Was this a result you were expecting?

Abstract

Since 1996, The Burnet Institute has been developing a program of research into the drug-use patterns and associated risk behaviours among injecting drug users of Vietnamese ethnicity.1−4 Ethnic Vietnamese drug users have been important in the functioning of the street-based drug markets across Melbourne for at least a decade.5 Injecting drug users (IDUs) born in south-east Asia are over-represented in the HIV notification data inVictoria.6 Furthermore, between 1999 and March 2003, 11 out of 38 (41%)HIV notifications in Victoria with injecting drug use as their sole exposure category were born in Vietnam.7 Between February and September 2003, I was part of a Burnet Institute team investigating the prevalence of blood-borne viruses among ethnic Vietnamese injecting drug users. The institutional ethics committee of the Department of Human Services approved this cross-sectional study where ethnic Vietnamese illicit drug injectors were recruited using street-based snowball techniques from three areas across metropolitan Melbourne. Participants were interviewed about their drug-use patterns and risk behaviours and were offered preand post-test counselling for HIV, hepatitis C (HCV) and hepatitis B (HBV). We recruited 127 ethnic Vietnamese IDUs, over 60% of whom reported injecting heroin daily. Of the participants, 103 (80%) were HCV antibody positive, and three people (2.4%) tested positive to HIV. In this field note, I describe and reflect on my personal responses to the first time I told someone they were HIV positive. Footscray (one of the main recruitment sites for the study) is located in the inner west of Melbourne and is a diverse multicultural community with a significant ethnic Vietnamese population. On entering Footscray for the first time, one is struck by its distinctly Asian feel. The smells and sounds are those of south-east Asia. Large numbers of people come to Footscray every day to shop, just as they would have done in their neighbourhood markets in their country of origin. But the fresh food market is not all that attracts people. Footscray also serves as a busy commercial and administrative centre for thewestern suburbs and the regional office for Centrelink (the government income support department). It is a public transport hub for the western suburbs and there are many suburban buses as well as a tram and rail line in the middle of the shopping district. Much of the preand post-test training I received had emphasised that the recruitment of active injectors in streetbased settings was not the perfect way to do HIV testing, but our previous research experience had shown us that it was hard to encourage testing in other ways. The study had been running for 3 months when I received a telephone call informing me that one of the 60 participants had tested positive for HIV. I checked my field notes to see who it was. ‘Lam’ (not his real name) is a young man in his early 30s who was born in Vietnam and arrived in Australia ∼15 years ago with his father and other siblings. His mother was left inVietnamwith her brothers and sisters and has never lived in Australia. Lam is well connected to the street drug market and has a long and established history with the justice system in Victoria. He is currently living with his father, but in the few years that I have known him, I have visited him in squats, at other friends’ houses and even in prison. In some ways I knew this had to happen eventually because ethnic Vietnamese injectors have been evident in much of the surveillance data. Just on 40% of those who have an injecting history, and who tested HIV positive in Victoria between 1999 and 2003, were born in Vietnam. After all, this was the reason we had received funding for the study. But the prospect of actually telling someone they had HIV produced an unexpected emotional response in me. I was almost nauseous, my head was spinning with all the information we had been taught about how to deliver the positive HIV test result and I had done several role-plays acting out the scenario. I remembered being told to just come out and tell them straight, don’t go round in circles. Then less than an hour after I had learned that Lam was HIV positive he walked right past me in the street. I was busy in the street drug market looking for potential study participants. Giving Lam his positive result was never going to be easy. I knew him well and had run into him almost every time I had recruited people for our research over the years. Was