This
group accepted the risks that accompanied their behaviour as they viewed
behaviour change as requiring considerable effort, whereas they perceived
medical treatment as an easier option. Thus, they accepted – and even expected
– multiple rounds of treatment or possibly living with a chronic hepatitis C
infection. However, they were concerned about disclosure and the possibility of
sexual rejection.
“It’s
hard to change much. Because in the moment you don’t want to talk about it.
Because that’s when you want to party, have sex, you want to enjoy and you
don’t want to say, ‘Hey stop! Hepatitis C!’ Then everything would be over.”
They had
lived with hepatitis C for a similar time to the second group (a median of 1.5
years) but went on an intensive search for information to better understand the
infection and prevent re-infection. Two had been previously treated with older
interferon-based therapy. While some men in this group had opted for some
risk-reduction strategies, there was frustration at not knowing exactly how
they became infected or re-infected. This occasionally led to abandonment of
risk-reduction strategies.
“The
first time it was so nice, because I knew exactly where it [hepatitis C] came
from, where I got it, from whom... Then it’s easy to say, ‘Ok, I’ll change
something.’ But when later I stand there and the liver values are high and I
can’t link it to any specific situation, then it’s difficult to change
anything.”
One
couple spoke of how much easier it was having a partner with both infections:
“What was
easy for us was that we had the same thing. He was positive [HIV and HCV] and
me, too. That’s why we got together, because we supported each other. Because
how do you want to find a life partner that doesn’t have it, that doesn’t
understand the problems?”
As these
men saw little possibility of changing their risk behaviours, the only
reasonable restriction for them that emerged from the behavioural counselling
was to have fewer sexual encounters and hope increased testing and cure would
lead to less hepatitis C in the community. Direct-acting antiviral treatment
was viewed not only as a means to cure infection, or to give ‘the liver a
break’, but it also enabled them to engage in the type of sex they wanted to
have.
However,
in some cases anxiety about re-infection after being cured got in the way of
sexual enjoyment. One man likened the anxiety to concerns around HIV transmission
in the time before U=U.