Everyday Violence of Hepatitis C among Young Women Who Inject Drugs in San Francisco, The

Human Organization, Fall 2004 by Bourgois, Philippe, Prince, Bridget, Moss, Andrew

A theoretical understanding of the gendered contours of structural, everyday, and symbolic violence suggests that young addicted women are particularly vulnerable to the infectious diseases caused by injection drug use-especially hepatitis C. Participant observation among heroin and speed injectors in San Francisco's Haight Ashbury neighborhood reveals that extreme levels of violence against women are normalized in the common sense of street-based youth drug culture. Physical, sexual, and emotional violence, as well as the pragmatics of income generation, including drug and resource sharing in the moral economy of street addicts, oblige most young homeless women to enter into relationships with older men. These relationships are usually abusive and economically parasitical to the women. Sexual objectification and a patriarchal romantic discourse of love and moral worth lead to the misrecognition of gender-power inequities by both the men and women who are embroiled in them, as well as by many of the public services and research projects designed to help or control substance abusers. Despite deep epistemological, theoretical, and logistical gulfs between quantitative and qualitative methods, applied public health research and the interventions they inform can benefit from the insights provided by a theoretical and cross-methodological focus on how social power contexts shape the spread of infectious disease and promote disproportional levels of social suffering in vulnerable populations.

Key words: gender, hepatitis C, intravenous drug users, participant observation, San Francisco

"The other night Heather 's boyfriend beat her up so bad that it woke everybody up. He was hitting her with a tent pole and nearly killed her."

I ask Note why no one in the camp intervened. "It's the code, Bridget. It's her fight, that's the deal. We can't get involved."

Calamity tells me that her boyfriend beat her up last night in their camp in China Basin. She is angry about it, but her friends reassure her. "The harder he hits you, the more he loves you."

Bridget Prince's fieldnotes, August 1 and 3, 2001

The Haight-Ashbury neighborhood of San Francisco was the symbolic epicenter of the American anti-war and hippie movements during the 1960s. Associated with sex, drugs, and rock-and-roll, "the Haight" continues almost half a century later, despite gentrification (Cavan 1972; Godfrey 1988) and an aggressive war on drugs, to be a mecca for countercultural youth. Even at the height of the popularity of psychedelic drugs in the late 1960s, the Haight hosted significant numbers of homeless amphetamine and heroin injectors of primarily working-class and lumpen origin (Howard and Borges 1970). Homeless injection drug users from poor backgrounds continue to have a visible public presence. They range in age from their early teens to their early 40s, with most in their mid-to-late 20s. Despite the peace, love, hippie symbolism of the neighborhood, they are enmeshed in a lifestyle in which violence against women is considered normative. Almost all the youth are white, and most consider racism and homophobia to be common sense.

Everyday Violence in the Haight

As part of an epidemiological hepatitis C prevention project for youth injectors, Bridget Prince conducted longterm participant observation primarily among a half dozen overlapping social networks of homeless young women in the Haight. While attempting to document the everyday pragmatic logics and cultural context for why injectors engage in risky injection practices, the ubiquity of violence against women emerged as her central focus. Unless otherwise specified, all the fieldnotes and transcribed conversations are from Prince's fieldwork, conducted primarily between August 2000 and December 2001 with periodic follow-up in 2002 and 2003. Philippe Bourgois made periodic visits to the youth injector scenes with Prince and was simultaneously conducting participant observation in San Francisco's warehouse district among several overlapping social networks of older homeless heroin injectors and crack smokers. His data, which serve as background comparison, were collected from November 1994 through August 2003 (Bourgois 1998). Simultaneously, Andrew Moss directed an epidemiological project known as the UFO (not an acronym) that documented an almost 50 percent higher hepatitis C seroconversion rate among women. Females represented 30 percent of the overall sample of 844 imder-30-year-old injectors that the UFO recruited at storefront sites in three neighborhoods where youth congregate, including the Haight (Evans et al. 2003; Hahn et al. 2002).1

In the conclusion, we discuss how the distinct theoretical and epistemological disciplinary traditions of ethnography and epidemiology made it difficult for us to combine our findings in a complementary manner to propose applied suggestions for interventions that prevent the spread of infectious disease among street-based youth injectors (see also Bourgois 2002; Moss 2003).