Beeching, 2004). There is also a public perception that HCV is highly contagious and that it is life-threatening in most cases (Conrad et al., 2006); this has led to discrimination on the part of people who inappropriately perceive themselves to be at risk from casual contact with an HCV-positive person. In a study of patients in a liver clinic in Iowa, 57% of HCV-positive people reported having experienced stigma associated with their infection (Zickmund et al., 2003). Many patients who have HCV infection wish to disclose their HCV status to family, intimate partners, and others in an effort to protect them from infection and to obtain psychosocial support. Even in work settings, people have been eager to disclose their HCV status so that in the event of injury co-workers would take extra care in avoiding exposure to contaminated blood. However, many people report that informing others of their HCV status has led to inappropriate reactions, such as “[I’m] not allowed to use the cups because they don’t really know … how to pass it on” (Conrad et al., 2006). In another study, a patient reported that “they didn’t want me drinking out of the water fountain” (Zickmund et al., 2003).

Education Programs

Although only a handful of studies have examined the influence of education on HCV-related risk behavior in IDUs, the results are consistent in showing that enhanced education and counseling are associated with safer injection practices (Garfein et al., 2007; Latka et al., 2008; Tucker et al., 2004). In the DUIT study by Garfein et al. (2007), young HIV-seronegative and HCV-seronegative IDUs were enrolled in a randomized trial of an intervention that sought to train them to be peer educators. The goals of the peer-education intervention (PEI) were to develop mastery over knowledge and skills necessary for prevention of HIV and HCV infection so that they could pass the knowledge on to their peers. Behavior change was measured in the PEI subjects and in subjects randomized to an equal-attention control group. Reductions in injection risk behavior were observed in both study arms, but the PEI group reported significantly greater reductions.

A parallel study, the Study to Reduce Intravenous Exposures (STRIVE), enrolled young HCV-seropositive IDUs (most of whom were chronically infected) and randomized them into a PEI or control condition. Significantly greater reductions in injection practices that could transmit HCV to other IDUs were observed in the PEI group (Latka et al., 2008). Thus, enhanced education and skill-building can lead to safer injection practices and may contribute to avoidance of infection in susceptible IDUs and reduction in transmission of infection to other IDUs. That strategy parallels the Prevention for Positives initiatives for HIV (CDC, 2003a).

Patients in drug-treatment programs have considerable needs for educa-



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