The relationship between psychiatric disorders, intimate partner violence and hepatitis C: results from the European reduce mixed-methods study

Introduction and Aims: Depression, intimate partner violence (IPV) and lack of assertiveness may decrease female injectors' ability to negotiate safer interactions in their personal drug and sex networks/relationships. The REDUCE study examined the relationship between hepatitis C virus (HCV) status, psychiatric disorders and IPV.

Design and Methods: Two hundred female injectors from outpatient drug treatment centres in Austria, Italy, Poland and Spain were interviewed using the Dual Diagnosis Screening Instrument and the Composite Abuse Scale. In Phase 2, a purposive sample of 96 participants from Phase 1 was interviewed in-depth about their risk-taking behaviours.

Results: Sixty-two percent were HCV positive. Of those who had recently shared injecting equipment, 48% reported sharing with their sexual partner. 69% had experienced IPV in the previous year of their current/most recent relationship, however there was no significant difference in HCV status between those who had and had not experienced IPV. The prevalence of probable depression (72%) and post-traumatic stress disorders (48%) was high, however, no significant associations were found between these disorders and HCV status. Qualitative interviews highlighted the relationship between depression “nothing matters … I pick up needles from the ground” and the control of the partner in risk-taking behaviours. HCV positive injectors reported greater difficulty in refusing to inject because they believed the drugs were prepared unsafely (32% vs. 15%; P = 0.013) and in being able to ensure safe drug preparation/injection (15% vs. 5%; P = 0.043).

Discussion and Conclusions: HCV risk behaviours should be understood in the context of female injectors' relationships with male sexual partners.

Implications for Practice or Policy: HCV risk behaviours could be reduced if female injectors were able to assertively insist on and negotiate safer sex and injecting practices.

Implications for Translational Research: The REDUCE project has developed and tested a behavioural intervention that educates female injectors about HCV transmission risks and how to negotiate safer practices.