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phone call. Participants took part in a
30 minute semi-structured interview,
covering topics such as hepatitis
C education, occupational risk of
hepatitis C, clients with blood-borne
viruses, clients who inject drugs, and
clients on opioid replacement therapy
(ORT) programs. Participants were also
asked their views on the ndings of
our earlier studies which suggested
that women and men with hepatitis C
perceived that their hepatitis C resulted
in less favourable treatment by health
professionals. Pilot interviews with
40 people with hepatitis C conducted
in the development phase of a large
scale survey for people with hepatitis
C had produced many examples of
poor treatment of those with hepatitis
C by health and other professionals.
Subsequently two large surveys included
a question to determine whether this
experience was common, and found that
48% of 462 women with hepatitis C and
40% of 312 men with hepatitis C believed
they had received less favourable
treatment by health professionals,
a result which was unrelated to
participants' drug use history.7,8 In both
studies, negative treatment was most
commonly reported to be from doctors,
followed by dentists, then nurses, and
pharmacists (Figure 1). The current
study was designed to elucidate these
data from the practitioner's viewpoint.
Qualitative research methods, such as
in-depth interviews, are most suited
to attempting to understand human
behaviour from the subject's own frame
of reference.9 By eliciting the meanings
given to the experiences and views of
participants, such methods produce
data which aim to re ect the diversity of
experience rather than the frequency of
that experience in a given population.
All interviews were audio taped,
transcribed, and coded for analysis
using NVIVO (V2.0) qualitative research
software (QSR International, 2002).
Interviews were initially coded by the
one author (KMJ) according to a code
list developed from themes identi ed in
the interview transcripts. As is common
practice in qualitative research, coding
was assessed by three researchers
independently before discussion to
achieve consensus. This study, conducted
while the rst author was employed at
LaTrobe University, had approval from
the LaTrobe University Human Ethics
Committee. All participants signed an
Informed Consent form.
Of the 32 pharmacists who were
approached, 27 agreed to participate.
Subsequently six declined to be
interviewed within the time allocated
for data collection, so a total of 21
pharmacists were interviewed --
nine females, 12 males. 18 pharmacists
were ORT dispensers. Eleven, some of
whom were not ORT dispensers, sold
needles (Table 1). City, regional and
rural pharmacists were represented in
Three major themes emerged from
in-depth analysis of the interviews:
1. Lack of knowledge of clients'
hepatitis C status
2. Relationships with ORT clients
3. Support for pharmacists.
Lack of knowledge of clients'
hepatitis C status
The interview commenced by the
interviewer showing participants
Figure 1 and asking how they would
explain these results. It was common
for pharmacists to express surprise
that people with hepatitis C might feel
they had been treated less favourably
'I treat everybody the same... I mean the
bottom line is nobody's better or worse than
anybody... I'm just as capable of catching
something from somebody as the next
person. I mean look at bird u' (PI 3,261).
Almost all pharmacists commented very
early on in the interview that what the
graph might be showing was not less
favourable treatment because clients
had hepatitis C, but because clients were
injecting drug users.
'I think the issue is more discrimination
against illicit drug users rather than people
having hep C and I'm wondering, yeah, if
what you're recording is not discrimination
of that' (PI 1, 96).
One participant, when shown the graph,
immediately suggested he treated clients
di erently under certain circumstances:
'Well, under some circumstances I have
treated people di erently but it's not
because of their disease state, it's because
of their behaviour... you catch someone
nicking stu or whatever ...and you kick
them o and they say, "Oh, you're doing
this because I'm a junkie"... "No, no, I'm
doing this because you're a cretin"' (laughs).
(PI 5, 31)
We asked pharmacists if they ever
asked clients about whether they have
'No. I don't ask them and they don't tell
me. ...That's not policy, that's just how it is'.
(PI 3, 136).
While some pharmacists said that
clients occasionally asked their opinion
about certain symptoms and whether
these could be due to their hepatitis C,
they generally had no reason to know
about hepatitis C status. However, they
sometimes did make assumptions
about whether clients had hepatitis C.
Similarly, ORT clients were often assumed
to have hepatitis C.
'I guess there's a high proportion of
injecting drug users that do carry hep C...I
guess it's just a safe assumption to make in
terms of when you're dealing with them for
your own safety too' (PI 14,264).
Figure 1: Percentage of men and women with hepatitis C reporting less favourable treatment by health professionals(7,8)
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