Abstract #2711  -  The Making of Patient Citizenship in the Treatment of HCV and HIV: Insights from qualitative research in Europe
Authors:   Presenting Author:   Dr Tim Rhodes - School of Hygiene and Tropical Medicine, University of London
Additional Authors:  Dr Harris M Donoghoe,
Aim: There is often low or delayed uptake of hepatitis C and HIV treatments among people who inject drugs in Europe. At the same time, there is increasing interest in facilitating early access to treatment, including for its potential community prevention effects. This paper seeks to map a sociological approach towards understanding the ?problem? of anti-viral treatment engagement. Rather than envisaging problems of treatment access and uptake primarily in relation to patient compliance and awareness, treatment engagement is explored as a product of social condition.
Method / Issue: Approach: Two key themes are developed. First, building on a synthesis of literature, we focus on how social research can help unpack the interplay of social and environmental factors mediating treatment engagement. This helps shape a framework for understanding the social relations of treatment engagement. Second, drawing upon qualitative case studies among people who inject drugs (London, Estonia, Russia), we explore how people?s experience of treatment contemplation and access creates as well as reproduces ?patient citizenship?. Findings: Drawing on ideas of ?biological? and ?therapeutic? citizenship in the fields of medical sociology, it becomes possible to discuss how entitlements to hepatitis C and HIV treatments are enabled as well as constrained. We conclude that narratives of rationed treatment expectation among people who inject drugs connect with ideas of the drug user as a less than fully acceptable or deserving citizen of treatment. We show how treatment systems and their navigation reproduce this diminished sense of treatment entitlement, which in turn can result in treatment delay and weak treatment engagement.
Results / Comments: This work helps to identify the role of social and structural interventions in facilitating access to hepatitis C and HIV treatment as well as point to some of the potential limits of envisaging treatment merely in biomedical terms.
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