristic of ID use. However, results indicated that participation in normalized HCV discourse was situational, strategic, and at times, contradictory with respect to (a) coping with HCV diagnosis and progression, (b) negotiating riskier or safer injection practices, and (c) disclosing serostatus to others.

Conclusions: While normalization is useful for understanding the internalization of a medico-epidemiologic concept ('HCV status') into this user population, systematic description of coping and risk management practices relative to IDUs' acceptance or rejection of normalized expectations of HCV is important for developing tailored harm reduction programs and policies.