Medicine & Health

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  • (2002) Hart, Bethne Lynda
    This is a study of the social management of human finitude, through explorations of breast cancer as a life-threatening illness. Three domains of social theory and research form the basis of theoretical analysis: the sociology of dying and death, social studies of women with breast cancer, and the sociology of human mortality. The sociology of dying and death contributes to our understandings of life-threatening illness, but fails to adequately encompass the trajectories of illness and recovery. The absence of feminist perspectives and gendered theorising towards human mortality is also evident. The methodology of this study was informed by a feminist sociological imagination and had two phases. Firstly, longitudinal semi-structured interviews with women with breast cancer (n=20) were conducted over one year. Secondly, health care providers (n=25) representative of the range of services for women with breast cancer were interviewed. Popular representations of women recovering from breast cancer illness present women engaging in heroic adventures and transforming their 'ordinary' lives into the 'extraordinary'. Did confrontation with their own mortality, through life-threatening illness, transform these women's lives? No, they did not pursue new life projects or satisfy long-held aspirations. Instead they appeared to return to 'ordinary' life, but conceived it differently. The illness narratives revealed also that women with breast cancer experienced the fateful moments of human finitude, throughout their illness trajectory. These experiences were commonly suppressed in all areas of social life, not least during the active stage of breast cancer treatment. And what of the health care providers? Some demonstrated awareness in finitude, and awareness to the finitude of others. Others did not, and actively engaged in the suppression of awareness of human mortality. In this study, life-threatening illness brought to consciousness the finiteness of human life. Of most significance is the thesis that life-threatening illness experiences are powerfully shaped and disrupted through the social management of human mortality. However, we can discern also patterns of living and healing that resist these prevailing social processes, and acknowledge the limitations of our lifetimes.

  • (2001) MacDonald, Margaret
    Two approaches were evaluated for inclusion in surveillance for HIV, HBV and HCV infection and related risk behaviours among injecting drug users in Australia. The first approach analysed routinely recorded patient data at methadone clinics. The second approach generated data from clients at Needles and Syringe Programs (NSPs) using capillary blood and a self-report questionnaire. In addition, residents' attitudes to NSPs were measured in a population-based telephone survey. Both the methadone and NSP studies confirmed a sustained low prevalence of HIV among drug injectors in Australia, except among males who also reported homosexual identity. Only male patients had HIV in the methadone study. Most patients with HIV infection did not have sexual identity recorded. Recording of sexual identity is an integral part of any HIV monitoring system. In addition, only two clinics provided data for the two years. Regular reporting of methadone patient data was not incorporated into national surveillance following the two-year trial. The NSP study design, repeated cross-sectional surveys of short duration, provided information on HIV and HCV seroprevalence, patterns of drug use and injecting and sexual risk behaviours in subpopulations defined by level of risk of acquiring infection. Nationally, 1,072 (45%), 1,497 (53%), 1,978 (48%) and 2,665 (46%) clients participated from 1995 to 1998 at 20 to 32 NSPs. HCV prevalence decreased among respondents reporting one or two years of injection from 22% (1995) to 13% (1996 & 1997, p < 0.001). Increased injection of cocaine was also reported among Sydney respondents. The design was adaptable to changing needs, yet provided consistent data. The NSP study was readily incorporated into national surveillance and the design can be applied in other settings. Support for state-wide NSPs (82%, and 88%, p = 0.04) and expansion of local NSPs was high (46% vs. 48%, p = 0.6) among 305 and 315 residents in an area of high drug use randomly selected for telephone interview in 1997 and 1998. There was also strong support for medically supervised injecting rooms (68% and 76%, p = 0.06) and prescription of heroin or cocaine (69% and 76%, p = 0.07). Monitoring indices of resident's attitudes to health services for drug users provided an informed basis for decision making and augments surveillance for blood borne viral infection and related risk behaviour among injecting drug users.