Author information

• ¹Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; National Drug Research Institute, Curtin University, Australia. Electronic address: a.farrugia@latrobe.edu.au.
• ²Australian Research Centre in Sex, Health and Society, La Trobe University, Australia. Electronic address: e.lenton@latrobe.edu.au.
• ³Australian Research Centre in Sex, Health and Society, La Trobe University, Australia. Electronic address: k.seear@latrobe.edu.au.
• ⁴Australian Research Centre in Sex, Health and Society, La Trobe University, Australia. Electronic address: d.kagan@latrobe.edu.au.
• ⁵Social Policy Research Centre, University of New South Wales, Australia. Electronic address: k.valentine@unsw.edu.au.
• ⁶Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; Centre for Social Research in Health, University of New South Wales, Australia. Electronic address: s.fraser@latrobe.edu.au.
• ⁷Australian Research Centre in Sex, Health and Society, La Trobe University, Australia. Electronic address: S.Mulcahy@latrobe.edu.au.
• ⁸Faculty of Addiction Psychiatry, Royal Australian and New Zealand College of Psychiatrists, Australia. Electronic address: mwedwards@outlook.com.au.
• ⁹CoHealth, Australia. Electronic address: Danny.Jeffcote@cohealth.org.au.

Abstract

With the advent of highly effective and tolerable direct-acting antiviral treatments for hepatitis C, widespread optimism for and investment in the project of disease elimination now informs the public health response. In Australia, the Commonwealth government has invested heavily in elimination by universally subsidising treatment, promising access for all. Reflecting concerns that commonly accompany ambitious public health projects, cost for governments supporting access to the treatment and cost for individuals consuming it have emerged as central issues. Drawing on 30 interviews with people who have been cured of hepatitis C with direct-acting antivirals, this article examines how cost shapes experiences of hepatitis C treatment and cure in Australia. Drawing on Lauren Berlant's (2011) influential work on 'cruel optimism', we analyse three interconnected ways that notions of cost shape participants' views of treatment as a beneficent gift from the state: (1) understandings of treatment access as a form of 'luck'; (2) conceptions of the cost of treatment; and (3) criticisms of others who are seen to waste state resources by not taking up treatment or by re-acquiring hepatitis C. We argue that, together, these dynamics constitute people affected by hepatitis C not as citizens worthy of public investment and fundamentally entitled to care, but as second-class citizens less deserving of treatment and of the health care to which they might otherwise be considered entitled. It is within this dynamic that the compromised quality of elimination optimism takes shape, binding people affected by hepatitis C to an inequitable relationship to health care, reproduced through the very things that promise to free them of such inequality - investments in access to treatment and cure.